title: Defining the need for blood and blood products transfusion following suicide bombing attacks on a civilian population: a level I single-centre experience.
abstract: BACKGROUND
  Knowledge of patterns of blood use in the care of mass casualty settings is important for preparedness of medical centre resources and for maximising survival when blood supplies are limited. Our objectives were to review of our experience with the use of blood products and define the utilisation of blood transfusion following suicide bombing attacks.
  
  
  METHODS
  We conducted a retrospective analysis of blood and blood product transfusion following civilian bombing attacks at a level I trauma centre in Jerusalem, Israel from 2000 to 2005. The study group consisted of 137 patients who were admitted following 17 suicide bombing attacks which were carried out in Jerusalem during the 5-year period. Demographic data, number of units of blood and blood products transfused and the need for massive transfusions were recorded and analyzed.
  
  
  RESULTS
  Fifty-three patients received blood transfusions (38.7%). There were 33 males (62.2%) with a median ISS of 13 (range 4-25). These 53 patients received 524 PRBC, 42 WB, and 449 FFP. The mean number of PRBC transfused/admitted patient was 3.82 units (range 0-59). Thirty patients (21.9%) received 236 PRBC (45% of total PRBC) at the first 2h. The ratio of ordered to transfused blood was 946:524. The FFP:PRBC ratio for all transfused patients was 1:1.17. The number of PRBC transfused per attack correlated with the number of patients admitted per attack. The most commonly transfused blood type was A (52.3%). Only 18 units of uncrossed-matched blood were transfused (3.3% of total). 14 patients (10.2%) received massive transfusions. These patients received 399 PRBC (76.1% of total units transfused) and the average number of PRBC transfused was 28.5/patient (10-59).
  
  
  CONCLUSIONS
  More than 1/3 of casualties admitted following civilian bombing attacks received transfusions, most in the first 2h. Large-scale attacks will require more blood and blood products than small-scale attacks. Twice the number of PRBC ordered than transfused reflects a known trend for over-triage during the initial assessment following bombing attacks. One tenth of patients received massive transfusion.
authors.affiliation: Department of General Surgery and Trauma Unit, Hadassah-Hebrew University Medical Centre, Israel.
authors.forename: Miklosh
authors.initials: M
authors.lastname: Bala
authors.forename: Tali
authors.initials: T
authors.lastname: Kaufman
authors.forename: Asaf
authors.initials: A
authors.lastname: Keidar
authors.forename: Orly
authors.initials: O
authors.lastname: Zelig
authors.forename: Gideon
authors.initials: G
authors.lastname: Zamir
authors.forename: Sigalit
authors.initials: S
authors.lastname: Mudhi-Orenshat
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
authors.forename: Avraham I
authors.initials: AI
authors.lastname: Rivkind
authors.forename: Gidon
authors.initials: G
authors.lastname: Almogy
mesh_terms: D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000401:mortality / Q000628:therapy*; D001771:Blood Banks / Q000706:statistics & numerical data; D016913:Blood Component Transfusion / Q000706:statistics & numerical data*; D054042:Bombs; D005260:Female; D006078:Government Programs; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007557:Israel / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D054527:Mass Casualty Incidents; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013405:Suicide; D023481:Terrorism; D014193:Trauma Centers; D014218:Triage