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Managing Mild Casualties in Mass-Casualty Incidents: Lessons Learned from an Aborted Terrorist Attack

Published online by Cambridge University Press:  28 June 2012

Yuval H. Bloch ,
Adi Leiba ,
Nurit Veaacnin ,
Yohanan Paizer ,
Dagan Schwartz ,
Ahuva Kraskas ,
Gali Weiss ,
Avishay Goldberg  and
Yaron Bar-Dayan
Yuval H. Bloch*
Affiliation:
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel “Soroka” Medical Center, Beer-Sheva, Israel
Adi Leiba
Affiliation:
Home Front Command Medical Department, Israel Defense Force
Nurit Veaacnin
Affiliation:
“Soroka” Medical Center, Beer-Sheva, Israel
Yohanan Paizer
Affiliation:
“Soroka” Medical Center, Beer-Sheva, Israel
Dagan Schwartz
Affiliation:
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Israeli EMS, Magen David Adom, Medical Division
Ahuva Kraskas
Affiliation:
Home Front Command Medical Department, Israel Defense Force
Gali Weiss
Affiliation:
Home Front Command Medical Department, Israel Defense Force
Avishay Goldberg
Affiliation:
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Yaron Bar-Dayan
Affiliation:
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Home Front Command Medical Department, Israel Defense Force
*
Col. Dr. Y. Bar-Dayan, MD, MHA, 16 Dolev St. Neve Savion, Or-Yehuda, Israel E-mail: bardayan@netvision.net.il
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Abstract

Introduction:

Mildly injured and “worried well” patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties.

Methods:

Data were collected during and after the event, using patient records and formal debriefings.They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission.

Results:

A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint.During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently.

Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%).Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine.

Conclusions:

Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to appear in two phases. In the first phase, the rate of admission is expected to be higher. Due to the high incidence of anxiety and other stress-related phenomena, many mildly injured patients will require psychiatric evaluation. In the case of a bombing attack, many of the victims must be evaluated by an otolaryngologist.

Keywords

early phase admissionemergency medical servicesmass-casualty incidentsmild casualtiessecond phase admissionsuicide bombingterrorism
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 22 , Issue 3 , June 2007 , pp. 181 - 185
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2007

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