Lessons Learned from Cross-border Medical Response to the Terrorist Bombings in Tabba and Ras-el-Satan, Egypt, on 07 October 2004

Abstract

Introduction:Large-scale, terrorist attacks can happen in peripheral areas, which are located close to a country's borders and far from its main medical facilities and involve multi-national casualties and responders. The objective of this study was to analyze the terrorist suicide bombings that occurred on 07 October 2004, near the Israeli-Egyptian border, as representative of such a complex scenario.Methods:Data from formal debriefings after the event were processed in order to learn about victim outcomes, resource utilization, critical events, and time course of the emergency response.Results:A total of 185 injured survivors were repatriated: four were severely wounded, 13 were moderately injured, and 168 were mildly injured. Thirty-eight people died. A forward medical team landed at the border town's airport, which provided reinforcement in the field and in the local hospital. Israeli and Egyptian search and rescue teams collaborated at the destruction site. One-hundred sixty-eight injured patients arrived at the small border hospital that rapidly organized itself for the mass-casualty incident, operating as an evacuation “staging hospital”. Twenty-three casualties secondarily were distributed to two major trauma centers in the south and the center of Israel, respectively, either by ambulance or by helicopter.Conclusion:Large-scale, terrorist attacks at a peripheral border zone can be handled by international collaboration, reinforcement of medical teams at the site itself and at the peripheral neighboring hospital, rapid rearrangement of an “evacuation hospital”, and efficient transport to trauma centers by ambulances, helicopters, and other aircraft.

A single, improvised "Kassam" rocket explosion can cause a mass casualty incident: a potential threat for future international terrorism?

“…Such a structure demands efficient information sharing in real time. Hospital notification was delayed (31 minutes) compared with MCI that have occurred in Israel in the past 3 years, when it took between one and 11 minutes from the explosion to alert the hospitals 6 8 9 13 14. Better coordination between participating operational centres could ensure better results.…”

“…This may be caused by different bomb build and the spread of the soldiers over a larger area than the crowds in open market places, malls or hotels in which suicide bombers detonated themselves 6 – 8 10 – 11 13. In three suicide bomber explosions the prevalence of moderately and severely injured casualties was between 3% and 10%, probably because the suicide bomber was discovered by the security forces before he could approach the crowd and detonated himself far away from it 9 12 15…”

Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv

“…Data were organised according to the Disastrous Incidents Systematic AnalysiS Through – Components, Interactions, and Results (DISAST-CIR) methodology 3 – 9 11. This methodology uses the information gathered by prospective systematic structured debriefings of all the organisations involved in the event and a prospective review of the computer system data and the patient medical charts from the EMS and the hospitals.…”

“…We believe that lessons learned from every such event must be prospectively described and analysed using the same methodology to allow generalisation from the accumulated experience and to draw conclusions from them. Such a methodology was recently described and used by our group in previous articles 3 – 9 11…”

SAGEC 67, a free-access database linking at least three countries, for finding spare beds in the event of a mass casualty incident

“…We decided to extend the software to deal with such a situation, with the aim of providing as fast a response as possible, given the known difficulty after triage of dispatching victims to the right beds [8]. We appreciated the need at that time to cooperate internationally, and initially by sharing experiences of mass casualty incidents between the three countries, as has been done in other countries [9]. In such an event, the software gives the exact location by GPS and Google map and specifies whether or not a dropping zone is available in the chosen medical structure.…”