Wounded Person Research Articles

Pulmonary Embolism of the Small Branches of the Pulmonary Artery as a Result of Combat Trauma: Review of the Literature and Analysis of a Clinical Case

Pulmonary embolism (PE) is recognized by WHO as one of the most common cardiovascular diseases. Even in peacetime, PE is the third leading cause of sudden death after coronary heart disease and stroke. Today, as a result of the war, there have been significant corrections in the understanding of etiology, pathogenesis, features of the clinical course and treatment of internal pathology in the wounded persons. It was established that an important feature of modern combat activity is a constant increase in the frequency of multiple and combined wounds, while combat injuries of the chest make up to 15% of the structure of sanitary losses, and closed chest injuries under combat conditions can make up to 5%. Diseases of the cardiovascular and respiratory system are observed both early and late after closed chest trauma. The early ones are represented by functional disorders of the blood circulation and breathing system and are the consequences of damage to the chest organs, and the late ones occur in the case of joining a wound infection and are characterized by inflammatory processes in the lungs, pleura, heart and blood vessels, include pneumonia, pleurisy, acute purulent-destructive diseases lungs, thromboembolic complications. The article analyzes the course and possibilities of diagnosis and treatment of PE using the example of a wounded military man. A clinical case is presented which describes the successful diagnosis and treatment of a wounded person with PE of small branches of the pulmonary artery with the development of infarct-pneumonia S8, S9 of the right lung, nosocomial pneumonia in the right lung, which was complicated by the destruction of lung tissue, with the formation of an abscess-hematoma, acute interstitial nephritis, complicated by acute kidney damage of the III degree. This therapeutic pathology arose after a gunshot shrapnel penetrating wound of the chest on the right side with damage to the right subclavian vein, migration and embolization by a metal fragment of the right pulmonary artery, a gunshot shrapnel blind wound of the upper third of the right forearm with a gunshot fracture of the ulna and the presence of a foreign body (debris) in the muscle what tissues of the forearm. During the operation a complication arose in the form of migration of a foreign body from the branches of the right pulmonary artery to the branches of the left pulmonary artery. The result of the patient’s treatment was positive dynamics of the pathological process. The serviceman was discharged from the hospital in satisfactory condition and returned to the Armed Forces of Ukraine after a medical treatment. PE of small branches of the pulmonary artery is a severe complication after gunshot shrapnel injury to the chest organs, which can occur without concomitant deep vein thrombosis of the lower extremities, most likely as a result of the development of shock and the migration of fragments along the branches of the pulmonary artery. Complex treatment with the use of surgical methods and adequate antibacterial therapy is the main method of treatment of chronic destruction of lung tissue with abscessation. Each patient needs a complex of imaging methods for dynamic examination and monitoring of the state of other organs and systems, in particular, kidney function.

PERWUJUDAN SPIRITUALITAS BELAS KASIH MENURUT PAUS FRANSISKUS DALAM PELAYANAN PASTORAL KORBAN PELECEHAN SEKSUAL

Lately there have been cases of sexual harassment in Indonesia. The stigma that has developed in society that demeans victims of harassment has succeeded in silencing the voice of truth that was about to be echoed. This causes lasting trauma. Pope Francis offers a cure for the hurt that is happening in the world today. The medicine is the Spirituality of Compassion which is manifested in pastoral care for victims of sexual abuse. The spirituality of compassion, according to Pope Francis, is described through the firm faith of a mother who cares for injured children. The mother does not wait for the injured to knock on her door but goes out to find, collect, hug, nurse and make them feel loved. This spirituality enables a person to read the hearts of those he meets and respond to their deepest needs. The spirituality of compassion is on the side of those who are branded guilty, evil and despised. The author personifies himself as a good Samaritan who is present to approach a wounded person. In the process of digging up wounds, the author uses a compassionate approach as Jesus did to the Samaritan woman at Jacob's well. Jesus looked at him with compassion. There is hope that through this process at least the victim can rise and move forward. There is hope that the impact of the wound will no longer make the victim feel hopeless.

