Scud Missile Attacks Research Articles

Comparative Study Illustrating Difficulties Educating the Public to Respond to Chemical Terrorism

In recent years, the perceived threat of chemical terrorism has increased. It is hoped that teaching civilians how to behave during a chemical incident will decrease the number of "worried well" patients at hospitals, reduce secondary contamination, and increase compliance with the instructions of emergency services. The governments of the United Kingdom and Israel sent booklets to every household in their respective countries. In Israel, the civilian population was issued chemical personal protective equipment (CPPE). The effectiveness of these public education programs was assessed using a scenario-based questionnaire that was distributed to 100 respondents in Birmingham, UK and Jerusalem, Israel. Respondents were asked how they would behave in three deliberate chemical release scenarios and how they would seek information and help. Only 33% of the UK respondents and 22% of the Israeli respondents recalled reading the government booklets. When asked what they would do after being contaminated in a deliberate release, approximately half of the respondents ranked seeking medical care at a hospital as the most appropriate action. The preferred sources of information in the wake of a chemical strike were (in descending order): radio, television, and the Internet. Approximately half of the respondents would call emergency services for information. Forty-one percent of the UK respondents and 33% of Israeli respondents stated that they either would call or go to the nearest hospital to seek information. The public information campaigns in both countries have had a limited impact. Many citizens claimed they would self-present to the nearest hospital following a chemical attack rather than waiting for the emergency services. A similar response was witnessed in the Sarin attacks in Tokyo and the 1991 Scud missile attacks in Israel. Current UK doctrine mandates that specialist decontamination teams be deployed to the scene of a chemical release. However, this takes > 1 hour, and it requires at least 30 minutes to don hospital CPPE. Therefore, it is imperative that hospitals are equipped to cope with unannounced self-presenters after a chemical attack. This requires CPPE and protocols that are easier to use.

Missile defense at the waterfront: Implications of the SCUD missile attack and Al Jubayl Port, 15–16 February 1991

(2003). Missile defense at the waterfront: Implications of the SCUD missile attack and Al Jubayl Port, 15–16 February 1991. Defense & Security Analysis: Vol. 19, No. 1, pp. 15-33.

Sitting it out in the sealed room: The Israeli response in the 1991 gulf war

The response of the Israeli civilian population to the Scud missile attacks and the possibility of chemical and biological warfare during the 1991 Gulf War have been monitored in various contexts. The present article reviews the findings and their implications for civilian defence planning in the event of a reprise. In 1991 the most controversial policy was the insistence that Israeli families prepare a sealed room in which to sit out the Iraqi attacks. The evidence suggests that in some instances this may have been counterproductive, even during relatively short periods of immurement.

The Enchanted World of Sleep

Back to table of contents Previous article Next article Book Forum: Sleeping and DreamingFull AccessThe Enchanted World of SleepBRADLEY J. SCHNIEROW, , M.D., M.S., BRADLEY J. SCHNIEROWSearch for more papers by this author, , M.D., M.S., La Jolla, Calif.Published Online:1 Jul 2000https://doi.org/10.1176/appi.ajp.157.7.1190-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Interest and concern about sleep continue to capture the public’s imagination, as evidenced by magazine cover stories and record sales of herbal and over-the-counter sleep preparations. Sleep complaints are a frequent symptom reported to psychiatrists, and untreated insomnia is associated with greater risk of subsequent depression and substance abuse (1). Despite their prevalence, very little instruction is given to medical students and residents about the issues that disturb a good night’s slumber. This English translation of the 1993 Hebrew text provides a solid introduction to sleep and its disorders. It is a first-person narrative account of modern sleep research and sleep medicine, as told by a pioneer in the field. Throughout this volume, Dr. Lavie’s sincere passion as both a clinician and researcher is readily apparent.From the investigation of sleep stages and the endogenous circadian pacemaker to the discovery of the sleep- and wake-promoting centers of the hypothalamus, Dr. Lavie covers most of the major findings regarding the regulation and possible functions of sleep. The scientific drama behind these discoveries is nicely captured in the narratives of the personal lives and intellectual quests of modern sleep scientists like Michael Jouvet, William Dement, and Allan Rechtschaffen. Dreams, perhaps the most fascinating aspect of sleep, are examined from both philosophical and scientific points of view.In addition to weaving together the history of sleep and dreams, Dr. Lavie takes the reader through his own life journey as a sleep researcher and clinician: from his doctorate work, studying human circadian rhythms in isolation, under the tutelage of Bernie Webb at the University of Florida; to his present role as Dean of the School of Medicine and Director of the Sleep Laboratory at the Technion-Israel Institute of Technology in Haifa. Dr. Lavie addresses some very interesting public policy issues, such as the effect of nighttime SCUD missile attacks on the sleep of the Israeli populace during the Gulf War.The second half of the book is devoted to the clinical diagnosis and treatment of sleep disorders. There are chapters on common complaints like insomnia, circadian rhythm abnormalities, excessive sleepiness, and even “children who refuse to sleep.” Dr. Lavie has a very down-to-earth approach to these issues, and he is an advocate of avoiding sleeping pills in favor of promoting proper “sleep hygiene” or behavioral rules. There is also advice for dealing with such problems as jet lag and shift work.This book will appeal to anyone who is interested in the scientific and clinical aspects of sleep, including the practitioner as well as the general public. The subject matter is presented with humor, and frequent references to classic literature and ancient mythology make for lively reading.By Peretz Lavie; translated by Anthony Berris. New Haven, Conn., Yale University Press, 1996, 270 pp., $32.50; $15.00 (paper).

