When a vehicle becomes a weapon: intentional vehicular assaults in Israel

Gidon Almogy,Miklosh Bala,Asaf Kedar

doi:10.1186/s13049-016-0338-9

Gidon Almogy, Miklosh Bala + Show 1 more

Open Access

https://doi.org/10.1186/s13049-016-0338-9

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Abstract

BackgroundWe have recently witnessed an epidemic of intentional vehicular assaults (IVA) aimed at pedestrians. We hypothesized that IVA are associated with a specific injury pattern and severity.MethodsRetrospective analysis of prospectively acquired data of patients injured following IVA from October 2008 to May 2016 who were admitted to the Hadassah Level I trauma center in Jerusalem, Israel. Comparison of injury parameters and outcome caused by vehicular attacks to non-intentional pedestrian trauma (PT). Measured outcomes included ISS, AIS, injury pattern, ICU and blood requirements, participating teams, length of stay, and mortality.ResultsThere were 26 patients in the IVA group. Mean age in the IVA group was significantly younger and there were more males compared to the PT group (24.7 ± 13.3 years vs. 48.3 ± 21.3, and 81% vs. 52%, respectively, p < 0.01). Lower extremity (77% of patients), followed by head (58%) and facial (54%) injuries were most commonly injured in the IVA group, and this was significantly different from the pattern of injury in the PT group (54, 35, and 28%, respectively, p < 0.05). Mean ISS and median head AIS were significantly higher in the IVA group compared with the PT group (23.2 ± 12.8 vs. 15.4 ± 13.8, p = 0.012, and 4.5 vs. 3, p = 0.003, respectively). ICU admission and blood requirement were significantly higher in the IVA group (69% vs. 38%, and 50% vs. 19%, p < 0.01). Mortality was significantly higher in the IVA group (4 patients, 15%, vs. 3 patients, 4%, respectively, p = 0.036) and was caused by severe head trauma in all cases.DiscussionThe severity of injury and mortality rate following IVA are higher compared with pedestrian injury. The pattern of injury following IVA is significantly different from non-intentional pedestrian trauma.ConclusionsIVA results in higher mortality than conventional pedestrian trauma secondary to more severe head injury. More hospital resources are required following IVA than following conventional road traffic accidents.

Highlights

We have recently witnessed an epidemic of intentional vehicular assaults (IVA) aimed at pedestrians
IVA results in higher mortality than conventional pedestrian trauma secondary to more severe head injury
We suggest the term “intentional vehicular assault” (IVA) to describe this specific type of violence

Summary

Introduction

We have recently witnessed an epidemic of intentional vehicular assaults (IVA) aimed at pedestrians. In the era of modern motor vehicles, we have acquired knowledge of the mechanism of injury and pathophysiology of injury, developed treatments protocols and prevention Injury caused by a motor vehicle driven intentionally into a pedestrian crowd with an intention to cause harm has recently become an uncommon and novel method of terrorism. This method of attack was first seen in Israel in 1987 during the first “Intifada” when a car was intentionally driven to into a group of soldiers inflicting severe injury. Radicals who embark on individual terrorist missions with little or no logistical support characterize this ‘lone wolf’ phenomenon [1]

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