The volcanic activities of Eyjafjallajökull have diminished. On the 26 April 2010 it was only pumping out 30 ton/sec of volcanic material (gases and ash) into the air compared to the 700 tons/sec during the first week of its eruption. The good news is that air travel is no longer affected to same extent as it was, though airports in Iceland are still closed from time to time. The front pages of the big news channels like Skynews, CNN, or BBC are no longer showing distressed and unhappy people at different airports. I missed The International Forum on Quality and Safety in Health Care in Nice. It is actually hard to imagine that there is a volcanic eruption still going on in Europe. A picture like this one (below) is not of interest anymore, but it is useful to bear in mind that the volcano can easily reach its former strength within hours. It cannot be predicted.

For an Icelandic doctor, or any Icelander the most important consequences of the eruption were never travel related. The main effects were, and still are, about safety and the possible harmful effects it could have on our health. Volcanic ash and toxic fumes are the real threat. In sufficient concentration they are deadly to both vegetation and animals, homo sapiens included. An eruption in this country 230 years ago (geologically a very short time) is thought by scientists to have cost the life of several hundreds of thousands of people all over the world. It is very likely that it caused the rice harvest failure in Japan. In comparison, not being able to attend a conference is minor event.

The eruption is affecting everyday life for many Icelanders. The full scale effect on health has yet to emerge but it is obvious that living with all this ash around is unhealthy. The ash is thrown up in the air again and again when the wind blows, and can affect people, especially the ones with chronic lung problems. Authorities have issued warnings to people with chronic lung disorders to stay inside their homes and to wear masks if they have to go outside. Fortunately so far those warnings have only applied to limited parts of the population of Iceland. More densely populated areas are not yet affected. The capital and its surroundings have been totally spared. But maybe the most difficult part is that you are never sure when this is going to end, or if it is going to increase in intensity again. Last time this volcano erupted it lasted for two years.

It seems absolutely clear that what you see to the right on this picture (below) can not be a healthy playground for a child though we will need a longer time to collect the scientific proof of whether this volcanic ash has had toxic effects on the health of children.

Another possible harm to a sparsely populated and remote island could be a lack of expertise, if highly skilled professionals were stranded outside Iceland for a long period of time.

Fortunately this has only happened on a minor scale and has not affected health care delivery to any greater extent than any other parts of society. That would only happen if the total travel ban lasted for a longer period of time. It is not unheard of in this country not to be able to travel for up to a week due to bad weather. So far Icelanders being stranded abroad has not caused a real problem.

Some of the things I have mentioned can be dealt with because we have done research. For example, we know about the harmful effect of small particles to lungs. The toxic effect of volcanic gases like sulphuric acid or carbon monoxide are well known and we have remedies in place for them. That is part of everyday work for doctors and toxicologists. It is the things that we do not know very much about that worry me and there seem to be many of them.

The airline industry was taken by total surprise with regards to the safety of flying jet planes into volcanic plumes. Jet engine manufacturers have not done their homework. They can not tell exactly how much an average jet engine can take of volcanic ash before it shuts down. It is a very disturbing fact since the lives of thousands of passengers could be at risk. Since the beginning of the jet age tens of eruptions have taken place in the world. Between ten and twenty in my country alone. It is only now after this volcanic eruption that the aviation industry seems to have got a wake up call and they are doing some tests to be able to answer this simple question. For me personally this uncertainty is extremely disturbing since I and of course all other Icelanders totally rely on flight when it comes to traveling abroad.

But what about the health care industry? Have we done our homework? Do we know if the delicate life supporting instruments we use today in treatment of very sick people are “ash proof?”  People living where there has been considerable ash fallout have discovered that it is completely impossible to shut the ash out of their houses. That means that if there was a big hospital situated where there would be ash fallout it would get inside the hospital. The only part which might not be affected would be the operating theatres with positive air pressure. How are we going to protect our delicate instruments in other rooms? Are they safe? What about the ventilators in the ICU? Are our ventilator systems prepared for particles of the size of 10 micron or less?  There are many questions to which we have no answer.

Another consideration is the fumes, for example sulphuric acid. All inhabitants of the capital Reykjavik know about the effect it has on silver. In the vicinity of Reykjavik there are several thermal power plants that produce electricity. During that process some sulphuric acid fumes are released into the air. When the wind is blowing from a certain direction some of those fumes reach the town. You can not smell it at all but you see that your silver teapots turn black. Does it affect the health of the inhabitants? Some vital parts of delicate lifesaving instruments that I wrote about earlier are silver coated.  Do the fumes affect the accuracy of the instruments ?

The problem again is: Do we know? Lack of knowledge in health care is always disturbing.

Leifur Bardarson worked as a pediatric surgeon. For the last ten years he has worked in quality improvement, particularly patient safety issues at The Landspitali University Hospital in Reykjavik, Iceland. He has been involved in evolving quality and safety indicators internationally.