76 - Suicide Bomber

Abstract

The continued perpetration of suicide bombings by terrorists throughout the world requires that knowledge of the topic be continually updated. Differences have been noted between bombs prepared by terrorists and those used in traditional warfare. Operating on more limited budgets, terrorists have discovered methods of packing bombs with nails, bolts, and other metal objects to inflict maximum injury. Training is essential for improved situational awareness and effective response. Planning activities should include yearly drills so that staff understand their roles in multicasualty incidents, especially those associated with blast injuries. In general, there is a higher injury severity score for those presenting to the hospital following terrorist attacks than those presenting because of other trauma. Often, the patient suffers from a combination of blast injury effects including blunt injury, penetrating trauma, and burns. This is known as the multidimensional injury pattern and is unique to bomb explosions. Because of concern for delayed injury presentation, patients with previously unremarkable examinations often require careful reevaluation. First responders should be versed in Tactical Emergency Casualty Care. The scene and receiving facilities need to be aggressively secured. Appropriate scene and hospital triage should be implemented based on regional best practices. The basic algorithms of Advanced Trauma Life Support should be followed in the field and hospital. Appropriate imaging, including x-rays, ultrasound, and computed tomography (CT), should be performed. Judicious use of blood products is important. Tetanus prophylaxis should be given. One should consider testing and prophylaxis for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV).