{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T10:48:13Z","timestamp":1751366893998},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"5-6","license":[{"start":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T00:00:00Z","timestamp":1572480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Casualty evacuation is a key point in medical support to military operations, sometimes being necessary to transfer them to National Territory for a definitive diagnosis and treatment. The aim of this work is to analyze the patients evacuated from Areas of Operations to the Orthopedic Surgery and Traumatology Unit of the Spanish Role 4 Medical Treatment Facility in the last 10 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>A cross-sectional, descriptive, and retrospective study carried out in the period between January 1, 2009 and December 31, 2018. The study population was all personnel evacuated from the Area of Operations to Spanish Role 4. For categorical variables, absolute and relative percent frequencies were used. Spanish military authorization was obtained to perform this study. This study has been approved by the Ethics and Clinical Research Committee of the Defense Central Hospital \u201cG\u00f3mez Ulla\u201d (code 12\/17).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 520 medical evacuations have been performed on Role 4, of which 227 were on the Orthopedic Surgery and Traumatology Unit. Seven percent of the evacuees were categorized as \u201ccombat\u201d casualties. The areas of operations from which more patients have been evacuated were Afghanistan and Lebanon, 30.39% and 19.38%, respectively. The most frequent lesion pattern was the fracture affecting the extremities. Accidents (n\u00a0=\u00a098, 43.17%) and sport (n\u00a0=\u00a057; 25.3%) were the main causes of injury. Sixty-seven (29.51%) patients were treated surgically in Role 4. No deaths were recorded among patients in this series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Evacuations because of trauma cause more than half of the medical repatriations carried out on the National Territory, of which the majority are due to fractures affecting the limbs, especially the bones of the hand. Sport was the first preventable cause of injury among evacuated patients. Our results are similar to the experience obtained by other allied armed forces. It is a moral imperative and a fundamental necessity for the Spanish military medical services to promote and maintain the Spanish Role 4 Medical Treatment Facility as an indispensable element in medical support for international missions.<\/jats:p><\/jats:sec>","DOI":"10.1093\/milmed\/usz354","type":"journal-article","created":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T13:24:45Z","timestamp":1591709085000},"page":"e734-e741","source":"Crossref","is-referenced-by-count":1,"title":["Strategic Orthopedic Evacuations to the Spanish Role 4 During a Decade (2009\u20132018)"],"prefix":"10.1093","volume":"185","author":[{"given":"Rafael Garc\u00eda","family":"Ca\u00f1as","sequence":"first","affiliation":[{"name":"Orthopedic Surgery and Traumatology Unit, Defense Central Hospital \u201cG\u00f3mez Ulla\u201d, Glorieta del Ej\u00e9rcito 1. 28047, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo Navarro","family":"Suay","sequence":"additional","affiliation":[{"name":"Anesthesiology, Reanimation and Pain Treatment Unit, Defense Central Hospital \u201cG\u00f3mez Ulla\u201d, Glorieta del Ej\u00e9rcito 1. 28047, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos Rodr\u00edguez","family":"Moro","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery and Traumatology Unit, Defense Central Hospital \u201cG\u00f3mez Ulla\u201d, Glorieta del Ej\u00e9rcito 1. 28047, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Aedo","family":"Mart\u00edn","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery and Traumatology Unit, University Hospital del Henares, Av. de Marie Curie, 0, 28822 Coslada, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael Tamburri","family":"Baria\u00edn","sequence":"additional","affiliation":[{"name":"Medical Services of the Spanish Royal Guard, Guardia Real espa\u00f1ola. Paseo del Pardo, 43, 28048 El Pardo, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier Areta","family":"Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery and Traumatology Unit, Defense Central Hospital \u201cG\u00f3mez Ulla\u201d, Glorieta del Ej\u00e9rcito 1. 