Abstract
Bombings and explosion incidents directed against innocent civilians are the primary instrument of global terror. In the present review we highlight the major observations and lessons learned from these events. Five mechanisms of blast injury are outlined and the different type of injury that they cause is described. Indeed, the consequences of terror bombings differ from those of non-terrorism trauma in severity and complexity of injury, and constitute a new class of casualties that differ from those of conventional trauma. The clinical implications of terror bombing, in treatment dilemmas in the multidimensional injury, ancillary evaluation and handling of terror bombing mass casualty event are highlighted. All this leads to the conclusion that thorough medical preparedness to cope with this new epidemic is required, and that understanding of detonation and blast dynamics and how they correlate with the injury patterns is pivotal for revision of current mass casualty protocols.
Highlights
Bombings and explosions directed against innocent civilians are the primary instrument of global terror, resulting in death, injury, fear and chaos
With the lessening of fullscale military conflicts, terror has become a prominent feature in modern life, as realized by the tripling of the number of serious terror incidents in recent years
In contradiction to the common perception that unconventional weapons are more dangerous than explosives, the number of lives lost and people injured and infrastructure damaged from bombings are orders of magnitude higher than those caused by chemical or biologic incidents
Summary
Bombings and explosions directed against innocent civilians are the primary instrument of global terror, resulting in death, injury, fear and chaos. Secondary blast injuries Projectiles like steel balls, nails, screws and nuts packed around the explosive cause secondary blast injuries, and the wounds reflect their velocity and shape Multiple penetrations of such pellets result in increased mortality and devastating injuries, and such were encountered in many suicide bombing incidents. Some have considered these to be the consequence of the primary blast mechanism causing acceleration-deceleration it is more likely that acceleration and deceleration of solid organs result from the bumping of the body against other objects, resembling classical injury of blunt trauma. Implementation of the Trauma Team concept has allowed establishing and adhering to the principle of unidirectional patient flow This is implemented upon declaration of a multiple casualty incident, as the emergency department is immediately emptied of its patients, and thereafter all bombing victims that are seen and transferred from the ED and do not return to it. While mostly only minor injuries were discovered during the tertiary survey, in one event two patients had vascular injuries that were recognized in the tertiary http://www.wjes.org/content/1/1/33 survey when already in intensive care for other severe injuries
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