Medical consequences of suicide bombing mass casualty incidents: the impact of explosion setting on injury patterns.
BACKGROUND
The increase in the incidence of suicide bombings on urban civilian populations in the recent years necessitates a better understanding of the related epidemiology in order to improve the outcome of future casualties.


OBJECTIVE
To characterise the epidemiology of mass casualty incidents following suicide explosions in relation to the surrounding settings.


METHODS
This study presents an analysis of the immediate medical consequences of 12 consecutive multiple casualty incidents (MCI's). Both pre-hospital and in-hospital data was assessed for each event including EMS evacuation times, types of injuries, body regions involved, Emergency Department (ED) triage, ED interventions and surgical procedures performed.


RESULTS
The average arrival time of the first ambulance to the scene was 6.8+/-2.3 min. The first "urgent" patient was evacuated in average of 7.6+/-5.3 min later, while the last "urgent" patient was evacuated 27.8+/-7.9 min after the explosion. Explosions that occurred in buses had the worst rates of overall mortality (21.2%). However, those who survived closed space explosions suffered from the highest number of severe and moderate (ISS>8) injuries (22.9%). Casualties in this group underwent the largest number of both Emergency Room and Surgical interventions. Of the three settings, open space explosions resulted in the largest numbers of casualties with the smallest percentage of severe injuries or death.


CONCLUSIONS
MCIs resulting from suicide explosions can be classified according to the setting of the event since each group was found to have distinct epidemiological characteristics.
Clinical Research Division, Trauma Branch, Medical Corps, Israeli Defense Force, Israel. Yonasofi@gmail.com
Yona
Y
Kosashvili
Mark I
MI
Loebenberg
Guy
G
Lin
Kobi
K
Peleg
Feigenberg
F
Zvi
Yoram
Y
Kluger
Amir
A
Blumenfeld
D000552:Ambulances; D001753:Blast Injuries / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D054042:Bombs; D002056:Burns / Q000453:epidemiology / Q000209:etiology; D002648:Child; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D005107:Explosions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D054527:Mass Casualty Incidents / Q000145:classification / Q000401:mortality / Q000706:statistics & numerical data; D018986:Motor Vehicles; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D040701:Stress Disorders, Traumatic, Acute / Q000453:epidemiology / Q000209:etiology; D013405:Suicide; D013997:Time Factors; D014505:Urban Population