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PubMed2003

Anomalous 235U/238U ratios and metal elements detected in the black rain from the Hiroshima A-bomb.

Contents of black rain from the A-bomb are important to clarify the health and environmental hazard caused by nuclear warfare. We analyzed the only existing physical remains of the black rain from Hiroshima A-bomb (Little Boy), a plastered wall with black streaks. Excess 137Cs and anomalous 235U/238U ratios detected in the black residues on the wall confirmed that the black streaks on the wall originated from Little Boy. The results also showed that excess 235U could be used as a fingerprint to clarify the distribution of materials discharged from Little Boy into the environment. High concentrations of lead and zinc, which may have caused a degree of heavy metal pollution in the area where the rain fell, were also detected in the black rain sample.

Environmental Exposure↗

PubMed2003

Tracking the errant cell after the atomic bombings: what went wrong?

Epidemiological data collected after the atomic-bomb blasts of Hiroshima and Nagasaki have established a link between radiation exposure and human cancer development and are the major source of information for current radiation-induced cancer risk assessment. To determine the mechanistic basis for radiation carcinogenesis, retrospective molecular analyses of archival hepatocellular carcinoma tissues from the atomic-bomb survivors were conducted. The tumor suppressor genes p53 and M6P/IGF2r were examined. HCC cases had either p53 mutations or M6P/IGF2r mutations, but rarely both. Moreover, the frequency of cases with M6P/ IGF2r mutations actually decreased with dose, while those for p53 increased. This implies two independent selection processes leading to liver cancer and that in radiation-induced HCC tumors the spectrum of molecular changes is different from that in "background" tumors.

Carcinoma, Hepatocellular↗

PubMed2003

Corrections in the atomic bomb data to examine low dose risk.

Cancer incidence and mortality data from the cohort of Japanese atomic bomb survivors in Hiroshima have been adjusted for the uncertainty that exists in the dose estimates, the systematic error in the neutron dose estimates, and a dose-dependent relative biological effectiveness. Once the adjustments were incorporated in the dose estimates, the data were modeled with a threshold term to allow for the possibility of a threshold dose response. The dose response models that were fit to the data were otherwise the same models used in the original papers. The threshold term was included in the model allowing for possible threshold values ranging from 0 to 0.35 Sv. These analyses suggest that the fit of the A-bomb solid tumor and leukemia incidence data are significantly improved by the addition of a threshold term in comparison with the purely linear or linear quadratic model. The results from the mortality data suggest that the leukemia data agree more with the threshold model than the linear quadratic model although the linear quadratic model is statistically equivalent, while the solid tumor data does not suggest any improvement with a threshold.

Algorithms↗

PubMed1999

Surgical resource utilization in urban terrorist bombing: a computer simulation.

BACKGROUND: The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident. METHODS: A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel. RESULTS: The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients. CONCLUSION: Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.

Computer Simulation↗

PubMed1983

Epidemiology of a thermonuclear bomb-burst over Nashville, Tennessee: a theoretic study.

A thermonuclear bomb explosion over any city in the world would have a devastating effect on the population and environment. For those who survive, with or without injuries, life would become primitive with little or no uncontaminated food or water, and with inadequate housing, fuel, and medical care, resulting in a breakdown of family and interpersonal relationships. This theoretic study of the potential outcome of a thermonuclear bomb-burst over Nashville, Tennessee, discusses epidemiologically the wide range of medical and psychologic effects from the direct trauma of blast and fire, widespread epidemics of otherwise controlled disease, long-term chronic illness, genetic damage, and catastrophic environmental havoc.

Adolescent↗

PubMedDate not supplied

Terrorist homicide bombings: a primer for preparation.

Contemporary planning for disaster response to terrorist events usually assumes the use of chemical, radiological, or biological weapons. Historically, most victims of terrorist attacks are injured by the use of conventional explosives rather than weapons of mass destruction. Such attacks will likely produce victims who have suffered burn injuries along with conventional trauma. Alternately, the large number of patients sustaining conventional soft-tissue or crush injuries will benefit from burn center expertise. This study summarizes the current state of knowledge related to the management of terrorism mass casualty incidents caused by the use of conventional explosives. A review of pertinent medical, technical, and popular literature relating to terrorism and explosives, along with instruction received at Hadassah Hospital, Jerusalem, Israel on the management of mass casualty terrorism events was undertaken, and the pertinent medical and scientific literature relating to bomb delivery methods, blast mechanics, blast pathophysiology, and medical response to a terrorist bombing is presented here. Although terrorist use of chemical, radiological, or biological weapons is possible, historical analysis consistently demonstrates that the most likely terrorist weapon causing a mass casualty event is a standard explosive device detonated in a crowded area. The medical basis for management of such casualties is herein described.

