Thiès, Senegal, In the operating room, the regular beep of machines confirms the good news: the “patient”, tested positive for COVID-19 and having just undergone an emergency Cesarean section, is fine. Everyone can breathe easier: the simulation exercise is a success. The fake patient sits up, the doctor reviews the proceedings with those present, and the observers put away their evaluation forms. 

From 11 to 13 May, the Senegalese army health service carried out an exercise unprecedented in Africa: a simulation of the deployment of an emergency medical team (EMT) in the context of a health crisis linked to an epidemic. The goal is to test and increase the Senegalese team’s clinical management capacities for dealing with COVID-19 patients. 

The exercise, organized by the military medical services with the support of the World Health Organization (WHO), is also a key step in the international EMT certification process Type 2. This involves being able to mobilize and install in under 72 hours a field hospital with at least 30 beds, including beds for medical and surgical resuscitation for serious patients, and an energy capacity of 100 kWa capable of supplying a surgical block. The EMT must also be able to take care of at least 2,500 patients in four weeks. 

At the end of the process, which should take another one or two years, Senegal would become the first African country to have international certification for its EMT. The country already has a long history of medical emergencies, having deployed teams to the Democratic Republic of Congo during an Ebola epidemic in 2018, then to Sierra Leone in 2021, after the explosion of a petrol tank that left 115 dead and hundreds injured. 

“We already have this know-how, the deployment capacities, and the human resources,” notes dentist Colonel Amady Barro Mbodj, Deputy Officer to the Director of the Health Service of the Armed Forces and principal evaluator of the exercise. “What we want to have are skills that allow us to deploy anywhere, while respecting the highest international standards.” 

A total of 59 members of Senegal's army health service were mobilized, including doctors, nurses, and logisticians. Nine containers were needed to transport the equipment to the military base of Thiès, 70 km from the capital Dakar, including a week’s worth of independent water reserves. 

"Logistics are the basis of everything," said Sergeant Ibrahim Ba, in charge of logistics. “We first had to completely level the ground and then, because of COVID-19, we adapted the distance between the structures to avoid contamination. In the end, we successfully set up the hospital in 48 hours. Usually it would take 72 hours or more,” he adds proudly. 

The team was then put through several medical emergency scenarios aimed at testing its ability to deliver health services in health emergencies and epidemics. Three elements in particular were submitted for evaluation: the capacity of the EMT to deploy in under 72 hours, the functionality of medical and surgical equipment, and the management of surgical pathologies during a serious crisis situation, such as the COVID-19 pandemic. 

The Senegal EMT still has to go through several steps before obtaining certification, in particular compliance with standards corresponding to the different types of emergencies. Reports from external observers and from WHO will help create a roadmap. Further mock deployment exercises will be required before an independent evaluation certifies the EMT. 

“What we have observed over these three days is gratifying, especially since 80% of the public health emergencies in the African region are epidemics, be it cholera, Ebola, Lassa fever, and now COVID-19. Preparing medical teams to be able to react to these epidemic diseases is therefore very important,” explains Dr Thierno Baldé, Head of COVID-19 Response Operations at the WHO Regional Office for Africa, present on site. “We want to make EMTs a tool for managing and increasing clinical care capacities in the context of epidemics on the continent.”

Representatives from five African countries – Cameroon, Congo, the Democratic Republic of Congo Ethiopia, and Guinea – were invited to observe the exercise. 

"We’re here to draw inspiration from the Senegalese EMT, a model for West Africa, in order to set up an emergency medical team at home in Guinea, at least on the national level,” says Doctor Captain Salifou Mariétou Sylla. 

Since the outbreak of the COVID-19 pandemic, WHO has supported the deployment of 18 such international EMTs in 16 countries of the region, and supported them in training health personnel to care for COVID-19 patients. WHO is also collaborating with 10 countries (Botswana, Ethiopia, Mauritania, Namibia, Niger, Nigeria, Uganda, Senegal, Togo, and Zimbabwe) to establish national EMTs. 

"Senegal’s simulation exercise should demonstrate to other African countries that having emergency medical teams is possible, and helps strengthen national emergency management capacity,” said Dr. Baldé.