Mass-Casualty, Terrorist Bombings: Implications for Emergency Department and Hospital Emergency Response (Part II)

Abstract

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.

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].…”

Traumatic brain injury

“…Additionally, collapse of buildings or surrounding structures confers a raised risk of severe tertiary blast injury both directly by injury to the head and by causing increased secondary insults through primary crush asphyxia and the consequences of extracranial injury [22][23][24][25][26].…”

Civilian Preparedness and Counter-terrorism: Conventional Weapons

“…Immediately upon learning about an event, the hospitals in the vicinity should perform a preliminary needs assessment [20] to identify key information from local EMS, police sources, or perhaps patients already arriving at the hospital [16]. Because the ED is probably the place in the hospital where the news is first received, an ED staff member should be assigned this task.…”

“…Essential information to be collected includes 1. Identification of the bombing site, which suggests the number of potential victims at risk, the proximity to the hospital, and the potential distribution of casualties through EMS [20] 2. Further information about the bombing characteristics, including use of a vehicle delivery system, explosion setting, and explosion sequelae, which helps identify the resources that should be mobilized (Table 1) [20] Ideally, before patients start arriving, the ED should accomplish several key tasks:…”