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Lessons Learned From the Syrian Sarin Attack: Evaluation of a Clinical Syndrome Through Social MediaLessons Learned From the Syrian Sarin Attack

Yossi Rosman, MD*; Arik Eisenkraft, MD*; Nadav Milk, MD; Arthur Shiyovich, MD; Nimrod Ophir, MD; Shai Shrot, MD; Yitshak Kreiss, MD; and Michael Kassirer, MD
[+] Article and Author Information

* Drs. Rosman and Eisenkraft contributed equally to this work.


From Medical Corps, Israel Defense Forces, Tel Hashomer, and Hebrew University, Jerusalem, Israel.

Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2799.

Requests for Single Reprints: Yossi Rosman, MD, Hashaked 4/19, Givat Shemuel, 54044, Israel; e-mail, rosmanyossi@gmail.com.

Current Author Addresses: Dr. Rosman: Hashaked 4/19, Givat Shemuel, 54044, Israel.

Dr. Eisenkraft: 32 Hashachaf Street, Tel Mond, 40600, Israel.

Dr. Milk: Zamir 11, Kefar-saba, 44264, Israel.

Dr. Shiyovich: Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah Tikva, 49100, Israel.

Dr. Ophir: Smuts Avenue 14, Tel-Aviv, 6200926, Israel.

Dr. Shrot: Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 52621, Israel.

Dr. Kreiss: Surgeon General Headquarters, Medical Corps, Israel Defense Forces, Tel Hashomer, 52621, Israel.

Dr. Kassirer: Moriyah 7, Nof Ayalon, 99875, Israel.

Author Contributions: Conception and design: Y. Rosman, Y. Kreiss, M. Kassirer.

Analysis and interpretation of the data: Y. Rosman, A. Eisenkraft, N. Milk, A. Shiyovich, S. Shrot, Y. Kreiss.

Drafting of the article: Y. Rosman, A. Eisenkraft, A. Shiyovich, S. Shrot.

Critical revision of the article for important intellectual content: A. Eisenkraft, A. Shiyovich, S. Shrot, Y. Kreiss, M. Kassirer.

Final approval of the article: Y. Rosman, A. Eisenkraft, A. Shiyovich, S. Shrot, Y. Kreiss, M. Kassirer.

Provision of study materials or patients: A. Eisenkraft.

Administrative, technical, or logistic support: A. Eisenkraft, N. Milk.

Collection and assembly of data: N. Milk, A. Shiyovich, N. Ophir.


Ann Intern Med. 2014;160(9):644-648. doi:10.7326/M13-2799
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On the night of 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. This article aims to delineate the clinical presentation and management of a mass casualty event caused by a nerve agent as shown in the social media. Authors searched YouTube for videos uploaded of this attack and identified 210 videos. Of these, 67 met inclusion criteria and were evaluated in the final analysis.These videos displayed 130 casualties; 119 (91.5%) of which were defined as moderately injured or worse. The most common clinical signs were dyspnea (53.0%), diaphoresis (48.5%), and loss of consciousness (40.7%). Important findings included a severe shortage of supporting measures and lack of antidotal autoinjectors. Decontamination, documented in 25% of the videos, was done in an inefficient manner. Protective gear was not noticed, except for sporadic use of latex gloves and surgical masks.This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events.

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