RESUMEN
Historically in charge of the search and rescue of aircraft in distress alongside military aeronautical crews, the doctors and nurses of the French Military Medical Service (FMMS) also participate in helicopter rescue missions for emergency medical aid at sea off the French metropolitan coast. This public service mission is placed at the heart of force medicine because it can be transposed to external theaters of operations (OPEX). Recent changes in the regulation of medical aid at sea, in particular the creation in 2013 of maritime emergency mobile resuscitation services, initially weakened the role of the teams of the FMMS. However, their 2018 and 2019 activity report reflects the persistence of strong involvement. The "FMMS 2020" model, especially through its "openness" aspect, allows the FMMS the optimal conditions to maintain its position as a key player in this field, particularly through the development of institutional partnerships with the public health service. Associated with their mastery of the air-maritime environment, strengthening the skills in emergency medicine of the military medical teams in charge of this mission appears to be 1 of the main measures ensuring the achievement of this objective and a high quality of care for patients.
Asunto(s)
Ambulancias Aéreas , Servicios Médicos de Urgencia , Personal Militar , Aeronaves , Humanos , Trabajo de Rescate , Estudios RetrospectivosRESUMEN
The aim of the study was to determine the seasonal influence of vitamin D status on bone metabolism in French submariners over a 2-mo patrol. Blood samples were collected as follows: prepatrol and patrol days 20, 41, and 58 on crewmembers from both a winter (WP; n = 20) and a summer patrol (SP; n = 20), respectively. Vitamin D status was evaluated for WP and SP. Moreover, extended parameters for acid-base balance (Pco(2), pH, and bicarbonate), bone metabolism (bone alkaline phosphatase and COOH-terminal telopeptide of type I collagen), and mineral homeostasis (parathyroid hormone, ionized calcium and phosphorus) were scrutinized. As expected, SP vitamin D status was higher than WP vitamin D status, regardless of the considered experimental time. A mild chronic respiratory acidosis (CRA) was identified in both SP and WP submariners, up to patrol day 41. Such an occurrence paired up with an altered bone remodeling coupling (decreased bone alkaline phosphatase-to-COOH-terminal telopeptide of type I collagen ratio). At the end of the patrol (day 58), a partial compensation of CRA episode, combined with a recovered normal bone remodeling coupling, was observed in SP, not, however, in WP submariners. The mild CRA episode displayed over the initial 41-day submersion period was mainly induced by a hypercapnia resulting from the submarine-enriched CO(2) level. The correlated impaired bone remodeling may imply a physiological attempt to compensate this acidosis via bone buffering. On patrol day 58, the discrepancy observed in terms of CRA compensation between SP and WP may result from the seasonal influence on vitamin D status.