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PubMed1984

Operation corporate--the Sir Galahad bombing. Woolwich Burns Unit experience.

During Military Operations in the South Atlantic to recover the Falkland Islands in 1982, the troopship Sir Galahad was bombed. Initial treatment of the injured in field medical units was followed by transfer to the hospital ship SS Uganda and evacuation to the United Kingdom where 48 patients were treated in the Burns and Plastics Unit, Queen Elizabeth Military Hospital, Woolwich. The treatment of these patients is described and the management of war burns discussed.

Burns↗
PubMed2000

The Omagh bombing--a medical perspective.

The bomb in Omagh on the 15th August 1998 was responsible for the largest loss of life of any single terrorist incident in the whole of the "Troubles" in Northern Ireland. However, the medical response to this tragedy provided an excellent opportunity for the civilian and military agencies to work together. As a consequence of this a number of lessons were drawn which are presented in the paper. Whatever the outcome of the peace process these lessons will have an important role in the future, since history would suggest that there is little possibility of the terrorist threat ever completely.

Disaster Planning↗
PubMed2005

"Bomb explosion on the Nis express" - lessons from a major incident, Kosovo 16 Feb 2001.

On Friday 16 February 2001, terrorists detonated a bomb under a civilian coach travelling from Nis in Serbia to Gracanica in Kosovo. 10 people were killed at the scene. 13 casualties were treated in the British KFOR hospital (Reynolds Hospital) in Pristina. Another 8 casualties were evacuated to the American KFOR hospital at Camp Bondsteel. The incident provided a unique opportunity for co-operation between British, American, Russian, German and French KFOR hospitals, as well as with Serbian clinicians and forensic pathologists. This article analyses the medical management of this major incident, identifies the lessons to be learned from it, and also provides enough detail for teaching scenarios.

Adolescent↗
PubMed2005

Individual variation of somatic gene mutability in relation to cancer susceptibility: prospective study on erythrocyte glycophorin a gene mutations of atomic bomb survivors.

It has previously been reported that hemizygous mutant fraction (Mf) at the glycophorin A (GPA) locus in erythrocytes increased with radiation dose in heterozygotes among Hiroshima and Nagasaki atomic bomb survivors. In the present study, we analyzed the relationship between GPA Mf and cancer risk using newly developed cancers among previously cancer-free subjects whose GPA Mf had been measured between 1988 and 1996. Among 1,723 survivors (1,117 in Hiroshima and 606 in Nagasaki), we identified 186 subjects who developed a first cancer by the end of 2000. We compared the radiation dose responses of GPA Mf between cancer and cancer-free groups using a linear-quadratic model fit by multiple regression analysis in combination with age, sex, and city. The slope of the GPA Mf dose-response curve was significantly higher in the cancer group than in the cancer-free group among Hiroshima subjects. Moreover, no significant difference of GPA Mf between cancer and cancer-free groups was found in unexposed controls in the two cities. The same conclusions were obtained using a linear dose-response model and by further analysis using Cox regression of cancer incidence. These findings suggest that there might be interindividual variation in mutability of somatic genes and that Hiroshima survivors who have higher mutability in response to radiation exposure would be expected to have a higher probability of suffering radiation-related cancer.

Aged↗
PubMed1999

Lessons from the first two years of Project Heartland, Oklahoma's mental health response to the 1995 bombing.

On April 19, 1995, a terrorist bombing in Oklahoma City killed 168 people and injured 853 others. The Oklahoma Department of Mental Health and Substance Abuse Services was the lead agency in crafting a community mental health response to reduce impairment of those affected. The Project Heartland program, which opened on May 15, 1995, was the first community mental health program in the U.S. designed to intervene in the short to medium term with survivors of a major terrorist event. The authors describe lessons learned in the areas of planning and service delivery, as well as the types and extent of services provided in the project's first two years.

Community Mental Health Services↗
PubMed2003

The role of anaesthetists in the Darwin response to the Bali bombing.

The bombing of nightclubs in Bali on the night of October 12, 2002 was one of the worst peacetime disasters affecting Australians. This paper examines the unique role of anaesthetists in helping manage the victims, with the main emphasis on events in Darwin. Anaesthetists were involved in the multiple stages of patient care; from the hospital in Bali, evacuation to Darwin, resuscitation and onward evacuation to burns units around Australia as well as definitive surgical management. We discuss the role of anaesthetists in disaster management.