Image control and posttraumatic symptoms in children following SCUD missile attacks.

Based on previous studies reporting an association between high image control and low posttraumatic symptoms in adults exposed to a traumatic event, this study explored whether a high capacity for image control by children may serve as protective factor against the long-term effect of trauma. The sample consisted of 39 children displaced due to the destruction of their homes after the missile attack on Tel-Aviv during the Gulf War. Analysis confirmed the hypothesis that low scores on the Test of Visual Image Control were associated with specific posttraumatic symptoms but not with general ones.

Complications from Supervised Mask Use in Post-operative Surgical Patients during the Gulf War

This is a report of three patients in a surgical ward of a hospital who developed complications seemingly related to the use of full-face-fitting masks associated with the first Scud Missile attack on Israel during the Gulf War. Patient 1 developed atrial fibrillation with an uncontrolled ventricular rate; Patient 2 redeveloped a gastrointestinal hemorrhage; and Patient 3 developed a severe anxiety attack. Each of the three was severely ill prior to the event. Special attention should be given to severely ill patients during such events.

Casualty Management: Scud Missile Attack, Dhahran, Saudi Arabia

On the evening of February 25, 1991, an Iraqi scud missile plunged into a "barracks/warehouse" used to house U.S. Army soldiers assigned to the 475th Quartermaster Group in Dhahran, Saudi Arabia. As a consequence of this scud attack, 28 soldiers died, 110 were hospitalized, and 150 experienced minor physical injuries and/or subsequent mental health problems. This one scud's impact accounted for more than one-third of all U.S. soldiers killed during the war. Fortunately, there were very few "models" of mass casualty experiences during the Persian Gulf War to evaluate the critical clinical outcomes to the soldiers. An analysis of this event has important implications for future military operations that feature a multinational medical force structure. This article summarizes the medical preparations before the war, the key, chronological events, and the medical outcomes of the mass casualty event. Lessons learned in casualty management for future Army contingency medical planners are identified.

Characteristics of calls to Israeli hotlines during the Gulf War.

The current study presents results of a survey of 3,215 calls received at seven centers of telephone emergency services (TES) in Israel during the Gulf War, when citizens of Israel experienced severe stress resulting from SCUD missile attacks. Whereas former surveys have shown that characteristics of calls to TES in Israel are generally not affected by external stressogenic events, a remarkable change was recorded in both the quantity and quality of calls received in TES centers in Israel during the Gulf War. The relative frequencies of problem categories presented by callers during the Gulf War revealed a significant increase in "environmental pressures," a category that reflected the stressful situation of the war, as opposed to intra- or interpersonal problems typical of peacetime calls. A comparison between this group of "war calls" and a control group of "nonwar calls," revealed that the two groups represented populations of callers differing in sociodemographic characteristics, expectations, and benefits from the calls. Results are discussed in reference to the unique role of TES as a source of psychological first-aid in a community crisis situation.

