New Trends in Terrorism-Related Injury Mechanisms: Is There a Difference in Injury Severity?

Abstract

The latest wave of terrorism worldwide has seen significant use by terrorists of mundane, "low-technology" weapons, such as utility knives and civilian vehicles. How do the injuries they produce compare with that of more conventional terrorism mechanisms, such as use of firearms and explosives? We compare injury patterns of the most frequent terrorism-related injury mechanisms in an Israeli data set.Methods: This was a retrospective study of 1,858 patients hospitalized because of terrorism events, which were recorded in the Israeli National Trauma Registry between January 1997 and December 2016. The events were divided into 4 groups based on weapon used: explosions, shootings, stabbings, and vehicular attacks. The groups were compared in terms of injuries sustained, use of hospital resources, and clinical outcomes.Results: Explosion-related and vehicular terrorism resulted in a higher proportion of multiple injuries, whereas stabbings and shootings mostly led to isolated injuries. Victims of vehicular attacks had a high proportion of severe head injuries, whereas stabbing victims had a high volume of vascular injuries. All mechanisms involved significant damage to extremities; however, among stabbing victims injury was mainly to the upper extremities, whereas among vehicular attack victims it was mostly to the lower extremities. The overall injury severity of the compared groups was similar, leading to comparable levels of intensive care use and inhospital mortality. Certain similarities in victims' characteristics were observed between the shootings and stabbings and between explosions and vehicular attacks. Conclusion:Despite differences between various terrorist attack mechanisms, the resulting injury severity and inhospital mortality are very similar, with stabbings and vehicular attacks causing injuries as serious as those caused by conventional weapons.

Counter-Terrorism Medicine: Creating a Medical Initiative Mandated by Escalating Asymmetric Attacks

“…The use of unique modalities such as military-grade firearms, shrapnel-filled bombs (ball bearings, screws, and nails), and chemical warfare agents also differentiate terrorist attacks from accidental trauma, with the subsequent impact on the health care services required to care for higher acuity patients. 10 The likelihood of long-term sequelae from both physical and psychological impact is also increased in terrorist events. 11,12 Understanding the complexity of victim suffering can change the recovery trajectory for individuals and communities.…”

Factors Associated with the Number of Injured and Fatalities in Motor Vehicle Intentional Mass-Casualty Incidents: A Timely Aid for Scaling the Emergency Response

“…Thus, these patients generate a high demand for both surgical and intensive care resources in the initial response phase of the incident. 2,[6][7][8]10,14,15 A rapid and early estimate of the number of casualties due to MV-IMCIs is therefore needed to adjust the necessary health care resources to respond both in the prehospital and in-hospital phases, when scarce information is available. 6,9,16 The objective of this study is to identify the factors associated with the number of casualties (injured/fatalities) during the initial phase of MV-IMCIs in order to improve the estimation of the resources required.…”

Penetration of Energized Metal Fragments to Porcine Thoracic Tissues

“…Energized blast fragments from explosive devices have been the most common mechanism of injury to both military personnel and civilians in recent conflicts [1,2] and terrorist attacks [3,4]. Primary fragments originate from the detonation device itself such as munition casings, or from embedded objects within the explosive device such as nuts and bolts [5][6][7][8].…”