Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-21T16:15:24.388Z Has data issue: false hasContentIssue false

Mass-Casualty, Terrorist Bombings: Implications for Emergency Department and Hospital Emergency Response (Part II)

Published online by Cambridge University Press:  28 June 2012

Pinchas Halpern
Affiliation:
Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Ming-Che Tsai
Affiliation:
Department of Emergency and Trauma Service, National Cheng-Kung University Hospital, Tainan, Taiwan, Republic of, China
Jeffrey L. Arnold*
Affiliation:
Yale New Haven Health System, New Haven, Connecticut, USA
Edita Stok
Affiliation:
Ministry of Health, Ljubljana, Slovenia
Gurkan Ersoy
Affiliation:
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: jeffrey.arnold@yale.edu

Abstract

This article reviews the implications of mass-casualty, terrorist bombings for emergency department (ED) and hospital emergency responses. Several practical issues are considered, including the performance of a preliminary needs assessment, the mobilization of human and material resources, the use of personal protective equipment, the organization and performance of triage, the management of explosion-specific injuries, the organization of patient flow through the ED, and the efficient determination of patient disposition. As long as terrorists use explosions to achieve their goals, mass-casualty, terrorist bombings remain a required focus for hospital emergency planning and preparedness.

Type
Special Report
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Arnold, J, Tsai, M-C, Halpern, P, Smithline, H, Stok, E, Ersoy, G: Mass-casualty, terrorist bombings: Epidemiological outcomes, resource utilization, and time-course of emergency needs (Part I). Prehosp Disast Med 2003; 18(3): 220234.CrossRefGoogle ScholarPubMed
2.Pesola, GR, Dujar, A, Wilson, S: Emergency preparedness: The World Trade Center and Singapore Airline disasters. Acad Emerg Med 2002; 9: 220222.CrossRefGoogle ScholarPubMed
3. Hospital Emergency Incident Command System Update Project: HEICS We b site. Available at http:www.emsa.cahwnet.gov. Accessed 20 February 2002.Google Scholar
4.Katz, E, Ofek, B, Adler, J, et al: Primary blast injury after a bomb explosion in a civilian bus. Ann Surg 1989; 209: 484488.CrossRefGoogle Scholar
5.Leibovici, D, Gofrit, ON, Stein, M, et al: Blast injuries — Bus versus open-air bombings: A comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma 1996; 41: 10301035.CrossRefGoogle ScholarPubMed
6.Hogan, DE, Waeckerle, JF, Dire, DJ, Lillibridge, SR: Emergency department impact of the Oklahoma City terrorist bombing. Ann Emerg Med 1999; 34: 160167.CrossRefGoogle ScholarPubMed
7.Biancolini, CA, Del Bosco, CG, Jorge, MA: Argentine Jewish community institution bomb explosion. J Trauma 1999; 47: 728732.CrossRefGoogle ScholarPubMed
8.Johnstone, DJ, Evans, SC, Field, RE, Booth, SJ: The Victoria bomb: A report from the Westminster Hospital. Injury 1993; 24: 59.CrossRefGoogle ScholarPubMed
9.Rignault, DP, Deligny, MC: The 1986 terrorist bombing experience in Paris. Ann Surg 1989; 209: 368373.CrossRefGoogle ScholarPubMed
10.Brown, MG, Marshall: The Enniskillen bomb: A disaster plan. BMJ 1988; 297: 11131116.CrossRefGoogle ScholarPubMed
11.Caro, D, Irving, M: The Old Bailey bomb explosion. Lancet 1973; 1: 14331435.CrossRefGoogle ScholarPubMed