Infusion therapy as an important element of anesthetic strategy for the wounded with hemorrhagic shock

Hemorrhagic shock remains the main cause of death of the wounded in all wars and military conflicts. A key aspect in modern anesthetic strategy for the wounded with hemorrhagic shock is the strategy of a balanced infusion therapy. It consists in restricting the infusion of crystalloids and colloids and the earliest possible transfusion of blood products to a wounded person with massive hemorrhage. Currently, the main option for blood transfusion both in civilian health care facilities and in medical facilities of the Armed Forces of Ukraine is the use of the so-called component blood transfusion therapy, i.e. transfusion of packed red blood cells and fresh-frozen plasma. This approach is absolutely justified for elective surgical and somatic patients, but has a number of significant disadvantages in the treatment of wounded with massive hemorrhage. In addition, blood transfusion in the conditions of hostilities, disasters and emergency situations has additional logistical (quick availability) and safety (risk of errors when combining blood groups) requirements for blood preparations. Therefore, the issue of alternative, relative to component therapy, variants of transfusion therapy in the treatment of hemorrhagic shock becomes especially relevant.

Videothoracoscopic removal of a foreign body (arrow-shaped element) of gunshot origin from the vertebral body, using radiation and magnetic technologies

Gunshot wounds to the chest have always occupied a special place among the entire set of gunshot wounds on the human body. Today, the one of the important challenges before the Navy of the Armed Forces of Ukraine, - not only to restore the damaged anatomical structures of the chest, but also to create optimal conditions for the restoration of the functional component. This will make possible to reduce the treatment period of a wounded serviceman and return him to the formation (or to the occupied position) as soon as possible. The use of minimally invasive methods (videothoracoscopy, radiation control and magnetic technologies) during the treatment of a wounded person with a penetrating gunshot wound of the chest is the key in the surgeon’s hands whose task is to save life and eliminate the defect (formed as a result of the wound). This approach is not only an example of highly specialised surgical care for the wounded in the navy, but also demonstrates the high quality of the proposed care scheme. Purpose - practically implement new organisational, tactical and professional approaches to the treatment of gunshot wounds to the thorax using a clinical case study. It is presented the clinical case of wounded man Sh., 35 years old, with a gunshot fragmentation blind wound of the posterior surface of the thorax, gunshot fracture of the Th7 vertebral body on the background of a foreign body (metal arrowhead). In the current world literature, there are many options for surgical tactics for the treatment of wounded patients with penetrating gunshot wounds to the chest. However, our clinical case draws attention to the high relevance of applying and combining minimally invasive techniques (video-othoracoscopy, radiation control and magnetic technology). This makes it possible to reduce the time (or duration) of surgical intervention, perform an «extended» revision of the pleural cavity, examine and assess the condition of the wound canal, remove a foreign body (shrapnel, bullets, arrowhead component), compensate for respiratory failure phenomena as quickly as possible and restore the integrity and function of the thoracic cells. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

A CASE OF SUCCESSFUL COMBINED SURGICAL TREATMENT OF A WOUNDED WITH PURULOUS MEDIASTINITIS AFTER CHEST AND NECK INJURY OF FIRE ORIGIN

Resume. The purpose of the study was to reveal the main features of the development of purulent mediastinitis in a wounded person with penetrating gunshot wounds of the chest and neck in order to further improve the diagnosis and treatment of this difficult complication. The work reports on the injured K., 29 years old, with acute purulent-necrotic mediastinitis and late bilateral empyema of the pleura caused by a gunshot wound to the chest and neck. With early diagnosis of suppurative mediastinitis due to penetrating gunshot wounds of the chest and neck, active surgical tactics including wound dressing, drainage, massive antibiotic therapy, and adequate postoperative care with intensive care generally help to save the patient's life.

