Thrombolyse d’un AVC ischémique vertébro-basilaire à N’Djamena, République du Tchad

L’accident vasculaire cérébral ischémique est une pathologie rare chez les militaires français, mais les médecins militaires projetés en opérations extérieures peuvent être amenés à en prendre en charge, notamment en Afrique Sub-Saharienne. Dès lors, il s’agit d’une urgence vitale nécessitant de réagir rapidement avec des moyens limités, de façon multidisciplinaire avec les médecins neurologues de France métropolitaine, afin d’assurer au patient une prise en charge optimale. Nous rapportons le cas d’un patient victime d’un accident vasculaire cérébral ischémique sur le territoire vertébro-basilaire, traité par thrombolyse intraveineuse

Ethical dilemmas faced by French military physicians deployed to Sahel (Operation Barkhane) : which place for ethical reflection within a constrained normative framework?

Les nombreuses missions des médecins militaires déployés sur l’opération Barkhane peuvent créer des dilemmes éthiques quand des décisions s'imposent, à l'origine de conflits de valeurs. Des entretiens avec 20 médecins récemment projetés au Mali ou au Tchad ont été réalisés. Tous ont déclaré avoir été confrontés à plusieurs dilemmes éthiques. Tous les dilemmes rapportés concernaient le traitement de personnels civils ou de personnes capturées, et étaient en lien avec le choix des patients à traiter, l'utilisation du soin à des fins diplomatiques, politiques ou de renseignement par les autorités militaires, et le niveau de soins à apporter aux patients en l'absence de capacité de prise en charge hospitalière d'aval. La plupart des dilemmes relevaient de la double loyauté (conflit entre le devoir des médecins militaires envers les patients et envers l'institution militaire), ainsi que de facteurs contextuels (limitation des ressources et contraintes sécuritaires). Ce travail fournit un aperçu unique de leurs expériences éthiques et s'avérera utile pour améliorer la formation opérationnelle du personnel de santé déployé en opérations extérieures.The missions of French military doctors deployed on Operation Barkhane are diverse and complex, and can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Semi-structured interviews with 20 military doctors deployed in Mali and Chad were conducted. All interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians or of persons under control. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Most dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors’ duty of care to patients and to the military institution, as well as contextual factors. This work provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions

Reply letter to: Physician's experience in decisions of withholding and withdrawing life-sustaining treatments: A multicenter survey in emergency departments

International audienc

Mesure de l'épaisseur de la paroi thoracique chez des militaires français (quelle technique pour l'exsufflation du pneumothorax compressif lors du sauvetage au combat ?)

LYON1-BU Santé (693882101) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Complications pulmonaires après chirurgie des cancers de l'oesophage (résultats d'une étude rétrospective de 734 patients)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Burn wound care of civilians in Sahel region by French military surgical teams: ethical challenges and future training requirements

International audienc

Médecins militaires français en opérations extérieures : enjeux éthiques et perspectives

International audienc

Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study.

International audienceAbstract Background French military doctors are currently deployed in the Sahel to support the armed forces of Operation Barkhane, in medical or surgical units. As well as supporting French soldiers, their other missions are diverse and complex: medical assistance to civilians and persons under control (PUC), advice to commanding officers. These tasks can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Little is known about the specific dilemmas experienced by French military doctors in overseas operations. We therefore conducted a qualitative study among doctors and surgeons recently deployed to the Sahel to explore and better understand this question. Method Semi-structured, face-to-face interviews were conducted with 20 French military doctors or surgeons deployed since January 2016 in medical or surgical facilities in Mali and Chad. Results All interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians (while delivering community medical assistance) or of PUC. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Questions of delivering care at the risk of their own safety or the mission’s and of treating openly hostile patients were also brought up. Most dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors’ duty of care to patients and to the military institution. Contextual factors (restricted resources and security constraints) were also associated with many of the reported dilemmas. Conclusion This is the first reported study focusing on the ethical dilemmas encountered by French military doctors in overseas operations. It provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions