I hope that an increasing number of hospitals are altering their approach to be more in line with Dr. Kelly's experience than Ian's - unfortunately I'm not so sure that's the case...
Back in January we went out into the desert (literally) to play with some of the 'toys' of the trade (military corrections). Among these were tear gas grenades that were likely of a near-Vietnam vintage (apparently the Navy never throws anything away). One of the trainers pulled the pin on one of the grenades which promptly exploded in his hands. Fortunately the casing is plastic as it is designed for deployment in riot conditions and the individual suffered only relatively minor lacerations to his hands and torso. He did however become completely contaminated with CS tear 'gas' which actually deploys as a crystalline powder and vaporizes at low temps. Needless to say this was a barrel of laughs as we rode him to the nearest ER, about half an hour away. We were about a quarter of the way there when we were met by the local fire department and ambulance, who mostly stood around and 'head scratched' at length about how to transport him in a closed ambulance with little ventilation. When we got to the hospital, things just got worse... I explained to the attending doc that this individual needed to be 'decontaminated' before he was admitted and everyone in the area exposed as well. The solution that the hospital staff came to was to have him shower off in one of the patient rooms, populated with three elderly patients... and shortly thereafter, voluminous clouds of CS gas!
All this is to say that I think we've got a hell of a learning curve to master in dealing with all but the simplest bio or chemical weaponry...
Greg
the hot zone
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
the hot zone
Allen
It's good to hear FEMA is planning for the worst.
You wrote <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
Those programs were nothing short of efforts to placate an ignorant public.
On the other hand, the FEMA programs most likely have value. Our next major attack - if and when it comes - isn't going to be from a superpower. It's going to be the consequence of some 2nd-rate "dirty bomb" or similar device that any amateur can make.
- Bill
It's good to hear FEMA is planning for the worst.
You wrote <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
The efforts of the 1950s and 1960s were nothing short of laughable. I remember the "duck and cover" exercises we practiced in our schools on a regular basis. Considering that I grew up near the largest harbor in the world, Norfolk Naval base, Newport News Shipbuilding, Langley Air Force base, Fort Monroe, Fort Eustis, etc, etc, the thought of ducking and covering for what would have essentially been a major nuclear explosion is ridiculous. Fallout shelter? Yea...right.In the 1950's it was uncomplicated. All you had to do was practice the drills when the frequent air-raid alarms would sound and build a fallout shelter -- or not.
Those programs were nothing short of efforts to placate an ignorant public.
On the other hand, the FEMA programs most likely have value. Our next major attack - if and when it comes - isn't going to be from a superpower. It's going to be the consequence of some 2nd-rate "dirty bomb" or similar device that any amateur can make.
- Bill
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jorvik
the hot zone
the reason that biological weapons scare me is the ease with which they can be acquired...many terrorists are extremely clever, in an idiot savante kind of way..they'll learn stuff that they think is useful,and improvise with it..say they wanted to attack using germ warefare...they could use different viruses in different locations..anthrax here ..smallpox there and they could use it with other things such as explosives..the way virus spread is pretty horrible as well..three infected people book three different plane flights..meet different people at the airport and the disease spreads out ...fans out from there....
next it has to be detected,isolated and treated.All doctors are not imbued with the same intelligence, some struggle through medical school on low averages ,scrape a pass then they are dr.somebody ( I'm not referring to anyone on this thread,so please don't take offence). Some are exceptionally brilliant...and will immediately notice the symptoms of a disease that they once read of years before in an obscure journal...but then again..some may have flu like symptoms...and get diagnosed as ...well,flu.
the dr.s are not immune, they can catch the disease..the longer the responce takes the harder the infection is to fight.
There are other biological weapons..what about Ricin..made from a plant..a small jug of that in a resavoir could wipe out a city.
...scary stuff... but better to be aware of it.
next it has to be detected,isolated and treated.All doctors are not imbued with the same intelligence, some struggle through medical school on low averages ,scrape a pass then they are dr.somebody ( I'm not referring to anyone on this thread,so please don't take offence). Some are exceptionally brilliant...and will immediately notice the symptoms of a disease that they once read of years before in an obscure journal...but then again..some may have flu like symptoms...and get diagnosed as ...well,flu.
the dr.s are not immune, they can catch the disease..the longer the responce takes the harder the infection is to fight.
