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Abstract

The Omagh bombing in August 1998 produced many of the problems documented in other major incidents. An initial imbalance between the demand and supply of clinical resources at the local hospital, poor information due to telecommunication problems, the need to triage victims and the need to transport the most severely injured significant distances were the most serious issues. The Royal Group Hospitals Trust (RGHT) received 30 severely injured secondary transfers over a 5-hour period, which stressed the hospital's systems even with the presence of extra staff that arrived voluntarily before the hospital's major incident plan was activated. Many patients were transferred to the RGHT by helicopter, but much of the time the gained advantage was lost due to lack of a helipad within the RGHT site. Identifying patients and tracking them through the hospital system was problematic. While the major incident plan ensured that communication with the relatives and the media was effective and timely, communication between the key clinical and managerial staff was hampered by the need to be mobile and by the limitations of the internal telephone system. The use of mobile anaesthetic teams helped maintain the flow of patients between the Emergency Department and radiology, operating theatres or the intensive care unit (ICU). The mobile anaesthetic teams were also responsible for efficient and timely resupply of the Emergency Department, which worked well. In the days that followed many victims required further surgical procedures. Coordination of the multidisciplinary teams required for many of these procedures was difficult. Although only seven patients required admission to adult general intensive care, no ICU beds were available for other admissions over the following 5 days. A total of 165 days of adult ICU treatment were required for the victims of the bombing.

Review of On-Scene Management of Mass-Casualty Attacks

“…One of the most frequent problems with communication is technical inadequacy, shown by overload of landline tele-phones, mobile networks, and radio-channels on walkietalkies [7,20,28,30,31,39,42,44,46,53,[61][62][63][64][65]. Equipment failure has also been caused by actual physical damage to the communication infrastructure [40,64,68].…”

“…Incompatible equipment and separate coordination centers between involved emergency organizations and between civilian and military actors have likewise caused communication and cooperation problems [30,65]. Consequences of equipment breakdown include inability to call in more staff or resources, failure to keep track of units on scene or inform them of safety issues, or prompting staff to drive to the scenes without knowing where to respond and stage [39,42,62,66]. To overcome communication shortfalls on scene, hand-held megaphones, runners, and hand signals can be used, but hand signals would require clear visibility and prior training [20,32,35,42].…”

“…Other communication solutions seen have been cellphone providers donating phones and activating reserve system capacity [46] or an alternative system for emergency communication only [62]. For maximum effectiveness, schemes of access overload control need to be pre-arranged [57].…”

“…Bombings, however, constitute the most common way to perpetrate terrorist attacks [75], which is why some aspects relevant for triage and treatment of blast injuries in the prehospital stage will be presented more in depth. A characteristic injury pattern of bomb explosions is one of a complex but often non-lethal nature, where most casualties do not require hospitalization as only a small number have severe injuries [9,32,39,55,62,75,82,90,[93][94][95][96]. The vast majority of deaths from bombings usually take place at the scene or en route to the hospital, followed by few early and occasional late deaths [17,58,62,97].…”

“…Several incidents have amounted to large groups of self-deployed medically trained "freelancers" and other volunteers; people approaching the scene or hospitals on their own initiative [39,44,46,48,55,62,83,106]. This has sometimes been discouraged and at other times encouraged, highlighting the importance of incorporating bystander response in response plans and training [20,29,57].…”