The interesting article by Flaishon et al.  1included prospective data on the difficulties of performing anesthetic and critical care duties in mass casualty situations. An additional factor to consider is the challenge of continuing to perform one’s duties while wearing full antichemical protective gear.

As a member of the Air National Guard, I am obligated to perform chemical warfare training. Wearing the full MOPP 4 antichemical warfare ensemble is uncomfortable, especially in warm environments such as the Middle East. The clinician must contend with the intrinsic difficulties of wearing the suit and be mindful of preventing his own severe dehydration and the need to be resuscitated himself.

Most United States civilians do not appreciate the need to maintain adequate hydration. In the Middle East, constant hydration is a way of life. Military personnel have become familiar with disaster management concepts. In the future, such training will be mandatory for civilians as well. The Society of Critical Care Medicine (Des Plaines, IL) sponsored its first course on disaster medicine at its annual meeting this year to provide civilian clinicians with the basic concepts of disaster management. The course will heighten awareness of the challenges of airway management as well as the challenges and hazards of extended wear of chemical warfare gear.

Eric L. Bloomfield, M.D., M.S., F.C.C.M.

Mayo Clinic, Jackson-ville, Florida.

Flaishon R, Sotman A, Ben-Abraham R, Rudick V, Varssano D, Weinbroum AA: Antichemical protective gear prolongs time to successful airway management: A randomized, crossover study in humans. Anesthesiology 2004; 100:260–6