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Leveraging Social Media in a Sarin Attack

By Amesh A. Adalja, MD, FACP, FACEP, May 13, 2014

As the use of mobile phone-based technology has increased, there has been much discussion about how the widespread availability of these and related devices can augment the provision of health care. Mobile phones are capable of doing much more than facilitating voice communication and text messaging. Much of the interest to date has focused on the ability to survey social media sites such as Twitter and Facebook to determine the trajectory of an infectious disease outbreak such as influenza. However, the use of cameras with video recording capabilities also can provide real-time viewing of actual patients facilitating telemedicine interventions. A new paper details how this technology can be used in a setting far removed from traditional healthcare settings: the sarin attacks employed in the Syrian conflict.

Social Media Videos Reviewed

On August 21, 2013, approximately 1,400 individuals were killed and thousands more were injured during a sarin attack in Damascus. Myriad videos portraying the victims were posted to YouTube. An Israeli research team, in a paper published in Annals of Internal Medicine, attempted to determine if social media videos could be used in diagnosing sarin poisoning.

In this study, Rosman et al. searched for videos on YouTube that were uploaded between August 21, 2013, and September 15, 2013, with relevant keywords. Videos that focused on victims for at least 3 seconds were sought. Ultimately, 67 videos of 130 casualties (amounting to 114 minutes) were included in the analysis. Two experienced physicians analyzed the video and scored each video for several signs consistent with sarin poisoning (eg, miosis, diaphoresis, etc), the presence of decontamination procedures, and treatment interventions.

The review of videos by the 2 physicians had excellent interobserver agreement and revealed that:

  • 60% of victims were children
  • 91.5% were classified as moderate or severely injured
  • 14% exhibited miosis
  • 48% exhibited diaphoresis
  • 53% exhibited dyspnea
  • 41% were unconscious

Interestingly, the researchers found no evidence of standard monitoring equipment, only 25% of videos showed evidence of decontamination procedures, and no personal protective equipment was employed in any video. The percentages were congruent with official UN estimates.

A New Paradigm?

This study is a proof-of-concept showing that social media videos can provide accurate and timely information needed in a complex mass casualty situation. Furthermore, such information is interpretable by physicians and capable of providing a realistic assessment of a situation. Future events will undoubtedly prompt further use of social media. Preparedness and response efforts should be poised to use the data generated in order to gain situational awareness and optimize operational activities.


Rosman Y, Eisenkraft A, Milk N, et al. Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media. Ann Intern Med 2014;160:644-648.