Anesthesiology↗
PubMed2002

Determination of chlorine and bromine in automotive shredder residues by oxygen bomb and ion chromatography.

An analytical procedure, oxygen bomb combustion-ion chromatography (IC), has been developed for the determination of total chlorine in Automotive Shredder Residues (ASR). Samples of these residues are fired under elevated oxygen pressure (30 atm) and the combustion products are transferred into a Na2CO3/NaHCO3 absorbent solution containing 1% of H2O2; the chlorine contents are then evaluated by ion chromatography. The use of the non-suppressed IC determination with a conductivity detector provides a rapid, sensitive and selective method for chlorine determination in ASR, allowing determinations of this heteroatom at levels below 1% in the presence of bromine and sulfur. Moreover, the proposed method allows the simultaneous determination of chlorine, bromine and sulfur which are potential environmental hazards.

Bromine↗
PubMed1995

The Oklahoma City bombing: a personal account.

On April 19, 1995, Oklahoma City (and the United States) lost its innocence. Almost all Oklahomans can relate exactly what they were doing either at 9:02 AM that day or when they first learned of the bombing. Of course, the whole world watched the events unfold through around-the-clock television coverage. One of the resident physicians in the University Hospital Emergency Medicine program, Dr Carl Spengler, was the first physician on the scene and directed early triage efforts. Because the Journal of Child Neurology is the only major biomedical journal with editorial offices in Oklahoma, we considered it appropriate that his personal account of this disaster be published in JCN.

Blast Injuries↗
PubMed2004

Terror bombing-mechanisms, consequences and implications.

Our objective in this review is to describe the unique features of bombing injury and to outline some special elements of their management. This is to allow the timely improvement and adjustment of existing mass casualty protocols. Forensic studies, detonation and explosion, mechanisms of injury in explosion and their bodily effects, chemical effects of the explosive, site of the explosion and the wounding potential, the Multidimensional Injury Pattern, diagnostic evaluation of Multidimensional Injury Pattern, and surgical and treatment dilemmas associated with it are described and discussed.

Blast Injuries↗
PubMed2004

11 March 2004: The terrorist bomb explosions in Madrid, Spain--an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital.

At 07:39 on 11 March 2004, 10 terrorist bomb explosions occurred almost simultaneously in four commuter trains in Madrid, Spain, killing 177 people instantly and injuring more than 2000. There were 14 subsequent in-hospital deaths, bringing the ultimate death toll to 191. This report describes the organization of clinical management and patterns of injuries in casualties who were taken to the closest hospital, with an emphasis on the critically ill. A total of 312 patients were taken to the hospital and 91 patients were hospitalized, of whom 89 (28.5%) remained in hospital for longer than 24 hours. Sixty-two patients had only superficial bruises or emotional shock, but the remaining 250 patients had more severe injuries. Data on 243 of these 250 patients form the basis of this report. Tympanic perforation occurred in 41% of 243 victims with moderate-to-severe trauma, chest injuries in 40%, shrapnel wounds in 36%, fractures in 18%, first-degree or second-degree burns in 18%, eye lesions in 18%, head trauma in 12% and abdominal injuries in 5%. Between 08:00 and 17:00, 34 surgical interventions were performed in 32 patients. Twenty-nine casualties (12% of the total, or 32.5% of those hospitalized) were deemed to be in a critical condition, and two of these died within minutes of arrival. The other 27 survived to admission to intensive care units, and three of them died, bringing the critical mortality rate to 17.2% (5/29). The mean Injury Severity Score and Acute Physiology and Chronic Health Evaluation II scores for critically ill patients were 34 and 23, respectively. Among these critically ill patients, soft tissue and musculoskeletal injuries predominated in 85% of cases, ear blast injury was identified in 67% and blast lung injury was present in 63%. Fifty-two per cent suffered head trauma. Over-triage to the closest hospital probably occurred, and the time of the blasts proved to be crucial to the the adequacy of the medical and surgical response. The number of blast lung injuries seen is probably the largest reported by a single institution, and the critical mortality rate was reasonably low.

Adult↗
PubMed1990

Psychological consequences of the Enniskillen bombing.

