Suicide bombing: how to prevent death in civilians? – Authors' reply

Abstract

www.thelancet.com Vol 379 January 14, 2012 e9 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ police stations, mosques, and markets. To establish the feasibility and effi cacy of such an intervention would require investigation. It is essential to point out that, to whatever degree civilian-administered tourniquets might improve immediate rates of survival from extremity wounds caused by suicide bombs, a tourniquet is a temporary measure that does not replace the adequate health care required by victims for their continued survival. If a civilian-applied tourniquet is required temporarily to stanch severe bleeding from an extremity, to survive in the long term, that civilian will require eff ective emergency and surgical treatment to the limb once arriving at hospital. Moreover, a study of victims of civilian suicide bombs arriving at hospitals in Israel suggests that substantial proportions of victims arrive not only with extremity injuries (44%), but also with internal injuries (32%), head injuries (22%), chest injuries (21%), abdominal injuries (16%), and burns (17%). Survival of these wounds would not be aff ected by tourniquets. 30% had three or more body regions injured, 29% had severe-to-critical injuries, 52% required surgery, and 27% required intensive care—all indicators of the need for high-quality, complex treatment of injuries caused by suicide bombs in civilians, as in soldiers. Although all forms of prevention and intervention should be considered, what is known so far suggests that the provision of adequate medical treatment and facilities is one necessary component for improved survival from suicide bombs, for both military and civilian victims.