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We examined the effect of the emergency response on medical and public health problems during the 1991 Gulf War in Israel. On the first day of the conflict, the number of deaths from suffocation, asphyxiation, aspiration, myocardial infarction, cardiac arrest, and cerebrovascular accident increased abruptly, as did the number of sudden deaths associated with the use of tight-fitting masks with filters in sealed rooms. Much of the excess risk for death from cardiorespiratory complications during the first alert may have been a consequence of its duration (140 minutes). Mass evacuation and concrete buildings are believed to have kept the death toll from trauma down, and mask use may have protected against facial and upper-airway injuries. Falls and hip fractures, airway irritation from exposure to bleach, carbon monoxide intoxication from open kerosene heaters in sealed rooms, and self-injection with atropine syringes were also noted. A measles epidemic and increased death rates from automobile crashes were other preventable causes of death. Protection against biological warfare was limited to surveillance of trends for pneumonia and gastroenteritis. Emergency planners failed to anticipate the need for better mask fit, hands-on training in the use of masks, and special guidelines for older persons to prevent deaths from suffocation and other cardiovascular-respiratory problems in the first minutes of use. If masks are to be distributed as a protection against chemical warfare, a simpler model including the use of shrouds for whole-body skin protection might help avoid cardiorespiratory complications. Public health problems not adequately dealt with in the predisaster period are apt to emerge with greater severity during a crisis.

Accidents, Traffic↗

PubMed1997

Emergency preparedness and response in Israel during the Gulf War.

We examined the effect of the emergency response on medical and public health problems during the 1991 Gulf War in Israel. On the first day of the conflict, the number of deaths from suffocation, asphyxiation, aspiration, myocardial infarction, cardiac arrest, and cerebrovascular accident increased abruptly, as did the number of sudden deaths associated with the use of tight-fitting masks with filters in sealed rooms. Much of the excess risk for death from cardiorespiratory complications during the first alert may have been a consequence of its duration (140 minutes). Mass evacuation and concrete buildings are believed to have kept the death toll from trauma down, and mask use may have protected against facial and upper-airway injuries. Falls and hip fractures, airway irritation from exposure to bleach, carbon monoxide intoxication from open kerosene heaters in sealed rooms, and self-injection with atropine syringes were also noted. A measles epidemic and increased death rates from automobile crashes were other preventable causes of death. Protection against biological warfare was limited to surveillance of trends for pneumonia and gastroenteritis. Emergency planners failed to anticipate the need for better mask fit, hands-on training in the use of masks, and special guidelines for older persons to prevent deaths from suffocation and other cardiovascular-respiratory problems in the first minutes of use. If masks are to be distributed as a protection against chemical warfare, a simpler model including the use of shrouds for whole-body skin protection might help avoid cardiorespiratory complications. Public health problems not adequately dealt with in the predisaster period are apt to emerge with greater severity during a crisis.

Accidents, Traffic↗

PubMed1995

Occupation and environment in internal medicine: sentinel events and trigger questions.

Patients who undergo sentinel events indicate a breakdown in the chain of prevention and protection. Because most work- or environmentally induced illnesses and disabilities produce nonspecific or late symptoms and signs, the search for exposures to physical, toxic, ergonomic, or sociopsychological events that induce these sentinel events has to be based on systematic investigative routine, and not on the physician's mere awareness. Routine use of five "trigger" questions to identify jobs, tasks, exposures, symptoms, and other persons at risk can be effective, quick, and inexpensive in the search for preventable illness related to work or environment in the sentinel patient, especially when illness persists, recurs, or progresses or occurs in others. Sometimes, others can be helped when it is too late to do anything for the sentinel individual. This holds true for the relatively simple situations of one exposure and one outcome and for settings in which there are many exposures or many diseases in one or many patients. The newer set of "clean" environments that include ergonomic and sociopsychological hazards and stress at the work-station have produced new sentinel events. Knowledge of the impact of macro-environmental hazards presupposes familiarity with their impact on individual risks. Using the sentinel event to promote prevention of hazardous exposures means opportunities for reducing unnecessary risk in individuals and small groups. Opportunities for prevention arise when sentinel events occur at the time of exposure. Where there is latency between exposure and outcome, an anticipatory approach based on awareness of future risks from preventable current exposures is needed. The search for external exposures that have already occurred and for those that are preventable should be a routine part of internal medicine.

