Urban Bombing: A Trauma Surgeon's Perspective

During the latter part of the 20 th century and entering the new millennium it becomes obvious that terrorism is playing a key role as the major form of armed conflict that affects civilians. In essence, terrorism is the calculated use of violence or the threat of violence to attain political, religious or ideological goals. Intimidation, coercion and spreading of fear are but a few of the methods used by perpetrators. The modern war zone is therefore no longer remote, and civilian casualties, sometimes in large numbers, present a unique challenge to medical facilities used to dealing with a single or few trauma patients at any one time. Urban terrorism brings about chaos and mass hysteria, together with occasional overwhelming of medical facilities, municipal or public services. Terrorists use mostly conventional munitions and explosives, but the threat of terrorism using weapons of mass destruction is foremost in the public’s mind. However, with the exception of the chemical attacks in Matsumoto (1) and the Tokyo subway (2, 3) in Japan, most significant terrorist attacks in the latter part of the 20 th and the beginning of the 21 st centuries used conventional weapons, resulting in thousands of traumatic injuries among civilians. Terror-related injuries present a new entity of multidimensional injury, involving blast, penetrating, blunt and burn mechanisms simultaneously. Hidden bombs or suicide bombers serving as “human guided missiles” (4) cause most of these injuries. With the experience in Beirut in 1983 (5, 6, 7), the numerous suicide explosions in Israel (8), other suicide terror like in Indonesia, Iraq and Chechnya, and the urban mass casualty incidents in Madrid (2004) and London (2005), the world has come to realize that modern terrorists are ready to go all the way, often paying with their own lives, just to make their point.