Rhonchi

Tracing Lung Ailments That Rose With 9/11 Dust – New York Times
After nearly five years, it is still too early for these doctors, scientists and forensic pathologists to say with certainty whether any long-term cancer threat came with exposure to the toxic cloud unleashed by the trade center collapse. But there are already clear signs that the dust, smoke and ash that responders breathed in have led to an increase in diseases that scar the lungs and reduce their capacity to take in and let out air.

The Fire Department tracked a startling increase in cases of a particular lung scarring disease, known as sarcoidosis, among firefighters, which rose to five times the expected rate in the two years after Sept. 11. Though that rate has declined, doctors worry that the disease may be lurking in other firefighters. Experts who regularly see workers who were at ground zero in the 48 hours after the towers’ collapse expect monitoring to show many more cases of lung- scarring disorders among that group.

New evidence also suggests that workers who arrived later or worked on the periphery may also be susceptible to debilitating lung ailments.

New York Daily News – Home – WTC air doomed ex-cop

An autopsy of a retired NYPD detective confirmed yesterday what his family and fellow cops long suspected – that James Zadroga’s death was “directly related” to the Ground Zero cleanup.

The stunning findings are believed to mark the first time the death of a cleanup worker has been officially tied to the aftermath of the terror attacks.

“It is felt with a reasonable degree of medical certainty that the cause of death in this case was directly related to the 9/11 incident,” Dr. Gerard Breton, a pathologist at the Ocean County, N.J., medical examiner’s office wrote in the Feb. 28 autopsy report.

Zadroga died on Jan. 5 of pulmonary disease and respiratory failure – and he had lung-tissue inflammation Breton attributed to “a history of exposure to toxic fumes and dust.”

…

Zadroga spent more than 450 hours at Ground Zero, digging through debris and inhaling the noxious gases that are believed to be related to death.

“On Sept. 11, 2001, James Zadroga was a 29-year-old healthy human being,” Palladino said.

But after his work at the 9/11 site, the nonsmoker’s health “began to deteriorate rapidly,” Palladino added.

Zadroga developed respiratory ailments, had difficulty breathing and was found to have fiberglass in his lungs, Palladino said.

The cop retired on a disability on Nov. 1, 2004. The 34-year-old widower died at his parents home in Little Egg Harbor, N.J., just over 14 months later.

In January, the Daily News revealed that 22 other men, most in their 30s and 40s, have died from causes their families say were accelerated by working at Ground Zero after the attacks.

Yesterday, Palladino said that nearly 400 NYPD detectives are suffering from symptoms believed to have been brought on by their work at the disaster site.

CurEvents.com – A Global Current Events Discussion Forum – Avian influenza (H5N1): implications for intensive care.
Abstract
Background As influenza A/H5N1 spreads around the globe the risk of an epidemic increases.
Discussion Review of the cases of influenza A/H5N1 reported to date demonstrates that it causes a severe illness, with a high proportion of patients (63%) requiring advanced organ support. Of these approx. 68% develop multiorgan failure, at least 54% develop acute respiratory distress syndrome, and 90% die. Disease progression is rapid, with a median time from presentation to hospital to requirement for advanced organ support of only 2 days.
Conclusion
The infectious nature, severity and clinical manifestations of the disease and its potential for pandemic spread have considerable implications for intensive care in terms of infection control, patient management, staff morale and intensive care expansion.

AARC Webcast Central:

Looks like a good service from the AARC. Live and archived webcasts for AARC members. The upcoming one about the issue of Mechanical Ventilation in Mass Casualty settings looks like an important one.

This looks useful:

CPHP Learning Center: Terrorism, Preparedness, and Public Health: An Introduction

At the end of this course, public health workers will be competent to describe the public health role in emergency response in a range of potential or possible emergencies and to recognize unusual events that might indicate an emergency and describe appropriate action. A minor focus is the chain of command in emergency response. Several activities are designed to help the learner identify personal limits of knowledge and direct the learner to useful resources when these limits have been exceeded.

NPR : Health Officials Consider Strategy for Possible Bird Flu Pandemic
Health experts worry that in the event of a bird-flu pandemic, there could be a severe shortage of ventilators and intensive care unit beds. Planning has begun to determine which cases would get treatment priority.

What happens if you have mass casualties who all need mechanical ventilation? Sounds like a mess to me, but folks are thinking hard about the allocation of ventilation technologies in such an event. Let’s hope we don’t need to implement it.
Concept of Operations for Triage of Mechanical Ventilation in an Epidemic — Hick and O’Laughlin, 10.1197/j.aem.2005.07.037 — Academic Emergency Medicine

The recent outbreak of severe acute respiratory syndrome and the growing potential of an influenza pandemic force us to consider the fact that despite great advances in critical care medicine, we lack the capacity to provide intensive care to the large number of patients that may be generated in an epidemic or multisite bioterrorism event. Because many epidemic and bioterrorist agent illnesses involve respiratory failure, mechanical ventilation is a frequently required intervention but one that is in limited supply. In advance of such an event, we must develop triage criteria that depend on clinical indicators of survivability and resource utilization to allocate scarce health care resources to those who are most likely to benefit. These criteria must be tiered, flexible, and implemented regionally, rather than institutionally, with the backing of public health agencies and relief of liability. This report provides a sample concept of operations for triage of mechanical ventilation in epidemic situations and discusses some of the ethical principles and pitfalls of such systems.

Read the whole thing.