Clinical review: the Israeli experience: conventional terrorism and critical care.
Over the past four years there have been 93 multiple-casualty terrorist attacks in Israel, 33 of them in Jerusalem. The Hadassah-Hebrew University Medical Center is the only Level I trauma center in Jerusalem and has therefore gained important experience in caring for critically injured patients. To do so we have developed a highly flexible operational system for managing the general intensive care unit (GICU). The focus of this review will be on the organizational steps needed to provide operational flexibility, emphasizing the importance of forward deployment of intensive care unit personnel to the trauma bay and emergency room and the existence of a chain of command to limit chaos. A retrospective review of the hospital's response to multiple-casualty terror incidents occurring between 1 October 2000 and 1 September 2004 was performed. Information was assembled from the medical center's trauma registry and from GICU patient admission and discharge records. Patients are described with regard to the severity and type of injury. The organizational work within intensive care is described. Finally, specific issues related to the diagnosis and management of lung, brain, orthopedic and abdominal injuries, caused by bomb blast events associated with shrapnel, are described. This review emphasizes the importance of a multidisciplinary team approach in caring for these patients.
Aschkenasy-Steuer
Gabriella
G
Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel.
Shamir
Micha
M
Rivkind
Avraham
A
Mosheiff
Rami
R
Shushan
Yigal
Y
Rosenthal
Guy
G
Mintz
Yoav
Y
Weissman
Charles
C
Sprung
Charles L
CL
Weiss
Yoram G
YG
D000007:Abdominal Injuries / Q000628:therapy; D001930:Brain Injuries / Q000175:diagnosis / Q000628:therapy; D003422:Critical Care / Q000458:organization & administration*; D050723:Fractures, Bone / Q000628:therapy; D006801:Humans; D007557:Israel; D055370:Lung Injury; D009104:Multiple Trauma / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods; D023481:Terrorism; D013997:Time Factors; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis / Q000628:therapy*