The Gulf War: The Experience of a Department of Anesthesiology in the Management of Scud Missile Casualties

The pivotal role of anesthesiologists in the implementation of disaster plans is not widely appreciated. To describe the role of anesthesiologists as managers in the operating room (OR) especially during hospital disaster management. On 25 February 1991, King Fahd Hospital of the University in Eastern Saudi Arabia, was alerted, received, triaged, and treated the victims of a Scud missile attack on a United States military barracks which killed 28 and injured more than 100 service personnel. There were 47 males and 15 females admitted to the hospital. Their initial triage categories of injuries were: 1) red, 23; 2) yellow, 27; and 3) green, 7. The flow of patients through the main operating rooms occurred in two peaks: 1) treated within nine hours (60%); and 2) during the next 11 hours (40%). A total 101 units of blood and blood products were consumed. The role of the Chief of Anesthesiology was vital in the dynamics of the situation regarding appropriate deployment of staff and ensuring an orderly throughput of victims in the operating room. He also was required to keep track of resources and supply levels in the operating room, so that he could advise the hospital administration appropriately. The successful management of a large multi-casualty incident, which involved use of the operating rooms, depended upon the efficient coordination of clearly defined functions with the Chief of Anesthesiology Service as the team leader.

Israeli preschoolers under Scud missile attacks. A developmental perspective on risk-modifying factors.

The devastating effects of traumatic events on children are modulated by risk and protective factors. This study examines the differential effects of traumatic displacement of preschool children and their families following Scud missile attacks on Israel during the Persian Gulf War. Three groups participated in the study: families displaced after their houses were damaged, undisplaced families from the same neighborhood (without home damage), and families from a distant city that was threatened but not directly attacked. Data concerning the traumatic event, the child (personality, internalizing, externalizing, and stress symptoms), the mother (Symptom Checklist-90-Revised), and the family (Family Adaptability and Cohesion Evaluation Scales) were gathered 6 months after the end of the war. Displaced children and mothers showed higher externalizing and stress symptom levels compared with undisplaced and threatened subjects. Destruction of the house and displacement, but not mere distance from the missile impact, explained symptomatic behavior. Inadequate family cohesion predicted symptomatic reaction for 3- and 4-year-old children but not for older ones. Both human and nonhuman factors contribute to the preschool child's adaptive mechanisms that regulate environmental stressful stimuli. These risk-modifying factors become more autonomous of caretakers with increasing age.

The influence of SCUD missile attacks on the utilization of ambulatory services in a family practice.

The consulting load in a family practice exposed to SCUD missile attacks during the 1991 Gulf War was compared with the equivalent period in 1990. The rate of visits was cut by half, with a relative and absolute increase in psychological consultations, and a decrease in consultations for infectious and respiratory conditions. There were more urgent consultations and fewer planned appointments. It is suggested that the stress of the SCUD missile attacks led to a reduction in consultations for trivial disorders, but an increase in the anxiety level of the population.

Studies in psychoneuroimmunology: psychological, immunological, and neuroendocrinological parameters in Israeli civilians during and after a period of Scud missile attacks.

Twenty-two male volunteers in Jerusalem were subjected to a battery of psychological tests at the height of the Iraqi Scud missile attacks on Israeli cities during the 1991 Persian Gulf War and again after the cessation of hostilities. Venous blood samples were taken at each time point. The separated mononuclear cells and plasma were cryopreserved, and a spectrum of immunological and neuroendocrine assays were performed on the preserved samples. Psychological testing indicated levels of anxiety were higher during the war than they were after the war ended, and both anxiety and anger during the hostilities were significantly elevated in comparison with prewar data. During the war, specific war-related pressures were greater than everyday pressures, and problem-focused coping was more evident than emotion-focused coping. Natural-killer cell activity and cell-mediated lympholysis were significantly elevated during the war, as were plasma levels of adrenocorticotrophic hormone, neurotensin, and substance P. The only biological test parameter found to be reduced during the war period was mononuclear cell thymidine incorporated in nonstimulated cultures.

Retraumatization of Holocaust survivors during the Gulf War and SCUD missile attacks on Israel.

The purpose of this work was to study the reaction to a new threat and a new trauma of people severely traumatized in the past, when the new trauma had associations with the original one caused by the Holocaust. The situation created during the Gulf War gave a rare occasion to study it. We also wanted to check if the reaction of Holocaust survivors to the war differed from that of the general population. In addition we wanted to find out if there was a difference in reaction to the war between two clinical populations: Holocaust survivors and patients who are not Holocaust survivors. Sixty-six Holocaust survivors living in Israel, 31 of them undergoing psychiatric or psychological treatment either as in-patients or as out-patients, were interviewed during the Persian Gulf War. In addition to the clinical group, there was a non-clinical group of 35 Holocaust survivors--21 whose homes were not damaged by SCUD missiles, and 14 whose homes were damaged by missiles. Those whose homes were damaged by SCUD missiles were retraumatized, and showed reactivation or exacerbation of the survivor syndrome. Six of them displayed the full syndrome of PTSD.

Response style and self-control under scud missile attacks: the case of the sealed room situation during the 1991 Gulf war.