Оrgan-preserving operations in the abdominal gun-shot penetrating woundings of large bowel. Experience of the medical help delivery in military environment Аntiterroristic operation/The Joint Forces Operation

Objective. To improve the results of treatment in injured persons with a gun-shot penetrating abdominal woundings with damages of large bowel, using introduction of principle for compliance between volumes of the damage and the primary operative intervention through organ-preserving operations.
 Materials and methods. There were analyzed 164 gun-shot abdominal woundings of large bowel in 151 injured persons. All the wounded persons were men, aged from 19 to 58 yrs old, (34 ± 5.2) yrs old at average. Penetrating cross-cutting abdominal woundings have occurred in 48 (31.8%) patients, the blunt – in 103 (68.2%). In accordance to character of the large bowel damage there were: deserozation - in 8 (5.3%) injured persons, the blunt wounding – in 57 (37.7%), and a through one – in 86 (57.0%). The bullet woundings have occurred in 31 (20.5%) injured persons, while the comminuted – in 120 (79.5%). The large bowel woundings have had following localizations: coecum – in 37 (24.5%) patients, ascending colon – 19 (12.6%), transverse colon – 32 (21.2%), descending colon – 18 (11.9%), sigmoid colon – 33 (21.9%), and several perts of large bowel – 12 (7.9%). The wounded persons were distributed into two groups, depending on volume of the operative intervention performed: the main – 49 (32.4%) wounded persons, in whom organ-preserving operations were performed, and a control one – 102 (67.6%) wounded persons, in whom resectional methods were applied. The large bowel wall defects suturing with or without formation of unloading colo- or enterostomy were considered as organ-preserving operations.
 Results. Definite decision, concerning the operative intervention volume, was made immediately after revision of the abdominal cavity organs, estimation of the damages character (special attention was drawn to dimensions, localization and quantity of intestinal defects, the state of its mesenterial edge and adequacy of a blood flow), presence and remoteness of extended peritonitis, general state of a wounded person (the blood loss volume, the sepsis features presence, hemodynamicac indices and common character of the woundings). Оne or several woundings of large bowel, including big in dimensions, were considered as indications for performance of organ-preserving operations (the intestinal wound suturing, the intestinal wound suturing with colo- or jejunostomy, extraperitonization). In patients of the main group, comparing with those of the control group, the stationary stay and the complications rate were reduced. After rehabilitation and staged closure of unloading stomas all wounded persons of the main group went back to service in Military Forces of Ukraine.
 Conclusion. Selecting the surgical treatment method for the gun-shot woundings of large bowel, it is necessary to base on complex analysis of the battle trauma character, the patient’s state and the risk for іntra- and postoperative complications. The first-line application of organ-preserving interventions as more physiological and those, which permit mostly rapid come back to the service duties functioning, is expedient. While choosing the organ-preserving operation volume, the surgeon must adhere to principle of compliance between the damage volume and prevalence, general state of a wounded person and the operative intervention volume.

Biological Therapy on Infected Traumatic Wounds: A Case-Control Study.

Background:Traumatic wound is a great challenging issue to surgeons, because of large in size, heavily contaminated, infected and unscenic. Infection proceeded to progressive tissue necrosis, septicemia, organ failure or even death. Majority has polymicrobial infections. Bacteriohage therapy will have revolutionized in the treatment of wound. The present study was planned to evaluate the efficacy of topical bacteriophage therapy on large traumatic wounds in comparison with conventional therapy. Methods:The Study conducted from Sept. 2018 to July 2020. Samples between 12- 60 years was taken into study. Customized bacteriophage applied over the wound after serial debridement in case and conventional dressing in control. Fifty four wounded person met the clinical inclusion criteria; 27 in each group. Wound swab and tissue biopsy was taken for bacterial isolation. Isolated specific phage was applied over the wound on alternate day till the wound become sterile and fit for further definitive management. Results: A significant and rapid improvement was observed in wound healing in cases then control group. Average number of day required for complete granulation of wound and attaining sterility was half in cases then control. The hospital stay of the patients on BT was half (20days) than those on CT (40 days). The financial analysis also favours the BT over CT as only 1/third expenditure incurred in BT group as compared to CT Conclusion:Topical Bacteriophage therapy is efficient, effective to clearing the infection in shorter length of time and cost effective for infected traumatic wounds as compared to conventional dressing.

