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20 results

  • Success!

  • James J. James, Merriline Satyamitra, Tom Hu, Peter Antinozzi, Brian J. Day
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 18 / 2024
    Published online by Cambridge University Press:
    16 April 2024, e73
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  • Public Health Responses to CBRN Terrorism in the Middle East and North Africa

  • Zakaria Mani, Virginia Plummer, Lisa Kuhn, Amir Khorram-Manesh, Derrick Tin, Krzysztof Goniewicz
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 18 / 2024
    Published online by Cambridge University Press:
    15 April 2024, e87
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  • Objective:

    Escalating global challenges (such as disasters, conflict, and climate change) underline the importance of addressing Chemical, Biological, Radiological, and Nuclear (CBRN) terrorism for sustainable public health strategies. This study aims to provide a comprehensive epidemiological analysis of CBRN incidents in the Middle East and North Africa (MENA) region, emphasizing the necessity of sustainable responses to safeguard healthcare infrastructures.

    Method:

    Utilizing a retrospective approach, this research analyzes data from the Global Terrorism Database (GTD) covering the period from 2003 to 2020. The study focuses on examining the frequency, characteristics, and consequences of CBRN incidents in the MENA region to identify patterns and trends that pose significant challenges to public health systems.

    Results:

    The analysis revealed a significant clustering of CBRN incidents in Iraq and Syria, with a predominant involvement of chemical agents. These findings indicate the extensive impact of CBRN terrorism on healthcare infrastructures, highlighting the challenges in providing immediate health responses and the necessity for long-term recovery strategies.

    Conclusions:

    The study underscores the need for improved healthcare preparedness, robust emergency response systems, and the development of sustainable public health policies. Advocating for international collaboration, the research contributes to the strategic adaptation of healthcare systems to mitigate the impacts of CBRN terrorism, ensuring preparedness for future incidents in the MENA region and beyond.

  • 14 - Burning Bridges

  • from Part V - The Schism (1978–1988)
  • Firoozeh Kashani-Sabet, University of Pennsylvania
  • Book:
    Heroes to Hostages
    Published online:
    03 August 2023
    Print publication:
    24 August 2023, pp 344-370

  • Summary

    A series of events fueled the protests against the shah’s regime. The burning of Cinema Rex and the Black Friday riots mobilized large swaths of the Iranian public against the king. Religious groups operated through their networks to protest the Pahlavi state. The shah’s government went through a rapid succession of prime ministers, as Ayatollah Khomeini became anointed as the leader of the opposition, which included many different political groups. The revolution came crashing in. Within months, Islamic policies reversed decades of Pahlavi secular reforms as women were forced to reveil. The regime promptly executed Pahlavi diehards and political activists who embraced different ideologies. An Islamic Republic took shape and punished America for its ties to the shah by taking US diplomats as hostages. Meanwhile, Iraq seized on this moment of domestic turmoil to launch a devastating war against Iran. That island of stability became a harbor of volatility.

  • Descriptive Analysis of the Healthcare Aspects of Industrial Disasters Around the World

  • Derrick Tin, Lenard Cheng, Ryan Hata, Attila J. Hertelendy, Alexander Hart, Gregory Ciottone
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 17 / 2023
    Published online by Cambridge University Press:
    02 May 2023, e400
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  • Objective:

    Industrial disasters can have a myriad of repercussions ranging from deaths, injuries, and long-term adverse health impacts on nearby populations, to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health-care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.

    Methods:

    Data were collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.

    Results:

    A total of 1054 industrial disasters were recorded from 1995 to 2021. Most of these disasters occurred in Asia (720; 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533; 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.

    Conclusions:

    A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters, and they remain a significant contributor to the health-care risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve health-care responses in the future.

  • 4 - Unveiling the Gas Mask

  • Susan R. Grayzel, Utah State University
  • Book:
    The Age of the Gas Mask
    Published online:
    21 July 2022
    Print publication:
    11 August 2022, pp 89-127

  • Summary

    Responding to imagined threats about chemical weapons delivered aerially, the British government intensified its efforts to create gas masks for everyone, testing fit and designs for those who might be unable to wear standard equipment. It did so in an atmosphere where popular culture continued to offer dire imaginings about poison gas’s potential for widespread destruction and where questions about anti-gas protection in the empire continued to emerge. By the start of 1938, the government’s air raid precautions department had developed extensive plans for how to distribute gas masks in case of an emergency across the United Kingdom. However, as it began to unveil such plans further, it encountered resistance from pacifists and antimilitarists as well as some grudging acceptance. The first significant test of these schemes came amid the Czechoslovakian or Munich Crisis in September 1938. On what became known as “Gas Mask Sunday,” the government asked its civilian inhabitants to line up across the nation to be fitted for gas masks. Although the outbreak of war was avoided, the limitations of anti-gas protection and the lack of suitable gas masks for all would propel this aspect of civil defense to the forefront as Britain’s entry into war seemed more likely than ever.

