[Emergency procedures for taking care of the victims of bomb attacks: logistical and medical aspects]

Abstract

In The Netherlands the threat of terrorist attacks also exist. Both doctors and hospitals alike should be prepared for such attacks both on the logistical as well as the medical level. Most terrorist attacks are carried out with explosives. This results in many victims and in cases of explosions in closed or semi-closed areas, often results in complex medical problems in many of the victims. An explosion that occurs as the result ofa bomb detonating can result in 4 patterns of injury: the primary explosion injury caused by the pressure of the blast, the secondary injuries caused by flying debris, the tertiary injuries caused by the explosion wind, and the quaternary caused by heat and fire. Common injuries seen following an explosion include: lung damage, neurological damage, abdominal injuries, bone fractures and skeletal damage and crush-syndrome. The triage occurs at the site of the explosion as well as on arrival in hospital. One especially important aspect of this is the sorting and selecting between victims who are likely to develop complex problems and who therefore need to receive aggressive treatment in a specially equipped centre and those patients for whom the nearest emergency department will suffice their needs. The triage should be repeated considering the possibility that initial estimates on these points may have been wrong. Epidemiological research should be carried out for each attack in order to make an inventory of the number of victims, the injuries incurred, the assessment of the effects of the medical help received and an assessment of the effectiveness of the total aid received.