Medical repatriation of British diplomats resident overseas

Background: The aim of this study was to analyse medical evacuations and sh ort tours (collectively known as medevacs) in British Foreign and Commonwea lth Office (FCO) staff and dependants residing overseas. Further aims were to look for groups with a disproportionate number of medical evacuations/sh ort tours, and to identify events which may have been predictable in retros pect. For the purposes of this study, a medical evacuation was defined as a journey to the UK or an appropriate regional referral center for medical t reatment or review, and a medical short tour was an early termination of po sting for medical reasons. Method:The medical records of all staff and dependants who had been medical ly evacuated/short toured in 1995 were ret respectively analysed. Informati on collected included demographic details, whether the medevac was an emerg ency or a predicted necessity, why the medevac was required, the diagnosis, and the time from medical clearance to medevac. Results: In 1995, 160 medevacs involving 137 individuals were authorized. T his represented 3.08% of individuals overseas, with only 0.4% of individual s posted overseas being evacuated with new medical events within 1 year of medical clearance. The proportion of medevacs for staff was significantly h igher than for dependants (spouses and children), and staff in their 20s an d fast-stream diplomats (young "high-flyers" with a university education) w ere over-represented in the evacuee group. Non-physical problems were predo minant in the latter groups. The main reason for evacuation (70%) was that medical facilities were considered unsuitable, and just over half of the me devacs (51%) were considered by the investigating team to have been unpredi ctable. Conclusions: Only a small percent of individuals posted overseas required m edevac. The likelihood of evacuation was significantly higher in staff when compared to dependants, and certain grades/age groups appeared to be over- represented in the evacuee group. These groups are possibly more vulnerable , particularly to non-physical problems, and this is a potential area for f uture research. A prospective study of medical events overseas is proposed to see if these results are reproduced. if these findings are confirmed, me dical clearance and FCO posting procedures may need to be altered for group s which are identified as being vulnerable.