title: Pitfalls to avoid in the medical management of mass casualty incidents following terrorist bombings: the hospital perspective.
abstract: BACKGROUND
  The unique patterns of injury following explosions together with the involvement of numerous physicians, most of whom are not experienced in trauma, may create problems in the medical management of mass casualty incidents.
  
  
  METHODS
  Four hundred patient files admitted in 19 mass casualty events following bombing incidents were reviewed and possible areas which could impact survival were defined.
  
  
  RESULTS
  Forty-nine (9.3 %) patients had an Injury Severity Score ≥16. Of 205 patients in whom triage decisions were available, 5 of 25 severely injured patients were undertriaged by the triage officers at the door of the hospital. Following primary evaluation inside the emergency department critical injuries in two patients were missed due to distracting, less serious injuries. Of 68 (16.1 %) patients who were operated, 28 were in need of either immediate, urgent or high-priority operations. Except for neurosurgical cases which needed to be transferred to other hospitals, there was no delay in surgery. One patient underwent negative laparotomy. There were 15 in-hospital deaths, 6 of which were deemed as either anticipated or unanticipated mortality with possibility for improvement.
  
  
  CONCLUSIONS
  Medical management should be evaluated following MCIs as this may illustrate possible problems which many need to be addressed in contingency planning.
authors.affiliation: Surgery Department, Hillel Yaffe Medical Center, P.O.Box 169, 38100, Hadera, Israel. i_ashkenazi@yahoo.com.
authors.forename: I
authors.initials: I
authors.lastname: Ashkenazi
authors.affiliation: Emergency Surgery Department, Gregorio Marañon Medical Center, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Turégano-Fuentes
authors.affiliation: Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Einav
authors.affiliation: Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: B
authors.initials: B
authors.lastname: Kessel
authors.affiliation: Surgery Department, Hillel Yaffe Medical Center, P.O.Box 169, 38100, Hadera, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Alfici
authors.affiliation: Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Olsha
keywords: Mass casualty incidents; Terror bombings
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