28047, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,10,31]]},"reference":[{"key":"2021020202050028100_ref1","volume-title":"STANAG 3204. AAMedP-1.1, Edition A, Version 1, Aeromedical Evacuation","year":"2014"},{"key":"2021020202050028100_ref2","volume-title":"Procedimiento Operativo Log\u00edstico S-2 \u201cEvacuaci\u00f3n de bajas urgente y bajas rutinarias entre ZO. y TN.\u201d. \u00c1rea Sostenimiento CALOG-OP. Fuerza Log\u00edstica Operativa. Ej\u00e9rcito de Tierra. Ministerio de Defensa","year":"2016"},{"issue":"1","key":"2021020202050028100_ref3","doi-asserted-by":"crossref","first-page":"71","DOI":"10.7205\/MILMED-D-13-00324","article-title":"Analysis of evacuations from areas of operation to the Spanish role 4 medical treatment facility (2008-2013)","volume":"179","author":"Navarro Suay","year":"2014","journal-title":"Mil Med"},{"issue":"3","key":"2021020202050028100_ref4","doi-asserted-by":"crossref","first-page":"154","DOI":"10.4321\/S1887-85712013000300002","article-title":"An\u00e1lisis de las repatriaciones por causas m\u00e9dicas en el contingente espa\u00f1ol de la ISAF durante los a\u00f1os 2009-2012 y de los fallecimientos ocurridos en Afganist\u00e1n desde el inicio de la misi\u00f3n hasta Diciembre de 2012","volume":"69","author":"Torres Le\u00f3n","year":"2013","journal-title":"Sanid Mil"},{"key":"2021020202050028100_ref5","article-title":"Doctrina Sanitaria Conjunta","author":"Estado Mayor de la Defensa. Ministerio de Defensa","year":"2003"},{"key":"2021020202050028100_ref6","volume-title":"Apoyo Sanitario en Operaciones Armada","author":"Villarejo","year":"2003"},{"key":"2021020202050028100_ref7","volume-title":"STANAG 2546. AJMedP-2, Edition A, Version 1, Allied Joint Medical Doctrine for Medical Evacuation","year":"2014"},{"issue":"9","key":"2021020202050028100_ref8","doi-asserted-by":"crossref","first-page":"e1864","DOI":"10.7205\/MILMED-D-17-00007","article-title":"Evaluating the military medical evacuation chain: need for expeditious evacuation out of Theater?","volume":"182","author":"van Dongen","year":"2017","journal-title":"Mil Med"},{"key":"2021020202050028100_ref9","article-title":"Unidad M\u00e9dica de Aeroevacuaci\u00f3n (UMAER) [Internet]","volume-title":"Ej\u00e9rcito del Aire. Spanish Ministry of Defence n.d."},{"key":"2021020202050028100_ref10","volume-title":"Spanish Ministry of Defence.","year":"2015."},{"issue":"2","key":"2021020202050028100_ref11","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4321\/S1887-85712014000200010","article-title":"El Sistema de Telemedicina Militar en Espa\u00f1a: una aproximaci\u00f3n hist\u00f3rica","volume":"70","author":"Hill\u00e1n Garc\u00eda","year":"2014","journal-title":"Sanid Mil"},{"key":"2021020202050028100_ref12","volume-title":"Spanish Ministry of Defence.","year":"2017"},{"key":"2021020202050028100_ref13","volume-title":"STANAG 2437. (AJP)-01, Edition E, Version 1, Allied Joint Doctrine.","year":"2017"},{"issue":"5","key":"2021020202050028100_ref14","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1093\/milmed\/158.5.348","article-title":"A retrospective review of orthopedic patients returning from operations Desert Shield and Desert Storm to an army medical center","volume":"158","author":"Travis","year":"1993","journal-title":"Mil Med"},{"key":"2021020202050028100_ref15","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1136\/jramc-143-01-08","article-title":"Medical repatriations from operation Resolute (Bosnia)","volume":"143","author":"Croft","year":"1997","journal-title":"J R Army Med Corps"},{"issue":"9711","key":"2021020202050028100_ref16","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/S0140-6736(09)61797-9","article-title":"Diagnoses and factors associated with medical evacuation and return to duty for service members participating in operation Iraqi Freedom or operation Enduring Freedom a prospective cohort study","volume":"375","author":"Cohen","year":"2010","journal-title":"Lancet"},{"issue":"6","key":"2021020202050028100_ref17","doi-asserted-by":"crossref","first-page":"521","DOI":"10.7205\/MILMED.170.6.521","article-title":"Aeromedical