Introduction:This article characterizes the epidemiological outcomes, resource utilization, and time course of emergency needs in mass-casualty, terrorist bombings producing 30 or more casualties.Methods: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.Results: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.Conclusion:Epidemiological outcomes and resource utilization in mass-casualty, terrorist bombings vary with the characteristics of the event.
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.
We investigated Turkish emergency physicians' views regarding family witnessed resuscitation (FWR) and to determine the current practice in Turkish academic emergency departments with regard to family members during resuscitation. A national cross-sectional, anonymous survey of emergency physicians working in academic emergency departments was conducted. Nineteen of the 23 university-based emergency medicine programs participated in the study. Two hundred and thirty-nine physicians completed the survey. Of the respondents, 83% did not endorse FWR. The most common reasons for not endorsing FWR was reported as higher stress levels of the resuscitation team and fear of causing physiological trauma to family members. Previous experience, previous knowledge in FWR, higher level of training and the acceptance of FWR in the institution where the participant works were associated with higher rates of FWR endorsement for this practice among emergency physicians.
An appropriate hemostatic dressing for prehospital use should lower mortality due to uncontrolled hemorrhage. In this study, the investigators explored the hemostatic effects of Microporous Polysaccharide Hemosphere (MPH) applied in a rat model with severe femoral artery bleeding. Twelve rats were randomly assigned to MPH and control groups: The femoral artery of each rat was pierced to initiate bleeding. Then, 0.25 g MPH was poured into the bleeding site. A 200-g scale weight was placed over the bleeding site for 30 sec. At 30-sec intervals, the scale weight was removed, and hemostasis was assessed visually. After 30 sec, if the bleeding had ceased, the test was scored and checked as "passed at 30 sec." If the bleeding had not stopped, the same procedures were repeated a maximum of 3 times. If hemostasis could not be achieved even after the third application, the test was scored as failed. The same sequence of procedures was repeated for the control group without use of MPH and with only standard compression. Application of MPH resulted in complete control of bleeding in 2 of 6, 4 of 6, and 6 of 6 rats at 30, 60, and 90 sec, respectively. In the control group, however, hemostasis could not be achieved in all 6 rats, even at 90 sec. The difference between the 2 groups was statistically significant (P=.007). Application of MPH and compression with a scale weight significantly decreased the time of hemostasis in the rat model with femoral arterial bleeding.
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