Amputation, Traumatic↗

PubMed2004

Mass casualties in the Oklahoma City bombing.

The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. Fatalities occurred primarily among victims in the collapse zone of the federal building. Only 83 survivors required hospitalization. Twenty-two surviving victims sustained multiple fractures. Most victims arrived at local emergency departments by private vehicle within 2 hours. More severely injured survivors were transported by ambulance. The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources.

Blast Injuries↗

PubMed2006

A reanalysis of atomic-bomb cataract data, 2000-2002: a threshold analysis.

To obtain the best statistical model for a previous study of cataract prevalence in atomic-bomb survivors, we tested the fitness of the threshold model in an updated dataset of the study, utilizing re-diagnosis by a single ophthalmologist, use of the DS02 dosimetry system, and separation of the in utero group. The results suggest that, in 730 atomic-bomb survivors, we cannot conclude thresholds are greater than 0 Sv in cortical cataract and posterior sub-capsular opacity since the lower 90% confidence limits of the thresholds were 0 Sv. Threshold dose point estimates were 0.6 Sv (90% CI, <0.0-1.2 Sv) and 0.7 Sv (90% CI, <0.0-2.8 Sv) for cortical cataract and posterior sub-capsular opacity, respectively. Detailed regression analyses with no threshold model showed that nuclear color and nuclear opacity have no dose responses (p > 0.40). Cortical cataract showed a significant dose effect (p = 0.002), with an odds ratio (OR)/Sv of 1.30 (95% CI, 1.10-1.53) and no dose-effect modifiers. Posterior sub-capsular opacity showed a significant dose effect (p < 0.001), with an OR/Sv of 1.44 at age of exposure of 10 y (95% CI, 1.19-1.73). The dose effect decreased significantly with increasing age at exposure (p = 0.022). No dose response was observed for in utero survivors (p > 0.20).

Adolescent↗

PubMed2006

Indications of the neutron effect contribution in the solid cancer data of the A-bomb survivors.

Risk estimates for radiation-induced cancer are primarily based on the follow-up of the Japanese A-bomb survivors. Their exposures were due to gamma rays and neutrons, and, currently--with the assumed low RBE = 10 of neutrons and reference to the colon dose--the late radiation effects are almost fully attributed to the gamma rays. Solid cancer risk estimates for different organ sites are assessed here, and an inconspicuous but statistically highly significant trend of larger values is found for the organs closer to the body surface; i.e., the organs with less body shielding and, therefore, with larger neutron dose-fractions. Underestimation of the RBE of neutrons can explain this apparent correlation. The trend of ERR/Gy vs. depth ceases to be statistically significant for RBE values close to 100. The suggestion of high RBE values and the corresponding reduction of gamma-ray risk estimates is found to be in line with log-likelihood computations in terms of AMFIT, which provide for the solid cancer mortality of the A-bomb survivors the minimum deviance for RBE = 100 with a 95% confidence lower limit of 25. The present assessment had to use the data made publicly available by RERF. In this form they contain city-, sex-, age-, and dose-categories, but--instead of a separate neutron-dose category--only the mean neutron dose for each data cell. The tentative conclusions that are here obtained should, therefore, be examined by a more definitive analysis, either in terms of grouped data with a separate classification of neutron doses or, ideally, in terms of person by person calculations to be performed at RERF with individually estimated neutron doses.

Body Burden↗

PubMed2006

Understanding estimation of time and age effect-modification of radiation-induced cancer risks among atomic-bomb survivors.

