Mass casualty incident after the Taba terrorist attack: an organisational and medical challenge

Two suicide bombings in and around Taba, Egypt, on 7 October 2004 created a complex medical and organisational situation. Since most victims were Israeli tourists, the National Emergency and Disaster Management Division handled their evacuation and treatment. This paper describes the event chronologically, as well as the organisational and management challenges confronted and applied solutions. Forty-nine emergency personnel and physicians were flown early to the disaster area to reinforce scarce local medical resources. Two hundred casualties were recorded: 32 dead and 168 injured. Eilat hospital was transformed into a triage facility. Thirty-two seriously injured patients were flown to two remote trauma centres in central Israel. Management of mass casualty incidents is difficult when local resources are inadequate. An effective response should include: rapid transportation of experienced trauma teams to the disaster zone; conversion of local medical amenities into a triage centre; and rapid evacuation of the seriously injured to higher level medical facilities.     

Prenatal diagnosis of gall bladder anomalies—report of 17 cases

We describe here 17 cases of fetal gall bladder anomalies, detected as early as the 14th week of gestation, out of 10 016 fetal systemic examinations performed by us in the last 6 years (015 per cent). In seven cases, agenesis of the fetal gall bladder was detected. The diagnosis was confirmed by post-abortal examination in five cases and in two post-partum. In six other cases, a left-sided gall bladder and in one case, a ‘floating’ gall bladder were detected at 15 weeks' gestation. In two cases, a septated or bilobed gall bladder was visualized. None of these 15 cases was dyskaryotic, but in five cases, two with agenesis and three left-sided gall bladders were associated with other fetal malformations. In two other cases, the gall bladder appeared dysmorphic on sonographic examination and in both of them intrauterine growth retardation and other anomalies were detected. Trisomy 18 was diagnosed by amniocentesis in one of them. According to our experience, failure to visualize the fetal gall bladder by the 15th gestational week is diagnostic of its absence and should raise the differential diagnosis between gall bladder atresia, which has a good prognosis, and external biliary atresia, which has a poor prognosis. Further experience is needed to characterize the various gall bladder malformations and their prognosis.     

Sense‐making of employment: on whether and why people read employment advertising

This paper suggests a process of sense‐making of “employment“ and identifies employment ads to be useful agents in this process. It is suggested that individuals read ads in surveillance of the employment market in addition to reading them to search for employment vacancies. Employment ads are suggested to be a forum for organizational self‐presentation that offers current information about the employment exchange as it is viewed by employers. Two exploratory studies are presented to support the thesis. Study 1 is an inductive survey of people's reading of employment ads, showing that people read ads even if they are not looking for a job because they view ads as a source of insight about the employment environment. Study 2 reviews the content of employment ads, showing them to convey prevailing elements of the idea of employment, namely that employment is an exchange of employee skills and responsibilities for organizational intrinsic and extrinsic rewards. Recognizing the individual need for sense‐making of employment, and identifying employment ads as a source of information about employment, opens up a new area for research and practice on recruiting, organizational self‐presentation, and sense‐making. Copyright © 2006 John Wiley & Sons, Ltd.     

Individual variation of (S)-4-methyl-3-heptanone in heads of braconid wasp, Leiophron uniformis, and Pogonomyrmex ants indicates costs of semiochemical production

(S)-4-Methyl-3-heptanone is an alarm pheromone released from the mandibular glands in heads of harvester ants (Pogonomyrmex spp.). We used gas chromatography–mass spectrometry (GC–MS) to study the variation in amounts of this ketone among individual ants of a colony. P. barbatus contained about 2,000 ng per head, while only about half of this amount was found in heads of P. rugosus and P. californicus. Individuals of P. barbatus from three different nests contained rather uniform amounts of the alarm pheromone within each colony (16–30% coefficient of variation CV; normal distributions skewed left), but one nest under food stress had a significantly lower mean amount. In contrast, both sexes of a small braconid wasp Leiophron uniformis, a parasitoid of Lygus plant bugs, contained up to 10 ng of the same volatile enantiomer in their heads; and groups of either sex of the wasp exhibited normal distributions of quantities (64% CV, skewed right). The differences in the distributions between parasitoids and ants suggest that related members within a social ant colony may attempt to maintain a uniform level of ketone compared to independent variation in unrelated, solitary wasp individuals. When the wasp’s leg was grasped with forceps, it tried to escape and bite the forceps as it ejected (S)-4-methyl-3-heptanone (detected by solid phase microextraction, SPME, and GC–MS). Since adult wasps are nonsocial and feed only on nectar, their sharp piercing mandibles in combination with this escape/biting behavior indicate the ketone is used for defense rather than for an alarm function as in harvester ants. Costs of producing the semiochemical in wasp L. uniformis and ants P. barbatus and P. californicus are suggested since populations exhibited a significant linear increase in the amount of (S)-4-methyl-3-heptanone with an increase in body weight of individuals.     

The significance of a small, level-3 'semi evacuation' hospital in a terrorist attack in a nearby town

Terrorist attacks can occur in remote areas causing mass-casualty incidents MCIs far away from level-1 trauma centres. This study draws lessons from an MCI pertaining to the management of primary and secondary evacuation and the operational mode practiced. Data was collected from formal debriefings during and after the event, and the medical response, interactions and main outcomes analysed using Disastrous Incidents Systematic Analysis through Components, Interactions and Results (DISAST-CIR) methodology. A total of 112 people were evacuated from the scene-66 to the nearby level 3 Laniado hospital, including the eight critically and severely injured patients. Laniado hospital was instructed to act as an evacuation hospital but the flow of patients ended rapidly and it was decided to admit moderately injured victims. We introduce a novel concept of a 'semi-evacuation hospital'. This mode of operation should be selected for small-scale events in which the evacuation hospital has hospitalization capacity and is not geographically isolated. We suggest that level-3 hospitals in remote areas should be prepared and drilled to work in semi-evacuation mode during MCIs.     

Simple digestion procedure followed by the azomethine-H method for accurate boron analysis and discrimination between its fractions in wastewater and soils

Excess boron is a growing environmental problem. It often affects agricultural yields, where reuse of wastewater for irrigation is practiced. This problem raises the need for reliable, simple and economical methods to monitor boron concentrations in wastewater and soil extracts. One such method, the commonly used azomethine-H spectrophotometric method, suffers from color interference, originating from high concentrations of dissolved organic matter, when applied to many wastewater and agricultural soil extracts. Moreover, this method only quantifies free dissolved boron and lacks the ability to quantify boron that is adsorbed to either the dissolved organic matter or suspended solids that are present in the sample. This work suggests a modification of the standard azomethine-H method, in which the solution is digested with potassium persulfate prior to the standard procedure. We show that this pretreatment can overcome the color interference and lead to highly accurate and precise boron analyses in wastewater. In soil extracts, the boron concentrations obtained using the suggested procedure were better correlated to inductively coupled plasma (ICP) spectrometry results than those measured by the standard method, because whereas the standard method quantifies the free dissolved boron only, the modified method, like the ICP method, quantifies the total dissolved boron in the sample. Thus, the suggested modification can be used to quantify the respective distributions of free dissolved boron, boron adsorbed to dissolved organic matter and boron adsorbed to suspended solids in soil extracts and water samples.