Adult↗

PubMed1990

Regulation of parathyroid cell gene expression in experimental uremia.

The secondary hyperparathyroidism of renal failure is an important component of renal osteodystrophy. We studied PTHmRNA levels and their regulation in control and subtotal nephrectomized (5/6 NX) rats at 3 wk, as well as levels of the 1,25(OH)2D3 receptor mRNA in parathyroids. Serum 1,25(OH)2D levels were decreased in 5/6 NX, whereas PTHmRNA levels were increased (7 +/- 0.7 OD U, N = 4) compared to controls (2.1 +/- 1.2, P less than 0.01); both decreased after 1,25(OH)2D3 (100 pmol/100 g body weight). Similar results were found in 5/6 NX rats after 3 months. There was no change in actin mRNA levels. PTHmRNA levels were highest in 5/6 NX rats with the most severe renal failure. The parathyroid gland 1,25(OH)2D3 receptor mRNA levels were not different between 5/6 NX rats and controls and were not affected by 1,25(OH)2D3 (100 pmol/100 g body weight daily) at 1 or 3 days. PTHmRNA levels of 5/6 NX rats did not increase when the serum calcium was decreased from 2.8 +/- 0.05 mmol/L to 0.9 +/- 0.15 mmol/L at 3 or 5 h, which contrasted with the marked increase in PTHmRNA in normal rats after hypocalcemia. As in normal rats, after hypercalcemia (4.8 mmol/L at 1 h) there was no change in the 5/6 NX rats' PTHmRNA levels. These results show that 5/6 NX rats have increased PTHmRNA levels that are normally regulated by injected 1,25(OH)2D3 but not by calcium. Parathyroid gland 1,25(OH)2D receptor mRNA levels are not increased in 5/6 NX in contrast to the increased PTHmRNA, which reflects the larger glands of uremia. 1,25(OH)2D receptor mRNA levels were not regulated by 1,25(OH)2D3.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1987

Focal pontine leukoencephalopathy in immunosuppressed patients.

In three patients who died of immunodeficiency syndromes, including two patients with acquired immunodeficiency syndrome (AIDS), foci of necrotizing leukoencephalopathy were found in the basis pontis. The lesions were identical in location and morphology to those previously described in patients who received chemotherapy and central nervous system radiotherapy for various malignancies, and (except for their restricted anatomic location) resembled the disseminated necrotizing leukoencephalopathy that complicates central nervous system leukemia and lymphoma. The lesions are to be distinguished from central pontine myelinolysis, are confined to pontocerebellar tracts, and are not specific for the immunodeficient state, but may reflect preterminal metabolic derangements, since they seem unrelated in this clinical setting to malignancy and/or its treatment. Alternatively, they may be a consequence of the immunosuppressed state. The presence of this morphologic abnormality in two AIDS patients is especially intriguing, in view of the frequency with which white matter lesions are seen in the AIDS population.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Complications from supervised mask use in post-operative surgical patients during the Gulf War.

This is a report of three patients in a surgical ward of a hospital who developed complications seemingly related to the use of full-face-fitting masks associated with the first Scud Missile attack on Israel during the Gulf War. Patient 1 developed atrial fibrillation with an uncontrolled ventricular rate; Patient 2 redeveloped a gastrointestinal hemorrhage; and Patient 3 developed a severe anxiety attack. Each of the three was severely ill prior to the event. Special attention should be given to severely ill patients during such events.

Adult↗