Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv

Background: Terrorist attacks in Israel cause mass events with varying numbers of casualties. A study was undertaken to analyse the medical response to an event which occurred on 17 April 2006 near the central bus station, Tel Aviv, Israel. Lessons are drawn concerning the management of the event, primary triage, evacuation priorities and the rate and characteristics of casualty arrival at the nearby hospitals. Methods: Data were collected both during and after the event in formal debriefings. Their analysis refers to medical response components, interactions and main outcomes. The event is described according to the DISAST-CIR methodology (Disastrous Incidents Systematic AnalysiS Through – Components, Interactions and Results). Results: 91 casualties were reported in this event; 85 were evacuated from the scene including 3 already dead on arrival, 9 severely injured, 14 moderately injured and 59 mildly injured. Six were declared dead at the scene. Emergency medical service (EMS) vehicle accumulation was rapid. The casualties were distributed between five hospitals (three level 1 and two level 2 trauma centres). The first evacuated casualty arrived at the hospital within 20 min of the explosion and the last urgent victim was evacuated from the scene after 1 h 14 min. Evacuation occurred in two phases: the first, lasting 1 h 20 min, in which most of the patients with evident trauma were evacuated and the second, lasting 8 h 15 min, in which most patients presented with tinnitus and symptoms of somatisation. The most common injuries were upper and lower limb injuries, diagnosed in 37% of the total injuries, and stress-related disturbances (anxiety, tinnitus, somatisation) diagnosed in 41%. Conclusion: Rapid accumulation of EMS vehicles, effective primary triage between urgent and non-urgent casualties and primary distribution between five hospitals enabled rapid conclusion of the event, both at the scene and at the receiving hospitals.

[1]  Y. Bar-dayan,et al.  Managing Mild Casualties in Mass-Casualty Incidents: Lessons Learned from an Aborted Terrorist Attack , 2007, Prehospital and Disaster Medicine.

[2]  Y. Bar-dayan,et al.  The significance of a small, level-3 'semi evacuation' hospital in a terrorist attack in a nearby town. , 2007, Disasters.

[3]  D. Mozingo,et al.  Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005 , 2008 .

[4]  Y. Bar-dayan,et al.  Lessons Learned from Cross-border Medical Response to the Terrorist Bombings in Tabba and Ras-el-Satan, Egypt, on 07 October 2004 , 2005, Prehospital and Disaster Medicine.

[5]  Kobi Peleg,et al.  Principles of emergency management in disasters. , 2003, Advances in renal replacement therapy.

[6]  Y. Bar-dayan,et al.  DISAST-CIR: Disastrous incidents systematic analysis through components, interactions and results: application to a large-scale train accident. , 2009, The Journal of emergency medicine.

[7]  Amir Blumenfeld,et al.  Lessons from a Terrorist Attack in Tel-Aviv Market: Putting All of the Golden Eggs in One Basket Might Save Lives , 2005 .

[8]  H. Belzberg,et al.  Suicide Bombing Attacks: Update and Modifications to the Protocol , 2004, Annals of surgery.

[9]  Y. Bar-dayan,et al.  Distribution of Casualties in a Mass-Casualty Incident with Three Local Hospitals in the Periphery of a Densely Populated Area: Lessons Learned from the Medical Management of a Terrorist Attack , 2007, Prehospital and Disaster Medicine.

[10]  Y. Bar-dayan,et al.  Significance of a Level-2,“Selective, Secondary Evacuation” Hospital during a Peripheral Town Terrorist Attack , 2007, Prehospital and Disaster Medicine.

[11]  Ilan Koren,et al.  A terrorist suicide bombing at a nightclub in Tel Aviv: Analyzing response to a nighttime, weekend, multi-casualty incident. , 2006, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[12]  K. Brohi,et al.  Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005 , 2006, The Lancet.