[Caregiving in an exceptional environment: the military operating theater nurse in a tropical zone]. / Soignant en milieu d'exception : l'infirmier de bloc opératoire militaire en zone tropicale.

The profession of operating theater nurse in the French Armed Forces Medical Corps is often little-known. Called upon to serve in mainland France, but also deployed on overseas operations, they provide medical and surgical support to the French armed forces. Personal qualities - human, physical and technical - are essential to adapt to the environmental constraints of this isolated post.

[Ballistic wound in the pre-hospital and emergency room: Damage Control Resuscitation]. / Plaies balistiques en préhospitalier et aux urgences : Damage Control Resuscitation.

Damage Control Resuscitation (DCR) is a strategy designed to prioritize hemostasis procedures, from the point of injury to surgical management, whether faced with an influx of bleeding casualties or a single casualty with severe hemodynamic instability. Widely disseminated, it provides clear objectives for prioritizing physiological restoration to the anatomy required for short-term survival. Initially applied to surgery, DCR has now been extended to the entire upstream care chain, including first aid and emergency medicine.

[Orthopedic ballistic injury, a five-beat waltz]. / Blessé balistique orthopédique, une valse à cinq temps.

Two-thirds of ballistic injuries result in severe limb damage. Damage Control Orthopaedic is a surgical strategy that makes it possible to save life, limb and function using simple mnemonic markers: 5minutes, 6hours, 7 days, 8 weeks and 9 months. The many players involved in this coherent care pathway, with its multiple surgical challenges, help to meet the challenge of comprehensive rehabilitation for orthopaedic ballistic injuries.

[Ballistic injury, decaying wounds: the nurse at the heart of the long rehabilitation process]. / Lésion balistique, plaies délabrantes : l'infirmier au cœur du long parcours de réhabilitation.

Ballistic injuries are disabling. Its functional impact is determined by its trajectory. Whether the injury affects a limb that could jeopardize its preservation, visceral lesions or craniocerebral and vertebro-medullary wounds, the nurse is at the heart of multidisciplinary care to limit and compensate for the after-effects. Directed healing, appropriate analgesia, settling in, technical training for this new, modified body (stoma, self-catheterization, appliances, etc.) and support in accepting the injury are all part of the nurse's role in helping the injured person rebuild his or her life.

[Ethical issues surrounding death in pre-hospital medicine]. / Enjeux et éthique face à la mort en médecine préhospitalière.

Mobile emergency and resuscitation teams are confronted with death on a daily basis. In the home, the management of a death is complex. It raises ethical questions and sometimes destabilizes personal or collective values. Our single-center qualitative survey, conducted over a one-month period (2022), questioned 64/154 caregivers about the moral burden and challenges of such situations. The consequences of operational experience are discussed: time, fatigue, emotions and training. The quality of presence is an alternative to the success or failure of cardiac arrest care at home.

[Covid-19 caregivers, psychotraumatized superheroes]. / Soignants de la Covid-19, de super-héros à psychotraumatisés.

The Covid-19 pandemic has taken its toll on health care teams faced with deaths and hospital overcrowding. Some caregivers suffered from vicarious trauma. Analyzing the impact of this trauma, its inclusion in a context of tension, fatigue and increased lassitude, is imperative in order to propose adjusted care. Eye Movement Desensitization and Reprocessing therapy seems to have a relevant place in this context.

[Optimization of critical care according to the principles applied in aeronautics]. / Optimisation des soins critiques selon les principes appliqués en aéronautique.

Care requires the full attention of caregivers, particularly in emergencies, where it consumes energy and generates emotions. To be efficient and to remain so, we must know how to manage our stress with full awareness. The culture of quality in the aeronautics industry teaches us to adjust the right tension over time, individually or as a team, on a daily basis as well as in times of crisis. The management of a patient in a critical somatic or psychological situation has strong similarities with the aeronautical crisis management model, which allows us to draw inspiration from it.

[A trilogy to understand: adrenalin, allergy and anaphylaxis]. / Une trilogie à bien appréhender : adrénaline, allergie et anaphylaxie.

Allergy, anaphylaxis and adrenaline are three closely related terms in medicine. Upon identification or suspicion of anaphylaxis, adrenaline should be administered as soon as possible. An allergy can be characterised by anything from a simple skin rash to severe vital parameter abnormalities. The role of the reception nurse will be first to identify clinically relevant features, to assign the right level of triage to the patient and adjust the care pathway.

[Angioedema and anaphylaxis, a family story]. / Angiœdème et anaphylaxie, une histoire de famille.

