The EMS Response to the Oklahoma City Bombing

Abstract

This is a descriptive study of the Emergency Medical Services response to a bombing of a United States Federal Building in Oklahoma City, Oklahoma on 19 April 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the front of the building and resulted in a pancaking effect of the upper floors onto the lower floors.There were three distinct phases of the medical response: 1) Immediately available local EMS ambulances and staff; 2) Additional ambulances staffed by recalled, off-duty personnel; and 3) mutual-aid ambulances and personnel from the surrounding communities. There were 361 persons in the building at the time of the explosion, 163 of these perished. Within the first hour of the explosion, 139 patients were transported to area hospitals. Of these, 32% were in critical condition. During the day of the explosion, 444 persons were treated for physical injuries: 410 of these were related to the explosion and 14, including one with fatal injuries, were sustained during search and rescue attempts. A total of 354 (80%) were treated and released from emergency departments, and 90 (20%) were admitted to hospitals. Six of the transported victims either were dead on arrival to the emergency department or died after admission to the hospital. Of those who died, 95% of the deaths were related to blunt trauma associated with the collapse of the structure. Only three persons were extricated alive after the first five hours following the explosion.The scene became flooded with volunteers who, although their intentions were to provide help and aid to those injured, created a substantial logistical problem for Incident Command. Several other lessons were learned: 1) Telephone lines and cells became overloaded, but the Hospital Emergency Administrative Radio system was operational only in three of the 15 hospitals; 2) Volunteer personnel should have responded to the hospitals and not to the scene; and 3) Training was an essential for the success of such a response. Thus, the success of this operation was a function of the intense training, practice, and coordination between multiple agencies.

The Importance of Evidence-Based Disaster Planning

“…9 Other reports also seem to indicate that many, if not most, disaster casualties are transported to hospitals by means other than ambulance. 14,17,26,27,43,51,54,61,63,64,76,78,80,81,88 112 Nonambulance transport has several implications for other aspects of disaster planning, as discussed below.…”

“…A similar pattern has been reported by others as well. 9,14,51,67,88,103,104,[122][123][124][125] In some disasters, however, injuries continue to occur after the immediate postimpact period, often as a result of prolonged search, recovery, and cleanup activities. [125][126][127][128][129] …”

Los Angeles County Addresses Pediatric Needs Using the Disaster Resource Center Program

“…20 The Oklahoma City bombing in 1995 affected a child care center within the Murrah Federal building. 21 The recent earthquake in China demonstrated potential risks to school buildings. 22 Additionally, children have been the specific targets of terrorist attacks, most infamously the school attack in Breslan, Russia, leaving 156 children dead and 337 injured.…”

Emergency Preparedness and Disaster Response Core Competency Set for Perinatal and Neonatal Nurses

“…It is important to point out that nurses working at nondesignated hospitals may have a false sense of security, believing that their hospital will not have to decontaminate disaster victims. Numerous studies clearly show that most disaster victims are transported to hospitals by nonambulance vehicles, such as private cars, taxis, police cars, or even on foot (Golec & Gurney, 1977; Kallsen, 1983; Maningas, Bobison, & Mallonee, 1997). Because of this, disaster victims, rather than ambulance personnel, determine the initial hospital destination.…”