Inappropriate distribution of casualties in mass casualty incidents (MCIs) may result in patient overload in primary medical facilities.

The aim of this study was to review the consequences of evacuating casualties from a bus accident to a single rural hospital and lessons learned regarding policy of casualty evacuation.

Hospital medical records of all casualties from primary and tertiary hospitals were independently reviewed by two senior trauma surgeons. In addition four senior trauma surgeons reviewed the impact of treatment provided in the primary hospital on patient outcomes.

31 survivors from the accident were transferred to the closest local hospital; 4 died en route to the hospital or within 30 minutes of arrival. 27 casualties were air evacuated from the local hospital within 2.5 to 6.15 hours to level I and II hospitals. Under-triage of 15% and over-triage of 7% were noted. 4 casualties did not receive treatment at the local hospital that might have improved their condition.

Over and under-triage might have been due to minimal trauma related experience of primary hospital personnel. Evacuation of casualties from an MCI to a limited capacity hospital may overwhelm the facility and affect its ability to provide appropriate medical care.

In MCIs occurring in rural areas, only immediate unstable casualties should be transferred to the closest primary hospital. On-site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.

The objective of this study was to compare injuries and hospital utilization and outcomes from terror and war for civilians and soldiers.

Injuries from terrorism and war are not necessarily comparable, especially among civilians and soldiers. For example, civilians have less direct exposure to conflict and are unprepared for injury, whereas soldiers are psychologically and physically prepared for combat on battlefields that often are far from trauma centers. Evidence-based studies distinguishing and characterizing differences in injuries according to conflict type and population group are lacking.

A retrospective study was performed using hospitalization data from the Israel National Trauma Registry (10/2000–12/2006).

Terrorism and war accounted for trauma hospitalizations among 1,784 civilians and 802 soldiers. Most civilians (93%) were injured in terrorism and transferred to trauma centers by land, whereas soldiers were transferred by land and air. Critical injuries and injuries to multiple body regions were more likely due to terrorism than war. Soldiers tended to present with less severe injuries from war than from terrorism. Rates of first admission to orthopedic surgery were greater for all casualties with the exception of civilians injured in terrorism who were equally likely to be admitted to the intensive care unit. In-hospital mortality was higher among terrorism (7%) than war (2%) casualties, and particularly among civilians.

This study provides evidence that substantial differences exist in injury characteristics and hospital resources required to treat civilians and soldiers injured in terrorism and war.

In the Indonesian earthquake a total 21 USAR teams comprising upward of 688 rescue personnel and 67 dogs. The cost of which was estimated at tens of millions of dollars did not succeed in extricating any trappers. In Haiti, there were around 350000 casualties and 250000 dead. In this disaster 43 international USAR missions comprising over 1700 rescuers were deployed. These teams succeeded in rescuing approximately 134 trapped people, an average of about 3 trapped people per mission. During this period one field hospital treated a total of 1,111 people, 737 of these patients were hospitalized, 243 surgical procedures were carried out, of which at least 200 were life-saving procedures. In addition many other life-saving procedures that were not directly related to the injuries inflicted as a result of the earthquake were also carried out. Without the resources of the field hospital it is very possible that most of the trappers would not have survived. It mean; One field hospital (personal: 120 people) was able to save more people than 43 USAR teams, all of the highly dedicated and professional, who worked day and night to extricate people trapped.ngs. It seems that there is no need to carry out a complex economic analysis in order to determine the cost benefits and understand the significance of providing field hospitals and clinics as soon as possible after the occurrence of a disaster stemming from an earthquake. A consensus/brainstorming conference is needed.

To formulate a logical and balanced approach to configuring and dispatching rescue and medical missions. The major goal of the conference would be to establish the guidelines for rescue missions that will result in the rescue of the maximum number of people, and to provide guidelines for the provision humanitarian aid in parallel to the rescue missions.