There are other biological weapons..what about Ricin..made from a plant..a small jug of that in a resavoir could wipe out a city.
...scary stuff... but better to be aware of it.
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
the hot zone
I don't know how things are in the U.K. But rest assured that in the U.S. the standards for getting into medical school are still very, very high. Medical schools pretty much get the cream of the crop here. A typical freshman class in a good University has about 50% of the students considering themselves as premed or prelaw. By the end of the first two years, about 90% of premeds have abandoned their dreams due to stiff competition in key required courses.
The biggest problems with medicine today have nothing to do with the quality of the talent. Problems exist in the financing of care. In the U.S., we are the victims of our own successes in technology and pharmaceutical sciences. All these new tests and treatment come at a cost. Meanwhile, key basic skills, like the ability to do a proper exam, need to be maintained. The knowledge base is growing so fast that medical student find it difficult to absorb it all.
And then there is the litigious society... Recently some Las Vegas area physicians essentially quit practicing at a Level 1 trauma center because malpractice insurance premiums became essentially unaffordable and an average physician had been sued around 3 times. I say GOOD.... Let people suffer a bit and then maybe they'll stop abusing folks that are only human, are the best trained in the world, and generally have their best interests in mind. We are in SERIOUIS need of tort reform.
As for the biological weapons, I still think these are dumb weapons. What are people going to do with smallpox? So it is released and some people get sick. Then what? Key folks in the U.S. population are going to get vaccinated before you can say "Boo." We have the lion's share of the vaccine, but not enough to help folks outside our country. Someone is going to get out of the area, and next thing you know you have a world epidemic. The folks that will be hurt the worst will be the folks from the land of the terrorists. Oops!!
Look to the Sarin gas release in a Japan subway station as a more likely scenario.
- Bill
The biggest problems with medicine today have nothing to do with the quality of the talent. Problems exist in the financing of care. In the U.S., we are the victims of our own successes in technology and pharmaceutical sciences. All these new tests and treatment come at a cost. Meanwhile, key basic skills, like the ability to do a proper exam, need to be maintained. The knowledge base is growing so fast that medical student find it difficult to absorb it all.
And then there is the litigious society... Recently some Las Vegas area physicians essentially quit practicing at a Level 1 trauma center because malpractice insurance premiums became essentially unaffordable and an average physician had been sued around 3 times. I say GOOD.... Let people suffer a bit and then maybe they'll stop abusing folks that are only human, are the best trained in the world, and generally have their best interests in mind. We are in SERIOUIS need of tort reform.
As for the biological weapons, I still think these are dumb weapons. What are people going to do with smallpox? So it is released and some people get sick. Then what? Key folks in the U.S. population are going to get vaccinated before you can say "Boo." We have the lion's share of the vaccine, but not enough to help folks outside our country. Someone is going to get out of the area, and next thing you know you have a world epidemic. The folks that will be hurt the worst will be the folks from the land of the terrorists. Oops!!
Look to the Sarin gas release in a Japan subway station as a more likely scenario.
- Bill
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jorvik
the hot zone
hi mr. Glasheen
I don't think that terrorists are the clearest thinkers in the world...I mean what did they think would happen after 9 11?
you don't kick sand in the face of the biggest guy on the block and expect no response..and I still can't get my head around that one...what did they think they would achieve,apart from their own destruction? so , no I wouldn't rule out the use of germ warefare.As to my comments about doctors, this applies to any profession..I've met people who were totally
devoted to what they do..and could think of nothing else..I've also met people who do it because its a good job. the biggest serial killer in the U.K was a Doctor...and he only scraped through med school
I don't think that terrorists are the clearest thinkers in the world...I mean what did they think would happen after 9 11?
