Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-20T01:16:29.480Z Has data issue: false hasContentIssue false
  • English
  • Français

The Impact of Terrorism on Children: A Two-Year Experience

Published online by Cambridge University Press:  28 June 2012

Yehezkel Waisman ,
Limor Aharonson-Daniel ,
Meirav Mor ,
Lisa Amir  and
Kobi Peleg
Yehezkel Waisman*
Affiliation:
The Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, andSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Limor Aharonson-Daniel
Affiliation:
The Gertner Institute for Epidemiology and Health Services Research, Center for Trauma and Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel
Meirav Mor
Affiliation:
The Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, andSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Lisa Amir
Affiliation:
The Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, andSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Kobi Peleg
Affiliation:
The Gertner Institute for Epidemiology and Health Services Research, Center for Trauma and Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel
*
Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petah Tiqva 49202, Israel, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To review and analyze the cumulative two-year, Israeli experience with medical care for children victims of terrorism during the prehospital and hospital phases.

Methods:

Data were collected from the: (1) Magen David Adom National Emergency Medical System Registry (prehospital phase); (2) medical records from the authors’ institutions (pediatric triage); and (3) Israel Tr auma Registry (injury characteristics and utilization of in-hospital resources). Statistical analyses were performed as appropriate.

Introduction:

During the recent wave of violence in Israel and the surrounding region, hundreds of children have been exposed to and injured by terrorist attacks. There is a paucity of data on the epidemiology and management of terror-related trauma in the pediatric population and its effects on the healthcare system. This study focuses on four aspects of terrorism-related injuries: (1) tending to victims in the prehospital phase; (2) triage, with a description of a modified, pediatric triage algorithm; (3) characteristics of trauma-related injuries in children; and (4) utilization of in-hospital resources.

Results:

During the study period, 41 mass-casualty events (MCEs) were managed by Magen David Adom. Each event involved on average, 32 regular and nine mobile intensive care unit ambulances with 93 medics, 19 paramedics, and four physicians. Evacuation time was 5–10 minutes in urban areas and 15–20 minutes in rural areas. In most cases, victims were evacuated to multiple facilities. To improve efficiency and speed, the Magen David Adom introduced the use of well-trained “first-responders” and volunteer, off-duty professionals, in addition to “scoop and run” on-the-scene management. Because of differences in physiology and response between children and adults, a pediatric triage algorithm was developed using four categories instead of the usual three. Analysis of the injuries sustained by the 160 children hospitalized after these events indicates that most were caused by blasts and penetration by foreign objects. Sixty-five percent of the children had multiple injuries, and the proportion of critical to fatal injuries was high (18%). Compared to children with non-terrorism-related injuries, the terrorism-related group had a higher rate of surgical interventions, longer hospital stays, and greater needs for rehabilitation services.

Conclusion:

Terrorism-related injuries in children are severe and increase the demand for acute care. The modifications in the management of pedi-atric casualties from terrorism in Israel may contribute to the level of preparedness of medical and paramedical personnel to cope with future events. Further studies of other aspects of traumatic injuries, such as its short- and long-term psychological consequences, will provide a more comprehensive picture of the damage inflicted on children by acts of terrorism.

