Review of the Senegalese Military Emergency Medical Team (EMT) Deployment Following a Tanker Explosion in Freetown, Sierra Leone

Background/Introduction: In November 2021, a tanker exploded in Freetown, injuring and killing people. The WHO facilitated a seven-week first deployment of the Senegalese military to support the Ministry of Health (MOH) in providing care to the wounded in three referral hospitals. Objectives: Review the deployed team’s processes and outputs of medical care provided to burns patients. Method/Description: This is a cross-sectional After-Action Review (AAR) debrief of the deployment, including the WHO and MOH staff (n =14) in a virtual workshop. Six thematic areas: mobilization, deployment, coordination, case management activities, national capacity, and community acceptance were analyzed. Results/Outcomes: The WHO facilitated the team’s deployment and mobilized medical supplies and equipment whilst the MOH provided accommodation and logistics through collaboration. The team dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care provided by the available health workers. They offered additional care: reconstructive surgery, pain management, palliative and wound care, rehabilitation, physiotherapy, and psychosocial counselling, which were initially inadequate. 87 out of 155 patients were discharged home at the end, the national clinicians acquired additional skills, and the community appreciated the team. Despite being perceived as a weakness, the language barrier did not hinder the patient-doctor/nurse relationship or the provision of clinical care. Conclusion: This sub-regional response had significant benefits, including speed, political acceptability, and health context experience to support rapid and safe deployment. Mechanisms to facilitate rapid and quality-assured deployment of EMTs at regional and sub-regional levels in collaboration with WHO should be strengthened in region to support future responses

Mapping of Autogenous Saphenous Veins as an Imaging Adjunct to Peripheral MR Angiography in Patients with Peripheral Arterial Occlusive Disease and Peripheral Bypass Grafting: Prospective Comparison with Ultrasound and Intraoperative Findings

<div><p>Background</p><p>Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery.</p><p>Methods</p><p>38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 44–88 years) underwent peripheral MR angiography using the blood pool contrast agent Gadofosveset trisodium. Apart from primary arterial assessment images were evaluated in order to determine great saphenous vein diameters at three levels: below the saphenofemoral junction, mid thigh and 10 cm above the knee joint (usability: diameter range: >3 and <10 mm at one level and >3.5 and <10 mm at a neighboring level). Duplex ultrasound was performed by an independent examiner providing diameter measurements at the same levels. Additionally, vessel usability was determined intraoperatively by the vascular surgeon during subsequent bypass surgery.</p><p>Results</p><p>Mean venous diameters for MR angiography/duplex ultrasound were 5.4±2.6/5.5±2.8 mm (level 1), 4.7±2.7/4.6±2.9 mm (level 2) and 4.4±2.2/4.5±2.3 mm (level 3), respectively, without significant differences between the modalities (<i>P</i> = 0.207/0.806/0.518). Subsequent surgery was performed in 27/38 patients. A suitable saphenous vein was diagnosed in 25 and non-usability was diagnosed in 2 of the 27 patients based on MR angiography/duplex ultrasound, respectively. Usability was confirmed by intraoperative assessment in all of the 24 patients that received a venous bypass graft in subsequent bypass surgery. In 1 case, in which the great saphenous vein was assessed as useable by both MR angiography and duplex ultrasound, it was not used during subsequent bypass surgery due to the patients clinical condition and comorbidities.</p><p>Conclusion</p><p>Simultaneous mapping of the great saphenous vein as an imaging adjunct to peripheral MR angiography with a blood pool contrast agent is an alternative to additive duplex ultrasound in patients undergoing subsequent peripheral bypass grafting.</p></div

Correlation between MR-angiographic (MRA) and duplex sonographic (DUS) values in the three levels.

<p>Pearson correlation coefficients R²: level 1: 0.989; level 2: 0.986, level 3: 0.973.</p

MR-angiographic and duplex sonographic images of the great saphenous vein.

<p>Magnetic resonance imaging (BPCA-MRA) and color-coded duplex sonography in the proximal level of the left GSV of a 63 year old female patient who suffered from PAOD stage III and was referred to the radiological department for assessment of the arterial status prior to a proposed bypass surgery. (a, b) Axial multiplanar reformat of contrast-enhanced T1-weighted gradient-echo images during the steady-state. (c) Axial color-coded duplex sonography.</p

Clinical and demographic characteristics of the study population.

<p>All patients were of white ethnicity.</p><p>Clinical and demographic characteristics of the study population.</p

Flowchart portraying the study design.

<p>Flowchart portraying the study design.</p

Multiplanar reformat of an MR-angiographic image of the great saphenous vein.

<p>The GSV displayed as a curved multiplanar reformat of high-spatial-resolution contrast-enhanced T1-weighted gradient-echo images during the steady-state of a 57 year old male patient suffering from PAOD stage III and thus being evaluated for bypass surgery.</p

Intraoperative measurement of the dissected great saphenous vein.

<p>Intraoperative measurement of the dissected great saphenous vein.</p