you don't kick sand in the face of the biggest guy on the block and expect no response..and I still can't get my head around that one...what did they think they would achieve,apart from their own destruction? so , no I wouldn't rule out the use of germ warefare.As to my comments about doctors, this applies to any profession..I've met people who were totally
devoted to what they do..and could think of nothing else..I've also met people who do it because its a good job. the biggest serial killer in the U.K was a Doctor...and he only scraped through med school
the hot zone
On the 9/11 response, I'm not sure that they thought Afghanistan was going to be invaded, but, they knew there would be hell. This was exactly the plan. It's worth pointing out that these nutjobs do not have a sense of self preservation. If they are willing to fly into a building or blow themselves up, what's the big deal about a little invasion? The objective was to elevate their antagonism to the level of a global cultural war, which they did quite nicely. They called it Jihad, Bush called it Crusade, and bam, Christian wackos (to them) fighting Islamic wackos (to us) on a global scale. WWIII is a guerilla war. Every student of islam is aware of it, many are drawn to it. Hell, priviledged white boys from the suburbs will fly across the world for it. Major recruitment coup for the nuitjobs. Think we didn't make thousands of terrorists for them with the bombs we dropped? Best efforts aside, we blew kids and women and townspeople to bits as well as fundamentalists. Take a survey and see if they were uniformly touched by apologies for collateral damage. Like the nut jobs in Israel, this situation is entrenched until one ideology is killed off or dies off and is replaced with MTV / McDonalds poisoned westernized folk. But as the influence of Western culture in fundamentalist countries grows, so will certain individuals' outrage.
They want a war, they don't care if they die, and they've got what they wanted.
Re: Docs, I'll take the middle road between Dr. Bill and Jorvik. I've seen astonishing lifesaving and organsaving and comfort saving care in the last 5 years... and seen lotsa med school grads at work, and I've learned that while the competition to get into med school is fierce, doctors are just people, and people can be really really stupid. Today, in one day, at a community hospital, I saw a woman whose condition was misdiagnosed for 2 months because no one reviewed the labs they sent on samples from 2 months ago (she thought she had a recurrent, terminal cancer this whole time). I checked em, and now she can get treated for what she has. Also saw a person with a serious new subdural bleed requiring neurosurgery who was put to bed without a neuro or neurosurg consult (!) with no intervention other than aspirin and low dose heparin which could have exacerbated the problem (!!!). There was also a guy with brain malfunction from endstage liver disease whose condition was going untreated because he had an "allergy" to the lactulose usually given for it--the allergy was diarrhea, the precise goal of therapy, because it carries toxins out of the body. Overhearing a conversation, I cut in, he's now getting the stuff. Walking from one of these to another, I ran in to the son of a 90 year old woman who had some confusion and came to the ER where a scan showed an enormous brain tumor likely untreatable given her frailty. She was her old self after steroids overnight, and I and my intern advised the son to enjoy his last few months with her and skip the brain biopsy for definitive diagnosis, because it wouldn't help and carried a risk of bleeding or death. An oncologist and neurosurgeon talked him into getting one--so the two of us threw up our hands and backed off--and she's unconscious in the ICU now with a lifethreatening bleed in her brain. She is now "comfort measures only" and will be allowed to die on morphine.
None of this is brilliance or skill on my part--all of it was common sense.
One day this is. I appreciate Bill's efforts at good press for my profession but I will never be caught dead (ahem) in any hospital except for the tertiary referral centers I'm used to. That said, my care at the same centers isn't / wasn't perfect, I'm still learning myself.
THAT SAID, a doctor that sees flu and diagnoses flu is going to be right almost all the time, and if we routinely jumped to anthrax in time enough to treat it, the whole country would be on cipro. Recognition of trends or culture data or classic presentations is going to detect the next bioterrorist attack--I just pray if it's anywhere near me it isn't spread patient to doctor
[This message has been edited by Ian (edited July 19, 2002).]
They want a war, they don't care if they die, and they've got what they wanted.