12.Weiner, T: 1,800 Injured overwhelming Kenya Hospital. New York Times We b site. Available at www.nytimes.com. Accessed 09 August 1998.Google Scholar
13.Mallonee, S, Shariat, S, Stennies, G, et al: Physical injuries and fatalities resulting from the Oklahoma City bombing. JAMA 1996;276(5): 382387.CrossRefGoogle ScholarPubMed
14.Carley, SD, Mackway-Jones, K: The casualty profile from the Manchester bombing 1996: a proposal for the construction and dissemination of casualty profiles from major incidents. J Accid Emerg Med 1997; 14: 7680.CrossRefGoogle ScholarPubMed
15.Adler, J, Golan, E, Golan, J, et al: Terrorist bombing experience during 1975–79. Casualties admitted to the Shaare Zedek Medical Center. Isr J Med Sci 1983; 19(2): 189193.Google Scholar
16.Williams, KN, Squires, S: Experience of a major incident alert at two hospitals: “The Soho Bomb”. Br J Anaesth 2000; 85: 322324.CrossRefGoogle Scholar
17.Tucker, K, Lettin, A: The Tower of London bomb explosion. BMJ 1975; 3: 287290.CrossRefGoogle Scholar
18.Frykberg, ER, Tepas, JJ, Alexander, RH: The 1983 Beirut Airport terrorist bombing. Injury patterns and implications for disaster management. Am Surg 1989; 55: 134141.Google ScholarPubMed
19.SoRelle, R: Terrorism's trajectory through NY EDs leaves helplessness, frustration, and sorrow. Emerg Med News 2001; 23: 1, 2022.Google Scholar
20.Gans, L, Kennedy, T: Management of unique clinical entities in disaster medicine. Emerg Med Clin North Am 1996; 14: 301326.CrossRefGoogle ScholarPubMed
21.Caseby, NG, Porter, MF: Blast injuries to the lungs. Clinical presentation, management and course. Injury 1976; 8: 112.CrossRefGoogle Scholar
22.Kerr, AG, Byrne, JET: Blast injuries of the ear. BMJ 1975; 1: 559561.CrossRefGoogle ScholarPubMed
23.Mellor, SG: The pathogenesis of blast injury and its management. Br J Hosp Med 1988; 39: 536539.Google ScholarPubMed
24.Stapczynski, JS: Blast injuries. Ann Emerg Med 1982; 11: 687694.CrossRefGoogle ScholarPubMed
25.Wightman, JM, Gladish, SL: Explosions and blast injuries. Ann Emerg Med 2001; 37: 664678.CrossRefGoogle ScholarPubMed
26.Hodgetts, TJ: Lessons from the Musgrave Park Hospital bombing. Injury 1993; 24: 219221.CrossRefGoogle ScholarPubMed
27.Cooper, GJ, Maynard, RL, Cross, NL, Hill, JF: Casualties from terrorist bombings. J Trauma 1983; 23: 955967.CrossRefGoogle ScholarPubMed
28.Scott, BA, Fletcher, JR, Pulliam, MW: The Beirut terrorist bombing. Neurosurgery. 1986; 18: 107110.CrossRefGoogle ScholarPubMed
29.Gray, RC, Coppel, DL: Intensive care of patients with bomb blast and gunshot injuries. BMJ 1975; 1: 502504.CrossRefGoogle ScholarPubMed
30.Stein, M, Hirshberg, A: Medical consequences of terrorism. Surg Clin North Am 1999; 79: 15371552.CrossRefGoogle ScholarPubMed
31.De Candole, CA: Blast injury. Can Med Ass J 1967; 96: 207214.Google ScholarPubMed
32.Coppel, DL: Blast injuries of the lungs. Br J Surg 1976; 63: 735737.CrossRefGoogle ScholarPubMed
33.Uretzky, G, Cotev, S: The use of continuous positive pressure in blast injuries of the chest. Crit Care Med 1980; 8: 486489.CrossRefGoogle ScholarPubMed
34.Boffard, K, MacFarlane, C: Urban bomb blast injuries: patterns of injury and treatment. Surg Annu 1993; 25(Pt 1): 2947.Google ScholarPubMed
35.Pizov, R, Oppenheim-Eden, A, Matot, I, et al: Blast lung injury from an explosion on a civilian bus. Chest 1999; 115: 165172.CrossRefGoogle ScholarPubMed
