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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

Published online by Cambridge University Press:  28 June 2012

Yuval H. Bloch ,
Dagan Schwartz ,
Moshe Pinkert ,
Amir Blumenfeld ,
Shkolnick Avinoam ,
Giora Hevion ,
Meir Oren ,
Avishay Goldberg ,
Yehezkel Levi  and
Yaron Bar-Dayan
Yuval H. Bloch*
Affiliation:
Home Front Command Medical Department, Israel Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
Dagan Schwartz
Affiliation:
Israeli Emergency Medical Services, Magen David Adom, Medical Division Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
Moshe Pinkert
Affiliation:
Home Front Command Medical Department, Israel
Amir Blumenfeld
Affiliation:
Israeli Defense Force Medical Corps, Surgeon General Headquarters
Shkolnick Avinoam
Affiliation:
Laniado Hospital, General Manager, Netanya, Israel
Giora Hevion
Affiliation:
Meir Hospital, Deputy of the General Manager
Meir Oren
Affiliation:
Hillel Yaffe Hospital, General Manager, Hedera, Israel
Avishay Goldberg
Affiliation:
Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
Yehezkel Levi
Affiliation:
Israeli Defense Force Medical Corps, Surgeon General Headquarters
Yaron Bar-Dayan
Affiliation:
Home Front Command Medical Department, Israel Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
*
Col. Dr. Y. Bar-Dayan MD, MHA, 16 Dolev St., Neve Savion, Or-YehudaIsrael E-mail: [email protected]
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Abstract

Introduction:

A mass-casualty incident (MCI) can occur in the periphery of a densely populated area, away from a metropolitan area. In such circumstances, the medical management of the casualties is expected to be difficult because the nearest hospital and the emergency medical services (EMS), only can offer limited resources.When coping with these types of events (i.e., limited medical capability in the nearby medical facilities), a quick response time and rational triage can have a great impact on the outcome of the victims. The objective of this study was to identify the lessons learned from the medical response to a terrorist attack that occurred on 05 December 2005, in Netanya, a small Israeli city.

Methods:

Data were collected during and after the event from formal debriefings and from patient files. The data were processed using descriptive statistics and compared to those from previous events. The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology.

Results:

Four victims and the terrorist died as a result of this suicide bombing. A total of 131 patients were evacuated (by EMS or self-evacuation) to three nearby hospitals. Due to the proximity of the event to the ambulance dispatch station, the EMS response was quick.The first evacuation took place only three minutes after the explosion. Non-urgent patients were diverted to two close-circle hospitals, allowing the nearest hospital to treat urgent patients and to receive the majority of self-evacuated patients. The nearest hospital continued to receive patients for >6 hours after the explosion, 57 of them (78%) were self-evacuated.

Conclusion:

The distribution of casualties from the scene plays a vital role in the management of a MCI that occurs in the outskirts of a densely populated area.Non-urgent patients should be referred to a hospital close to the scene of the event, but not the closest hospital.The nearest hospital should be prepared to treat urgent casualties, as well as a large number of self-evacuated patients.

Keywords

close-circle hospitalearly terrorismemergency medical servicesimmediate circle hospitalmild casualtiesmass-casualty incident (MCI)suicide bombing
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 3 , June 2007 , pp. 186 - 192
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

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