Health and Safety Threats to Ukraine From Nonconventional Weapons

“Although a focus on trauma response and humanitarian care is essential for the ongoing Russia-Ukraine war, recent posturing by Russian leadership indicates that radiological or nuclear weapons could be used to defend illegally annexed territories in Ukraine. This situation necessitates readiness for nonconventional warfare threats, which include chemical, biological, radiological, nuclear, and explosives (CBRNE) attacks. CBRNE preparedness has been variable among Ukrainian and European Union member states, which may be called on to detect and respond to potential attacks. Russia or its proxies have used CBRNE weapons in several recent conflicts, and awareness of these risks and mitigation strategies are prudent measures now. Based on these historical ingressions, prioritizing education and equipment for health care professionals to recognize and respond to potential CBRNE threats within Ukraine and bordering countries is essential.

Despite regulations against the use of chemical weapons by the Organisation for the Prohibition of Chemical Weapons (OPCW), Russian chemical weapons research has focused on developing highly potent weaponized organophosphates, or nerve agents. The past decade has seen Russia use these agents in assassination attempts of the Skripals and Alexei Navalny through the introduction of nerve agents in food and clothing. These fourth-generation agents (eg, Novichok, a group of nerve agents) are characterized by their lethality, unconventional routes of poisoning, and long-term environmental persistence. Russia’s connections to Syria also provide insight. The majority of the more than 55 chemical weapon attacks in Syria between 2013 and 2018 involved chlorine gas or the deadly nerve agent sarin in cannisters or combined with bombs dropped from aircraft. Although these events have been attributed to the Syrian government, the close relationship between Syria’s Assad regime and Russia suggests that these indiscriminate strategies could be used in the current conflict.

Weaponized opioids have also been used during the Putin regime. In 2002, Chechen terrorists attacked the Dubrovka Theater in Moscow, resulting in a hostage standoff. In response, Russian special forces instilled a chemical aerosol into the theater’s vents, incapacitating occupants and resulting in 125 deaths. Analysis of clothing from 2 victims demonstrated the presence of remifentanil and carfentanyl, 2 potent opioids, with death likely from poisoning. Although less practical on the battlefield, it is plausible that the Russian military could use similar compounds to cause serious casualties among opposing soldiers, political protestors, or civilians trapped in buildings, hospitals, subways, or bomb shelters.”

Read more on Health and Safety Threats to Ukraine From Nonconventional Weapons: A Clear and Present Danger via JAMA.

Smartphones, Social Media Use, & Youth Mental Health

  • “Evidence from a variety of cross-sectional, longitudinal and empirical studies implicate smartphone and social media use in the increase in mental distress, self-injurious behaviour and suicidality among youth; there is a dose–response relationship, and the effects appear to be greatest among girls.
  • Social media can affect adolescents’ self-view and interpersonal relationships through social comparison and negative interactions, including cyberbullying; moreover, social media content often involves normalization and even promotion of self-harm and suicidality among youth.
  • High proportions of youth engage in heavy smartphone use and media multitasking, with resultant chronic sleep deprivation, and negative effects on cognitive control, academic performance and socioemotional functioning.
  • Clinicians can work collaboratively with youth and their families, using open, nonjudgmental and developmentally appropriate approaches to reduce potential harms from social media and smartphone use, including education and practical problem-solving.
  • There is a need for public awareness campaigns and social policy initiatives that promote nurturing home and school environments that foster resilience as youth navigate the challenges of adolescence in today’s world.”

Learn more about Smartphones, Social Media Use & Youth Mental Health via CMAJ.

Cannabis Vaping: Acute & Long-Term Risks

“The rapid emergence of youth vaping has completely changed the landscape of adolescent substance use in Canada and has become a pressing public health issue of our time. While nicotine remains the most common substance encountered in vaping devices, cannabis vaping is now reported by one-third of youth who vape. Though cannabis vaping is thought to generate fewer toxic emissions than cannabis smoking, it has been associated with several cases of acute lung injury and often involves high-potency forms of cannabis, exposing youth to several acute and long-term health risks. The low perceived riskiness of cannabis as a substance and of vaping as a mode of consumption may bring a false sense of security and be particularly appealing for youth who may be looking for a ‘healthier way’ to use substances. While research is still lacking on how best to support youth who may have already initiated cannabis vaping, concerted efforts among paediatric providers, public health experts, schools, communities, and families are urgently needed to limit the spread of cannabis vaping among Canadian youth.”

