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Mass-Casualty, Terrorist Bombings: Epidemiological Outcomes, Resource Utilization, and Time Course of Emergency Needs (Part I)

Published online by Cambridge University Press:  28 June 2012

Jeffrey L. Arnold*
Yale New Haven Center for Emergency and Terrorism Preparedness, New Haven, Connecticut, USA
Ming-Che Tsai
Department of Emergency and Trauma Service, National Cheng-Kung University Hospital, Tainan, Taiwan, Republic of, China
Pinchas Halpern
Department of Emergency Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
Howard Smithline
Department of Emergency Medicine, Tufts University School of Medicine, Baystate Medical Center, Springfield, MA, USA
Edita Stok
Ministry of Health, Ljubljana, Slovenia
Gurkan Ersoy
Department of Emergency Medicine, Dokuz Eylul University Medical Center, Izmir, Turkey
Medical Director, Yale New Haven Center for Terrorism and Emergency Preparedness, 1 Church Street, 5th Floor, New Haven, CT 06510 USA, E-mail:



This article characterizes the epidemiological outcomes, resource utilization, and time course of emergency needs in mass-casualty, terrorist bombings producing 30 or more casualties.


Eligible bombings were identified using a MEDLINE search of articles published between 1996 and October 2002 and a manual search of published references. Mortality, injury frequency, injury severity, emergency department (ED) utilization, hospital admission, and time interval data were abstracted and relevant rates were determined for each bombing. Median values for the rates and the inter-quartile ranges (IQR) were determined for bombing subgroups associated with: (1) vehicle delivery; (2) terrorist suicide; (3) confined-space setting; (4) open-air setting; (5) structural collapse sequela; and (6) structural fire sequela.


Inclusion criteria were met by 44 mass-casualty, terrorist bombings reported in 61 articles. Median values for the immediate mortality rates and IQRs were: vehicle-delivery, 4% (1–25%); terrorist-suicide, 19% (7–44%); confined-space 4% (1–11%); open-air, 1% (0–5%); structural-collapse, 18% (5–26%); structural fire 17% (1–17%); and overall, 3% (1–14%). A biphasic pattern of mortality and unique patterns of injury frequency were noted in all subgroups. Median values for the hospital admission rates and IQRs were: vehicle-delivery, 19% (14–50%); terrorist-suicide, 58% (38–77%); confined-space, 52% (36–71%); open-air, 13% (11–27%); structural-collapse, 41% (23–74%); structural-fire, 34% (25–44%); and overall, 34% (14–53%). The shortest reported time interval from detonation to the arrival of the first patient at an ED was five minutes. The shortest reported time interval from detonation to the arrival of the last patient at an ED was 15 minutes. The longest reported time interval from detonation to extrication of a live victim from a structural collapse was 36 hours.


Epidemiological outcomes and resource utilization in mass-casualty, terrorist bombings vary with the characteristics of the event.

Original Research
Copyright © World Association for Disaster and Emergency Medicine 2003

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