Medical consequences of terrorist bombs containing spherical metal pellets: analysis of a suicide terrorism event.
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.
Kluger
Yoram
Y
Division of Trauma, Department of Surgery, Tel-Aviv Soursky Medical Centre, Tel-Aviv, Israel. y_kluger@rambam.health.gov.il
Mayo
Ami
A
Hiss
Jehuda
J
Ashkenazi
Eitamar
E
Bendahan
Jose
J
Blumenfeld
Amir
A
Michaelson
Moshe
M
Stein
Michael
M
Simon
Daniel
D
Schwartz
Ivan
I
Alfici
Ricardo
R
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
D008670:Metals