Learn more on Cannabis vaping: Understanding the health risks of a rapidly emerging trend via Paediatr Child Health.

Percentage of persons needing intubation and hospitalization among persons with vaping-associated lung injury.

Read more on the 2019-2020 Vaping Lung Illness Outbreak in Canada here.

Exam Preparation

Greetings Residents & Preceptors,

I wanted to forward out additional resources for your exam preparation and for those assisting in the process at their sites. The CFPC has posted a series of videos and guidebooks that I encourage you to review.

SAMPs: April 11-13, 2023
SOOs: April 22-23, 29-30, 2023
More on exam dates here.

CFPC’s “Quick Links” to the exam via the CFPC.
Virtual simulated office oral candidate training resources via CFPC.

For those interested in serving as examiners, visit “Get Involved” via CFPC.
The CFPC has also posted a video designed to prepare examiners.
See Simulated Office Orals for Examiners: Overview and Q&A below.

To learn more, visit the CFPC.

Happy Holidays :),


Setting Up a New Standard of Healthcare in BC

Join us virtually on Wednesday, January 18, 2023 from 12–3:30 pm. This fifth Indigenous Speaker Series session features a panel that brings together BC healthcare organizations and their senior representatives to discuss the work of cultural safety, cultural humility, and the broader work in regards to the recommendations from In Plain SightTruth and Reconciliation, and the Declaration on the Rights of Indigenous Peoples Act Action Plan. This important and timely dialogue will highlight the work being undertaken across the province in an effort to reconcile and redress the relationship between Indigenous peoples and health care professionals and systems.

Register here.

It Starts With Us: Contextualizing and Education about the Holocaust

The VHEC is proud to present Contextualizing and Educating about the Holocaust as part of the Respectful Environments, Equity, Diversity & Inclusion program, Faculty of Medicine UBC for International Holocaust Remembrance Day.

This event will feature introductory remarks by Executive Director of VHEC, Nina Krieger, an engaging historical overview by historian and Professor Chris Friedrichs and a keynote address by hidden child Holocaust Survivor Dr. Robert Krell. Following the presentation, an audience q and a will be facilitated by VHEC’s Program and Development Manager, Dr. Abby Wener Herlin.

Topic: It Starts With Us: Contextualizing and Education about the Holocaust
Date: Wednesday, January 25th, 2023
Time: 12:00 – 1:30 PM PST

Register here.

CaRMS 2022-2023

Hi & Welcome!

Thanks for being here–you made the right choice! We’re the Abbotsford-Mission Family Practice Residency Team based out of Abbotsford and Mission, British Columbia, Canada. We’re passionate about medicine, your educational journey, and delivering the best care to our community. We know you have several choices ahead and we’re here to help you in making the right decision for your future. Let’s get started!

Highlights of the Abbotsford-Mission Site

Cardiology’s Bat Signal ❤

Our program admins do a spectacular job matching us up with our family clinics and preceptors. There’s a questionnaire sent out before the start of residency which is almost eerily good at placing you in a clinic with aligned interests–whether that be dermatological procedures, women’s health, long-term care, or anything else that strikes your fancy!

One of the benefits of our program is that our residents complete a 4-week Cardiology rotation with the Cardiologists at their offices and in the CCU. The Cardiologists have a group chat with residents (aka “The Bat Signal“) inviting us to participate in procedures such as cardioversions, central lines, and pericardiocentesis.

We have a Youth Clinic that is part of the Foundry. The Foundry is a centre that provides health care and mental health services to vulnerable youth. We work evening shifts there during our Pediatrics and Psychiatry rotations.

We allow 18-20 weeks of elective time depending on your needs during your R2 year.

We have a weekly Academic Half Day on Thursday mornings, which is always a good time! This includes monthly ECG rounds led by one of the cardiologists, regular SIM lab training so you can navigate emergencies in a reduced pressure environment, and informative presentations from staff and residents.

Academic half day is followed by an afternoon in your family clinic. This allows for continuity of care for many of your patients and gives you the opportunity to see your preceptor and MOA’s friendly face every week! We also have family blocks of 2-6 weeks sprinkled across the year, so you get block-based family exposure.

