Psychological first aid in operation for military healthcare providers : a study on pre-deployment training.

INTRODUCTION: During operational missions, while the management of physical injuries in the field remains the priority, the identification of operational incapacity of psychological origin is necessary as it is equally crucial for the safety of the individual, the group and the mission. The French Military Health Service has developed a Psychological First Aid Training in Operation (PFATO) course based on relational simulations, for military service members. The aim is to identify the early signs of psychological distress in a comrade and to adopt an adapted and protective attitude. PFATO training is also offered to healthcare providers. METHODS: We conducted a descriptive cross-sectional study using a self-administered online questionnaire which was sent after deployment to all physicians or nurses trained in PFATO between July 2019 and July 2021 (n=80). The main objective of our work was to evaluate the relevance of this awareness training among physicians and nurses and to identify specific complementary expectations in operational psychiatry for this population. RESULTS: We obtained a response rate of 55%. Significantly, 21.62% of participants used PFATO during their last deployment and another 20% observed a team member using PFATO. The circumstances of use as reported by participants included acute stress related to combat, conflict with hierarchy or comrades, and suicidal crisis. Among those who used PFATO, the training helped 87.5% of them to identify signs of psychological distress and 100% of them to assist combatants . All respondents stressed the added value of practical simulations during PFATO education. Moreover, this study also makes it possible to identify adaptations needed to optimize this module for healthcare providers. CONCLUSION: The results suggest the value for healthcare provider of training in first-response psychological care using relational simulation based on the model of raising awareness about PFATO.

[Rehabilitation and reintegration of soldiers injured on deployment]. / Réadaptation et réinsertion des militaires blessés en operation.

The participation of the French army in the Afghan conflict has highlighted the need for discussion and action regarding the pathway, rehabilitation and reintegration of soldiers who have been physically or psychologically injured. Clinical experience demonstrates that difficulties are less likely to appear during the initial treatment phase than later on, when there is less group support and there are fewer visible effects of the recognition on the part of the institution. It is important to strengthen the links between healthcare personnel and institutional players, in order to optimise the medical and social care of these war casualties.

[Role of a military psychiatrist in Afghanistan]. / Place d'un psychiatre militaire en Afghanistan.

Operational conditions expose soldiers to situations which are potentially traumatic on a psychological level. The specific and non specific psychological disorders which can result require relatively flexible treatment tools which can be adapted to the circumstances.As the first "link in the chain", the intervention of a psychiatrist in a theatre of operations enables the psychological care to begin at an early stage to be followed by long-term treatment when necessary. This article focuses on a mission in Afghanistan.

[States of acute stress of soldiers in operational situations]. / Les états de stress aigu chez les militaires en opération.

Being a member of the armed forces means being confronted with violent events. For some this can lead to subjective destabilisation, a frequent clinical expression of which is a state of acute stress. In operational situations, treatment is provided as early as possible through the joint action of the army psychiatrist and the armed forces medical teams, using individual and/or collective treatment approaches. After the initial treatment, an assessment of the soldier's capacity to continue the mission is carried out.

Ejection in hostile environments: medico-psychological aspects for the fighter pilot.

INTRODUCTION: In the French Air Force, commitment of fighter squadrons in Afghanistan revives the fear among pilots of being ejected in a hostile environment, along with the prospect of being captured. CLINICAL OBSERVATIONS: Although ejection in a hostile environment is an exceptional event, it is what flight crews fear most strongly over enemy territory. Since the widespread use of ejection seats in fighter aircraft in the 1950s, ejection has become a means of protecting the crews' lives. Ejection is a breaking point when the pilot suddenly passes from an intense activity to a passive position in which he (or she) is often helpless and sometimes exposed to the hostility of the environment where he lands. It is always important to analyze the circumstances surrounding an ejection. Some clinical observations allow us to understand the psycho-traumatic potential of this brutal experience. In a hostile environment, ejection quite rapidly becomes a question of survival. DISCUSSION: The pilot is technically and physically prepared during training. He (or she) regularly trains for the use of the ejection seat and the equipment to protect himself, to report, and ensure his survival until his recovery. Because it is always a singular event, on a case-by-case basis, no psychological reaction to such a situation can be modeled with a view to predicting psycho-traumatic disorders. CONCLUSION: Since 2007, there has been a medico-psychological supporting device, organized by the French Air Force, to be used after this type of event.

Psychosocial and Clinical Correlates of Substance use Disorder in an Adolescent Inpatient Psychiatric Population.

OBJECTIVE: This study aimed at exploring the psychosocial and clinical correlates of substance use disorder in an adolescent inpatient psychiatric population. METHOD: During the period from 2006-2007, all subjects were systematically screened for substance use disorder (SUD) and were assessed for SUD characteristics by an independent support team using the RECAP (Joint Report on Drug Addiction and Treatment). Each SUD case was matched for age, gender, unit, and admission week, so as to compare a consumer sample (cases) with a non-consumer sample (controls). We retrospectively extracted data (socio-demographic and clinical characteristics) from charts to realize a case-control comparison. To assess Axis II borderline psychopathology, the child retro-DIB (Diagnosis Interview for Borderline) was used. RESULTS: The sample included 30 cases and 30 controls between 14 and 17 years of age. SUD was significantly associated with maltreatment (p=0.038), loss of a first-degree relative (p=0.039), school absenteeism (p=0.035) and suicide attempts (p=0.02). Regarding psychopathology, significant co-occurrence was observed between SUD and conduct disorder (p=0.019), all personality disorders (p=0.003) and borderline personality disorder specifically (p=0.021). CONCLUSION: Adolescent inpatients with SUD possess differential psychosocial and clinical characteristics and particular correlates that justify adopting a specific multidisciplinary approach to this high-risk clinical subgroup.