In-hospital resource utilization during multiple casualty incidents.
OBJECTIVE
To suggest guidelines for hospital organization during terror-related multiple casualty incidents (MCIs) based on the experience of 6 level I trauma centers.


BACKGROUND
Most terror-related MCIs are bombings. The sporadic nature of these events complicates in-hospital preparation.


METHODS
Data were collected at all level I Trauma centers during/after MCIs for the Israel National Trauma registry. Patients were included if they were admitted or died in hospital following injury in suicide bombings (October 1, 2000 to June 30, 2003), which fulfilled Ministry of Health suggested criteria for MCIs (number of admissions, severity of injury).


RESULTS
Included were 325 casualties from 32 events, 34% of which had an Injury Severity Score >16. A third of the admissions arrived within 10 minutes and 65% within 30 minutes. Forty percent of the patients underwent CT scans directly from the ED. Operative procedures were performed on 60% of patients and 36% were transferred directly from the ED to the OR. Initiation of surgical procedures peaked at 1 to 1.5 hours, mainly multidisciplinary abdominal, thoracic, and vascular surgery. Orthopedic and plastic surgery predominated later. A third of the patients were admitted to ICUs, often (31%) directly from the ED.


CONCLUSIONS
High staffing demands for ED, OR, and ICU overlap. Anesthesiologists, general, thoracic, and vascular surgeons are in immediate demand. ICU admissions occur simultaneously with ongoing patient arrival to the ED. Most patients operated within the first 2 hours require multidisciplinary surgical teams. Demand for orthopedic and plastic surgery and anesthesiology services continues for >24 hours.
Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel. bromi@md2.huji.ac.il
Sharon
S
Einav
Limor
L
Aharonson-Daniel
Charles
C
Weissman
Herbert R
HR
Freund
Kobi
K
Peleg
D000293:Adolescent; D000328:Adult; D000368:Aged; D001753:Blast Injuries / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005107:Explosions / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000458:organization & administration; D007557:Israel / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D012042:Registries; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D023481:Terrorism / Q000706:statistics & numerical data*; D013996:Time and Motion Studies; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014218:Triage