With the exception of Obstetrics, all of our call shifts end at 2300. This means you get to go home and sleep in your own bed. There’s also an option to do 24hr call, which is great for seeing high-acuity ward emergencies and an excellent option if you’re considering hospitalist medicine.

Abbotsford hosts UBC ICC students from Chilliwack or elective students in the hospital. You will sometimes be on rotation with them or see them in the resident lounge. This provides an opportunity for resident-led teaching.We have our own space in the resident lounge, which comes equipped with a Keurig and snack locker. It’s a great place to catch up with your fellow residents and complete your dictations.

All residents complete two weeks of Nephrology as a core rotation in R1. This is a great rotation to learn about chronic kidney disease, working up AKIs, and better understand how dialysis works. Most residents also get to participate in starting dialysis lines as well.

All residents also complete two weeks in Anesthesia, which comes with practice managing airways for a variety of different procedures and a better understanding of cardiopulmonary physiology/pathology.

We’re convenient! When you move to Abbotsford everyone is able to get to the hospital or their family medicine clinic within a ten-minute drive. We also have our own Walmart and Costco for your shopping pleasure!

2nd year call is “Choose Your Own Adventure“! Residents can choose Hospitalist, Emergency, Peds ER, Youth Clinic, Obstetrics, and CCU.

There’s an Addictions Medicine rotation integrated into the second year core curriculum. This highlights the social context of disease and familiarizes residents with the key principles of managing a complex psychosocial illness.

Special interest opportunities in Youth Medicine, Prison Medicine, Maternity Care, and Telehealth.Generally the only learner on each rotation. This means that you receive 1-on-1 education from staff that is tailored to your skill level and understanding. This also means that you’re first in line for choosing consults, procedures, and all the other cool things you’ll encounter!

Abbotsford and Mission doctors, regardless of their specialty, are extremely kind and love to teach residents. Many of the in-house specialists are happy to have you tag along for practice with procedures and skills – everyone at ARH is extremely nice and happy to make your residency experience the best one it can be!

Abbotsford is a close-knit town that’s easy to integrate into. You’ll find yourself included on all sorts of socials, both in our resident group and with your clinic/rotation. There’s lots to do including many local breweries, delicious dining options, and blueberry/fruit picking in the summer (we’re the blueberry capital)!

We’re happy to answer any questions you may have! Send your emails to

The Impacts of Flooding on Health

“Flooding is a seasonal hazard that many communities in the BC Interior encounter. It has become, and will likely continue to be, more frequent and more severe. Flooding affects not only health but also infrastructure and communities. Between 80% and 90% of all documented disasters from natural hazards in the last 10 years have resulted from floods, droughts, heat waves, and severe storms. The extreme conditions they generate are expected to increase due to climate change and will impact health.

Flooding impacts health directly, as well as indirectly through infrastructure and community disruption. Although young men are most at risk of mortality due to flooding, those most vulnerable to mental and physical effects are women, the elderly, and children. Individuals affected by flooding are at least 5 times more likely to suffer from anxiety and depression. Those who experience disruption to utility infrastructure or increased floodwater depth have even higher odds of both outcomes. Repeat flooding events lead to a higher prevalence of depression, quality-of-life measures such as chronic pain, and disrupted access to usual activities, with impacts persisting for multiple years.

Our personal clinical experience from living in flooded areas has shown that although Canadians are often spared from the acute effects of flooding, such as death and injury, intermediate effects are pronounced, including impacts on underlying health conditions and damage to infrastructure; long-term effects include worsening mental health, poverty, displacement, and community change. Many individuals in flood-prone areas live in homes that are not insurable against flooding, with studies showing increased mental distress among the uninsured. Flooding in Grand Forks in 2018 led to displacement of an entire neighborhood, further contributing to housing instability for many families. Individuals living there tended to be low income before the flood and after being displaced found themselves largely unable to secure reliable housing in a constricted housing market. In the severe 2021 flooding in Princeton, damage to vulnerable infrastructure resulted in evacuation of long-term care facilities due to inadequate heat as well as a multiweek hospital closure due to water damage. Loss of critical infrastructure, when it is most needed, is a serious health challenge.”

More on the Impacts of Health on Flooding via BCMJ.