Providing protection to patients with chronic respiratory diseases in a toxic industrial compound scenario


  • Arik Eisenkraft, MD, MHA
  • Amir Krivoy, MD



CBRN, disaster planning and response, guidelines, poisoning, mass incidents, ventilation


Background: In case of dispersion of toxic industrial compounds (TICs), patients with chronic respiratory diseases would be highly endangered, as they would be unable to use the standard-issue Chemical-Biological-Radio-Nuclear (CBRN) mask. Therefore, we defined guidelines to deliver the appropriate respiratory protection devices to this subpopulation of patients.

Methods: We used the Israel Ministry of Health Registry to analyze and define chronic respiratory disease patients, both hospitalized and at home, according to their ventilatory and supportive needs. We then identified the gaps in the current available protection measures, and performed a set of in vitro, in vivo, and human studies, aimed to validate the provided tailored solutions and to develop a flow chart and a set of guidelines to be used as requested.

Results: Chronic respiratory disease patients were subdivided into three distinct groups. We found that standard oxygen and ventilator tubes do not compromise the protection factor afforded by standard protection hoods. We further developed a CBRN filter adaptor, enabling the use of standard-issued CBRN filter with all ventilators. These experiments have led to the development of a flow chart and guidelines to allow both the Military and the Civil Health authorities distributing the most appropriate respiratory protection devices to patients with chronic respiratory diseases.

Conclusions: As TIC incidents occur mostly in fixed facilities, both local and national authorities can use our approach in preparing for such an incident.

Author Biographies

Arik Eisenkraft, MD, MHA

Israel Defense Force Medical Corps Headquarters, Tel Hashomer, Ramat-Gan, Israel; The Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel

Amir Krivoy, MD

Israel Defense Force Medical Corps Headquarters, Tel Hashomer, Ramat-Gan, Israel; Sackler Faculty of Medicine, Geha Mental Health Center, Petach-Tikva, Tel-Aviv University, Tel- Aviv, Israel


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How to Cite

Eisenkraft, MD, MHA, A., and A. Krivoy, MD. “Providing Protection to Patients With Chronic Respiratory Diseases in a Toxic Industrial Compound Scenario”. American Journal of Disaster Medicine, vol. 14, no. 3, Aug. 2019, pp. 157-65, doi:10.5055/ajdm.2019.0327.




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