Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: report of the events and the prehospital emergency response.
BACKGROUND
This paper describes the two mass-casualty, terrorist attacks that occurred in Istanbul, Turkey in November 2003, and the resulting pre-hospital emergency response.


METHODS
A complex, retrospective, descriptive study was performed, using open source reports, interviews, direct measurements of street distances, and hospital records from the American Hospital (AH) and Taksim Education and Research State Hospital (TERSH) in Istanbul.


RESULTS
On 15 November, improvised explosive devices (IEDs) in trucks were detonated outside the Neve Shalom and Beth Israel Synagogues, killing 30 persons and injuring an estimated additional 300. Victims were maldistributed to 16 medical facilities. For example, AH, a private hospital located six km from both synagogues, received 69 injured survivors, of which 86% had secondary blast injuries and 13% were admitted to the hospital. The TERSH, a government hospital located 1 km from both synagogues, received 48 injured survivors. On 20 November, IEDs in trucks were detonated outside the Hong Kong Shanghai Banking Corporation (HSBC) headquarters and the British Consulate (BC), killing 33 and injuring an estimated additional 450. Victims were maldistributed to 16 medical facilities. For example, TERSH, located 18 km from the HSBC site and 2 km from the the BC received 184 injured survivors, of which 93% had secondary blast injuries and 15% were hospitalized. The AH, located 9 km from the HSBC site and 6 km from the BC, received 16 victims.


CONCLUSIONS
The twin suicide truck bombings on 15 and 20 November 2003 were the two largest terrorist attacks in modern Turkish history, collectively killing 63 persons and injuring an estimated 750 others. The vast majority of victims had secondary blast injuries, which did not require hospitalization. Factors associated with the maldistribution of casualties to medical facilities appeared to include the distance from each bombing site, the type of medical facility, and the personal preference of injured survivors.
Rodoplu
Ulkümen
U
Emergency Medicine Association of Turkey, Izmir, Turkey. ulkumenrodoplu@ttnet.net.tr
Arnold
Jeffrey L
JL
Tokyay
Rifat
R
Ersoy
Gurkan
G
Cetiner
Serkan
S
Yücel
Tayfun
T
D000552:Ambulances; D001753:Blast Injuries / Q000145:classification / Q000453:epidemiology* / Q000401:mortality; D004189:Disaster Planning; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005107:Explosions; D006297:Health Services Accessibility; D006742:Hospital Bed Capacity; D006801:Humans; D019982:Organizational Case Studies; D011635:Public Health Administration; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data; D023481:Terrorism; D014187:Transportation of Patients / Q000592:standards / Q000706:statistics & numerical data*; D014218:Triage; D014421:Turkey / Q000453:epidemiology