Views And Reviews

Environmental Medical Emergencies

BMJ 1994; 309 doi: (Published 12 November 1994) Cite this as: BMJ 1994;309:1310
  1. J Sloan

    Oxford University Press, pounds sterling 16.95, pp 211 ISBN 0-19-262392-3.

    Sometimes when a book appears, I wonder why no one wrote it before. The topic of Environmental Emergencies is easy to leave to one side during training, and many doctors would need to check a reference book before making any definitive comment on such matters. The problem is that although there have been plenty of publications from North America, very little has been written from within the United Kingdom. As the author points out, the increasing interest in outdoor pursuits has not led to medical understanding of the problems that they may cause. While no one will become an expert by reading this book, it will equip doctors in a variety of situations.

    At this point you might reasonably ask what an environmental emergency is. There is no strict understanding of its definition, but I take it to be any medical condition that has resulted from dangers of the outside world and requires time-critical intervention. The book is aimed at accident and emergency specialists, and deals with the majority of problems that may present. Most of us have learnt how to manage unusual emergencies - such as venomous bites and stings - by being confronted with a sick patient. Now we have a reliable reference for some time to come. The material is thoroughly researched and up to date. I appreciated the chapter layout; there is a “Key points” page at the start of each chapter, which summarises the most important issues to grasp. The “Further reading” section at the end details sources of help, such as antivenom centres and hyperbaric chambers.

    * A secure laboratory for the diagnosis of dangerous pathogens (note the explosion proof hood covering the centrifuge on the right) from the fourth edition of Medical Virology by David O White and Frank J Fenner (Academic Press, S95, ISBN 0-12-746642-8), first published in 1970. It provides a systematic view of 19 families of viruses, with electron microscope pictures, followed by a short account of the clinical syndromes that viruses cause.

    Just as the environment has common ownership, so this topic affects every doctor. Both medical students and trainees in general medicine will benefit from the concise approach to topics such as hypothermia and heat illness. Doctors who engage in any form of sports medicine will find issues relating to diving, aviation, and altitude climbing. Some of the detailed management schedules will be of use to intensivists. The chapters on chemical accidents and radiation accidents should be useful in major incident planning, and those who oversee their hospital plans will appreciate them. Managers of rescue services may find it a useful reference.

    Neither the environment nor its dangers will change a great deal, and this book is going to remain relevant for long time. It is stimulating to read, and the author has succeeded in writing at a level which does not presume a certain understanding, while not being too basic.

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