Terrorist suicide bombings: Lessons learned in Metropolitan Haifa from September 2000 to January 2006

Abstract

Background: The threat of suicide bombing attacks has become a worldwide problem. This special type of multiple casualty incidents (MCI) seriously challenges the most experienced medical facilities.Methods: The authors concluded a retrospective analysis of the medical management of victims from the six suicide bombing attacks that occurred in Metropolitan Haifa from 2000 to 2006.Results: The six terrorist suicide bombing attacks resulted in 411 victims with 69 dead (16.8 percent) and 342 injured. Of the 342 injured, there were 31 (9.1 percent) severely injured, seven (2.4 percent) moderately severely injured, and 304 (88.9 percent) mildly injured patients.Twenty four (77 percent) of the 31 severely injured victims were evacuated to the level I trauma center at Rambam Medical Center (RMC). Of the seven severely injured victims who were evacuated to the level II trauma centers (Bnai-Zion Medical Center and Carmel Medical Center) because of proximity to the detonation site, three were secondarily transferred to RMC after initial resuscitation. Eight of the 24 severely injured casualties, admitted to RMC, eventually died of their wounds.There was no in-hospital mortality in the level II trauma centers.Conclusions: A predetermined metropolitan triage system which directs trauma victims of a MCI to the appropriate medical center and prevents overcrowding of the level I facility with less severe injured patients will assure that critically injured patients of a suicide bombing attack will receive a level of care that is comparable with the care given to similar patients under normal circumstances. Severe blast injury victims without penetrating injuries but with significant pulmonary damage can be effectively managed in ICUs of level II trauma centers.

A mouse model of blast-induced mild traumatic brain injury

“…The complex neurological and neuropsychiatric clinical picture presented by injured soldiers and civilians exposed to IEDs far exceed the physical injuries following exposure to low-level blast waves (Crabtree, 2006; Mekel et al, 2009). The spectrum of moderate to severe brain injury is easily detectable, both clinically by focal neurological signs and by neuroimaging (Mintz et al, 2002) as well as by altered (deficient functional synchronization) EEG activity (Sponheim et al, 2011).…”

Brain Injuries from Blast

“…Statistics reported by the Defense Department indicate that 3,238 fatalities were attributed to enemy action from indirect fire weapons, IED, grenade, or rocket-propelled grenade in Iraq and Afghanistan from October 2001 through July 2011. 103 68 These fatalities do not include deaths from smaller terrorist incidents not reported in the medical literature. It is therefore clear that blast injury carries significant importance to both military and civilian health care systems.…”

Blast Injury and the Human Skeleton: An Important Emerging Aspect of Conflict‐Related Trauma

“…Primary blast injury is one of the main concerns of ongoing research, and the current medical findings have elements that would translate well to use in anthropological investigation. Current knowledge which is of use to anthropologists is summarized in Table 1 (32,47,48,51,(57)(58)(59)(60)(61)(62)(72)(73)(74)(75)(76)79,80).…”

“…These increase the amount of superficial damage to surrounding victims while decreasing the more serious organ trauma. Significantly, the second most common injury in these incidents is long bone fractures, again predominantly in the lower limb . Comparatively, bus bombings also demonstrate a pattern of extensive soft tissue laceration and lower limb fracture (caused by the placement of explosive charges under the bus).…”