Eleven people were killed and 60 injured in the Enniskillen bombing of November 1987. Survivors were psychologically appraised six months and one year later. At six months 50% had developed post-traumatic stress disorder (PTSD). This group comprised more females than males. However, all victims had high scores on the GHQ. We found no correlation between psychological injury (as measured by the GHQ) and physical injury (as measured by the ISS), calling into question previous assertions.

Adolescent↗
PubMed2005

Impact of the terrorist bombings of the Neve Shalom and Beth Israel Synagogues on a hospital in Istanbul, Turkey.

OBJECTIVES: The authors sought to estimate the impact of the open-air mass-casualty terrorist bombings of the Neve Shalom and Beth Israel Synagogues in Istanbul, Turkey, on November 15, 2003, on the American Hospital (AH) in terms of resource utilization, epidemiologic outcomes, and time course of emergency needs. METHODS: A retrospective descriptive study using data from hospital records of injured survivors who used the emergency department at AH on November 15, 2003, to determine the number and percentage of injured survivors who were hospitalized, received operative care, had specific injury types, had an Injury Severity Score >/=16, died, and arrived within certain time intervals. RESULTS: AH received 69 (91%) injured survivors from the scene, of which nine (12%) were hospitalized and three (4%) received operative care. Starting four hours after the initial blast, seven (9%) injured survivors were transferred to AH from other hospitals, of which five (7%) were hospitalized and four (5%) received operative care. Of the 49 injured survivors from the scene with documented injuries, 43 (88%) had injuries to the head or face, 42 (86%) had lacerations, five (10%) had fractures, one (2%) had a penetrating eye injury, one (2%) had a serious intracranial injury, and none had primary blast injuries. Four (5%) injured survivors at AH had an Injury Severity Score >/=16, and none died. CONCLUSIONS: Seventy-six injured survivors used the emergency department at AH, including a delayed wave of injured survivors transferred from other hospitals. The majority of injured survivors with documented injuries had non-life-threatening lacerations of the head or face, and relatively few injured survivors were hospitalized or received operative care.

Blast Injuries↗
PubMedDate not supplied

First response, rehabilitation, and outcomes of hand and upper limb function: survivors of the bali bombing disaster. A case series report.

In October 2002, two bombs exploded in Bali injuring hundreds, and killing 202 people. The purpose of this paper is to report the organization of the first response, rehabilitation strategies, and outcome of a series of patients evacuated to the Royal Perth Hospital (RPH), a civilian hospital in Australia. The initial medical response in Bali was primarily conducted by holidaying health professionals supporting the hospital on the island. The Australian Defence Force was primarily responsible for the ongoing acute clinical management during the evacuation and repatriation of survivors to all major burn units in Australia. At the RPH, hospital adaptations included novel staffing and treatment strategies to sustain a team effort beyond the acute phase of the disaster to manage the surge of 28 patients (15% of yearly admissions) in 7 days. Data collected were related to service delivery and patient outcomes (shoulder active range of motion, grip strength, and the Burns Specific Health Scale). Data were compared to baseline, similar data collected during normal practice and population norms. Bali patients received 3.2% more therapy treatment sessions and 6.8% less contact hours than usual protocols. Shoulder AROM recovered to normal limits by 3 months postdischarge. Grip strength for women was shown to reach population norms by 1 month after discharge and by 6 months for males. Self-rated physical recovery exceeded major burn population norms at 6 months postdischarge. Physical therapy outcome measures demonstrated upper limb recovery as usual in the Bali group, despite a mass casualty situation. To achieve this required support from the multidisciplinary team, in combination with community, government, and hospital administrative assistance.

Adolescent↗
PubMed2005

Do glucose and lipid metabolism affect cancer development in Nagasaki atomic bomb survivors?

