Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products

Abstract

Background Terrorism-related incidents that are associated with mass casualties (mass-casualty terrorist incidents) are a medical and organisational challenge for every hospital because of the special injury patterns involved, the time of the incident, the development of the situation, the initial lack of information, the number of injured, and the number of uninjured survivors who self-refer to a hospital. Methods The Terror and Disaster Surgical Care (TDSC®)-Course was developed in order to address mass-casualty terrorist incidents and to provide surgeons with the specialist medical and surgical knowledge and skills required for these special situations. The focus of the TDSC® course is on how to provide surgical care and how to deploy scarce resources in a particular tactical situation in such a way that the number of survivors is maximised. Results The effective management of such a tactical situation must be based on priorities and first and foremost requires the standardised sorting and categorisation of the injured at the hospital. The aim of triage, or the sorting of the injured, is to immediately identify patients with life-threatening injuries in environments with strained resources. The medical management of mass-casualty terrorist incidents requires tactical abbreviated surgical care (TASC) teams that have the skills needed to perform a primary survey and to provide care for casualties who need immediate surgery (triage category 1-T1). Initial fluid therapy should be restrictive (permissive hypotension) unless contraindicated. Clotting products are replaced in a standardised manner on the basis of patient requirements, which are calculated using rapidly available surrogates (blood gas analysis). Blood products can be administered or kept available depending on risks and triage categories. The highest priority should be given to the identification and management of haemodynamically unstable patients who require immediate surgery for injuries associated with bleeding into body cavities (T1 + +). Conclusion The recommendations and approaches described here should be considered as proposals for hospitals to develop standards or modify well-established standards that enable them to prepare themselves successfully for situations (e.g. masscasualty terrorist or shooter incidents) in which their resources are temporarily overwhelmed.

Education and training as a key enabler of successful patient care in mass-casualty terrorist incidents

“…Regardless of their size and bed capacities, all hospitals should take part in exercises since the resources of all facilities within a network will likely be rapidly overwhelmed in the event of a mass-casualty terrorist incident [37,38]. The problem of overwhelmed resources results not only from the presence of severely injured patients who are brought in by emergency medical services but also from an uncontrolled influx of patients with minor injuries who self-refer to hospitals [55].…”

“…Triage is another extremely important aspect of training for mass-casualty (terrorist) incidents since large numbers of patients with injuries of varying severity require a rapid and accurate assessment of injuries and of the need for surgical treatment [48]. It is also essential to reliably identify patients with life-threatening injuries and to avoid overtriage and undertriage [55].…”

Inpatient surgical treatment in mass casualty situations and disasters—Current treatment capacities depending on alarm status of the hospital and treatment concept

“…In der Selbsteinschätzung der Behandlungskapazitäten nach Sichtungskategorien konnte gezeigt werden, dass die Aktivierung des KAEP und die Fokussierung der Notfallversorgung auf eine taktisch abgekürzte chirurgische Versorgung (TASC) mit Zielsetzung „Überleben jedes Patienten“ die Anzahl der behandelbaren Patienten nach Sichtungskategorien verdoppelt [ 4 – 6 ].…”

Preparation of hospitals for mass casualty incidents in Bavaria, Germany: care capacities for penetrating injuries and explosions in TerrorMASCALs

“…Injury patterns primarily involve penetrating and perforating injuries, which can result in rapid blood loss. As a result, the number of severely injured people is increased in a TerrorMASCAL [ 2 ].…”