A modern analysis of a historical pediatric disaster: the 1927 Bath school bombing.
BACKGROUND
Children have unique anatomy and physiology that may necessitate a unique approach to a pediatric surge. An analysis of the Bath school bombings of 1927, the largest pediatric terrorist disaster in U.S. history, provides an opportunity to gain perspective on pediatric patterns of injury and future disaster preparedness.


METHODS
Eighty-nine contemporary newspaper accounts, the official coroner's inquest, interviews, online resources, and the Michigan state archives of the disaster were reviewed with respect to the demographics, pattern of injury, gender, age, duration of hospitalization, relative distance of each classroom from the blast, and severity of injuries sustained using the Injury Severity Scale (ISS).


RESULTS
Eighty-seven children and three teachers were unable to safely evacuate the building; 36 children (41%) were dead on-site, 40 sustained mild injuries (76.9%), nine sustained moderate injuries (17.3%), and one sustained serious injuries (1.9%). Mean ISS scores decreased with increasing relative distance of each classroom from the primary blast, while the classrooms involved in structural collapse had the highest initial mortality and ISS score. Patterns of injury sustained imply a predominance of crush and penetrating trauma.


CONCLUSIONS
Mean ISS scores and initial mortality by classroom were a function of proximity to the blast and structural collapse. The pattern of injury closely approximates those of other pediatric disasters such as Columbine, Oklahoma City, and 911. The absence of severe abdominal trauma and one reported hospital mortality may reflect an initial under-triage of patients, possibly due to the medical technology of the times.
Kim
David
D
Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan 48823, USA.
Mosher
Benjamin D
BD
Morrison
Chet A
CA
Parker-Lee
Carol
C
Opreanu
Razvan C
RC
Stevens
Penny
P
Moore
Sarah
S
Kepros
John P
JP
D000293:Adolescent; D001753:Blast Injuries / Q000150:complications / Q000266:history / Q000401:mortality; D054042:Bombs; D002648:Child; D004190:Disasters / Q000266:history*; D005260:Female; D049673:History, 20th Century; D006801:Humans; D007902:Length of Stay; D008297:Male; D008824:Michigan; D012720:Severity of Illness Index; D023481:Terrorism / Q000266:history*