Multiple Casualty Terror Events: The Anesthesiologist??s Perspective

Abstract

Anesthesiologists provide essential care to patients injured in terror events, from the initial resuscitation through therapeutic/diagnostic procedures and surgeries. Operational issues faced by a department of anesthesiology during the initial 8 h after terrorist actions were examined. Multiple, and often parallel, efforts were required of the department.

The Approach to Suicide Bombing Attacks: Changing Concepts

“…Our experience following SBA is that advanced imaging studies can be and are performed. At HUH computed tomography (CT) scanners and angiography suites were used extensively within 8 h of the attack (75 and 11% of victims, respectively) [22]. This is achieved by postponing nonurgent studies and procedures, and redirecting available personnel and resources to the treatment of casualties [5].…”

“…Based on these findings and in order to ensure better delivery of care to salvageable victims and provide optimal utilization of limited resources, we propose a modification to triage protocol for EMS crews at the scene (Figure 1). EMS crews are instructed to apply the scoop and run method and only immediate life-saving procedures, such as needle application, oro-tracheal intubation and control of massive external bleeding, are performed [22,24]. This is reflected in data from the Israeli EMS: in the urban setting, the first crew will arrive at the scene within 4 min of the explosion; the first victim will be evacuated within 5 min; and will reach the hospital within 20 min [24].…”

“…However, victims with limb-threatening injuries such as long bone fractures and extensive soft tissue damage comprise the majority of patients who require surgery within the first 24 h [22]. They will be taken to the OR once their imaging studiers are completed, and an adequate number of operating rooms and ICU beds has been made available.…”

“…Ongoing procedures in the OR continue without interference. Patients in the general ICU are examined by an attending physician who determines which can be transferred to another ICU or to a ward to clear for more ICU beds [18,22].…”

Lésions pulmonaires liées aux explosions

“…En outre, les hôpitaux doivent être en mesure d'accueillir les autres urgences comme le rappelle Kirschenbaum et al qui traitent dans un hôpital de Manhattan une dissection aortique le 11 septembre 2001 à New York ou Shamir et al qui évoquent les transplantations hépatiques effectuées conjointement à la prise en charge de victimes d'attentats à Jérusalem [6,44].…”