title: Medical consequences of terrorist bombs containing spherical metal pellets: analysis of a suicide terrorism event.
abstract: OBJECTIVE
  Various metal objects added to explosives increase and diversify the wounding from bombing; especially favoured are spherical missiles for their special injuring characteristics. Our objective was to study the medical consequences and ballistic effects on human tissue of spherical metal pellets used in terrorist bombings.
  
  
  METHODS
  The clinical and forensic data of all bodily injured casualties of a suicide terrorist bombing in a crowded hotel dining room were analysed retrospectively.
  
  
  RESULTS
  Of the 250 people at the scene, 164 were injured, with 91 (55.5%) suffering bodily injuries; 30 of them died. The immediately deceased had disseminated tissue damage and their bodies were saturated with steel spheres. Thirty-two immediate survivors sustained severe injuries (Injury Severity Score > or =16), and all suffered tissue penetration by the pellets. Twenty-three (32%) underwent surgery and 15 (21%) required intensive care.
  
  
  CONCLUSIONS
  Metal pellets propelled by the explosion enhanced the secondary pattern of injury and injured even patients remote from the origin. Tissue destruction and specific organ injuries among survivors were limited. To evaluate and manage victims of terrorist bombings properly, medical teams should become familiar with these severe injuries.
authors.affiliation: Division of Trauma, Department of Surgery, Tel-Aviv Soursky Medical Centre, Tel-Aviv, Israel. y_kluger@rambam.health.gov.il
authors.forename: Yoram
authors.initials: Y
authors.lastname: Kluger
authors.forename: Ami
authors.initials: A
authors.lastname: Mayo
authors.forename: Jehuda
authors.initials: J
authors.lastname: Hiss
authors.forename: Eitamar
authors.initials: E
authors.lastname: Ashkenazi
authors.forename: Jose
authors.initials: J
authors.lastname: Bendahan
authors.forename: Amir
authors.initials: A
authors.lastname: Blumenfeld
authors.forename: Moshe
authors.initials: M
authors.lastname: Michaelson
authors.forename: Michael
authors.initials: M
authors.lastname: Stein
authors.forename: Daniel
authors.initials: D
authors.lastname: Simon
authors.forename: Ivan
authors.initials: I
authors.lastname: Schwartz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alfici
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005107:Explosions; D044709:Forensic Ballistics; D017052:Hospital Mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008670:Metals; D008875:Middle Aged; D013405:Suicide; D016019:Survival Analysis; D023481:Terrorism; D014950:Wounds, Penetrating / Q000145:classification / Q000453:epidemiology* / Q000503:physiopathology
chemical_list: D008670:Metals