Working out of oppel stage-by-stage treatment system and further development of military field surgery

Congratulating the wonderful journal “Clinical Medicine” that has played a significant role in the development of medicalcare in Russia on the centennial anniversary, the surgical community also celebrates the centenary of the birth of modernmilitary field surgery.An article “Great surgery in the frontline of the field army” was published by the surgeon-consultant of a number of frontsof the Russian army in World War I, professor of the Military Medical Academy V.A. Oppel in 1916, and the monograph“Organizational issues of the advanced surgical frontline of the army” appeared in 1917. V.A. Oppel was the first to formulatethe idea of stage treatment of the wounded in these works and a number of other ones. From the point of view of stage-by-stagetreatment, the wounded receives a surgical measure where this measure is needed; the wounded person is evacuated as soonas his health condition allows it.However, such an approach may seem unrealistic in large-scale wars because military environment often precluded thepossibility of providing assistance to the wounded in the place where they needed it. It was not always possible to comply withthe contraindications for the evacuation of the wounded. During the world wars, the system of stage-by-stage treatment of thewounded was more a theory, but it was successfully applied practically, and highly improved, during local wars of the lateXX — early XXI centuries.

Prehospital Scheduling Management by the Critical Path Method for Burn Mass Casualty Incidents.

In 2015, a dust explosion occurred in New Taipei Water Park in Taiwan, and 499 casualties was appallingly high. In fact, the government spent 208 min of response time from receiving calls for emergency to sending the last wounded person to hospital. To stop a similar accident happening again, a well-prepared strategy, with an aim to reduce the rescue time, to respond to such an emergency is necessary. This study mainly focuses on the execution of mass casualty operations while both efficiency and quality of care are considered. We not only find that there is only 1 h or less to allocate rescue resources after a Burn Mass Casualty Incident (BMCI) happens but also shorten the response time. It is our first time to use a special method, called Critical Path Method (CPM), to analyze the rescue process. But before CPM is created, the benefit of available resources should be maximized, and timely, safe, and effective emergency medical services should be provided. With CPM, the interrelations of every activity can be visualized, and the most time-consuming activity can be found by this efficient time management. If the relationship between the predecessors and its successors operations of the most time-consuming activity item is reshaped, BMCI prehospital scheduling management becomes more effective based on its efficiency and quality of care.

“AMONG DEAD AND WOUNDED”: MAPPING, CHARACTERIZATION AND ANALYSIS OF FIRES WITH VICTIMS IN RECIFE’S METROPOLITAN ZONE

This article presents the mapping and analysis of fires with dead and wounded people in the Metropolitan Region of Recife (MRR) served by the Firefighters Department from 2013 to 2016. There was an average rate of 1 death per million inhabitants, similar to countries such as Singapore and Vietnam. The weighted number of fires per wounded or dead person results in rates of 0.5 and 1.7 per 100 recorded fires, respectively. These numbers are concerning, especially when compared to rates from other regions in the world. The victims of fires in MRR were shown to generally not be a perceivable problem in terms of common sense, yet they are real and require accurate analysis and effective measures.

Making and storing blood to save lives

Blood can be a scarce resource, but a multitude of approaches are promising new ways to store, create, and deliver blood’s component parts to patients in need . As soon as a wounded person starts hemorrhaging, the clock is ticking. The quicker an emergency responder can stop the bleeding and replace that blood, the better the chances are for survival. But most bleeding patients do not receive optimal prehospital trauma care, including blood transfusions. That costs lives—up to 30,000 people a year, according to a 2016 report by the National Academies of Sciences, Engineering, and Medicine (1). As noted by the military trauma surgeons who informed that report, the answer to this problem is not necessarily more blood collection, but rather better access to and storage of blood, and, ultimately, production of shelf-stable blood components. To save the lives of patients in dire need of blood, hospitals and emergency responders don’t necessarily need more blood collection. They need better access to and storage of blood, and, ultimately, production of shelf-stable blood components. Image credit: Shutterstock/Ben Carlson. After decades of failed trials to create artificial blood, researchers may finally be starting to meet that challenge. Several are looking to create products that serve as a complement to blood—a sufficient substitute to keep hemorrhaging patients alive until they have access to the real thing. Some researchers are developing freeze-dried versions of blood components; others are looking to create artificial particles that offer replacement components. Hemorrhaging patients rarely receive whole blood; instead, they receive reconstituted blood components. Donated whole blood is broken down into its parts: Red cells carry oxygen, platelets are responsible for clotting, and plasma is the liquid component that plays a role in coagulation. Breaking down blood into parts allows some of those components to be stored longer. Plasma, for …

