title: [The pre-hospital medical treatment of the victims of multi-casualty incidents caused by explosions of suicide bombers during the Al-Aksa Intifada--April 2001 to December 2004: the activity and experience gained by the teams of Magen David Adom in Israel].
abstract: This article deals with the pre-hospital medical treatment provided by Magen David Adom (MDA) teams to the victims of 36 multi-casualty incidents caused by suicide bombers during the Al-Aksa Intifada. A total of 2048 people were injured in those 36 incidents--an average of 57 injured per incident. The data collection and analysis is based on operational and medical debriefing performed after each incident, with the participation of all MDA teams that treated and evacuated injured that were defined as urgent. The medical debriefing focused on: triage--the definition of the injured situation: urgent or not urgent, priority for treatment and priority for evacuation; the Level of treatment--advanced life support (ALS) (paramedics and physicians) in comparison with basic life support (BLS) [medics]; life saving procedures performed on the scene; and the way in which the teams on the scene decided on the hospital in the region to evacuate the injured.
  
  
  METHODS
  MDA forces amassed [average per incident)--42 ambulances and 116 health providers. The timetable from the time of the explosion (average per incident] included: arrival of first ambulance--3.9 minutes and the evacuation of the first urgently injured from scene--10.7 minutes. The evacuation of the last urgently injured from the scene was 25.2 minutes.
  
  
  METHODS
  Triage data showed that: 70% of the injured defined on the scene as urgent had a moderate--ISS > 9, or severe ISS> 16 injury. Life-saving procedures were performed on the scene on 99 victims [24% of all injured defined as urgent by MDA teams). Findings on decision-making regarding which hospital to evacuate the urgently injured revealed: 9 incidents took place in regions where Level 1 trauma centers were not available--all urgently injured were evacuated to regional hospitals, 63% of these patients were secondarily transferred to a Level 1 trauma center. In 27 incidents--one or more Level 1 trauma centers were available in the region and 71% of the urgently injured were transported directly from the scene to Level 1 trauma centers. Only 12% of those transported to regional hospitals were secondarily transported to Level 1 trauma centers. Even in multi-casualty incidents caused by explosions of suicide bombers, incidents that are characterized by stress, confusion and chaos--MDA teams succeeded in organizing the medical activity on the scene, acted professionally and provided medical treatment to those who were severely injured. This pre-hospital performance of MDA teams had a significant contribution to the successful treatment of the victims of those events by the entire trauma system in Israel.
authors.affiliation: Medical Division, Magen David Adom, Israel. zvif@mdais.co.il
authors.forename: Zvi
authors.initials: Z
authors.lastname: Feigenberg
mesh_terms: D054042:Bombs; D003657:Decision Making; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D007557:Israel; D054527:Mass Casualty Incidents; D013405:Suicide; D023481:Terrorism; D013997:Time Factors; D014218:Triage / Q000458:organization & administration