Global & Disaster Medicine

Archive for the ‘Environment’ Category

Climate-related disasters: Looking at the numbers

OXFAM

Noaga Oueda in her field of sorghum, in Burkina Faso.

Let’s look at the numbers

30 Y The number of climate-related disasters has tripled in 30 years. By the 2030s, large parts of Southern, Eastern and the Horn of Africa and South and East Asia will experience greater exposure to droughts, floods and tropical storms.
20 M On average, over 20 million people a year were internally displaced by extreme weather disasters over the last 10 years. Eighty percent of those displaced live in Asia – home to over a third of the world’s poorest people.
10 % The richest 10 percent of people in the world produce around half of global emissions. The poorest half of the world’s population – 3.5 billion people – is responsible for just 10 percent of carbon emissions.
100 Just 100 companies are responsible for close to three quarters of global emissions (71 percent) and spend millions lobbying against climate action.
700 $ Between 2008 and 2018, 18 African countries have collectively suffered an annual loss of over 700$ million from climate-related disasters.

Chronic Mountain Sickness in Peru

Science

“…La Rinconada….the world’s highest human settlement, a gold-mining boomtown at 5100 meters in southeastern Peru. An estimated 50,000 to 70,000 people live here, trying to make it—and, many hope, strike it rich—under brutal conditions. La Rinconada has no running water, no sewage system, and no garbage removal. It is heavily contaminated with mercury, which is used to extract the gold. Work in the unregulated mines is back-breaking and dangerous. Alcohol abuse, prostitution, and violence are common. Freezing temperatures and intense ultraviolet radiation add to the hardships.

La Rinconada’s most defining feature, however, the one that lured the scientists, is its thin air. Every breath you take here contains half as much oxygen as at sea level. The constant oxygen deprivation can cause a syndrome called chronic mountain sickness (CMS), whose hallmark is an excessive proliferation of red blood cells. Symptoms include dizziness, headaches, ringing ears, sleep problems, breathlessness, palpitations, fatigue, and cyanosis, which turns lips, gums, and hands purplish blue. In the long run, CMS can lead to heart failure and death. The condition has no cure except resettling at a lower altitude—although some of the damage may be permanent…….”


3/24/1989: Exxon Valdez crashes


Costa Rica: Going “Green”

NYT

“……Costa Rica’s green bid, though fraught with challenges, has a head start. Electricity comes largely from renewable sources already — chiefly hydropower, but also wind, solar and geothermal energy. The country has doubled its forest cover in the last 30 years, after decades of deforestation, so that half of its land surface is now covered with trees. ……”


Bangkok cracks the list of the top 10 cities with the foulest air on the planet.

NYT

“……Bangkok suffers from a toxic amalgam: unchecked industrialization and urbanization, a car-crazy populace and lax regulation. The burning of fallow fields and a dry season with little wind exacerbate the crisis...…”


Air Pollution: The top 20 worst cities

Guardian

20 worst cities overall
PM2.5 annual mean, micrograms per cubic metre
Zabol Iran 217
Gwalior India 176
Allahabad India 170
Riyadh Saudi Arabia 156
Al Jubail Saudi Arabia 152
Patna India 149
Raipur India 144
Bamenda Cameroon 132
Xingtai China 128
Baoding China 126
Delhi India 122
Ludhiana India 122
Dammam Saudi Arabia 121
Shijiazhuang China 121
Kanpur India 115
Khanna India 114
Firozabad India 113
Lucknow India 113
Handan China 112
Peshawar Pakistan 111

CDC: After Hurricane Florence—Clinical Guidance for Carbon Monoxide Poisoning

CDC

CDC Health Alert Network (HAN) Health Advisory: Hurricane Florence—Clinical Guidance for Carbon Monoxide (CO) Poisoning

CDC issued the following Health Alert Network (HAN) Health Advisory on September 16, 2018. You are receiving this information because you subscribe to COCA email updates. If a colleague forwarded this email to you, yet you would like to receive future updates directly from COCA, click here.

If you have any questions about this or other clinical issues, please e-mail coca@cdc.gov

On behalf of the Clinician Outreach and Communication Activity (COCA)
Centers for Disease Control and Prevention (CDC)
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HAN Logo
Distributed via the CDC Health Alert Network
September 16, 2018 1345 ET (1:45 PM ET)
CDC HAN-00415

Hurricane Florence—Clinical Guidance for Carbon Monoxide (CO) Poisoning

Summary
The Centers for Disease Control and Prevention (CDC) is reminding clinicians seeing patients from the areas affected by Hurricane Florence to maintain a high index of suspicion for CO poisoning. Other people who may be exposed to the same CO source may need to be identified and assessed.

The signs and symptoms of CO exposure are variable and nonspecific. A tension-type headache is the most common symptom of mild CO poisoning. Other symptoms may include dizziness, flu-like symptoms without a fever, drowsiness, chest pain, and altered mental status.