Keywords

childrendisaster medicinedisaster-planning-organization-admin-istrationemergency medicineemergency medical servicesinjurypedi-atricterrortraumatriage
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 3: Terrorism-II: Special Reports , September 2003 , pp. 242 - 248
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Quintana, DA, Jordan, FB, Tuggle, DW, et al: The spectrum of pediatric injuries after a bomb blast. J Pediatr Surg 1997; 32: 307–311.CrossRefGoogle ScholarPubMed
2.Goldstein, RD, Wampler, NS, Wise, PH: War experiences and distress symptoms of Bosnian children. Pediatrics 1997; 100: 873–878.CrossRefGoogle ScholarPubMed
3.Schuster, MA, Stein, BD, Jaycox, L, et al: A national survey of stress reactions after the September 11, 2001 terrorist attacks. N Engl J Med 2001; 345:1507–1512.CrossRefGoogle ScholarPubMed
4.Schlenger, WE, Caddell, JM, Ebert, L, et al: Psychological reactions to terrorist attacks: Findings from the National Study of Americans’ Reactions to September 11. JAMA 2002; 288: 581–588.CrossRefGoogle ScholarPubMed
5.Committee on Environmental Health and Committee on Infectious Diseases: Chemical-biological terrorism and its impact on children. A subject review. Pediatrics 2000; 105: 662–670.CrossRefGoogle Scholar
6.Patt, HA, Feigin, RD: Diagnosis and management of suspected cases of bioterrorism: A pediatric perspective. Pediatrics 2002; 109: 685–692.CrossRefGoogle ScholarPubMed
7.Mor, M, Waisman, Y: Triage principles in multiple casualty situations involving children—The Israeli experience. Pediatric Emergency Medicine Database. Available at www.pem-database.org; Invited Review Article, August 2002.Google Scholar
8.Sorting of Casualties. In: Bowen, TE, Bellamy, RF (Eds) Emergency War Surgery. Washington DC: US Government Printing Office, 1988, pp 181–192.Google Scholar
9.Waisman, Y, Hadas, N: Integration of foreign and local medical staff in a disaster area — The La Ceiba, Honduras experience. Pediatr Emerg Care 2000; 6: 273–277.CrossRefGoogle Scholar
10.Super, G, Groth, S, Hook, R, et al: START: Simple Triage and Rapid Treatment Plan. Newport Beach, CA: Hoag Memorial Presbyterian Hospital, 1994.Google Scholar
11.Wesson, DE, Scorpio, R: Field triage: Help or hindrance? Can J Surg 1992; 35: 19–21.Google ScholarPubMed
12.American College of Surgeons Committee on Trauma: Field categorization of trauma victims. Bull Am Coll Surg 1986; 71: 17–21.Google Scholar
13.Last, M: Putting children first. Disasters 1994; 18: 192–202.CrossRefGoogle ScholarPubMed
14.Schultz, CH, Koenig, KL, Noji, EK: A medical disaster response to reduce immediate mortality after an earthquake. N Engl J Med 1996; 334: 438–444.CrossRefGoogle ScholarPubMed
15.Garner, A, Lee, A, Harrison, K, Schultz, CH: Comparative analysis of multiple casualty incident triage algorithms. Ann Emerg Med 2001; 38: 541–548.CrossRefGoogle ScholarPubMed
16.Holbrook, PR: Pediatric disaster medicine. Crit Care Clin 1991; 7: 463–470.CrossRefGoogle ScholarPubMed
17.Eichelberger, MR, Mangubat, EA, Sacco, WS, et al: Comparative outcomes of children and adults suffering blunt trauma. J Trauma 1988; 28: 430–436.CrossRefGoogle ScholarPubMed
18.Mackway-Jones, K, Carley, SD, Robson, J: Planning for major incidents involving children by implementing a Delphi study. Arch Dis Child 1999; 80: 410–413.CrossRefGoogle ScholarPubMed
19.Hirshberg, A, Holcomb, GB, Mattox, KL: Hospital trauma care in multiple casualty incidents: A critical review. Ann Emerg Med 2001; 37: 647–652.CrossRefGoogle Scholar
20.Barell, V, Aharonson-Daniel, L, Fingerhut, LA, et al: An introduction to the Barell body region by nature of injury diagnosis matrix. Inj Prev 2002; 8: 91–96.CrossRefGoogle Scholar
21.Barell, V. The Barell body region by nature of injury diagnosis matrix. Available at http://www.cdc.gov/nchs/about/otheract/ice/barellmatrix.htm. Accessed September 2003.CrossRefGoogle Scholar
22.Aharonson-Daniel, L, Waisman, Y, Danon, YL, Peleg, K and the Israel Tr auma Group: Epidemiology of terror-related versus non-terror-related traumatic injury in children. Pediatrics 2003 (in press).Google Scholar
23.Baker, SP, O'Neill, B, Haddon, W, Long, WB: The Injury Severity Score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187–196.CrossRefGoogle ScholarPubMed
24.Brazle, EM: MCI (mass casualty incident) success story. How an EMS system improved its MCI-response strategy through planning & practice. J Emerg Med Serv 2001; 26: 58–60,66–71.Google ScholarPubMed
25.Wheeler, DS, Poss, WB: Mass casualty management in a changing world. Pediatr Ann 2003; 32: 98–105.CrossRefGoogle Scholar
26.Maniscalco, PM, Christen, HT: EMS incident management: Emergency medical logistics. Emerg Med Serv 1999; 28: 49–52.Google ScholarPubMed
27.Plischke, M, Wolf, KH, Lison, T, Pretschner, DP: Telemedical support of pre-hospital emergency care in mass casualty incidents. Eur J Med Res 1999; 4: 394–398.Google Scholar
28.Stein, M, Shemer, J: Urban mass casualty terrorist incident: Systematic management approach. Harefuah 1997; 132: 300–304.Google ScholarPubMed
29.Kluger, Y: Bomb explosions in acts of terrorism—Detonation, wound ballistics, triage and medical concerns. IMAJ 2003; 5: 245–248.Google ScholarPubMed
30.Risavi, BL, Salen, PN, Heller, MB, Arcona, S: A two-hour intervention using START improves prehospital triage of mass casualty incidents. Prehosp Emerg Care 2001; 5: 197–199.CrossRefGoogle ScholarPubMed
31.Peleg, K, Aharonson-Daniel, L, Stein, M, Shapira, SC, ITG: Terror—Severe form of external injury: Pattern of injury during 15 months of terror hospi-talizations. Am J Emerg Med 2003 (in press).Google Scholar
32.Hanoch, J, Feigin, E, Pikarsky, A, et al: Stab wounds associated with terrorist activities in Israel. JAMA 1996; 276: 388–390.CrossRefGoogle ScholarPubMed
33.Bellamy, FR.Textbook of Military Medicine, Part I V. Surgical Combat Casualty Care. Office of the Surgeon General, Department of the Army, USA, 1995.Google Scholar
34.Lebovici, D, Gofrit, ON, Heruti, RJ, et al: Interhospital patient transfer; A quality improvement indicator for prehospital triage. Am J Emerg Med 1997; 15: 341–344.CrossRefGoogle Scholar
35.Baker, DR: A public health approach to the needs of children affected by terrorism. J Am Med Womens Assoc 2002; 57: 117–118.Google Scholar
36.Gidron, Y, Gal, R, Zahavi, S: Bus commuters' coping strategies and anxiety from terrorism: an example of the Israeli experience. J Trauma 1999; 12:185–192.Google ScholarPubMed