研发特效药械组合产品提高急性化学损伤救治水平

为有效应对日益增多的急性化学损伤事件,化学应急医学卫勤职能正由单纯应对经典化学战剂向突发化学事故和化学恐怖袭击的应急医学处置拓展。反映在重要的防化特需药品研发上,应大力推进作用机制新、疗效好、安全性高的解毒/抗毒药物,如疑似氰化物中毒即可服用的抗氰新药羟钴胺,以及更加便捷自如的现场递药技术如针头能自动回撤隐藏、注药时限可智能提示的自动注射针等新型药械产品的研发,从而提高突发化学事件的现场处理与应急救援能力。     

Medical response to bioterrorism: are we prepared?

The 1995 bombing of the Federal Building in Oklahoma City made terrorism a shocking reality for all Oklahomans. The fact that such an event could happen here, far from foreign political and ethnic conflicts and from large coastal cities, made us realize that no one is immune from the terrorist threat. But as horrific as that event and other terrorist incidents have been, the present threat of the use of infectious agents in acts of terrorism has the potential to cause far greater human death and suffering than any previously used terrorist weapon. Although health care professionals have not historically participated in terrorist planning and response activities, the addition of infectious agents to the terrorists' arsenal makes medical and public health professionals critical players in these efforts. Indeed, physicians have the ability to first recognize and report such an event and thereby diminish the impact. To meet the bioterrorism responsibility, physicians must be knowledgeable of this type of threat. In this article we present an overview of bioterrorism and review the organisms most likely to be used in a terrorist event.     

Bioterrorism : A Public Health Perspective

The intentional release or threat of release of biologic agents (i.e. viruses, bacteria, fungi or their toxins) in order to cause disease or death among human population or food crops and livestock to terrorize a civilian population or manipulate the government in the present scenario of increased terrorist activity has become a real possibility. The most important step in the event of a bioterrorist attack is the identification of the event. This can be achieved by generating awareness, having high degree of suspicion and having a good surveillance system to assist quick detection.Bioterrorist attacks could be covert or announced and caused by virtually any pathogenic microorganism. Bioterrorist agents of major concern have been categorized as A, B and C based on the priority of the agents to pose a risk to the national security and the ease with which they can be disseminated. The five phases of activities in dealing with a bioterrorist attack are preparedness phase, early warning phase, notification phase, response phase and recovery phase.A bioterrorism attack in a public place is a public health emergency. Early detection and rapid investigation is the key to contain such attacks. The role of public health epidemiologist is critical not only in determining the scope and magnitude of the attack but also in effective implementation of interventions.Key Words: Bioterrorism, Anthrax, Botulism, Plague, Smallpox, Public health emergency, Category A, B and C agents     

Bioterrorism : A public health perspective

The intentional release or threat of release of biologic agents (i.e. viruses, bacteria, fungi or their toxins) in order to cause disease or death among human population or food crops and livestock to terrorize a civilian population or manipulate the government in the present scenario of increased terrorist activity has become a real possibility. The most important step in the event of a bioterrorist attack is the identification of the event. This can be achieved by generating awareness, having high degree of suspicion and having a good surveillance system to assist quick detection.     

Are Saudi Arabian hospitals prepared for the threat of biological weapons?

The use of biological weapons has been recorded repeatedly in history. Until recently, biological terrorism had been little discussed or written about. However, events over the past 12 to 18 months have made it clear that likely perpetrators already envisage every possible scenario. Nations and dissident groups exist that have both the motivation and access to utilize biological weapons. In April 1994, a Russian biological weapons expert presented the conclusions of the Russian experts as to the agents most likely to be used: smallpox, anthrax, and plague. Health care workers in the Kingdom of Saudi Arabia (physicians, nurses, and emergency medical technicians) need to be aware of the seriousness of the threat of biological weapons, and to have an approach for the early identification, triage, and management of biological weapons victims. Clues to the occurrence of a bioterrorism attack include the abrupt onset of a large number of cases of a similar disease or syndrome, the occurrence of diseases with unusual geographic or seasonal distribution, and epidemics of non-endemic diseases. Health care workers must maintain a high index of suspicion, involve the hospital epidemiologist or infectious diseases specialist, identify a clear administrative chain-of-command to minimize confusion, and rely on existing networks such as the hospital disaster-and-safety committee to ensure a multidisciplinary response. Maximum readiness can be achieved by periodic readiness drills.     

Chemical and biological warfare. Should defenses be researched and deployed?