36.Waterworth, TA, Carr, MJT: Report on injuries sustained by patients treated at the Birmingham General Hospital following the recent bomb explosions. BMJ 1975: 2: 2527.CrossRefGoogle ScholarPubMed
37.Leibovici, D, Gofrit, ON, Shapira, SC: Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med 1999; 34: 168172.CrossRefGoogle ScholarPubMed
38.Walsh, RM, Pracy, JP, Huggon, AM, Gleeson, MJ: Bomb blast injuries to the ear: The London Bridge incident series. J Accid Emerg Med 1995; 12: 194198.CrossRefGoogle Scholar
39.Frykberg, ER, Tepas, JJ: Terrorist bombings. Lessons learned from Belfast to Beirut. Ann Surg 1988; 208: 569576.CrossRefGoogle ScholarPubMed
40.Hill, JF: Blast injury with particular reference to recent terrorist bombings incidents. Ann Roy Coll Surg Engl 1979; 61: 411.Google ScholarPubMed
41.Kennedy, TL, Johnston, GW: Civilian bombing injuries. BMJ 1975; 1: 382383.CrossRefGoogle Scholar
42.Mines, M, Thach, A, Mallonee, S, et al: Ocular injuries sustained by survivors of the Oklahoma City bombing. Ophthalmology 2000; 107: 837843.CrossRefGoogle ScholarPubMed
43.Thach, AB, Ward, TP, Hollifield, RD, et al: Eye injuries in a terrorist bombing: Dhahran, Saudi Arabia, June 25, 1996. Ophthalmology 2000; 107: 844847.CrossRefGoogle Scholar
44.Connaughton, D: Heroes of September 11 tell their stories. ACEP News 2001; pp 1, 10.Google Scholar
45.Rutherford, WH: Experience in the Accident and Emergency Department of the Royal Victoria Hospital with patients from civil disturbances in Belfast 1969–1972, with a review of disasters in the United Kingdom 1951–1971. Injury 4(3): 189199.CrossRefGoogle Scholar
46.Boehm, TM, James, JJ: The medical response to the La Belle Disco bombing in Berlin, 1986. Mil Med 1988; 153: 235238.CrossRefGoogle Scholar
47.Hirshberg, A, Stein, M, Walden, R: Surgical resource utilization in urban terrorist bombing: A computer simulation. J Trauma 1999; 47: 545550.CrossRefGoogle ScholarPubMed
48.Brismar, B, Bergenwald, L: The terrorist bomb explosion in Bologna, Italy, 1980: An analysis of the effects and injuries sustained. J Trauma 1982; 22: 216220.CrossRefGoogle ScholarPubMed
49.Huller, T, Bazini, Y: Blast injuries of the chest and abdomen. Arch Surg 1970; 100: 2430.CrossRefGoogle ScholarPubMed
50.Paran, H, Neufeld, D, Shwartz, I, et al: Perforation of the terminal ileum induced by blast injury: Delayed diagnosis or delayed perforation? J Trauma 1996; 40: 472475.CrossRefGoogle ScholarPubMed
51.Finnegan, AP, Cumming, PA, Piper, ME: Critical incident stress debriefing following the terrorist bombing at army headquarters Northern Ireland. J R Army Med Corps 1998; 144: 510.CrossRefGoogle ScholarPubMed
52.Bisson, JI, Jenkins, PL, Alexander, J, et al: Randomised controlled trial of psychological debriefing for victims of acute burn trauma. Br J Psychiatry 1997; 171: 7881.CrossRefGoogle ScholarPubMed
53.Budd, F.Helping the helpers after the bombing in Dhahran: Critical incident stress services for an air rescue squadron. Mil Med 1997; 162: 515520.CrossRefGoogle ScholarPubMed
54.Deahl, MP, Gillham, AB, Thomas, J, Searle, MM, Srinivasan, M: Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing. Br J Psychiatry 1994; 165: 6065.CrossRefGoogle ScholarPubMed
55.Lyons, HA: Terrorists’ bombing and the psychological sequelae. J Irish Med Assoc 1974; 67: 1519.Google ScholarPubMed