The Relationship between Female Labor Force Participation and Violent Conflicts in South Asia

This paper explores the link between the prevalence of violent conflicts and extremely low female labor force participation rates (FLFPR) in South Asia. We merge Labor Force Surveys (LFSs) from Bangladesh, Sri-Lanka, India, and Pakistan to the Global Terrorism Database (GTD) to estimate the relationship between terrorist attacks and female labor supply. We exploit the availability of geographical level data on exposure to violence, comparing administrative units exposed to attacks with administrative units not exposed. We find that one additional attack reduces FLFP rates by about 0.008 percentage points, on average. Violence has less impact on male labor participation, thus widening the gender labor participation gap. Also, one extra wounded person or one extra killed person reduces FLFP rates by 0.0015 and 0.0048 percentage points on average, respectively. We test the added-worker effect theory - which posits that violence might increase FLFP as women try to make up for lost household income - and find mixed evidence: greater prevalence of attacks may encourage married women to exert more working hours, but when the environment gets more risky as number of dead and wounded people increase, all women work less hours. We also test the non-linearity of various violence effects, finding that violence decreases FLFP less where FLFP was already higher before the advent of violence, and that violence has a progressively greater impact on lowering FLFP where the number of attacks is higher.

Energy expenditure of flight crew of military transport aviation depending on function during typical training activities

AbstractIntroductionThe knowledge of energy expenditure during typical activities is the basic information to estimate nutritional requirements. This is especially important with irregular lifestyle, such as service in transport aviation. Aircraft personnel fly in every part of a day. Flights often take place with changes in climate and time zones. Time of flights fluctuated from a several dozen to a dozen hours.AimThe aim of the work was to assess and compare the energy expenditure of military aircraft crews – “CASA C-295”, “ C-130 Hercules” and helicopter “W-3 Sokol” during typical air training activities.Material & MethodThe study was conducted in a group of 31 members of flight crews. The energy expenditure was based on the examination of heart rate frequency with the Polar RS800 heart rate monitor.ResultsThe study was conducted among crew members of various types of transports aircrafts. The average value of energy expenditure of the CASA pilots (n = 14) was 3,071 ± 0,84 kcal/min (training flight during the day, n = 10) and 5,64 ± 2,45 kcal/min (training flight during the night and in noctovision goggles, n = 4). In a group of flight technicians (n = 7) in aircraft Herules C-130 the average energy expenditure was 3,55 ± 1,83 kcal/min (passeneger reception and service). In a group of loadmasters (n = 6), in aircraft CASA and Hercules C-130 the average energy expenditure was 6,63 ± 1,55 kcal/min (baggage service, dropping paratroopers). The average energy expenditure in a group of paramedics (n = 4), which are members of helicopter W-3 Sokol crew was 8,51 ± 4,29 kcal/min (going down the rope, lifting wounded person from watercrafts).ConclusionThe presented data show the variation in energy expenditure between groups, as well as within groups. The energy expenditure was varied depending on the function on board and on the conditions in which the tasks were performer. Obtained values of energy expenditures during flights allow to classify the work performed in the categories of work from light to heavy (according to the Christensen's classification). Nutrition in the study group should be adapted to the nature of the work performed.

Surgical tactics of treatment of the wounded persons with the gun-shot injuries of the hip on all levels of medical support

Objective. To substantiate the introduction of differentiated surgical tactics, taking into account the trauma severity for improvement of the treatment results in the wounded persons, suffering the gun-shot injuries of the hip (GSIH).
 Маterials and methods. Differentiated surgical tactics was substantiated by the authors, using as a measure for trauma severity estimation the AdTS (Admission trauma Scare) on different levels of medical support, and introduced in 57 wounded persons, suffering the GSIH. Medical efficacy of the tactics and treatment elaborated for the wounded persons was compared in accordance to conventional methods without application of the AdTS scale.
 Results. There was reduced the mortality from 7.3 tо 1.8%, the extremities amputation performance rate - from 24.4 tо 8.8%, the local complications quantity, calculated for one wounded person, - from 1.07 tо 0.58 (рα < 0.05), relative quantity of poor functional results - from 34.1 tо 19.3% (рα < 0.05), while the specific weight of good functional results increased - from 29.3 to 47.4 due to introduction of differentiated surgical tactics, taking into account the trauma severity on various levels of medical support.
 Conclusions. In the wounded persons, suffering nonsevere trauma (lesser, than 5 points) it is necessary to perform a complete volume of surgical aid; while in severe one (5 - 9 points) and in extremely high (more than 9 points) trauma the help must be delivered in a shortened volume, using the damage control principle.