The threat of chemical and biological weapons of mass destruction has intensified because of improved delivery systems and advances in chemistry, genetics, and other sciences. Possible US responses to this threat include deterrence, defenses, and/or disarmament, including a reaffirmation of the Biological and Toxin Weapons Convention of 1972, which is now in jeopardy. This article discusses the history of chemical and biological warfare, existing and potential weapons, the proliferation of weapons and delivery systems, ways to prevent the use of these weapons, and ways to protect populations from their effects.     

Medicine in defense against biological warfare

Personnel from the U.S. Army's Medical Research Institute of Infectious Disease (Fort Detrick) offer their private views on why research in medical defenses against biological warfare is needed. They assert that research, development, storage, and use of medical countermeasures to biological weapons comply with and support the 1972 Biological Weapons Convention. Huxsoll, et al. review the potential impact of the threat of biological warfare and describe the work of the medical component of the Army's Biological Defense Research Program. They emphasize the differences between defensive and offensive research, and argue that Army scientists have a moral, scientific, and political obligation to protect the armed forces from endemic disease and the potential threat of biological warfare.     

A Heuristic Indication and Warning Staging Model for Detection and Assessment of Biological Events

Objective

This paper presents a model designed to enable rapid detection and assessment of biological threats that may require swift intervention by the international public health community.

Design

We utilized Strauss’ grounded theory to develop an expanded model of social disruption due to biological events based on retrospective and prospective case studies. We then applied this model to the temporal domain and propose a heuristic staging model, the Wilson–Collmann Scale for assessing biological event evolution.

Measurements

We retrospectively and manually examined hard copy archival local media reports in the native vernacular for three biological events associated with substantial social disruption. The model was then tested prospectively through media harvesting based on keywords corresponding to the model parameters.

Results

Our heuristic staging model provides valuable information about the features of a biological event that can be used to determine the level of concern warranted, such as whether the pathogen in question is responding to established public health disease control measures, including the use of antimicrobials or vaccines; whether the public health and medical infrastructure of the country involved is adequate to mount the necessary response; whether the country’s officials are providing an appropriate level of information to international public health authorities; and whether the event poses a international threat. The approach is applicable for monitoring open-source (public-domain) media for indications and warnings of such events, and specifically for markers of the social disruption that commonly occur as these events unfold. These indications and warnings can then be used as the basis for staging the biological threat in the same manner that the United States National Weather Service currently uses storm warning models (such as the Saffir-Simpson Hurricane Scale) to detect and assess threatening weather conditions.

Conclusion

Used as a complement to current epidemiological surveillance methods, our approach could aid global public health officials and national political leaders in responding to biological threats of international public health significance.     

Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare

Context  In the 1980-1988 Iran-Iraq War, extensive use of chemical weapons resulted in high rates of morbidity and mortality. While much is known about the physical consequences of chemical warfare, there is a paucity of information about the long-term effects of chemical attacks on mental health. Objective  To assess the long-term psychological impact of chemical warfare on a civilian population. Design, Setting, and Participants  Cross-sectional randomized survey conducted in July 2004 of 153 civilians in 3 towns exposed to warfare in northwestern Iran: Oshnaviyeh (low-intensity conventional warfare), Rabat (high-intensity conventional warfare), and Sardasht (both high-intensity conventional warfare and chemical weapons). Main Outcome Measures  Full or partial posttraumatic stress disorder (PTSD) diagnosis, anxiety symptoms, and depressive symptoms were assessed using Farsi versions of the Clinician-Administered PTSD Scale, Hamilton Scale for Anxiety, and Beck Depression Inventory, respectively. Results  Overall participation rate was 93%. Respondents had a mean age of 45 years and were all of Kurdish ethnicity. Among individuals exposed to both high-intensity warfare and chemical weapons, prevalence rates for lifetime PTSD, current PTSD, major anxiety symptoms, and severe depressive symptoms were 59%, 33%, 65%, and 41%, respectively. Among the low-intensity warfare group, the corresponding rates were 8%, 2%, 18%, and 6%, respectively, while intermediate rates were found among those exposed to high-intensity warfare but not to chemical weapons (31%, 8%, 26%, and 12%, respectively). Compared with individuals exposed to low-intensity warfare, those exposed to both high-intensity warfare and chemical weapons were at higher risk for lifetime PTSD (odds ratio [OR], 18.6; 95% confidence interval [CI], 5.8-59.4), current PTSD (OR, 27.4; 95% CI, 3.4-218.2), increased anxiety symptoms (OR, 14.6; 95% CI, 6.0-35.6), and increased depressive symptoms (OR, 7.2; 95% CI, 3.3-15.9). Exposure to high-intensity warfare but not to chemical weapons was also significantly associated with lifetime PTSD (OR, 5.4; 95% CI, 1.7-17.6), compared with those in the low-intensity warfare group. Further, compared with individuals exposed to high-intensity warfare alone, those exposed to both high-intensity warfare and chemical weapons were at higher risk for lifetime PTSD (OR, 3.4; 95% CI, 1.5-7.4), current PTSD (OR, 6.2; 95% CI, 2.0-20.1), increased anxiety symptoms (OR, 5.6; 95% CI, 2.5-12.6), and increased depressive symptoms (OR, 3.7; 95% CI, 1.8-7.2). Conclusion  Exposure to chemical warfare is an extreme traumatic event that has long-lasting adverse consequences on mental health.      

