title: Suicide bombing attacks: update and modifications to the protocol.
abstract: OBJECTIVE
  To review the experience of a large-volume trauma center in managing and treating casualties of suicide bombing attacks.
  
  
  BACKGROUND
  The threat of suicide bombing attacks has escalated worldwide. The ability of the suicide bomber to deliver a relatively large explosive load accompanied by heavy shrapnel to the proximity of his or her victims has caused devastating effects.
  
  
  METHODS
  The authors reviewed and analyzed the experience obtained in treating victims of suicide bombings at the level I trauma center of the Hadassah University Hospital in Jerusalem, Israel from 2000 to 2003.
  
  
  RESULTS
  Evacuation is usually rapid due to the urban setting of these attacks. Numerous casualties are brought into the emergency department over a short period. The setting in which the device is detonated has implications on the type of injuries sustained by survivors. The injuries sustained by victims of suicide bombing attacks in semi-confined spaces are characterized by the degree and extent of widespread tissue damage and include multiple penetrating wounds of varying severity and location, blast injury, and burns.
  
  
  CONCLUSIONS
  The approach to victims of suicide bombings is based on the guidelines for trauma management. Attention is given to the moderately injured, as these patients may harbor immediate life-threatening injuries. The concept of damage control can be modified to include rapid packing of multiple soft-tissue entry sites. Optimal utilization of manpower and resources is achieved by recruiting all available personnel, adopting a predetermined plan, and a centrally coordinated approach. Suicide bombing attacks seriously challenge the most experienced medical facilities.
authors.affiliation: Trauma Unit and Department of Surgery, Hadassah University Hospital, Jerusalem, Israel. galmogy@surgery.usc.edu
authors.forename: Gidon
authors.initials: G
authors.lastname: Almogy
authors.forename: Howard
authors.initials: H
authors.lastname: Belzberg
authors.forename: Yoaz
authors.initials: Y
authors.lastname: Mintz
authors.forename: Alon K
authors.initials: AK
authors.lastname: Pikarsky
authors.forename: Gideon
authors.initials: G
authors.lastname: Zamir
authors.forename: Avraham I
authors.initials: AI
authors.lastname: Rivkind
mesh_terms: D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000145:classification / Q000453:epidemiology / Q000628:therapy*; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods*; D005107:Explosions; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D013405:Suicide; D023481:Terrorism; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014218:Triage; D014950:Wounds, Penetrating / Q000145:classification / Q000453:epidemiology / Q000628:therapy*