Lessons Learned From the Surgical Experience of a World Health Organization Classified Emergency Medical Team (EMT-2).

Abstract

On December 14, 2024, Cyclone Chido struck Mayotte, a small French island in the Indian Ocean, isolated, economically fragile and marked by social difficulties driven by rapid population growth and migration pressures. This climate disaster caused numerous casualties (40 killed, about 4000 wounded and around 40 people unaccounted for) and severe damage to already strained healthcare infrastructure. This study reports the deployment and surgical activity of the ESCRIM WHO-EMT-2 Civil Protection field hospital in Mamoudzou, Mayotte's main town. Online sources, mission reports, logbooks, and interviews with deployed staff and local surgeons were reviewed to analyze the setup and surgical activity of the French WHO-EMT-2 field hospital. The first surgery started 10 days after the cyclone, and 46 hours after the WHO-EMT-2 landing in Mayotte. Over a 37-day mission (32 days of active mission and 5 days suspended due to a subsequent cyclone), 268 procedures were performed on 205 patients. The WHO EMT-2 substantially increased the island's surgical capacity during the initial phase of the response. After an initial massive influx of patients, the surgical team mainly managed septic indications (98%), with primary closure (9%), secondary intention healing (78%), negative pressure wound therapy (4.8%), and amputations (3%). Among these septic indications, 69% involved the extremities (hands and feet). Readmission exceeded 10%, representing up to one-third of the daily caseload at the end of the mission. When deployed, WHO-EMT-2 field hospitals can significantly expand local surgical capacity. Initial mass influx and high reoperation rates must be anticipated. This should contribute to developing procedural guidelines for surgical practice in disaster settings.