Impact of the Terrorist Bombings of the Neve Shalom and Beth Israel Synagogues on a Hospital in Istanbul, Turkey

Abstract

Objectives: The authors sought to estimate the impact of the open-air mass-casualty terrorist bombings of the Neve Shalom and Beth Israel Synagogues in Istanbul, Turkey, on November 15, 2003, on the American Hospital (AH) in terms of resource utilization, epidemiologic outcomes, and time course of emergency needs. Methods: A retrospective descriptive study using data from hospital records of injured survivors who used the emergency department at AH on November 15, 2003, to determine the number and percentage of injured survivors who were hospitalized, received operative care, had specific injury types, had an Injury Severity Score $16, died, and arrived within certain time intervals. Results: AH received 69 (91%) injured survivors from the scene, of which nine (12%) were hospitalized and three (4%) received operative care. Starting four hours after the initial blast, seven (9%) injured survivors were transferred to AH from other hospitals, of which five (7%) were hospitalized and four (5%) received operative care. Of the 49 injured survivors from the scene with documented injuries, 43 (88%) had injuries to the head or face, 42 (86%) had lacerations, five (10%) had fractures, one (2%) had a penetrating eye injury, one (2%) had a serious intracranial injury, and none had primary blast injuries. Four (5%) injured survivors at AH had an Injury Severity Score $16, and none died. Conclusions: Seventy-six injured survivors used the emergency department at AH, including a delayed wave of injured survivors transferred from other hospitals. The majority of injured survivors with documented injuries had non-life-threatening lacerations of the head or face, and relatively few injured survivors were hospitalized or received operative care. ACADEMIC EMERGENCY MEDICINE 2005; 12:135-141.

The neurological consequences of explosives

“…Victims who are not breathing at the site, who have 100% body burns, or who have fixed and dilated pupils, do not survive, and resuscitation is discouraged. The walking wounded will take themselves for attention, and this is where the secondary triage assures that the most severely wounded, who usually arrive later from the scene, receive the more critical immediate hospital attention before those who arrive injured, but awake and ambulatory [2,5,7,9,10,[24][25][26].…”

Review of On-Scene Management of Mass-Casualty Attacks

“…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]. In a study of 33 MCAs, Einav and colleagues [96] found that roughly a fifth (n = 236; 20.4%) of the injured were considered urgent casualties.…”

“…In a study of 33 MCAs, Einav and colleagues [96] found that roughly a fifth (n = 236; 20.4%) of the injured were considered urgent casualties. Consequently, a large majority of surviving victims can likely be triaged and treated on an outpatient basis [17,97]. Medical preparedness should anticipate most injuries from bombings to be nonfatal secondary and tertiary blast injuries [9,10,44,81,97].…”

“…A study of 647 terrorist bombing survivors showed that all casualties with BLIs had a fully developed clinical picture in the first hour after admission and that intestinal blast injury were rare and typically associated with other severe injuries [13]. Secondary blast injuries (SBI) occur when objects accelerated by the energy of the explosion strike a victim, often causing the most numerous injuries from blunt or penetrating ballistic trauma [14,15,17]. Tertiary blast injuries (TBI) can be viewed as the converse of SBI; the missile is stationary and the victim is propelled by expanding gases from high winds, resulting in a high incidence of blunt trauma from tumbling and impacting objects [15,98].…”

“…The setting of modern urban terrorist bombings also means that civilian medical systems are confronted with patients arriving at the hospital alive who would likely have died of their injuries in previous conventional war settings [6]. Moreover, there is a difference in those at risk of injury in a military setting versus those in a civilian setting, where the civilian environment includes children and the elderly [16][17][18][19]. Antagonistic acts thus result in injuries that are not commonly encountered in the civilian environment and also augment the challenges of an unintentional mass-casualty incident by adding the factor of a hostile environment which together, demand other approaches by the responders on scene.…”