  • 3 - Before the Leaves Fall from the Trees …

  • from Part I - The Fronts
  • Włodzimierz Borodziej, Uniwersytet Warszawski, Poland, Maciej Górny
  • Book:
    Forgotten Wars
    Published online:
    15 March 2021
    Print publication:
    01 April 2021, pp 61-137

  • Summary

    In the summer of 1914 the armies that went to war in the East were formed according to similar rules and used similar tactics; all were based on conscription and all boasted vast numbers of men. It was believed that the biggest reservoir of human beings offered the best chance of victory. In this respect the statistics were unequivocal: no state could rival Russia. Moreover, even on a peace footing, the Russian army was three times the size of the German army and ten times that of the Austro-Hungarian army. One could attempt to redress this imbalance through training and equipment, and indeed that is what the Central Powers started to do on a large scale, once war had begun. In July 1914 all sides in the conflict – Russia, Germany, Austria-Hungary, and Serbia – had comparable ordnance which did not differ much from the arsenals tested recently on the battlefields of Thrace and Macedonia.

  • COVID-19 in Chemical Lung Injury Cases

  • Ramezan Jafari, Amin Saburi, Mostafa Ghanei
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 16 / Issue 4 / August 2022
    Published online by Cambridge University Press:
    08 January 2021, pp. 1311-1312
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  • Pregnancy Outcomes of Wives of Chemical and Non-Chemical Weapons Exposed Veterans in Ahvaz, Iran: A Retrospective Cohort Study

  • Leila Karimi, Andrew C. Miller, Alberto A. Castro Bigalli, Somaye Makvandi, Hossein Amini, Amir Vahedian-Azimi
  • Journal:
    Prehospital and Disaster Medicine / Volume 35 / Issue 5 / October 2020
    Published online by Cambridge University Press:
    25 June 2020, pp. 477-481
    Print publication:
    October 2020
  • Background:

    Sulphur mustard (HD) is a lipophilic caustic alkylating vesicant (blister agent) that has mutagenic and carcinogenic effects. Among the studied perturbations are long-term genitourinary (GU) and fertility effects. Approximately 50,000 Iranian soldiers and civilians were exposed to HD during the Iraq-Iran war (1980-1989). This study questioned the wives of Iraq-Iran war veterans to determine the effects of male HD-exposure on pregnancy complications, adverse pregnancy outcomes, and secondary infertility.

    Methods:

    A retrospective, survey-based cohort study was conducted of wives of Iranian military veterans that survived HD-associated injuries while serving in Ahvaz, Iran during the Iraq-Iran war (1980-1989), as compared to non-exposed veterans serving concomitantly. Patients were identified from a database of injured veterans maintained by the Foundation of Martyrs and Veterans Affairs (Iran) via a systematic random sampling method utilizing a random number table. Using a validated questionnaire, collected data included: demographics; type and severity of chemical injury; spouse’s obstetric history (pregnancy number, duration, complications, and outcomes before and after spouse’s chemical injury); and secondary infertility.

    Results:

    An increase in spontaneous abortion (P = .03), congenital anomalies (P < .0001), and secondary infertility (P = .003) were observed. These findings were greatest amongst those with HD injuries affecting >50% body surface area. No difference in stillbirth, premature birth, or low birth weight was observed.

    Conclusion:

    Exposure to HD in combat may have long-lasting fertility effects on soldiers and their spouses, including spontaneous abortion, congenital anomalies, and secondary infertility. Further investigation is needed into the long-term effects of HD exposure as well as methods to better protect soldiers.

  • The International Review of the Red Cross and the protection of civilians, c. 1919–1939

  • Ben Holmes
  • Journal:
    International Review of the Red Cross / Volume 100 / Issue 907-909 / April 2018
    Published online by Cambridge University Press:
    29 April 2019, pp. 115-141

  • This article will use past issues of the International Review of the Red Cross to examine how the International Red Cross and Red Crescent Movement (the Movement) has engaged with the issue of civilian protection over the course of its history. Although founded to organize humanitarian relief and legal protection for wounded and sick combatants, the International Committee of the Red Cross and the wider Movement have increasingly incorporated civilian war victims into their remit since their establishment. Yet, as this article will highlight, this process has not been straightforward. Focussing on the critical period between the two World Wars, the article will use the Review to illustrate why the Red Cross began engaging with the “civilianization” of conflicts in response to the threat of new technologies like gas and aerial bombardment. Using articles from the Review to highlight the key challenges faced by the Movement in protecting civilians over this period, it will also consider the gaps in the Red Cross's initial conceptions of who “the civilian” was, why belligerents attacked them, and what was the best means of protecting them.