Practical control of a rescue robot while maneuvering on uneven terrain

This paper presents the maneuvering stabilization method for the rescue robot. In general, the stability index such as center of mass (CoM), zero moment point (ZMP), moment height stability (MHS), and force angle (FA) measure during maneuvering can be used for the mobile manipulator. Among these stability indices, the appropriate stability index can be determined according to the target application. In this paper, the new rescue robot is introduced to accomplish various missions including the rescue and maneuver with a wounded person. The CoM as the stability index is determined due to relatively low closed-loop bandwidth of the tracked lower body for the rescue robot. Therefore, the maneuvering stability can be practically obtained by using the CoM tracking control method. Furthermore, the position-based motion control method using the closed-loop inverse kinematics (CLIK) algorithm is used for the HURCULES. To verify the effectiveness of the CoM tracking controller using the CLIK method, the experiments were conducted on a longitudinal slope and uneven terrain. Satisfactory performance of the maneuvering stabilization was obtained from the experimental results.

Die helende krag van regverdige vergifnis, sonder kondonering van onreg

The healing power of just forgiveness, without excusing injustice. Justice is closely related to forgiveness and the extent of the injustice gap experienced depends on how much or how little personal justice a wounded person desires. The experience of forgiveness includes two diverse forms of forgiveness: decisional and emotional forgiveness. Decisional forgiveness is controlling humans’ behavioural intentions, while emotional forgiveness replaces negative, unforgiving emotions with positive, other-orientated emotions. A victim may make a decision to forgive, but never feels emotional peace about the decision to forgive. Both decisional and emotional forgiveness are experienced internally within a wounded person and depends on the social context of the transgression and the response to it. Justice can narrow the injustice gap, but rarely closes it, while forgiveness can heal the pain within the injustice gap. The sense of desired justice is to some degree justifiable, but by granting decisional forgiveness and experiencing emotional forgiveness a wounded person can slow down if not stop ruminating vengeful thoughts. Christians can forgive transgression and wrongdoing because they are responding in gratitude to God’s mercy, loving-kindness and forgiveness through Jesus’ death on the cross. God guides Christian believers through the example of Jesus’s humility to forgive wrongdoing and ultimately grow spiritually when Jesus requires decisional forgiveness and desires emotional forgiveness between victim and offender. Forgiveness is based on God’s forgiveness, while humans tend to both forgive and also pursue justice without excusing injustice. Humans are in their own power incapable of justly forgiving transgression, but God can guide people through the Holy Spirit to just forgiveness.

Conventional care of wounded in Susruta Samhita—A Review

Wound healing is a physiological process and there are various supportive aids to speedy healing. Acharya Susruta has given due importance to explain about the proper care of a wounded patient irrespective of the cause of wound either surgery or trauma. Injury is a public health problem of enormous magnitude and surgery is another common cause creating the burden of wounds. Statistical data regarding the complications of wound healing and infections of wound is so alarming that there arises a need for retrospection into the conventional concepts of care of a wounded person. Optimal management of the wounded patient is essential as a prophylaxis to surgical site infections and post traumatic complications. The general practitioners with expertise and experience who are an integral part of providing the essential care should appreciate the integrity of a science like Ayurveda and also promote the ideas incorporated in the age old compendiums. Careful management of the wound post traumatically or post operatively is an important part of post wound recovery of the patient. Current care of wounded must be appraised and reassessed for appropriateness and effectiveness. Nutritional status, psychological well-being, environmental and personal hygiene has been long ago recognised as essential in improving the quality of life of the wounded. This article is an attempt to collect and validate these concepts mentioned in Vranitopasaneeya Adhyaya of Susruta.Â

