Medical consequences of suicide bombing mass casualty incidents: the impact of explosion setting on injury patterns

Abstract

Background: The increase in the incidence of suicide bombings on urban civilian populations in the recent years necessitates a better understanding of the related epidemiology in order to improve the outcome of future casualties.

Objective: To characterise the epidemiology of mass casualty incidents following suicide explosions in relation to the surrounding settings.

Methods: This study presents an analysis of the immediate medical consequences of 12 consecutive multiple casualty incidents (MCI's). Both pre-hospital and in-hospital data was assessed for each event including EMS evacuation times, types of injuries, body regions involved, Emergency Department (ED) triage, ED interventions and surgical procedures performed.

Results: The average arrival time of the first ambulance to the scene was 6.8+/-2.3 min. The first "urgent" patient was evacuated in average of 7.6+/-5.3 min later, while the last "urgent" patient was evacuated 27.8+/-7.9 min after the explosion. Explosions that occurred in buses had the worst rates of overall mortality (21.2%). However, those who survived closed space explosions suffered from the highest number of severe and moderate (ISS>8) injuries (22.9%). Casualties in this group underwent the largest number of both Emergency Room and Surgical interventions. Of the three settings, open space explosions resulted in the largest numbers of casualties with the smallest percentage of severe injuries or death.

Conclusions: MCIs resulting from suicide explosions can be classified according to the setting of the event since each group was found to have distinct epidemiological characteristics.