(P2-8) Analysis of the Performance of Emergency Medical Services Management of 51 Mass-Casualty Incidents in Israel

Abstract

IntroductionBetween February 2002 and January 2004, a total of 51 terrorism-related mass-casualty incidents (MCIs) occurred in Israel.ObjectiveThe objective of this study was to analyze data provided in After Action Reports (AAR) held by Magen David Adom (MDA), after each MCI.MethodsInformation relating to the type of MCI, location, number of ambulances dispatched in five-minute intervals from time of notification, and number of casualties evacuated by urgency in five-minute intervals from the start of the incident was analyzed.ResultsThere were 34 MCIs in 2002, 15 in 2003, and two in 2004. More MCIs (24%) occurred on Wednesdays, and more MCIs occurred during the 05:30–08:59 (18%), 12:00–14:59 (20%), and 17.00–19.59 (24%) time slots. More MCIs occurred in the Jerusalem (24%) area, followed by Tel Aviv (16%). Twenty-six percent of the MCIs resulted from explosions in open areas, 22% in buses, 20% from shootings, and 28% from explosions in semi-closed and closed areas. The mean dispatch time of the first ambulance after notification was 48 seconds. An average of 14.25 ambulances were dispatched in the first five minutes, followed by eight, three, and three in the five-minute slots following. An ANOVA indicated a significant difference in dispatch times by towns/cities (p = 0.05). The average arrival of the first ambulance was 6.4 minutes, and evacuation of the first urgent casualty was 13.6 minutes, the last evacuation was 26.5 minutes after arrival. More urgent casualties (45%) compared to 20% non-urgent were evacuated in first 15 minutes; the majority of non-urgent victims (79%) were evacuated after 16 minutes. The mean number of dispatched ambulances ranged from 37.9 to 26 in urban versus rural areas, respectively. The number of ambulances actually used for evacuation in urban and rural areas was 55% and 44%, respectively.ConclusionsInformation analyzed from AAR is useful for improving Standard Operating Procedures and structuring continuing education interventions for MCIs.