In radiation risk assessment based on follow-up data, estimation of the excess relative cancer rate involves evaluation of effect-modification by time-related factors such as age at exposure, time since exposure, and attained age. Because these variables are collinear, the regression coefficients purportedly measuring effect-modification of the radiation-related excess relative rate by time and age factors generally differ from the individual effects of these factors. For example, depending on whether it is an age-at-exposure/attained-age effect-modification model or an age-at-exposure/time-since-exposure model which is used, the regression coefficient for the effect of changes in age at exposure on the excess relative rate per Gray measures the combined effects of changes in both age at exposure and time since exposure, or of age at exposure and attained age, respectively, rather than the individual effect of changes in age at exposure, which is of interest for scientific purposes. Such insights should be integrated when reporting and interpreting estimates for time-related risk modification in cohort studies of radiation-exposed populations. Cancer incidence data for the Life Span Study of atomic-bomb survivors are used for illustration in parallel to theory. In summary, model coefficients for time-since-exposure, age-at-exposure, and attained-age effects on radiation-induced cancer risks among atomic-bomb survivors and in other cohort studies estimate combined effects (estimable combined effects are explicated). An appropriate unequivocal display of results for effect-modification is suggested. Goodness of fit appears unreliable for sorting out the most significant effect-modifiers. For example, a model including only one of the effect-modifiers may provide a fit similar to a model including the other two effect-modifiers, even when only the latter are actually related to effect-modification. Also, due to collinearity between these effect-modifier variables, all three models with two of the effect-modifiers necessarily show equivalent fits.

Age Factors↗

PubMed2006

Suicide bombing attacks: Can external signs predict internal injuries?

OBJECTIVE: To report the distribution and types of injuries in victims of suicide bombing attacks and to identify external signs that would guide triage and initial management. SUMMARY BACKGROUND DATA: There is a need for information on the degree to which external injuries indicate internal injuries requiring emergency triage. METHODS: The medical charts and the trauma registry database of all patients who were admitted to the Hadassah Hospital in Jerusalem from August 2001 to August 2004 following a suicide bombing attack were reviewed and analyzed for injury characteristics, number of body areas injured, presence of blast lung injury (BLI), and need for therapeutic laparotomy. Logistic analysis was performed to identify predictors of BLI and intra-abdominal injury. RESULTS: The study population consisted of 154 patients who were injured as a result of 17 attacks. Twenty-eight patients suffered from BLI (18.2%) and 13 patients (8.4%) underwent therapeutic laparotomy. Patients with penetrating head injury and those with > or =4 body areas injured were significantly more likely to suffer from BLI (odds ratio, 3.47 and 4.12, respectively, P < 0.05). Patients with penetrating torso injury and those with > or =4 body areas injured were significantly more likely to suffer from intra-abdominal injury (odds ratio, 22.27 and 4.89, respectively, P < 0.05). CONCLUSION: Easily recognizable external signs of trauma can be used to predict the occurrence of BLI and intra-abdominal injury. The importance of these signs needs to be incorporated into triage protocols and used to direct victims to the appropriate level of care both from the scene and in the hospital.

Abdominal Injuries↗

PubMed1999

Crisis management to controlled recovery: the emergency planning response to the bombing of Manchester City Centre.

Fuelled by terrorist attacks on urban areas, emergency planning responses to manmade disasters is a growing area of critical debate within the field of urban management. The response of a major British city--Manchester--to the 1996 bombing of its commercial core, is examined in this paper. It focuses on the transformation of the emergency planning response from dealing with the immediate crisis during the first week, to a stage of controlled recovery that still continues. The response to the devastation caused by the bomb was co-ordinated by the city council, which developed a range of short- and long-term initiatives, but the re-opening of the city centre could not have happened so quickly had the council not worked in collaboration with other key organisations and agencies. Working partnerships were crucial to the immediate response and subsequent recovery, with such capacity for organisational learning built upon existing co-operative arrangements within the city, which had developed over the previous decade.

Crisis Intervention↗

PubMed1975

Report on injuries sustained by patients treated at the Birmingham General Hospital following the recent bomb explosions.

As a result of recent bomb explosions a total of 82 patients were treated at the Birmingham General Hospital, 61 with minor injuries. Bomb injuries may be divided into three main groups due to the blast effect (such as blast lung and ruptured tympanic membranes), the flash (such as burns to the exposed part of the body), and shrapnel (which may cause a wide variety of injuries). The amount of warning of such explosions is usually minimal, and so the prepared accident schemes of most hospitals are inappropriate. If the disaster occurs outside normal working hours much responsibility initially falls on the resident staff. This report gives some idea of the type of injuries they are likely to see.

Adolescent↗

PubMed1995

Bomb blast injuries to the ear: the London Bridge incident series.

