Suicide Bombers Form a New Injury Profile

In Brief Background: Recent explosions of suicide bombers introduced new and unique profiles of injury. Explosives frequently included small metal parts, increasing severity of injuries, challenging both physicians and healthcare systems. Timely detonation in crowded and confined spaces further increased explosion effect. Methods: Israel National Trauma Registry data on hospitalized terror casualties between October 1, 2000 and December 31, 2004 were analyzed. Results: A total of 1155 patients injured by explosion were studied. Nearly 30% suffered severe to critical injuries (ISS ≥ 16); severe injuries (AIS ≥ 3) were more prevalent than in other trauma. Triage has changed as metal parts contained in bombs penetrate the human body with great force and may result in tiny entry wounds easily concealed by hair, clothes etc. A total of 36.6% had a computed tomography (CT), 26.8% had ultrasound scanning, and 53.2% had an x-ray in the emergency department. From the emergency department, 28.3% went directly to the operating room, 10.1% to the intensive care unit, and 58.4% directly to the ward. Injuries were mostly internal, open wounds, and burns, with an excess of injuries to nerves and to blood vessels compared with other trauma mechanisms. A high rate of surgical procedures was recorded, including thoracotomies, laparotomies, craniotomies, and vascular surgery. In certain cases, there were simultaneous multiple injuries that required competing forms of treatment, such as burns and blast lung. Conclusions: Bombs containing metal fragments detonated by suicide bombers in crowded locations change patterns and severity of injury in a civil population. Specific injuries will require tailored approaches, an open mind, and close collaboration and cooperation between trauma surgeons to share experience, opinions, and ideas. Findings presented have implications for triage, diagnosis, treatment, hospital organization, and the definition of surge capacity. Suicide bombers schedule detonation in crowded and confined spaces creating injuries from small metal fragments besides blast. Israel National Trauma Registry data (October 1, 2000 to December 31, 2004) produced 1155 such casualties. Entry wounds were easily concealed by hair and clothes, affecting triage. A total of 36.6% had a computed tomography (CT), 26.8% ultrasound scanning in the emergency department, and 532% had an x-ray. A high rate of surgical procedures was recorded, including thoracotomies, laparotomies, craniotomies, and vascular surgery. Injuries were mostly internal, open wounds, and burns, with an excess of injuries to nerves and to blood vessels. Severe injuries (AIS ≥ 3) were more prevalent in explosion victims than in patients with other trauma. In certain cases, there were simultaneous multiple injuries that required competing forms of treatment, such as burns and blast lung. Findings have implications for triage, diagnosis, treatment, and hospital organization.