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A 58-year-old man was rushed to the Emergency Room (ER) due impaired consciousness, dysarthria, and nausea. Initially an acute CVA was suspected, however additional signs such as bilateral mydriasis, dry skin and mucosa, and diffuse cutaneous vasodilation, prompted a more thorough evaluation. It was discovered that the patient had consumed water in which lupin seeds had been boiled, prior to his arrival to the ER. A diagnosis of anticholinergic toxidrome was established and the patient was treated appropriately.

Keywords: Toxidrone; Anticholinergic; Intoxication; Poisoning; Lupin Introduction.

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Background: The vestibular system plays an important role in spatial orientation, posture, balance, and gaze stabilization. A vestibular insult will have a detrimental effect on the patient's short and long-term performance of his or her day-to-day activities. The past few decades have seen an increase in the popularity of recreational diving, and as a result, a comparable growth in specific diving-associated medical problems. One of the organs susceptible to diving-related injury is the vestibular system, which is situated in the inner ear.

Goals: This review will focus on the differential diagnosis, prognosis, and recommendations for continued monitoring and fitness routines for patients with a diving-related injury of the vestibular system.

Methods: We will conduct a review of the literature on vestibular injuries in the marine environment by presenting cases of barotrauma/decompression sickness of the inner ear, sea sickness and mal de debarquement.

Conclusions: Although the various pathological states of the vestibular system due to diving may have diverse etiology, the site of injury, clinical presentation and required treatment may be very similar. As a result, the major challenge facing the clinician is to reach the appropriate diagnosis. The differential diagnosis and the approach to treatment, as well as recommendations for follow-up monitoring and continued diving, are crucial for the future well-being of the diver.

Keywords: Submarine; Remote medicine; Naval Medicine; Fish Bones; Foreign body

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During a submarine mission, deep beneath the ocean’s surface and thousands of miles away from the home port, one of the crew members complained of having a foreign body lodged in his throat following the ingestion of fish.
A local anesthetic was applied to his pharynx and the foreign body was removed from his right tonsil. This paper will describe the case in detail and subsequently present the literature on the approach to diagnosing and treating the presence of foreign bodies following fish ingestion. In addition, it will describe a general framework for the appropriate approach to a patient in need of urgent care in the remote military environment.

Keywords: submarine; remote medicine; Naval Medicine; foreign body.

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Background: During an emergency, professionals are required to take part in national intervention missions amidst civilian population. Professional preparation for such an assignment may increase their confidence in being able to do the job effectively. The aim of the present survey was to describe the characteristics of the Israeli Home Front Command (HFC) medical forces that specialize in mental health, as well as assess the effectiveness of the existing protocol for intervention and enhancement of mental resilience.

Method: The study included 116 participants (82 – 71% – of whom were male). Median age was 27.5. Of the participants, 95% defined their health as good or very good. Upon recruitment to the HFC first aid hotline reinforcement mission during COVID-19, a questionnaire for each participant was completed by a medical orderly on reserve duty. All participants had the nature of the study and its aims explained to them, while emphasizing the strict preservation of the anonymity of the participants. Participants were divided into two groups, those who had undergone preparation in accordance with a specific mental resilience enhancement protocol (i.e. the study group) and those whose preparation had not adhered to that protocol (control group).

Findings: The study found that among members of the study group the level of burnout was lower and the level of mental well-being was higher compared to the control group. The study also found that study groups view of the military's handling of the COVID-19 crisis was more positive than their view of the state's handling of the crisis.

Summary: The medical personnel of the Home Front Command are trained to rescue and evacuate the injured and dead during a national emergency. The reinforcement of the MDA phone hotline mission was a new and unfamiliar task for them. The nature of the mission exposed the medical forces to civilians' anxieties, frustrations, anger and sometimes even to verbal abuse. The low level of burnout and high level of optimism demonstrated by the study group participants, as well as the satisfaction with the military's handling of the crisis, point to the possible efficacy of the training protocol. It seems that the training is efficient in preparing the hotline workers for periods of crisis such as the COVID-19 epidemic. Larger, and more long-term studies are warranted.

Keywords: COVID-19; Home Front Command; medical unit; resilience; mental health officer.

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Research conducted following the outbreaks of previous epidemics such as SARS, Ebola, and MERS suggest that the outbreak of an epidemic has a negative impact on the mental health of the civilian population, in many cases even leading to suicide. Despite the scarcity of publications regarding the COVID-19 pandemic at this time and the absence of evidence-based studies on its potentially negative impact, one can hypothesize, on the basis of past research, that the impact of COVID-19 on morbidity and mortality rates may go far beyond the number of deaths from the infection itself, including some that may result from mental distress and loss. The purpose of the present study is to review the minimal existing literature on suicidal behavior in the general population, as well as among soldiers and veterans during the COVID-19 pandemic.

Keywords: Suicide; soldiers; veteran; COVID-19; epidemic.

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Unit 669 is the Israel Defense Forces (IDF) Air Rescue Unit. The unit was formed in 1974 with the primary mission of saving downed air crews. Today, the unit's range of operation includes rescue of air crews, aeromedical evacuation, inter-hospital transfer and long-range medical repatriation. This article commemorates forty-four years of the unit's operation. Following a historical review, issues of sorting and training of candidates, operational and medical equipment for air rescue missions, and some operational aspects will be discussed.

Keywords: 669; Air Rescue Unit; Aeromedical evacuation.