Clinical manifestations of severe CO poisoning include tachycardia, tachypnea, hypotension, metabolic acidosis, dysrhythmias, myocardial ischemia or infarction, noncardiogenic pulmonary edema, neurologic findings including irritability, impaired memory, cognitive and sensory disturbances, ataxia, altered or loss of consciousness, seizures, coma, and death, although any organ system might be involved.

Although CO poisoning can be fatal to anyone, children, pregnant women, the unborn, persons with sickle cell disease, older adults, and persons with chronic illness (e.g., heart or lung disease) are particularly vulnerable.

Background
High winds and heavy rain from Hurricane Florence began affecting the southeastern U.S. around September 12, 2018. Impact on the southeast coast and inland led to thousands of people without power.  Those without power may turn to alternate power sources such as gasoline generators and may use propane or charcoal grills for cooking. If used or placed improperly, these sources can lead to CO build up inside buildings, garages, or campers and poison the people and animals inside.

With a focused history of patient activities and health symptoms, exposure to a CO source may become apparent. Appropriate and prompt diagnostic testing and treatment are crucial to reduce morbidity and prevent mortality from CO poisoning. Identifying and mitigating the CO source is critical in preventing other poisoning cases.

Recommendations for Clinicians

  1. Consider CO poisoning in patients affected by Hurricane Florence, particularly those in areas currently without power. Assess symptoms and recent patient activities that point to likely CO exposure. Evaluation should also include examination for other conditions, including smoke inhalation, trauma, medical illness, or intoxication.
  2. Administer 100% oxygen until the patient is symptom-free or until a diagnosis of CO poisoning has been ruled out.
  3. Perform COHgb testing when CO poisoning is suspected. Venous or arterial blood may be used for testing. A fingertip pulse multiple wavelength spectrophotometer, or CO-oximeter, can be used to measure heart rate, oxygen saturation, and COHgb levels in the field, but any suspicion of CO poisoning should be confirmed with a COHgb level by multiple wavelength spectrophotometer (CO-oximeter). A conventional two-wavelength pulse oximeter is not accurate when COHgb is present. For more information, see https://www.cdc.gov/disasters/co_guidance.html.
  4. An elevated carboxyhemoglobin (COHgb) level of 2% or higher for non-smokers and 9% or higher COHgb level for smokers strongly supports a diagnosis of CO poisoning. The COHgb level must be interpreted in light of the patient’s exposure history and length of time away from CO exposure, as levels gradually fall once the patient is removed from the exposure. In addition, carbon monoxide can be produced endogenously as a by-product of heme metabolism. Patients with sickle cell disease can have an elevated COHgb level as a result of hemolytic anemia or hemolysis. For additional information about interpretation of COHgb levels, visit https://www.cdc.gov/disasters/co_guidance.html or call Poison Control at (800) 222-1222.
  5. Hyperbaric oxygen therapy (HBO) should be considered in consultation with a toxicologist, hyperbaric oxygen facility, or Poison Control Center (800) 222-1222. For additional management considerations, consult a toxicologist, Poison Control at (800) 222-1222, or a hyperbaric oxygen facility.
  6. Be aware that CO exposure may be ongoing for others spending time in or near the same environment as the patient. These individuals should be evaluated and tested as described in this advisory.
  7. Clinicians treating people for CO poisoning should notify emergency medical services (EMS), the fire department, or law enforcement to investigate and mitigate the source and advise people when it is safe to return.
  8. Advise patients about safe practices related to generators, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices. Stress that that these devices should never be used inside an enclosed space, home, basement, garage, or camper — or even outside near an open window or window air conditioner. Please see https://www.cdc.gov/co/pdfs/generators.pdf.

For More Information
Clinical Guidance for Carbon Monoxide (CO) Poisoning After a Disaster
https://www.cdc.gov/disasters/co_guidance.html

 


Global Drowning: 3.72 million drown annually in the world

WHO on Drowning

“…..WHO in its latest report on drowning reported that 3,72,000 people die every year worldwide due to drowning. 90 per cent of these deaths takes place in LMIC’s (Low and middle income countries). It is a major contributor towards mortality rates in south east Asia……”

 


Walking in a polluted environment in London: New research on the perils of pollution on bad hearts and lungs;

Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study

Sinharay, Rudy et al.
The Lancet , Volume 391 , Issue 10118 , 339 – 349
“….a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park).….”
“…Interpretation:  Short-term exposure to traffic pollution prevents the beneficial cardiopulmonary effects of walking in people with COPD, ischaemic heart disease, and those free from chronic cardiopulmonary diseases….”

An oil spill from an Iranian tanker that sank in the East China Sea is rapidly spreading (two huge slicks covering 52 square miles)

NY Times


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