Civilian hospital response to a mass casualty event: the role of the intensive care unit.
BACKGROUND
We studied the response of the Shaare Zedek Medical Center (SZMC) in Jerusalem, Israel, to terrorist multiple- or mass-casualty events (TMCEs) that occurred between 1983 and 2004, to document the role of the intensive care unit (ICU) in this response.


METHODS
The SZMC Disaster Plan was reviewed in detail. Hospital and ICU records were retrospectively reviewed for all patients presenting to SZMC between 1983 and 2004 after a TMCE. Data were coded for age, sex, injuries, length of stay, and mortality.


RESULTS
Eight hundred seventy-five patients presented to SZMC after 31 TMCEs. The number of patients presenting ranged from 1 to 84 with an average of 28 patients per TMCE. Forty-one (4.7%) of the patients were admitted to the ICU. The age of the ICU patients ranged from 4 to 80 with an average of 30.9 years. Twenty-nine (70%) of the patients had blast lung injury, 3 (7%) had intestinal blast injury, and 30 (73%) had ruptured tympanic membranes. Forty-two surgical procedures were performed in 23 patients. Thirty (73%) patients required mechanical ventilation. One patient (2.4%) died of multiple organ failure caused by a delay in diagnosis of intestinal blast injury.


CONCLUSIONS
Of the patients presenting to SZMC after TMCE, 4.7% required ICU care. Seventy-three percent of the ICU patients required mechanical ventilation. The ICU plays a critical role in the SZMC response to TMCEs.
Avidan
Vered
V
Department of Surgery, Anesthesiology and Intensive Care, Shaare Zedek Medical Center, Jerusalem, Israel, and University of California, San Francisco General Hospital, USA.
Hersch
Moshe
M
Spira
Ram M
RM
Einav
Sharon
S
Goldberg
Sara
S
Schecter
William
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000458:organization & administration*; D004189:Disaster Planning / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007557:Israel; D008875:Middle Aged; D010355:Patient Identification Systems; D012189:Retrospective Studies; D023481:Terrorism; D014218:Triage; D014947:Wounds and Injuries / Q000209:etiology / Q000628:therapy*