An IDF source says many citizens who have no respiratory problems will ask their doctors for mendacious notes stating that they cannot use regular masks.
Moti Kimchi
The Home Front Command has criteria for people who need special gas masks, but nobody knows what they are.
Asthmatics, who suffer from disruptions in the passage of air through their respiratory system, are likely to find wearing a regular gas mask very quickly turns into a nightmare. The pressure on the face, the effort required to inhale through the filter and the feeling of suffocation remind them of the horrible feelings they experience during an asthma attack.
During an asthma attack the patient's bronchial tubes become blocked and without immediate medication, he is unable to breathe. When an asthmatic patient puts on a gas mask, he is liable not only to feel as if he is having an attack, but to actually have one as a result of the tremendous effort required to inhale through the filter.
A study conducted by Dr. Shabtai Versano of the Meir Medical Center in Kfar Sava found that 7 percent of children and 3.7 of the general population in Israel suffer from asthma. With preparations currently underway for the possibility that Israel will be attacked with missiles bearing chemical or biological warheads, those patients who under normal circumstances suffer from the chronic obstruction of their airways, and who are vulnerable to relatively light air pollution, find themselves in a paradoxical situation - they, who are most in need of gas masks, are least able to benefit from the protection they provide.
Doctors who work in this field say there is a chance that the unique difficulties experienced by patients with respiratory ailments when wearing a mask will cause them to refrain from using the masks at all. "There is a double danger," says Dr. Shlomo Bar Sela, a lung and allergy specialist at the Meuhedet Health Maintenance Organization. "If a person has difficulty with air flow resistance, it could trigger an asthma attack. On the other hand, there is a risk that he won't wear any mask due to his discomfort and fear. With or without a mask, there might be a problem."
The possibility that asthmatics might remove their masks during an emergency, or will not wear them at all, is not equally worrisome to all those involved.
"Wearing a gas mask is very difficult for asthmatics," says Dr. R. Melamed, who heads the department of behavioral medicine at Hadassah University Hospital. "The first thing that putting on a mask is supposed to do is to calm the wearer, to give him a feeling that he is doing something to improve his situation. For asthmatics, the opposite is true. Wearing the mask increases stress and increases the likelihood of the onset of an attack. I would advise patients to use their inhalators immediately before putting on a mask, and if they still feel stressed, I would tell them to simply remove their masks. The chance that something [untoward] will happen is minimal."
The solution to this problem is theoretically simple. The Home Front Command (HFC) should issue specially equipped masks with bellows that are designed to make it easier for people who have difficulty breathing through the regular filter. These masks should be issued not only to people with respiratory difficulties, but also to heart patients and in certain cases, people with other handicaps, such as mental incapacity.
These masks, which are called "Super Kaiser" masks, have a plastic hood that covers the head and part of the torso. The hood is attached to a motor that pumps air through the filter and into the hood. The Super Kaiser is actually an active hood mask for adults, which obviates the need for additional effort for breathing.
It is unclear, however, whether asthmatics know that they are eligible to receive these masks, and it is also unclear on what basis the medical committee of the HFC decides who is really eligible for them, or how often it makes such decisions.
Anyone who would like to apply for a Super Kaiser should go to a Protective Kit Distribution Center (or to the HFC's Web site) and ask for an application form. The form should be filled out by the patient's attending physician and sent to the HFC's post office box for review by the medical committee. Colonel Dr. Ariel Horowitz, the chief medical officer of the HFC, told Haaretz that applications are processed quickly, within a week or two, and that there are currently no pending applications.
Informal investigations by patients at clinics in Jerusalem, however, indicate a different picture. Soccer coach Yossi Mizrahi, for example, who applied for a Super Kaiser mask for his 13-year-old daughter who has asthma, has been waiting for three weeks already and has received no response.
Asthma sufferer Hirsh Ginzburg, 25, on the other hand, went to a distribution center and received an active hood mask on the spot, "because I have a beard." His daughter, 18, who also suffers from asthma, waited a month before receiving a certificate of eligibility.
A large number of patients at Bar Sela's crowded clinic had no intentions of putting on masks, and in many cases never bothered to apply. Others have been waiting for replies for a month or more. Some patients report an impression of total chaos when they go to a distribution center to ask for Super Kaisers.
Yuri Sufrin, former head of the population protection department of the HFC, says that some 3,000 applications are currently being processed by the medical committee. People don't seem to understand this and feel that their applications are not being processed.
Spokespersons from both the Israel Defense Forces (IDF) and the HFC declined to answer questions regarding the criteria for receiving special masks and likewise declined to relate the number of applications that the HFC has received and either approved or rejected.
An IDF source who asked to remain anonymous told Haaretz that this is because suspicions that many citizens who have no respiratory problems will ask their doctors for mendacious notes stating that they cannot use regular masks.
Sufrin has no knowledge of such a suspicion, but he did not discount the possibility. "It is not pleasant for anyone to wear a rubber mask that presses on his face." Maybe the HFC thought that if it did publicize the Super Kaiser masks, there would be false applications.
The forms for patients who suffer from respiratory problems require the doctor to indicate whether the patient suffers from bronchial or pulmonary asthma, or from cystic fibrosis (all these terms appear on the forms in English only, with several spelling mistakes). In addition, the doctor must detail the patient's history of asthma attacks and/or hospitalizations, and which drugs he is receiving.
The form does not note the medical criteria for receiving a special mask. "They don't ask for quantitative information, such as lung function," says Bar Sela. "They never mentioned clear criteria. I don't think they have any. If they did, they would send them to the doctors. It would be possible to ask for objective data on each patient, but there is no space for that on the form."
The IDF spokesperson also refused to allow reporters to speak with the doctors on the medical committee, claiming their information was classified.
Prof. Moti Kramer, head of the pulmonary diseases department at the Rabin Medical Center at Beilinson Hospital, knew nothing of criteria either. "People come here with the forms and I fill them out. That's all. I was never consulted. Usually, a patient who suffers from an obstructive respiratory disorder such as asthma or other chronic lung disease is supposed to get a mask with bellows. It's only logical.
"As far as I know," added Kramer, "anyone for whom I signed received a special mask, no matter what I wrote. I think they approve everyone and don't do a thorough check.
Haaretz.com, the online edition of Haaretz Newspaper in Israel, offers real-time breaking news, opinions and analysis from Israel and the Middle East. Haaretz.com provides extensive and in-depth coverage of Israel, the Jewish World and the Middle East, including defense, diplomacy, the Arab-Israeli conflict, the peace process, Israeli politics, Jerusalem affairs, international relations, Iran, Iraq, Syria, Lebanon, the Palestinian Authority, the West Bank and the Gaza Strip, the Israeli business world and Jewish life in Israel and the Diaspora.