  • Evidence-Based Patient Decontamination: An Integral Component of Mass Exposure Chemical Incident Planning and Response

  • Adam D. Leary, Michael D. Schwartz, Mark A. Kirk, Joselito S. Ignacio, Elaine B. Wencil, Susan M. Cibulsky
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 8 / Issue 3 / June 2014
    Published online by Cambridge University Press:
    27 May 2014, pp. 260-266

  • Decontaminating patients who have been exposed to hazardous chemicals can directly benefit the patients’ health by saving lives and reducing the severity of toxicity. While the importance of decontaminating patients to prevent the spread of contamination has long been recognized, its role in improving patient health outcomes has not been as widely appreciated. Acute chemical toxicity may manifest rapidly—often minutes to hours after exposure. Patient decontamination and emergency medical treatment must be initiated as early as possible to terminate further exposure and treat the effects of the dose already absorbed. In a mass exposure chemical incident, responders and receivers are faced with the challenges of determining the type of care that each patient needs (including medical treatment, decontamination, and behavioral health support), providing that care within the effective window of time, and protecting themselves from harm. The US Department of Health and Human Services and Department of Homeland Security have led the development of national planning guidance for mass patient decontamination in a chemical incident to help local communities meet these multiple, time-sensitive health demands. This report summarizes the science on which the guidance is based and the principles that form the core of the updated approach. (Disaster Med Public Health Preparedness. 2014;0:1–7)

  • 13 - Personal Protective Equipment

  • from PART II - OPERATIONAL ISSUES
  • Edited by Kristi L. Koenig, University of California, Irvine, Carl H. Schultz, University of California, Irvine
  • Book:
    Koenig and Schultz's Disaster Medicine
    Published online:
    05 August 2011
    Print publication:
    30 September 2009, pp 184-194

  • Summary

    Personal protective equipment (PPE) as a means to protect human beings from hazardous materials has been an evolving science throughout history. Discussion on PPE requires a brief historical review of biological, chemical, and nuclear warfare. In responding to disasters, healthcare providers may be exposed to toxic and infectious agents. Therefore, knowledge of PPE and why such equipment would be necessary is important. The selection of PPE is challenging and is based on several factors: the environment in which the hazardous agent is deployed, the concentration of the agent, the type of threat encountered, and the duration of an individual's exposure to the hazardous agent. Although research and development to further improve technologies and capabilities is required if healthcare personnel are to protect themselves and the healthcare infrastructure, it is also equally important that all healthcare personnel be trained and educated on the use of PPE and decontamination techniques.

  • Military Unit of the Hospital

  • B. Lederman, G. Sadovsky, B. Davidson
  • Journal:
    Prehospital and Disaster Medicine / Volume 17 / Issue S2 / December 2002
    Published online by Cambridge University Press:
    28 June 2012, pp. S79-S80
    Print publication:
    December 2002
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  • Medical and Surgical Issues in the Persian Gulf War

  • Jacov Adler
  • Journal:
    Prehospital and Disaster Medicine / Volume 12 / Issue 1 / March 1997
    Published online by Cambridge University Press:
    28 June 2012, pp. 73-76
    Print publication:
    March 1997

  • This report includes the preparations for and the medical impact of the missile attacks launched by Iraq on Israel. It includes the authorization language for the preparations, the preparations undertaken, the perceived threat to the civilian population of Israel, the operational plans activated, the attacks and the medical impact of these attacks, the number and types of casualties, the damage to property, and the initial and subsequent protection times. There occurred a total of 18 missile attacks with 40 conventional missiles launched against Israeli civilians. They resulted in an 4.4 times overall increase in the number of ambulance responses, 228 civilians injured; and two deaths. In addition, five persons died of myocardial infarction related to these attacks. Eight persons died of suffocation due to use of the gas masks.

  • Emergency Medical Training in the 82d Airborne Division: The Gulf War Experience

  • Leopoldo C. Cancio, Gary A. Goforth
  • Journal:
    Prehospital and Disaster Medicine / Volume 8 / Issue 4 / December 1993
    Published online by Cambridge University Press:
    28 June 2012, pp. 345-348
    Print publication:
    December 1993

  • The 82d Airborne Division, as the Army's worldwide contingency division, places unique demands on its medical personnel. This was true particularly during Operations Desert Shield and Desert Storm in 1990–1991. An unprecedented emergency medical training program was carried out in preparation for the Gulf War.

    All levels of expertise were involved: non medical Combat Lifesavers, medics, physician assistants, and physicians. Courses provided included Combat Lifesaver provider and refresher training, Basic Trauma Life Support (BTLS) provider and instructor training, Chemical Casualty courses, and a Combat Surgical Skills course. Approximately 736 personnel, including 80 Saudi and allied physicians and medics, participated in these courses. Confidence and competence in handling war casualties at all levels was enhanced greatly. Prepackaged courses such as BTLS enabled the rapid training of large numbers of medical personnel under challenging conditions.