The relationship between lipid or glucose metabolism and cancer has not yet been elucidated. We conducted 75-g oral glucose tolerance tests (75-g OGTTs) and lipid measurements between 1983 and 1985 in 516 Nagasaki atomic bomb survivors. Excluding those who already had cancer at the baseline examinations and those who developed cancers or died of any cause within 5 yr after the baseline examinations, we determined incident cancer cases until 2000 in the remaining 451 subjects (214 males and 237 females) and evaluated, by means of the Cox proportional hazard model, whether glucose or lipid metabolism predicts cancer development. The age- and sex-adjusted relative risk (RR) for incident cancer was 0.903 (95% confidence interval, CI = 0.842-0.968), 1.740 (95% CI = 1.238-2.446), 1.653 (95% CI = 0.922-2.965), and 1.024 (95% CI = 0.996-1.053) for total cholesterol (10 mg/dl), radiation dose (1 Sv), smoking, and 1-h blood glucose (1-h BG; 10 mg/dl) in 75-g OGTTs, respectively. Multiple regression analysis of age, sex, smoking, body mass index, 1-h BG, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and radiation dose also showed that total cholesterol was negatively (RR = 0.872; 95% CI = 0.793-0.958) and radiation dose positively (RR = 1.809; 95% CI = 1.252-2.613) related to incident cancer. Cholesterol could be negatively and radiation dose positively associated with cancer development independently.

Adult↗
PubMed2005

Distinct roles for Mind bomb, Neuralized and Epsin in mediating DSL endocytosis and signaling in Drosophila.

Ligands of the Delta/Serrate/Lag2 (DSL) family must normally be endocytosed in signal-sending cells to activate Notch in signal-receiving cells. DSL internalization and signaling are promoted in zebrafish and Drosophila, respectively, by the ubiquitin ligases Mind bomb (Mib) and Neuralized (Neur). DSL signaling activity also depends on Epsin, a conserved endocytic adaptor thought to target mono-ubiquitinated membrane proteins for internalization. Here, we present evidence that the Drosophila ortholog of Mib (Dmib) is required for ubiquitination and signaling activity of DSL ligands in cells that normally do not express Neur, and can be functionally replaced by ectopically expressed Neur. Furthermore, we show that both Dmib and Epsin are required in these cells for some of the endocytic events that internalize DSL ligands, and that the two Drosophila DSL ligands Delta and Serrate differ in their utilization of these Dmib- and Epsin-dependent pathways: most Serrate is endocytosed via the actions of Dmib and Epsin, whereas most Delta enters by other pathways. Nevertheless, only those Serrate and Delta proteins that are internalized via the action of Dmib and Epsin can signal. These results support and extend our previous proposal that mono-ubiquitination of DSL ligands allows them to gain access to a select, Epsin-dependent, endocytic pathway that they must normally enter to activate Notch.

Adaptor Proteins, Vesicular Transport↗
PubMed2005

Mind bomb 1 is essential for generating functional Notch ligands to activate Notch.

The Delta-Notch signaling pathway is an evolutionarily conserved intercellular signaling mechanism essential for cell fate specification. Mind bomb 1 (Mib1) has been identified as a ubiquitin ligase that promotes the endocytosis of Delta. We now report that mice lacking Mib1 die prior to embryonic day 11.5, with pan-Notch defects in somitogenesis, neurogenesis, vasculogenesis and cardiogenesis. The Mib1-/- embryos exhibit reduced expression of Notch target genes Hes5, Hey1, Hey2 and Heyl, with the loss of N1icd generation. Interestingly, in the Mib1-/- mutants, Dll1 accumulated in the plasma membrane, while it was localized in the cytoplasm near the nucleus in the wild types, indicating that Mib1 is essential for the endocytosis of Notch ligand. In accordance with the pan-Notch defects in Mib1-/- embryos, Mib1 interacts with and regulates all of the Notch ligands, jagged 1 and jagged 2, as well as Dll1, Dll3 and Dll4. Our results show that Mib1 is an essential regulator, but not a potentiator, for generating functional Notch ligands to activate Notch signaling.

Animals↗
PubMed1982

Fractionation of isolated liver cells after disruption with a nitrogen bomb and sonication.

Hepatocytes from rat liver were prepared by perfusion with collagenase, and rough and smooth microsomes and mitochondria were prepared after cell disruption. By applying 1000 lb/in2 (1 lb/in2 = 6.9 kPa) in a nitrogen bomb followed by decompression, 75% of the cells were disrupted after four consecutive treatments. Intact mitochondria, and rough and smooth microsomes with little contamination were prepared from the homogenate. A more rapid disruption was attained by a short sonication with a low output, thus increasing the efficiency of homogenization. The microsomal subfractions prepared from this homogenate were comparable to those obtained after decompression. Sonication resulted in smooth microsomes, which exhibited a higher contamination with non-microsomal membranes. These, however, were partly removed by additional centrifugation with a discontinuous sucrose gradient containing divalent cations.

Animals↗