Re: Docs, I'll take the middle road between Dr. Bill and Jorvik. I've seen astonishing lifesaving and organsaving and comfort saving care in the last 5 years... and seen lotsa med school grads at work, and I've learned that while the competition to get into med school is fierce, doctors are just people, and people can be really really stupid. Today, in one day, at a community hospital, I saw a woman whose condition was misdiagnosed for 2 months because no one reviewed the labs they sent on samples from 2 months ago (she thought she had a recurrent, terminal cancer this whole time). I checked em, and now she can get treated for what she has. Also saw a person with a serious new subdural bleed requiring neurosurgery who was put to bed without a neuro or neurosurg consult (!) with no intervention other than aspirin and low dose heparin which could have exacerbated the problem (!!!). There was also a guy with brain malfunction from endstage liver disease whose condition was going untreated because he had an "allergy" to the lactulose usually given for it--the allergy was diarrhea, the precise goal of therapy, because it carries toxins out of the body. Overhearing a conversation, I cut in, he's now getting the stuff. Walking from one of these to another, I ran in to the son of a 90 year old woman who had some confusion and came to the ER where a scan showed an enormous brain tumor likely untreatable given her frailty. She was her old self after steroids overnight, and I and my intern advised the son to enjoy his last few months with her and skip the brain biopsy for definitive diagnosis, because it wouldn't help and carried a risk of bleeding or death. An oncologist and neurosurgeon talked him into getting one--so the two of us threw up our hands and backed off--and she's unconscious in the ICU now with a lifethreatening bleed in her brain. She is now "comfort measures only" and will be allowed to die on morphine.
None of this is brilliance or skill on my part--all of it was common sense.
One day this is. I appreciate Bill's efforts at good press for my profession but I will never be caught dead (ahem) in any hospital except for the tertiary referral centers I'm used to. That said, my care at the same centers isn't / wasn't perfect, I'm still learning myself.
THAT SAID, a doctor that sees flu and diagnoses flu is going to be right almost all the time, and if we routinely jumped to anthrax in time enough to treat it, the whole country would be on cipro. Recognition of trends or culture data or classic presentations is going to detect the next bioterrorist attack--I just pray if it's anywhere near me it isn't spread patient to doctor
[This message has been edited by Ian (edited July 19, 2002).]
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jorvik
the hot zone
IAN and MR.Glasheen.
I must apologise for my comments on the medical profession.......Doctors are committed professionals who, with their intelligence and practical abilities could easily obtain employment in many other fields and indeed could probably be better paid for them....it is therefore refreshing to see such individuals prepared to put something back into society-rather than take as much as they can, out-,by persuing a medical career.
Dr. Kelly must stand as a good example, as a police officer he would have been well paid..and well respected..to choose to walk away from that ..just to embark on a new career, which at the time must have seemed uncertain, surely demonstrates that point...I have nothing but admiration for such people...the point I was so inadequately trying to make is that nobody is infallible...and that in every profession there are going to be different levels of expertese...witness the many branches of medicine...so many different specialities.
I think that to spot something, so different from the norm as a dangerous virus( chosen as a weapon..and presumably chosen to be hard to identify or cure) is difficult enough.....to do so and then to stand up and say that..risk whole areas closing down and being isolated..shutting hospitals that have been contaminated. must require tremendous courage and self assurance.
I also think that it is wrong to sue doctors or hospitals...as a general principle, but obviously in serious cases of breach of trust or negligence, then perhaps there is some recourse to the courts...but I would expect that to be only in exceptional circumstances..and not as a matter of course
I must apologise for my comments on the medical profession.......Doctors are committed professionals who, with their intelligence and practical abilities could easily obtain employment in many other fields and indeed could probably be better paid for them....it is therefore refreshing to see such individuals prepared to put something back into society-rather than take as much as they can, out-,by persuing a medical career.
Dr. Kelly must stand as a good example, as a police officer he would have been well paid..and well respected..to choose to walk away from that ..just to embark on a new career, which at the time must have seemed uncertain, surely demonstrates that point...I have nothing but admiration for such people...the point I was so inadequately trying to make is that nobody is infallible...and that in every profession there are going to be different levels of expertese...witness the many branches of medicine...so many different specialities.
I think that to spot something, so different from the norm as a dangerous virus( chosen as a weapon..and presumably chosen to be hard to identify or cure) is difficult enough.....to do so and then to stand up and say that..risk whole areas closing down and being isolated..shutting hospitals that have been contaminated. must require tremendous courage and self assurance.
I also think that it is wrong to sue doctors or hospitals...as a general principle, but obviously in serious cases of breach of trust or negligence, then perhaps there is some recourse to the courts...but I would expect that to be only in exceptional circumstances..and not as a matter of course