evacuations from operation Iraqi Freedom a descriptive study","volume":"170","author":"Harman","year":"2005","journal-title":"Mil Med"},{"key":"2021020202050028100_ref18","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.3357\/ASEM.4005.2014","article-title":"United Kingdom military aeromedical evacuation in the post-9\/11 era. 2014; 85:1005\u201312","volume":"85","author":"Patterson","year":"2014","journal-title":"Aviat Sp Env Med"},{"issue":"4","key":"2021020202050028100_ref19","first-page":"087","article-title":"\u00c9vacuations m\u00e9dicales a\u00e9riennes tactiques et strat\u00e9gique en R\u00e9publique Centroafricaine au cours de l\u2019op\u00e9ration \u00ab Sangaris \u00bb. Synth\u00e8se des onze premiers mois d\u2019op\u00e9rations","volume":"44","author":"Beylot","year":"2016","journal-title":"M\u00e9decine et arm\u00e9es"},{"key":"2021020202050028100_ref20","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jsr.2016.11.004","article-title":"Non-battle injuries among U.S. Army soldiers deployed to Afghanistan and Iraq, 2001\u20132013","volume":"60","author":"Patel","year":"2017","journal-title":"J Safety Res"},{"key":"2021020202050028100_ref21","volume-title":"An\u00e1lisis de las evacuaciones atendidas por los servicios m\u00e9dicos en HCDGU por baja \u201cno de combate\u201d durante los a\u00f1os 2011 a 2013","author":"Mata Forte","year":"2016"},{"issue":"3","key":"2021020202050028100_ref22","first-page":"227","volume":"72","author":"Gonz\u00e1lez Garc\u00eda","year":"2016","journal-title":"Sanid Mil"},{"issue":"9711","key":"2021020202050028100_ref23","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/S0140-6736(09)61797-9","article-title":"Diagnoses and factors associated with medical evacuation and return to duty for service members participating in operation Iraqi Freedom or operation Enduring Freedom: a prospective cohort study","volume":"375","author":"Cohen","year":"2010","journal-title":"Lancet (London, England)"},{"issue":"4","key":"2021020202050028100_ref24","doi-asserted-by":"crossref","first-page":"713","DOI":"10.4269\/ajtmh.2005.73.713","article-title":"Impact of illness and non-combat injury during operations Iraqi Freedom and Enduring Freedom (Afghanistan)","volume":"73","author":"Sanders","year":"2005","journal-title":"Am J Trop Med Hyg"},{"key":"2021020202050028100_ref25","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1016\/j.afjem.2018.09.004","article-title":"A descriptive analysis of casualties evacuated from the Africa area of operations","volume":"9","author":"Schauer","year":"2019","journal-title":"African J Emerg Med"},{"issue":"1","key":"2021020202050028100_ref26","first-page":"1","article-title":"Repatriation for diseases or non-battle injuries (DNBI): long-term impact on quality of life","volume":"7","author":"Huizinga","year":"2019","journal-title":"J R Army Med Corps"},{"issue":"9","key":"2021020202050028100_ref27","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1001\/jamasurg.2018.1166","article-title":"A 12-year analysis of nonbattle injury among US service members deployed to Iraq and Afghanistan","volume":"153","author":"Le","year":"2018","journal-title":"JAMA Surg"},{"issue":"3","key":"2021020202050028100_ref28","first-page":"39","article-title":"Hern\u00e1ndez-Abad\u00eda de Barbar\u00e1 a. ten years, Ten changes. Spanish medical corps experience during a decade (2005-2015) in Afghanistan. Int rev armed forces","volume":"90","author":"Navarro Suay","year":"2017","journal-title":"Med Serv"},{"issue":"1","key":"2021020202050028100_ref29","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1017\/S1049023X17007038","article-title":"Disease and non-Battle traumatic injuries evaluated by emergency physicians in a US tertiary combat hospital","volume":"33","author":"Bebarta","year":"2018","journal-title":"Prehosp Disaster Med."