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Objectives: This prospective, nationally representative, multi-centre study was undertaken to assess noncollision injuries sustained by public bus passengers in Israel. Methods: The emergency departments (EDs) of six medical centres, which participated in this eight month study, were chosen to represent both urban and rural catchment areas. All patients diagnosed with injuries sustained on a public bus not involved in a road traffic accident were promptly evaluated for mechanism and nature of injury and demographic parameters. Results: The study cohort consisted of 120 patients (86 were female, 34 were male, age range 3-89 years). Over half were older than 55 years. The most common injuries were to the limbs, vertebral column, and head. The major mechanism of injury was acceleration/deceleration. Most patients were standing when they sustained the injuries. There were no fatalities, and 17 patients were admitted to hospital (9 of 17, 52% older than 55 years). Extrapolation to yearly national statistics suggests a probable total of 729 such injuries. Conclusion: The significant injuries inflicted on passengers of public buses not involved in road traffic accidents warrant decisive preventative measures by transportation authorities.

Extraperitoneal rectal gunshot injuries are rare, but may be encountered in civilian practice. We report on a series of 26 such cases. The aim of the study is to attempt to evolve a treatment policy of this injury. The principles of management include the repair of rectal wound in selected cases and the formation of a diverting colostomy. Distal rectal washout and presacral drainage, although advocated by some authors, do not seem to be indispensable adjuncts to the management of these injuries.

Mass casualty incidents (MCI) resulting from terrorist bombings pose special problems and may overwhelm even the most experienced trauma centre. Although role assignments for MCI management and control are documented, we would like to share several aspects that we have found to be crucial for the management of terrorist bombing MCI. Twelve topics and possible answers were brought up and discussed extensively in MCI debriefing sessions in our institution. They were of two main categories: assignments and functions of key personnel, and principles and definitions. The first category includes the Triage Officer, the Medical Director, the Administrative Director, the Head Nurse, the Emergency Medical System Coordinator, the Blood Bank Liaison, and the trauma teams. The second category encompasses the concept of triage hospital, the unidirectional patient flow, ancillary evaluation during MCI, the consultancy, and tertiary survey. All were identified as critical for proper event handling. The integration and implementation of the topics discussed throughout the medical system may enable emergency departments to handle MCI resulting from terrorist bombings better.

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Penetrating cardiac injuries are an increasing cause of traumatic deaths in urban areas. The management of these injuries has undergone a transition from simple pericardiocentesis to cardiac ultrasound evaluation in the stable patient, and emergency thoracotomy and repair of myocardial wounds in the unstable patient in extremes. The incidence of traumatic coronary artery injury is not accurately known because not all victims are examined. With the improvement in emergency medical services, including speed of transportation of these patients, better resuscitation, and knowledgeable use of cardiac ultrasound or emergency room thoracotomy, more patients with coronary artery injuries will survive and reach the operating room. The operative management of the injured coronary artery is dependant on the location of the injury and whether there is myocardial dysfunction. Distal injuries with small myocardial infarction should be treated by ligation alone. Proximal injury and those injuries associate with larger area of ischaemia or infarction are best treated with coronary artery bypass. The role of cardiopulmonary bypass pump in these patients should be evaluated depending on the homodynamic stability of the patient. We present two cases of cardiac stab wounds with transection of the left anterior descending (LAD), which were successfully managed. A literature review regarding the management of combined cardiac and coronary artery injuries is also provided.

The use of occluder pins to stop bleeding from intercostal arteries may be life-saving.