The management of nuclear, biological and chemical (NBC) terrorism events is critical to reducing morbidity and mortality in the next decade; however, initial patient care considerations and protective actions for staff are unfamiliar to most front-line clinicians. High explosive events (bomb and blast) remain the most common type of terrorism and are easy to detect. Conversely, some types of terrorist attacks are more likely to be unsuspected or covert. This paper explains the current threat of terrorism and describes clues for detection that an event has occurred. Specific criteria that should lead to a high suspicion for terrorism are illustrated. The manuscript outlines initial actions and clinical priorities for management and treatment of patients exposed to nuclear/radiological, biological, chemical and combined agents (for example an explosion involving a chemical agent). Examples of terrorist events include: a nuclear explosion, an aerosolised release of anthrax (biological), dissemination of sarin in a subway (chemical), and the detonation of a radiologic dispersion device or "dirty bomb" (combined explosive and radiological). Basic principles of decontamination include potential risks to healthcare providers from secondary exposure and contamination. Unique issues may hinder clinical actions. These include coordination with law enforcement for a crime scene, public health entities for surveillance and monitoring, hazardous materials teams for decontamination, and the media for risk communications. Finally, the importance of personal preparedness is discussed.
Biological Warfare Agents ; Chemical Warfare Agents ; Civil Defense ; Nuclear Weapons ; Terrorism

An interesting aspect of the many recent researches on the history of medicine in Korea is a concentration on oral histories, a trend that is sure to supplement the lack of medical documents and historical materials covering the modern period. This trend will also contribute to the invention of new approaches in the historiography of medicine. Although the fragments of oral testimony cannot be expected to give a perfect representation of historical reality, such "slices of life" help represent history from the viewpoint of ordinary people and members of the medical profession who are less often acknowledged. The recent researches that have taken oral testimony on the history of medicine in Korea have both racked up achievements as well as encountered limitations. First, many disciplines such as history, literature, cultural anthropology, folklore, sociology, and the history of medicine have used the technique of oral histories in the research approaches, and, especially since the start of the 2000s, have produced a variety of materials. The large amounts of raw materials published in these many disciplines are sure to bring even higher research achievements. Second, for the most part, oral history researches in the medical profession have concentrated on second-tier practitioners, such as midwives, apothecaries, and acupuncturists, and the experiences of such untypical sufferers as lepers and victims of germ and atomic warfare. While the oral history of more prominent medical figures tends to underline his or her story of success, the oral histories of minority participants in the medical profession and patients can reveal the truth that has remained veiled until now. It is especially meaningful that these oral histories enable researchers to reconstruct history from below, as it were. Third, the researches that take the oral history approach are intended to complement documentary records. Surprisingly, through being given the opportunity to tell their histories, the interviewees have frequently experienced the testimony as an act of self-healing. Formally, an oral history is not a medical practice, but in many cases the interviewee is able to realize his or her own identity and to affirm his or her own life's story. It is in this light that we need to pay attention to the possibilities of such a humanistic form of therapy. Finally, because the research achievements depend on oral materials, the objectivity and rationality of description take on an important research virtue. When conducting an oral history, the researcher partakes of a close relationship with interviewees through persistent contact and can often identify with them. Accordingly, the researcher needs to take care to maintain a critical view of oral materials and adopt an objective perspective over his or her own research object.
Achievement ; Anthropology, Cultural ; Complement System Proteins ; Folklore ; Historiography ; History of Medicine ; Humans ; Inventions ; Korea ; Light ; Midwifery ; Nuclear Warfare ; Sociology ; Virtues

Chernobyl Nuclear Accident ; Humans ; Japan ; epidemiology ; Neoplasms, Radiation-Induced ; etiology ; mortality ; Nuclear Warfare ; Radiation Dosage ; Radiation Injuries ; etiology ; mortality ; Radioactive Hazard Release ; Risk ; Ukraine ; epidemiology

Many Koreans, in addition to Japanese, were killed or injured by the atomic bombs detonated over Hiroshima and Nagasaki, Japan, in 1945. Our study examined noncancer diseases of Korean A-bomb survivors in residence at Hapcheon, Republic of Korea and evaluated whether they had significantly higher prevalence of noncancer diseases than non-exposed people. We evaluated a number of tests, including anthropometric measurements, blood pressure, blood chemistry, hepatitis B surface antigen, and urinalysis, of survivors (n=223) and controls (n=372). Univariate analysis revealed significantly lower fasting glucose and creatinine, and higher diastolic blood pressure, aspartate aminotransferase, alanine aminotransferase, and blood urea nitrogen levels in the survivors than in the controls. The calculation of crude prevalence ratios (PRs) revealed that A-bomb survivors had a significantly higher prevalence of hypertension (PR, 1.16; 95% CI, 1.00-1.35) and chronic liver disease (2.20; 1.59-3.06) than controls. After adjusting for covariates (age, sex, body mass index, marital status, education, alcohol consumption, and smoking), A-bomb survivors had a significantly higher prevalence of hypertension (1.24; 1.06-1.44), chronic liver disease (2.07; 1.51-2.84), and hypercholesterolemia (1.79; 1.11-2.90) than controls. This study suggests that A-bomb exposure is associated with a higher prevalence of non-cancer diseases in Korean survivors.
Survivors ; Radioactive Fallout ; Radiation Injuries/diagnosis/*epidemiology ; Nuclear Warfare ; Neoplasms ; Middle Aged ; Male ; Korea ; Japan ; Humans ; Female ; Aged, 80 and over ; Aged ; Abnormalities, Radiation-Induced

In 1945, many Koreans, in addition to Japanese, were killed or injured by the atomic bombs dropped on Hiroshima and Nagasaki, Japan. This study compared the biological profiles of Korean atomic bomb survivors in residence at Daegu and Kyungbuk, Republic of Korea with those of a representative sample of Koreans obtained during a similar period. We evaluated anthropometric measurements, blood pressure, blood cell counts, blood chemistry, and urinalysis of survivors (n=414) and age- and sex-matched controls (n=414) recruited from the third Korea National Health and Nutrition Examination Survey conducted in 2005. Univariate analyses revealed significantly higher systolic blood pressure, white blood cell count, and serum total cholesterol, triglycerides, high-density lipoprotein-cholesterol, and aspartate aminotransferase levels (p<0.01) in the survivors. Conversely, hemoglobin concentration, hematocrit, red blood cell count, and the proportion of positive urine occult blood (p<0.01) were lower in the survivors. Our findings suggest that biological profiles of Korean atomic bomb survivors were adversely affected by radiation exposure.
Abnormalities, Radiation-Induced ; Aged ; Biological Markers/analysis ; Female ; Humans ; Japan ; Korea ; Male ; *Nuclear Warfare ; Radiation Injuries/diagnosis/*metabolism ; Radioactive Fallout ; Survivors