},{"key":"2021020202050028100_ref30","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1136\/jramc-2017-000766","article-title":"Non-battle injury among repatriated UK armed forces since cessation of combat operations: a prospective observational study","volume":"164","author":"Toman","year":"2018","journal-title":"J R Army Med Corps"},{"issue":"4","key":"2021020202050028100_ref31","doi-asserted-by":"crossref","first-page":"321","DOI":"10.17184\/eac.6566","article-title":"Rapatriements sanitaires \u00e0 l\u2019\u00e9chelon d\u2019un service d\u2019orthop\u00e9die-traumatologie durant trois ann\u00e9es","volume":"39","author":"Martin","year":"2011","journal-title":"M\u00e9dicine et arm\u00e9es"},{"issue":"1","key":"2021020202050028100_ref32","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1136\/jramc-143-01-07","article-title":"Sports injuries in British troops deployed on operation Resolute (Bosnia)","volume":"143","author":"Adams","year":"1997","journal-title":"J R Army Med Corps"},{"issue":"2","key":"2021020202050028100_ref33","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1136\/jramc-144-02-05","article-title":"A pilot study of J95 in secondary care in Bosnia","volume":"144","author":"Owen","year":"1998","journal-title":"J R Army Med Corps"},{"issue":"4","key":"2021020202050028100_ref34","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s12018-018-9252-1","article-title":"Military fractures: overtraining, accidents, casualties, and fragility","volume":"16","author":"Wheeler","year":"2018","journal-title":"Clin Rev Bone Miner Metab"},{"issue":"5","key":"2021020202050028100_ref35","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/milmed\/159.5.376","article-title":"A prospective evaluation of orthopedic patients evacuated from operations Desert Shield and Desert Storm the Walter Reed experience","volume":"159","author":"Hansen","year":"1994","journal-title":"Mil Med"},{"issue":"2","key":"2021020202050028100_ref36","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1136\/jramc-143-02-03","article-title":"Orthopaedic casualty evacuation to the Royal Hospital Haslar November 1995 to April 1996","volume":"143","author":"Cannon","year":"1997","journal-title":"J R Army Med Corps"},{"issue":"4","key":"2021020202050028100_ref37","doi-asserted-by":"crossref","first-page":"210","DOI":"10.5603\/IMH.2014.0040","article-title":"Reasons for medical evacuations of soldiers serving in international security assistance force (ISAF) operation in Afghanistan","volume":"65","author":"Korzeniewski","year":"2014","journal-title":"Int Marit Health"},{"issue":"7","key":"2021020202050028100_ref38","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.injury.2014.02.012","article-title":"Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan","volume":"45","author":"Hoencamp","year":"2014","journal-title":"Injury"},{"issue":"1","key":"2021020202050028100_ref39","first-page":"2","article-title":"Epidemiology of combat wounds in operation Iraqi Freedom and operation Enduring Freedom: orthopaedic burden of disease","volume":"19","author":"Belmont","year":"2010","journal-title":"J Surg Orthop Adv"},{"issue":"12","key":"2021020202050028100_ref40","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1016\/j.injury.2013.08.001","article-title":"Pelvic, spinal and extremity wounds among combat-specific personnel serving in Iraq and Afghanistan (2003-2011): a new paradigm in military musculoskeletal medicine","volume":"44","author":"Schoenfeld","year":"2013","journal-title":"Injury"},{"issue":"5","key":"2021020202050028100_ref41","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1097\/BOT.0b013e3182703188","article-title":"The nature and incidence of musculoskeletal combat wounds in Iraq and Afghanistan (2005-2009)","volume":"27","author":"Belmont","year":"2013","journal-title":"J Orthop Trauma"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/185\/5-6\/e734\/36169220\/usz354.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/185\/5-6\/e734\/36169220\/usz354.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T05:19:27Z","timestamp":1696223967000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/185\/5-6\/e734\/5610396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,31]]},"references-count":41,"journal-issue":{"issue":"5-6","published-online":{"date-parts":[[2019,10,31]]},"published-print":{"date-parts":[[2020,6,8]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usz354","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,5]]},"published":{"date-parts":[[2019,10,31]]}}}