ABSTRACT
Introduction: To look after a person in an emergency situation leaves little time for philosophical reflections. A life must be saved. The sensitivity of care receivers and their relatives is however at its highest when faced with the caregiver's humane negligence, which they perceive as abusive
Materials and methods:Creating a working group of the different professional caregivers and of care-receivers. Writing down a list of shared values of care, and of what is considered to be unacceptable behavior. Definition of care, both that which is respectful of the individual person and that which is not, and what to do in the case of excesses of abusive situations. Conclusions of the French Ministerial Group "Humane treatment in health care institutions [2010-2011]"
Results: The ordinary, involuntary non-respectful care treatment [the "bad care"] is found in all our activities, mostly through the trivialization of the human being and the caregivers' indifference, preoccupied more with urgency, action, the medico-economic and administrative contingencies, and technicality. Awareness must be increased, which will allow the questioning of all those who take part in the care chain. Discussions should be led with a selection of caregivers, which would allow them to express their human values and their feelings about the quality of their work environment. A virtuous circle unites humane treatment of care receivers with that of caregivers
Discussion: All caregivers' efforts must tend to an improvement in quality of life of care receivers, to a care system which respects the human being. Nevertheless, recent concepts which tend to make the patient a "health system user", if not a "client", carry within them the seeds of a consumerist tendency which, far from building a joint relationship of trust, where one requires the other, impose its views while asking the other to assume all the responsibilities. And, unlike the past paternalistic approach in medicine, it is not the caregiver that put themselves in such position. Good care can only come from shared trust and respect
ABSTRACT
Introduction: Taking into consideration the natural disasters, the industrial and terrorist attacks had changed significantly with time. The idea of terrorist threats such as chemical biological radiologic or nuclear [CBRN] have determined the authorities to change and adjust their approach
Methods: Through the experience of the Fire Brigade of Paris [BSPP], we focus on the emergency services organization during a major event and on the triage of the victims, whether of a natural disaster or exposed to the CBRN
Results: The new approach is based on a very clear and very well organized emergency care support, a very well organized commanding network, and last but not least a very well prepared logistic support
Conclusion: The willingness and the necessity to anticipate the occurrence of such risks is materialized by the systematic well organized and clearly assigned functions: transport, triage, medical care, and evacuation of the victims. All of which are coordinated by the medical rescue direction
ABSTRACT
Chloroquine, a well-known anti-malarial drug may be lethal when ingested in large amount. We report the case of a 45 year-old patient who ingested 10 g of chloroquine in a suicidal attempt, 3 h prior to presentation. Despite aggressive management, the patient died on the third day. The ingested dose [> 4 g], the QRS duration [> 0.10 sec], and the onset of hypotension [systolic blood pressure < 100 mmHg] are the established prognosticators. The delay in management, the blood chloroquine concentration on admission, and the onset of cardiovascular complications also influence the final outcome. The treatment consists in tracheal intubation, mechanical ventilation, epinephrine and diazepam in the presence of any bad prognostic factor as well as 8.4% sodium bicarbonate in case of QRS complex enlargement on EKG. The chloroquine is not dialyzable nor hemofiltrated. extracorporeal membrane oxygenation [ECMO] might be helpful in the most severe case refractory to the pharmacological treatments
ABSTRACT
Aim: The wound is the consequence of an acute skin aggression either limited or spreading, sometimes iatrogenic, which may be worsened by a delay in care in peculiar circumstances. The aim of this study is to present the benefits and give potential indications of a waterproof dressing. This dressing guarantees the protection during the healing process and increases the patient's compliance to the treatment of his wounds, even in difficult situations
Methods: We used various dressings or means [primary adherent dressings, polyurethane film, cling film] to protect wounds in isolated or precarious care situations, but also in a more conventional context
Results: Secuderm is the only dressing that is waterproof, reliable for acute and chronic protection for repeated exposures to water: excessive sweating, friction of clothing, projection or complete immersion under water. We report the use of Secuderm in different exemption situations: in Guyana during French military missions by the Navy divers, in Cameroon for the treatment of Buruli ulcers, after arthroscopy, to protect medical devices [catheters, etc.] on acute wounds, or even during patient exposure to a nuclear, radiological, biological or chemical risk [NRBC]
Discussion: To effectively protect a wound is difficult when the human resources and materials are limited. An efficient protection of the healing wound allows the resumption of professional, social and private activities in a certain comfort. Probably the only solution that is currently available, Secuderm is a cunning waterproof protection for several days. Its indications are multiple whether in the treatment of acute, chronic or iatrogenic wounds, at the hospital, at home, in degraded situation or even when exposed to nuclear, radiological, biological or chemical risk. Prospective comparative studies are required