Medical consequences of suicide bombing mass casualty incidents: The impact of explosion setting on injury patterns

Kosashvili, Yona; Loebenberg, Mark I.; Lin, Guy; Peleg, Kobi; Feigenberg, Zvi; Kluger, Yoram; Blumenfeld, Amir

doi:10.1016/j.injury.2008.06.037

Cited by 31 publications

(14 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Terrorist acts not only result in death, illness, and severe injury to members of the public and emergency services, they also impact adversely on social cohesion, accentuating divisions between different racial and religious groups [59]–[61]. They raise legitimate fears about safety and security [61], [62].…”

Section: Discussionmentioning

confidence: 99%

Might Depression, Psychosocial Adversity, and Limited Social Assets Explain Vulnerability to and Resistance against Violent Radicalisation?

2014

View full text Add to dashboard Cite

BackgroundThis study tests whether depression, psychosocial adversity, and limited social assets offer protection or suggest vulnerability to the process of radicalisation.MethodsA population sample of 608 men and women of Pakistani or Bangladeshi origin, of Muslim heritage, and aged 18–45 were recruited by quota sampling. Radicalisation was measured by 16 questions asking about sympathies for violent protest and terrorism. Cluster analysis of the 16 items generated three groups: most sympathetic (or most vulnerable), most condemning (most resistant), and a large intermediary group that acted as a reference group. Associations were calculated with depression (PHQ9), anxiety (GAD7), poor health, and psychosocial adversity (adverse life events, perceived discrimination, unemployment). We also investigated protective factors such as the number social contacts, social capital (trust, satisfaction, feeling safe), political engagement and religiosity.ResultsThose showing the most sympathy for violent protest and terrorism were more likely to report depression (PHQ9 score of 5 or more; RR = 5.43, 1.35 to 21.84) and to report religion to be important (less often said religion was fairly rather than very important; RR = 0.08, 0.01 to 0.48). Resistance to radicalisation measured by condemnation of violent protest and terrorism was associated with larger number of social contacts (per contact: RR = 1.52, 1.26 to 1.83), less social capital (RR = 0.63, 0.50 to 0.80), unavailability for work due to housekeeping or disability (RR = 8.81, 1.06 to 37.46), and not being born in the UK (RR = 0.22, 0.08 to 0.65).ConclusionsVulnerability to radicalisation is characterised by depression but resistance to radicalisation shows a different profile of health and psychosocial variables. The paradoxical role of social capital warrants further investigation.

show abstract

Section: Discussionmentioning

confidence: 99%

Might Depression, Psychosocial Adversity, and Limited Social Assets Explain Vulnerability to and Resistance against Violent Radicalisation?

2014

View full text Add to dashboard Cite

show abstract

“…Open-air (OA) bombings, e.g. in outdoor cafés or bus stops, result in fewer casualties than those detonating in a confined-space (CS) setting, in addition to having lower immediate, and late, mortality rates [16,76,77]. Casualties of OA bombings, however, show higher rates of penetrating soft tissue injury due to shrapnel, which are mostly minor and can often be treated and released [78].…”

Section: Overviewing Scene Layout and Interpreting Environmental Indicamentioning

confidence: 99%

“…Casualties of OA bombings, however, show higher rates of penetrating soft tissue injury due to shrapnel, which are mostly minor and can often be treated and released [78]. While Leibovici et al [79] classified bus bombings as confined-space bombings, Kosashvili et al [16] stated that bus bombings should be further distinguished from other CS settings, such as restaurants and nightclubs. Instead, buses ought to be considered an ultra-confined space (UCS), because buses constitute a smaller confined space, leading more people to be closer to the explosion center.…”

Section: Overviewing Scene Layout and Interpreting Environmental Indicamentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Review of On-Scene Management of Mass-Casualty Attacks

Holgersson

2016

Journal of Human Security

View full text Add to dashboard Cite

Background: The scene of a mass-casualty attack (MCA) entails a crime scene, a hazardous space and a great number of people needing medical assistance. Public transportation has been the target of such attacks and involves a high probability of generating mass casualties. The aim of the review was to investigate challenges for on-scene responses to MCAs and suggestions made to counter these challenges, with special attention given to attacks on public transportation and associated terminals. Methods: Articles were found through PubMed and Scopus, "relevant articles" as defined by the databases, and a manual search of references. Inclusion criteria were that the article referred to attack(s) and/or a public transportation-related incident and issues concerning formal on-scene response. An appraisal of the articles' scientific quality was conducted based on an evidence hierarchy model developed for the study. Results: One hundred and five articles were reviewed. Challenges for command and coordination on scene included establishing leadership, inter-agency collaboration, multiple incident sites, and logistics. Safety issues entailed knowledge and use of personal protective equipment, risk awareness and expectations, dynamic risk assessment, cordons, defensive versus offensive approaches, and joining forces. Communication concerns were equipment shortfalls, dialoguing and providing information. Assessment problems were scene layout and interpreting environmental indicators as well as understanding setting-driven needs for specialist skills and resources. Triage and treatment difficulties included differing triage systems, directing casualties, uncommon injuries, field hospitals, level of care and providing psychological and pediatric care. Transportation hardships included scene access, distance to hospitals, and distribution of casualties. Conclusion: Commonly encountered challenges during unintentional incidents were augmented during MCAs, implying specific issues for safety, assessment, triage, and treatment, which require training. Effectively increasing readiness for MCAs will likely entail struggles to overcome fragmentation between the emergency services and the broader crisis management system as well as enabling critical and prestige-less, context-based assessments, of needed preparatory efforts.

show abstract

“…Kosashvili et al reported that explosions occurring in buses had the highest rates of overall mortality (21.2%), whilst those caught in enclosed space explosions (eg restaurants) suffered the highest number of severe injuries and required the largest number of surgical interventions; Open spaced explosions caused the largest number of casualties but with the smallest percentage of severe injuries or death [17]. The location of the explosion may also influence infections post-injury.…”

Section: Suicide Bombingsmentioning

confidence: 99%

Improvised Explosive Devices: Pathophysiology, Injury Profiles and Current Medical Management

Ramasamy

Hill

Clasper³

2009

J R Army Med Corps

147

View full text Add to dashboard Cite

The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.

show abstract

Medical consequences of suicide bombing mass casualty incidents: The impact of explosion setting on injury patterns

Cited by 31 publications

References 9 publications

Might Depression, Psychosocial Adversity, and Limited Social Assets Explain Vulnerability to and Resistance against Violent Radicalisation?

Might Depression, Psychosocial Adversity, and Limited Social Assets Explain Vulnerability to and Resistance against Violent Radicalisation?

Review of On-Scene Management of Mass-Casualty Attacks

Improvised Explosive Devices: Pathophysiology, Injury Profiles and Current Medical Management

Contact Info

Product

Resources

About