{"id":1799,"date":"2010-04-29T08:50:47","date_gmt":"2010-04-29T07:50:47","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=1799"},"modified":"2010-05-01T20:07:13","modified_gmt":"2010-05-01T19:07:13","slug":"leifur-bardarson-we-have-a-lot-to-learn-from-eyjafjallajokull","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/04\/29\/leifur-bardarson-we-have-a-lot-to-learn-from-eyjafjallajokull\/","title":{"rendered":"Leifur Bardarson: We have a lot to learn from Eyjafjallaj\u00f6kull"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/columns\/icons\/leifur_bardarson.jpg\" alt=\"Leifur Bardarson\" width=\"160\" height=\"160\" align=\"left\" \/>The volcanic activities of Eyjafjallaj\u00f6kull have diminished.\u00a0On the 26 April 2010\u00a0it 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\u00a0affected 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. <!--more-->I missed <a href=\"http:\/\/internationalforum.bmj.com\/\">The International Forum on Quality and Safety in Health Care in Nice<\/a>. 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.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/columns\/icons\/iceland_sky.gif\" alt=\"\" width=\"160\" height=\"110\" align=\"left\" \/><\/p>\n<p>For an Icelandic doctor, or any Icelander the most important\u00a0consequences of the eruption were never travel related. The main effects\u00a0were, and still are, about safety and the possible harmful effects it could have\u00a0on our health. Volcanic ash and toxic fumes are the real threat. In sufficient concentration they are deadly to both vegetation and\u00a0animals, 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\u00a0over 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.<\/p>\n<p>The eruption\u00a0is affecting everyday life for many Icelanders.\u00a0The 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\u00a0when the\u00a0wind blows, and can affect people, especially the ones with chronic lung problems. Authorities have issued\u00a0warnings 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\u00a0it is going to increase in intensity again. Last time this volcano erupted it lasted for two years.<\/p>\n<p>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\u00a0of whether\u00a0this volcanic ash has had toxic effects on the health of children.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/columns\/icons\/iceland_playground.gif\" alt=\"\" width=\"160\" height=\"110\" align=\"left\" \/><br \/>\nAnother 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.<\/p>\n<p>Fortunately this has only\u00a0happened on a minor scale and has not affected health care delivery to any greater extent than any other parts of society.\u00a0That would only happen if the total travel ban lasted for a longer\u00a0period of time.\u00a0It is not unheard of in this country not to\u00a0be able to travel\u00a0for up to a week due to bad weather.\u00a0So far Icelanders being stranded abroad has not caused a real problem.<\/p>\n<p>Some of the things I have mentioned can be dealt with because we have done research. For example, we know about the\u00a0harmful 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\u00a0part of\u00a0everyday 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.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/columns\/icons\/iceland_sky2.gif\" alt=\"\" width=\"160\" height=\"110\" align=\"left\" \/><\/p>\n<p>The airline industry was taken by total surprise\u00a0with regards to the safety of\u00a0flying 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\u00a0only now after this volcanic eruption that the aviation industry seems to\u00a0have got\u00a0a wake up call and they are doing some tests to be able to answer this\u00a0simple 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.<\/p>\n<p>But what about the health care industry?\u00a0Have we done our homework? Do we know if\u00a0the delicate life supporting instruments we use today in treatment of very sick people are \u201cash proof?\u201d\u00a0 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\u00a0big 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?\u00a0 There are many questions to which we have no answer.<\/p>\n<p>Another consideration is\u00a0the fumes, for example sulphuric acid. All inhabitants of the capital Reykjavik know about the effect it has on silver. In\u00a0the 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\u00a0wrote about earlier are silver coated.\u00a0 Do the fumes affect the accuracy\u00a0of the instruments ?<\/p>\n<p>The problem again is: Do we know? Lack of knowledge in health care is always disturbing.<\/p>\n<p><em><strong>Leifur\u00a0Bardarson<\/strong> worked\u00a0as a pediatric surgeon.\u00a0For the last ten years he has\u00a0worked\u00a0in 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.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The volcanic activities of Eyjafjallaj\u00f6kull have diminished.\u00a0On the 26 April 2010\u00a0it was only pumping out 30 ton\/sec of volcanic material (gases and ash) into the air compared to the 700 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/04\/29\/leifur-bardarson-we-have-a-lot-to-learn-from-eyjafjallajokull\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-1799","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Leifur Bardarson: We have a lot to learn from Eyjafjallaj\u00f6kull - 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