Die helende krag van regverdige vergifnis, sonder kondonering van onreg : original research

The healing power of just forgiveness, without excusing injustice Justice is closely related to forgiveness and the extent of the injustice gap experienced depends on how much or how little personal justice a wounded person desires. The experience of forgiveness includes two diverse forms of forgiveness: decisional and emotional forgiveness. Decisional forgiveness is controlling humans' behavioural intentions, while emotional forgiveness replaces negative, unforgiving emotions with positive, other-orientated emotions. A victim may make a decision to forgive, but never feels emotional peace about the decision to forgive. Both decisional and emotional forgiveness are experienced internally within a wounded person and depends on the social context of the transgression and the response to it. Justice can narrow the injustice gap, but rarely closes it, while forgiveness can heal the pain within the injustice gap. The sense of desired justice is to some degree justifiable, but by granting decisional forgiveness and experiencing emotional forgiveness a wounded person can slow down if not stop ruminating vengeful thoughts. Christians can forgive transgression and wrongdoing because they are responding in gratitude to God's mercy, loving-kindness and forgiveness through Jesus' death on the cross. God guides Christian believers through the example of Jesus's humility to forgive wrongdoing and ultimately grow spiritually when Jesus requires decisional forgiveness and desires emotional forgiveness between victim and offender. Forgiveness is based on God's forgiveness, while humans tend to both forgive and also pursue justice without excusing injustice. Humans are in their own power incapable of justly forgiving transgression, but God can guide people through the Holy Spirit to just forgiveness.

La continuité des soins pour les militaires atteints de syndrome de stress post-traumatique : projet d’un centre de référence interministériel

Nine hundred cases of post-traumatic stress disorder syndrome (PTSD) have been identified these last ten years within the French army corps (2013). This pathology described since Antiquity, was the object of famous works by military psychiatrists (Barrois, Crocq, Lebigot). The various armed conflicts of the last years saw the fighters suffering from psychic wounds further to the fights. For their treatment, a psychic trauma plan builds a way to military care starting from the battle zone. This consideration of the PTSD by the Ministry of Defense is essential in the process of acceptance of the wound by the soldier and in his (her) process of reconstruction. Indeed it gives a sign of gratitude and solidarity to the wounded person. But, this global treatment can be partially or totally interrupted if the subject leaves the army or if he or she wishes to quit and his family wants him to quit the military institution, fearing an unfavorable valuation of his aptitude. In this case, the soldier and his family can be made a break by symptoms which can appear years after the initial trauma, not knowing towards which healthcare professional they can be addressed. Policemen, firemen, diplomats, customs officers, staff of the NGO can, during their functions, be exposed to a traumatic event. The current event demonstrates unfortunately that the exposure in the trauma can take place as much on the national territory as abroad, and thus concern a very important number of people belonging to very different circles. The civil offer of care is heterogeneous and not always visible for a not warned public. Every ministerial structure develops its own model of care. Yet the “Livre blanc” (White book) 2013 on the Defense and the National Security recommends a solidarity and a commitment for all the military and civil staffs who make a commitment in the service of the State. The treatment of PTSD becomes de facto interministerial, and both a civil and a military matter. In fact, managing crises requires multidisciplinary competences. Therefore, an interministerial PTSD reference Center under the guidance of the Ministry of Defense would be a very well structured and adapted response to the issue, with an territorial implantation of military and civil specialized professionals well knowing incidences of maintaining in the army or reinserting in the civil word. This center would be federative of an innovative approach to assure the continuity of treatments. It would allow to develop a common doctrine on the psychic trauma from the exchanges of experts.

The telegraph and the beginnings of telemedicine in Australia.

The history of telemedicine is at times presented to commence in the 20th century. Events in Central Australia in 1874 show that the history goes further back, when the newly constructed telegraph played an important telemedicine role not only in enabling care for a wounded person, but also in uniting a dying man with his wife 2000 kilometres away. Innovation with the tools at hand has proven to be effective to bridge the tyranny of distance in the delivery of health care.