title: Can external signs of trauma guide management?: Lessons learned from suicide bombing attacks in Israel.
abstract: BACKGROUND
  Following a suicide bombing attack, scores of victims suffering from a combination of blast injury, penetrating injury, and burns are brought to local hospitals.
  
  
  OBJECTIVE
  To identify external signs of trauma that would assist medical crews in recognizing blast lung injury (BLI) and effectively triaging salvageable and nonsalvageable victims.
  
  
  METHODS
  Retrospective analysis of all 15 suicide bombing attacks that occurred in Israel from April 1994 to August 1997.
  
  
  METHODS
  National survey.
  
  
  METHODS
  One hundred fifty-three victims died and 798 were injured as a result of 15 attacks. Medical records were reviewed for external signs of trauma, such as burns and penetrating injuries, and the presence of BLI. Main Outcome Measure The odds ratio for BLI and death.
  
  
  RESULTS
  Three settings were targeted: buses, semiconfined spaces, and open spaces. Sixty survivors (7.5%) suffered from BLI, which was more common in buses (37 of 260) than semiconfined spaces (14 of 279) and open spaces (9 of 259) (P<.001). Victims with BLI were more likely to suffer from penetrating injury to the head or torso, burns covering more than 10% of the body surface area, and skull fractures (odds ratios, 4, 11.6, and 55.8, respectively; P<.001). Victims who died at the scene were more likely to suffer from burns, open fractures, and amputations in comparison with survivors (odds ratios, 6.5, 18.6, and 50.1, respectively; P<.001).
  
  
  CONCLUSIONS
  Following a suicide bombing attack, external signs of trauma should be used to triage victims to the appropriate level of care both at the scene and in the hospital. Triage of salvageable and nonsalvageable victims should take into account the presence of amputations, burns, and open fractures.
authors.affiliation: Department of Surgery and Trauma Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Gidon
authors.initials: G
authors.lastname: Almogy
authors.forename: Tal
authors.initials: T
authors.lastname: Luria
authors.forename: Elihu
authors.initials: E
authors.lastname: Richter
authors.forename: Reuven
authors.initials: R
authors.lastname: Pizov
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mintz
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; D000368:Aged; D000369:Aged, 80 and over; D001753:Blast Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002056:Burns / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment / Q000379:methods*; D005107:Explosions; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013405:Suicide; D023481:Terrorism; D015599:Trauma Severity Indices; D014218:Triage; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*