The interrelationships of coping responses, self-control and trait anxiety in Israeli university students during the 1991 Gulf war were investigated. Respondents (35 male and 58 female students) responded to a battery of questionnaires at the end of the war to assess these variables. Their responses, which referred to the sealed room situation, were characterized by attempts to help others and relatively low emotion-focused reactions. Based on factor analysis, a three-factor structure of response modes is suggested: instrumental, emotion-focused and blunting-like. Self-control was found to be associated with a lower intensity of the emotion-focused response mode. Trait anxiety did not correlate with any of the response modes.

Response style and self‐control under scud missile attacks: The case of the sealed room situation during the 1991 Gulf war

AbstractThe interrelationships of coping responses, self‐control and trait anxiety in Israeli university students during the 1991 Gulf war were investigated. Respondents (35 male and 58 female students) responded to a battery of questionnaires at the end of the war to assess these variables. Their responses, which referred to the sealed room situation, were characterized by attempts to help others and relatively low emotion‐focused reactions. Based on factor analysis, a three‐factor structure of response modes is suggested: instrumental, emotion‐focused and blunting‐like. Self‐control was found to be associated with a lower intensity of the emotion‐focused response mode. Trait anxiety did not correlate with any of the response modes.

Reactions to Stress During the Persian Gulf War: The Use of Structural Equations for Testing the Horowitz Model

In one of the few models specific to victims' reactions to traumatic events, it has been proposed that consequences typically include alternating patterns of intrusive and avoidance symptoms. The present exploratory investigation examined the responses of 120 victims who had been evacuated to a hotel after a SCUD missile attack on their home. Analyses using structural equation modeling showed that both psychological states follow stressful stimuli and perceived threat. In addition, results were found to be consistent with a model that posits intrusion as antecedent to anxiety which, in turn, was found to precede a latent outcome measure consisting of psychological, physical, and work functioning.

Stress and epilepsy: the Gulf war experience

Stress is commonly believed to precipitate seizures in some patients with epilepsy, but direct examination of this assumption is problematic because of the difficulty in defining vague factors such as 'emotional stress'. Using a questionnaire, we have recorded seizure frequency during the 1991 Persian Gulf war, when Israelis were under stress from the threat of Scud missile attacks, in 100 consecutive adult patients with epilepsy. Increased frequency of seizures was reported by eight patients. These were younger than the other patients, the majority showed generalized epileptic EEG activity and all had generalized seizures (secondarily generalized in four). Only four had seizures directly related to the sounding of an alarm and in the others, non-compliance, being off medication at the time and disturbed sleep were probable contributory factors. We conclude that, in this series, epilepsy control was only weakly affected by an acute external emotional stress factor.

A nation's response to attack: Israelis' depressive reactions to the Gulf War.

We examined Israelis' reactions to the Gulf War and SCUD missile attacks. Four national samples of Israelis (n = 3,204) were interviewed as to depressive mood on four occasions--prior to the Gulf Crisis, as the war approached, during the SCUD missile attacks, and after cessation of hostilities. There was an expected increase in depressive mood during the period of SCUD missile attacks and a quick return to base-line levels following the hostilities. Less educated and older individuals reported higher base-line levels of depressive mood and were at higher risk for clinical depression. Women and men did not differ in depressive mood before or after the SCUD missile attacks. However, women experienced a marked increase in depressive mood when the SCUD missile attacks occurred.

Preparing Visually Impaired Israelis for the Persian Gulf War

During the Persian Gulf War, the Israeli army's Civil Defense Unit, in conjunction with the Rehabilitation Teaching Division of Migdal Or, developed a program to train visually impaired people to protect themselves in the case of biological or chemical warfare and provided them with equipment, including gas masks. This article describes how the program was set up and the problems that were experienced during the scud missile attacks.

A nation's response to attack: Israelis' depressive reactions to the gulf war

AbstractWe examined Israelis' reactions to the Gulf War and SCUD missile attacks. Four national samples of Israelis (n = 3,204) were interviewed as to depressive mood on four occasions—prior to the Gulf Crisis, as the war approached, during the SCUD missile attacks, and after cessation of hostilities. There was an expected increase in depressive mood during the period of SCUD missile attacks and a quick return to base‐line levels following the hostilities. Less educated and older individuals reported higher base‐line levels of depressive mood and were at higher risk for clinical depression. Women and men did not differ in depressive mood before or after the SCUD missile attacks. However, women experienced a marked increase in depressive mood when the SCUD missile attacks occurred.