Twelve patients who were treated for ear injuries at Guy's Hospital following the London Bridge bomb blast in February 1992 were reviewed. Among three there were four perforated eardrums, two of which closed spontaneously (50%). All three patients had a persistent mixed hearing loss. The remaining nine patients had acute sensorineural hearing loss and/or tinnitus only. Four of these had resolved completely by 4h, another one by 48h, and two by 4 weeks. Two patients had a residual high frequency hearing loss. In total, five patients (42%) have a persistent hearing loss. None of the patients suffered from balance problems. In summary, the ear is very susceptible to bomb blast injury, but there is a high rate of spontaneous closure of perforations and improvement of sensorineural hearing loss and tinnitus.

Adult↗

PubMed2001

Angiosarcoma arising from skeletal haemangiomatosis in an atomic bomb survivor.

The authors report a unique case in which an angiosarcoma arose from skeletal haemangiomatosis in a 72 year old man. This patient had a history of atomic bomb irradiation more than 50 years ago. Radiographically, the patient had multiple sclerotic foci of benign haemangiomas in the pelvis, the sacrum, and the left femur. The patient developed a high grade angiosarcoma in the left pubic bone. It is thought that atomic bomb irradiation played an important role in the development of the malignant lesion.

Aged↗

PubMed1975

Absenteeism among survivors of the atomic bombing of Hiroshima.

Atomic bomb survivors who worked at the Atomic Bomb Casualty Commission in Hiroshima during the years 1968-71 and held handbooks identifying them as survivors took significantly more days of both annual leave and sick leave than did matched and paired control subjects. These differences in leave-taking patterns are considered to be due to behavioural causes as they could not be attributed to radiation dose-response effects.

Absenteeism↗

PubMed1998

A new microwave acid digestion bomb method for the determination of total fluorine.

A new microwave acid digestion method for total fluorine analysis was compared to the reliable reverse-extraction technique. The commercially available Parr bombs which are compatible with microwave heating were modified for this purpose. The Mann-Whitney statistical test did not show any significant differences (p > 0.05) in the determinations of total fluorine in various samples between the two above-mentioned methods. The microwave method also gave high fluorine recoveries (> 97%) when fluoride was added to different samples. The great advantage of the microwave acid digestion bomb method is that the digestion under pressure is so aggressive that only a few minutes is needed for complete digestion (also of covalently bonded fluorine), which reduces the time for fluorine analysis dramatically, while no loss of fluorine or contamination from extraneous sources could take place during the ashing procedure. The digestion solution was made up of 300 microliter of concentrated nitric acid plus 537 microliter of water. After digestion 675 microliter of approximately 8.5 M sodium hydroxide plus 643 microliter of citrate/TISAB buffer was added resulting in an alkaline solution (pH approximately 12) which was finally adjusted to a pH of approximately 5.3 for fluoride determination.

Acids↗

PubMed2004

The psychological impact of terrorism: an epidemiologic study of posttraumatic stress disorder and associated factors in victims of the 1995-1996 bombings in France.

OBJECTIVE: A wave of bombings struck France in 1995 and 1996, killing 12 people and injuring more than 200. The authors conducted follow-up evaluations with the victims in 1998 to determine the prevalence of and factors associated with posttraumatic stress disorder (PTSD). METHOD: Victims directly exposed to the bombings (N=228) were recruited into a retrospective, cross-sectional study. Computer-assisted telephone interviews were conducted to evaluate PTSD, per DSM-IV criteria, and to assess health status before the attack, initial injury severity and perceived threat at the time of attack, and psychological symptoms, cosmetic impairment, hearing problems, and health service use at the time of the follow-up evaluation. Factors associated with PTSD were investigated with univariate logistic regression followed by multiple logistic regression analyses. RESULTS: A total of 196 respondents (86%) participated in the study. Of these, 19% had severe initial physical injuries (hospitalization exceeding 1 week). Problems reported at the follow-up evaluation included attack-related hearing problems (51%), cosmetic impairment (33%), and PTSD (31%) (95% confidence interval=24.5%-37.5%). Results of logistic regression analyses indicated that the risk of PTSD was significantly higher among women (odds ratio=2.54), participants age 35-54 (odds ratio=2.83), and those who had severe initial injuries (odds ratio=2.79) or cosmetic impairment (odds ratio=2.74) or who perceived substantial threat during the attack (odds ratio=3.99). CONCLUSIONS: The high prevalence of PTSD 2.6 years on average after a terrorist attack emphasizes the need for improved health services to address the intermediate and long-term consequences of terrorism.

Adult↗