Non-allergic angioedema has a worrying morbidity. Clinical examination is central, as C1-esterase inhibitor deficiency will not be documented in the acute phase. In the case of anaphylaxis that does not respond to adrenaline, an early diagnosis can optimise referral of the patient to a reference healthcare establishment for a specific therapeutic protocol (icatibant, C1 inhibitor) recently updated by recommendations.

[Initial and surgical care of foot ailments]. / Soins initiaux et chirurgicaux des dégantages du pied.

A rare lesion, limb dislocation, particularly of the foot, is extremely serious. Its initial mortality is related to hemorrhage. Its morbidity is major due to lack of skin coverage of the bones and infection with functional issues. Management remains poorly codified and unknown, and requires a multidisciplinary medical and paramedical team from pre-hospital to rehabilitation. The initial surgery is ideally conservative to control the infection and cover the persistent skin flaps. An unfavorable evolution imposes amputation, sometimes early.

[Pre-hospital management of a psychiatric emergency]. / Prise en charge préhospitalière d'une urgence psychiatrique.

The pre-hospital care process of a patient presenting a psychiatric emergency involves many pre-hospital and hospital personnel. Identifying such high-risk situations, allowing an initial approach that is adjusted and authorises care are often very delicate moments. An adapted management, concerted within a network, allows the safety of the patient, his entourage and the interveners. These situations are characterised by their polymorphism with major constants: training, anticipation and knowledge of organisations.

[Reception of a patient suspected of having a psychiatric condition in an emergency department]. / Accueil d'un patient suspect d'une pathologie psychiatrique en structure des urgences.

Many emergency patients have pre-existing psychiatric conditions. They may also present a symptomatology likely to evoke this type of psychiatric pathology. The way in which these patients are received and managed is of prime importance, as it determines the subsequent treatment. It is therefore essential that the emergency services organise a specific pathway for these patients.

[Pharmacological and multimodal care of the adult patient with psychiatric presentation in the emergency department]. / Soins pharmacologiques du patient adulte à présentation psychiatrique dans les structures d'urgence.

The pharmacological management of patients with psychiatric presentations, on prescription, and by nurses in emergency medicine structures is based on knowledge of a limited number of molecules and their methods of administration. This is accompanied by a relational approach and techniques to ensure the safety of the teams in the case of an agitated or very resistant patient.

[Organisation and methods of intervention of the medical-psychological emergency units]. / Organisation et modalités d'intervention des cellules d'urgence médico-psychologique.

In the particular case of exceptional health situations involving multiple victims or not, the early psychiatric care of patients affected, directly or not, relies on the medical-psychological emergency cells (Cump). The organisation of these units is based on ministerial instructions. The indications for recourse to the Cump as well as the method of triggering it are based on recommendations established by French learned societies.

[Rescue workers: at the heart and head of the traumatic event]. / Soignants - sauveteurs, au cœur et à la tête de l'événement traumatique.

With the traumatic event, the victim has suffered and fallen into a world of horror, violence and chaos. Emergency first aid is intended to give him a sign, to reach out to him so that the victim can return to the shore of the living world. The duality of technical and psychological first aid is necessary for the immediate and post-medical management of these highly traumatic interventions. These are important points of reference for the future of the subject as well as for the carer in the management of his individual or team stress.

[Managing mass psychiatric chaos]. / Gérer le chaos psychiatrique de masse.

During an event with a high traumatic potential, the patient, as well as the first intervener in the care process, will resonate with his or her own intimate life experience and that of the other person. This happens in the reality of experiences, but also in the constructed projections. These stress-related phenomena must be widely known and taught, in order to increase the capacity to respond and adjust to these individual and collective crisis situations. This guarantees the physical and psychological health of the people involved.

[Medico-legal framework for emergency care of a patient with psychiatric conditions]. / Cadre médico-légal des soins en urgence d'un patient à présentation psychiatrique.

The care and referral of patients with psychiatric conditions is a perilous process. It combines the need for care with respect for individual freedom. Knowledge of the different legal frameworks is thus necessary for psychiatric care at the request of a third party, care without request of a third party within the framework of a procedure for imminent danger, and finally for the injunction of psychiatric care on the decision of a State representative. These are necessary prerequisites for practising in an emergency structure.

[Plea for a collegial practice of emergency psychiatric care]. / Plaidoyer pour un exercice collégial du soin psychiatrique en urgence.

The care of patients, especially in the field of agitation or psychiatry, requires close coordination between different actors. Interdisciplinarity makes it possible to analyse and harmonise the links between various disciplines with the common aim of solving complex problems. This interdisciplinarity must now become a fundamental in the teaching of health sciences and a prerequisite for the functioning of hospital services, in particular in the formalisation of acute care pathways.