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01.06.2015 | Leitthema | Ausgabe 4/2015

Notfall +  Rettungsmedizin 4/2015

Dealing with terror-related mass casualty events

Principles and lessons learned

Notfall + Rettungsmedizin > Ausgabe 4/2015
PhD MPH K. Peleg, MA M. Rozenfeld
Wichtige Hinweise


J. Hinkelbein, Köln
H. Moecke, Hamburg
A German version of this article is available at http://​dx.​doi.​org/​10.​1007/​s10049-015-0029-5.



To describe the evidence-based insights and guidelines regarding the preparedness of health-care systems to deal with terror attacks.


Review of the existing literature on the subject with an emphasis on data from the Second Intifada of 2000–2005.


The most critical components of dealing with terror attacks are not the clinical guidelines and protocols but organization, command, control, communication, and coordination (OCCCC). Creating universal protocols for dealing with terror attacks is problematic because they can differ greatly in injury characteristics, time to evacuation and treatment, and levels of hospital preparedness. Overall, terror casualties involve more severe injuries than other types of trauma and require more hospital resources. The most important clinical parameter of injuries from terrorist explosion attacks is a mix of different types of severe injury in the same patient. This complicates triage, and thus the dichotomic distinction of “urgent” and “not urgent” patients may be more helpful than the classic “color system.” The stream of severely injured patients into hospital frequently creates bottlenecks, especially in the emergency department, the intensive care unit, and imaging and operation rooms.


The most important guidelines for the preparedness of health-care systems for terror attacks are: establishment of a central authority for coordinating preparedness and response; existence of clear preparedness goals; definition of standard operating procedures for all organizational levels; enhancement of surge in hospital capacity; quick clearance of emergency departments to receive urgent casualties with non-urgent patients directed elsewhere; quick reinforcement of emergency departments by additional staff; distribution of severe casualties between adjacent hospitals with possible definition of the closest one as triage hospital; training and exercising of medical staff on all levels.

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