Conventional terrorist bomb incidents and the intensive care unit

Abstract

A terror bombing creates a momentary stress on acute care services, including the emergency medical system, emergency departments, and intensive care units. A knowledge of the progression of events, the anticipated volume of injured survivors, and the pattern of injuries will enable the physician in the intensive care unit to prepare the unit quickly and efficiently for the expected rush of injured survivors. In the past 2 years it has become apparent in the medical literature that terror bombing causes more complicated injuries than other types of trauma. The injuries are a combination of blast, penetrating, and blunt trauma, as well as burns. As a result, a significant number of patients will need care in the intensive care unit for a long time. Treating these injuries mandates an understanding of the combination of injury mechanisms because the ideal treatment for one mechanism might cause harm if another coexists. In addition, recent literature delineates the volume of admissions an intensive care unit should anticipate. This information should allow the preparation of sufficient vacant intensive care unit beds and facilitate the efficient use of equipment and personnel. This review, based on recently published data, aims to provide the intensive care unit physician with crucial information about the anticipated progression of events, the possible numbers of patients, and the nature of their injuries after a terrorist bombing. This information should aid in rational crisis planning.