Is the Australian hospital system adequately prepared for terrorism?

Australian hospitals need to be prepared to deal with mass casualties from terrorist strikes, including bomb blasts and chemical, biological and radiation injury. Injuries from bomb explosions are more severe than those commonly seen in Australian hospitals. In disasters involving mass casualties in urban areas, many of the injured make their own way to hospital, often arriving before the more seriously injured casualties. Major hospitals in Australia should plan for large numbers of undifferentiated and potentially contaminated casualties arriving with minimal warning. It is critical that experienced and trained senior medical officers perform the triage of casualties in emergency departments, with frequent reassessment to detect missed injuries (especially pulmonary blast injury). Hospitals require well developed standard operating procedures for mass casualty events, reinforced by regular drills. Preparing for a major event includes training staff in major incident management, setting up an operational/control unit, nominating key personnel, ensuring there is an efficient intra-hospital communication system, and enhancing links with other emergency services and hospitals.     

Effect on pacemakers of airport weapons detectors

An investigation was carried out using a variety of pacemakers and all the types of weapons detectors in common use in Canada, to determine whether or not such detectors present a hazard to pacemaker bearers. The results indicate that only left-side implants of unipolar sensing pacemakers are likely to be affected, that ventricular fibrillation initiated by interference-induced competitive pacing is the only conceivable hazard, but that the probability of 10⁻⁹ for the occurrence of this event is so low that it may be completely disregarded. Physicians may therefore reassure pacemaker bearers of their safety in and around airport weapons detectors.     

The use of chemical weapons. Conducting an investigation using survey epidemiology

The use of chemical weapons in conflict represents a breach of international law as well as a grave violation of human rights. Investigating allegations of their use often is difficult. A basic tool is the survey interview. Experience has shown that a rigorous epidemiologic approach should be taken. A primary emphasis should be designing the study so that consistency of responses can be analyzed to judge the validity of the testimony. Only when the testimony can withstand this scrutiny is it possible to surmise the possible identity of agents employed. Securing samples of the putative agent is of obvious importance. Two recent investigations are discussed herein, one conducted by US Army medical researchers on allegations of chemical weapons use against the Hmong in Laos and another mounted by us on allegations of poison-gas attack against the Iraqi Kurds.     

腹部开放性海水浸泡伤损伤控制性手术救治策略

军事武器的发展使高威力精确制导炸弹成为了海战主要杀伤武器,使腹部炸伤成为海战伤高发伤情。同时,武器威力增大使伤员极易发生海水浸泡状况,发生腹部开放性海水浸泡伤。本文将分析腹部开放性海水浸泡伤伤情特点,提出针对此种伤情的损伤控制性手术救治策略,并对该救治策略的未来应用进行展望。     

城市炭疽气溶胶恐怖事件医学处置效果评估方法

目的 构建一种炭疽气溶胶恐怖事件医学处置效果的量化评估方法。方法 首先构建炭疽暴露后医学干预的决策树模型、关键资源消耗配置模型及不同干预措施下人群状态转移模型,从而形成一个资源约束下炭疽事件医学处置效果的评估框架。然后基于离散事件仿真技术,以我国大城市遭受炭疽恐怖袭击为情景,分析评估52种干预策略对发病人数、峰值、死亡人数的影响。结果 干预效果对介入延迟时间和资源储备量2个因素均敏感。在仿真案例中,当介入延迟时间为事发后1 h时,将资源储备量从25%提高到100%可减少约59.91%的死亡人数;当介入延迟时间为事发后145时,将资源储备量从25%提高到100%只能减少约7.33%的死亡人数。干预策略对发病人数达到峰值的时间影响很小,最大值为10.52 d,最小值为9.67 d;对峰值人数影响较大,最大值为255 072人,最小值为103 943人。结论 建立了一种炭疽气溶胶恐怖事件医学处置效果的定量评估方法,在医学救援能力建设、应急策略选择方面具有一定的参考价值。     

现代战争爆炸伤特点系统评价

目的 分析现代战争中爆炸伤的发生率、致死率、类型和特点,为我军制订高效战伤救治措施及建立战伤数据库提供参考.方法 根据《系统评价和荟萃分析的优先报告条目》规范构建检索策略、文献纳入标准,对所有关于现代战争爆炸伤发生率、伤情特点、致伤机制及特殊战伤的文献进行检索.结果 最终纳入分析的文献共31篇,包括32474例爆炸伤伤...     

The Informatics Response in Disaster, Terrorism, and War

The United States currently faces several new, concurrent large-scale health crises as a result of terrorist activity. In particular, three major health issues have risen sharply in urgency and public consciousness—bioterrorism, the threat of widespread delivery of agents of illness; mass disasters, local events that produce large numbers of casualties and overwhelm the usual capacity of health care delivery systems; and the delivery of optimal health care to remote military field sites. Each of these health issues carries large demands for the collection, analysis, coordination, and distribution of health information. The authors present overviews of these areas and discuss ongoing work efforts of experts in each.The United States currently faces several new, concurrent large-scale health crises as a result of terrorist activity. These crises are both real and potential, both known and unknown in their direction and magnitude. Each one carries large demands for the collection, analysis, coordination, and distribution of health information. The need for applied informatics expertise may be more pressing, and more in the public eye, than ever before.In particular, three major health threats have risen sharply in urgency and public consciousness:

• Bioterrorism—the threat of widespread delivery of anthrax, smallpox, and other agents of illness. Optimal response to bioterrorist threats requires continuous surveillance with the collection of multifactorial data; coordination and standards to combine data coming from many hospitals and agencies; analysis and logic to detect unusual, statistically significant patterns from highly specific and less-specific indicators; and reliable, centralized sources of current diagnostic and therapeutic information.
• Mass disasters—local events that produce thousands of casualties, often overwhelming the usual capacity of health care delivery systems. In disasters, it is imperative to manage and dispatch resources to avoid bottlenecks, increase capacity through the temporary use of additional services, reduce idle time through precise advance communication, and track both patients and supplies.
• Remote military operations—problems of preventing and treating illness and injury among soldiers in remote, inaccessible regions, thousands of miles from appropriate medical expertise. Field health care can be improved by appropriate communication from the field to local medical corps and base hospitals, secure access to patient data from central data banks, and telemedicine techniques that allow a centrally located expert to provide service to multiple field locations.

Without question, there is a critical need for information management and communication in generating coordinated, effective action to prevent large-scale health problems and to respond to them when they arise. In this article, we present overviews of each area and discuss the ongoing efforts of experts who began working on these problems long before the current national crisis.     

现代海战卫勤保障特点

研究海战卫勤保障特点是确定卫勤保障原则、要求和措施的前提,是组织实施海战卫勤保障的基础性工作.本文通过文献调研及研究分析,根据未来海战的作战样式、投入兵力、武器装备、作战环境等,从保障对象、保障范围、伤员发生、伤员救治、卫勤组织指挥、药材供应、卫勤安全等角度,提出了现代海战卫勤保障的六大特点,为军事、后勤、卫生部门提供参考.     

Disposing of the US chemical weapons stockpile. An approaching reality

A congressional mandate to dispose of the current US stockpile of lethal unitary weapons (Public Law 99-145, Department of Defense Authorization Act of 1986) has international implications and is responsible for a recent major assessment of available disposal alternatives. Eight installations in the continental United States currently host aging stockpiles of chemical warfare agents. The stockpiles are described, the toxicology and physical properties of each agent are characterized, disposal options considered by the US Army are identified, and the role of a programmatic health and environmental assessment in the decision-making process is outlined. Critical findings are that existing community emergency planning and preparedness are inadequate and that communication of risk information requires significant improvement. Measures are under way to address these needs. However, timely disposal of the stockpile entails less of a hazard than continued storage.     

Rapid Detection of Yersinia pestis by Real-time Recombinase- aided Amplification

Yersinia pestis, the causative agent of bubonic and pneumonic plague, is considered to be one of the most dangerous and deadly pathogenic bacteria in the world[1]. Y. pestis? is classified as a category A pathogen by the United States Center for Disease Control and Prevention because of its ease of aerosol-to-human transmission, high lethality, and potential for mass casualties as a biological warfare agent[2]. Therefore, both prevention and treatment require the development of a rapid, sensitive, and specific?method?to?detect?Y. pestis.     

Ring vaccination versus mass vaccination in event of a smallpox attack

Since vaccination is critical in responding to smallpox exposure, vaccination strategies must be evaluated during bioterrorism preparedness. Information on historical factors, smallpox characteristics, public health capabilities and hypothetical attack scenarios was used to evaluate major vaccination strategies. In event of a smallpox attack, the optimal strategy is situational, mass vaccination may be best for dense island populations such as Oahu.