Capt. Neta Gery-Golomb Lt. Reuben Haber, Lt. Col. Yuval Heled,
Capt. Barliz Waissengrin, Col. Ram Sagi
Hypothermia is a condition in which the core body temperature
drops to below 35 degrees Celsius, and its severity can be
divided into mild, moderate and severe. The current Israel
Defense Force (IDF) medical guidelines state that in all
cases of suspected hypothermia in the field, patients must
be evacuated to a hospital, regardless of the degree of
hypothermia. The relevance of these guidelines in cases of
mild hypothermia has been called into question, with the aim
to helping medical officers in the field deal with these cases.
We have performed a literature review focusing on the
complications of hypothermia, of varying degrees, with an
emphasis on cardiovascular complications. In addition to
accidental hypothermia, we have looked at outcomes from
iatrogenic hypothermia, used in varying medical situations.
From the currently available data, it would appear that lifethreatening
complications of hypothermia occur only in
moderate-severe cases, and not in its mild form. Despite
there being cases of electrocardiographic changes seen in
mild hypothermia (such as PVTs and prolongation of the QT
interval), these have not been scientifically proven to be lifethreatening.
In addition, mild hypothermia did not contribute
to excessive complications in those treated with iatrogenic
hypothermia.
In light of the fact that there is a significant difference
between complications seen in moderate-severe hypothermia
compared to mild hypothermia, and that the available
literature regarding accidental hypothermia in a young,
healthy population is limited, we recommend to deepen the
investigation of the hypothermia cases in the IDF, and to
consider updating the current guidelines if necessary.
Raya Madar ,Limor Aharonson-Daniel, Ygal Plakht, Bruria Adini
It has recently been proven that during the civil war
currently raging in Syria, Sarin gas was used, causing
numerous casualties and deaths. Chemical warfare agents,
as a component of mass casualty weapons, have the ability
to cause massive injury, mortality and destruction. There
is concern that chemical warfare will be used against
civilians not only in wartime, but also as an act of terror.
Thus, preparedness of hospitals to manage such disasters
is required. Effective management of chemical warfare
casualties depends on medical staff’s ability to operate
in an appropriate way. Although hospital staff is expected
to respond to chemical incidents only rarely, it is crucial
that it maintains a high level of competency in order to
ensure provision of optimal care when necessary. Effective
management of such incidents necessitates proficiency
of hospitals’ staff regarding characteristics of chemical
agents, mechanism of action, protection measures,
clinical signs and symptoms of victims and principles of
decontamination and treatment. Various training methods
for medical teams were described. However, identifying the
optimal strategy and its impact on knowledge retention are
still controversial. Examining the effectiveness of training
programs is challenging, mainly due to the difficulty of
evaluating staff performance during real-time events. It is
essential that the overall policy of emergency management
includes components of training, exercises and evaluation
based on improvement of performance. This article reviews
the existing methodologies to train hospital personnel