Mass-casualty, terrorist bombings: epidemiological outcomes, resource utilization, and time course of emergency needs (Part I).
BACKGROUND
This article characterizes the epidemiological outcomes, resource utilization, and time course of emergency needs in mass-casualty, terrorist bombings producing 30 or more casualties.


METHODS
Eligible bombings were identified using a MEDLINE search of articles published between 1996 and October 2002 and a manual search of published references. Mortality, injury frequency, injury severity, emergency department (ED) utilization, hospital admission, and time interval data were abstracted and relevant rates were determined for each bombing. Median values for the rates and the inter-quartile ranges (IQR) were determined for bombing subgroups associated with: (1) vehicle delivery; (2) terrorist suicide; (3) confined-space setting; (4) open-air setting; (5) structural collapse sequela; and (6) structural fire sequela.


RESULTS
Inclusion criteria were met by 44 mass-casualty, terrorist bombings reported in 61 articles. Median values for the immediate mortality rates and IQRs were: vehicle-delivery, 4% (1-25%); terrorist-suicide, 19% (7-44%); confined-space 4% (1-11%); open-air, 1% (0-5%); structural-collapse, 18% (5-26%); structural fire 17% (1-17%); and overall, 3% (1-14%). A biphasic pattern of mortality and unique patterns of injury frequency were noted in all subgroups. Median values for the hospital admission rates and IQRs were: vehicle-delivery, 19% (14-50%); terrorist-suicide, 58% (38-77%); confined-space, 52% (36-71%); open-air, 13% (11-27%); structural-collapse, 41% (23-74%); structural-fire, 34% (25-44%); and overall, 34% (14-53%). The shortest reported time interval from detonation to the arrival of the first patient at an ED was five minutes. The shortest reported time interval from detonation to the arrival of the last patient at an ED was 15 minutes. The longest reported time interval from detonation to extrication of a live victim from a structural collapse was 36 hours.


CONCLUSIONS
Epidemiological outcomes and resource utilization in mass-casualty, terrorist bombings vary with the characteristics of the event.
Arnold
Jeffrey L
JL
Yale New Haven Center for Emergency and Terrorism Preparedness, New Haven, Connecticut 06510, USA. jeffrey.arnold@yale.edu
Tsai
Ming-Che
MC
Halpern
Pinchas
P
Smithline
Howard
H
Stok
Edita
E
Ersoy
Gurkan
G
D004630:Emergencies; D016021:Epidemiologic Studies; D006301:Health Services Needs and Demand; D006801:Humans; D017063:Outcome Assessment, Health Care; D040841:Resource Allocation; D023481:Terrorism; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology / Q000628:therapy*