Elsevier

Injury

Volume 40, Issue 7, July 2009, Pages 727-731
Injury

Israeli hospital preparedness for terrorism-related multiple casualty incidents: Can the surge capacity and injury severity distribution be better predicted?

https://doi.org/10.1016/j.injury.2008.11.010Get rights and content

Abstract

Background

The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams.

15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs.

Methods

A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as ≥10 casualties or ≥4 suffering from injuries with an ISS  16 arriving to a single hospital.

Results

The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8 ± 13.3 (range 4–56, median 16.5). In 95% of the HMCIs the casualty load was ≤52. Based on severity scores and ED discharges 1022 (79.2%) casualties did not necessitate immediate medical treatment.

Conclusion

Hospital preparedness can be better defined by a fixed number of casualties rather than a percentile of its bed capacity. Only 20% of the arriving casualties will require immediate medical treatment. Implementation of this concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.

Section snippets

Background

Terror attacks against civilian populations in urban settings have become much more common in recent years. Many countries in Europe, the Americas, Middle East and Asia have experienced such events and remain at risk of future attacks. Some countries such as Israel, United Kingdom, Turkey and Spain have been subjected to repeated attacks over many years.3, 4, 17, 22, 23 In Israel, a site of frequent terror attacks over the past decade, hundreds of civilians have lost their lives and thousands

Materials and methods

This study includes data regarding all terrorist attacks in a civilian setting in Israel, occurring between November 2000 and June 2003 and resulting in a HMCI. Two data sets were used for the study: the Israeli National Trauma Registry (ITR) and data obtained from the Home Front Command of the Israeli Defense Force (IDF). IDF Home Front Command records include the total numbers of casualties arriving at all Israeli hospitals due to terrorist related MCIs. The Israeli Trauma Registry (ITR)

Results

IDF records contain data regarding 54 terror attacks, ensuing in 106 HMCIs and 2563 casualties arriving at hospital. The mean number of hospitals managing an HMCI per terror attack was 2 ± 1.1 (range 1–6 hospitals, median 2 hospitals). The mean number of casualties arriving at hospital per HMCI was 24.2 ± 15.1 (range 10–81 casualties, median 18.5 casualties). In 101 out of 106 (95.3%) HMCIs the casualty load was up to 56 patients (Fig. 1).

The ITR subgroup contains data regarding 47 terror attacks,

Discussion

Hospital's preparedness for terrorist related HMCI comprises organisational infrastructure, staff training, manpower and equipment.2, 26 The predetermined level of preparedness has direct impact on the derivative costs. The numbers of ventilation and x-ray machines purchased and stored in reserve, emergency equipment and medication inventory, number of staff on call, as well as the magnitude of training scenarios should all be set accordingly.

In a recent comprehensive review of terror related

Conclusion

Appropriate preparedness for terrorist related HMCIs, an increasing threat in our world, is necessary in order to ensure appropriate medical treatment. Unfortunately, sufficient data has accumulated that enables us to replace the traditional “20% preparedness key” for hospital surge capacity. Based on data from past years’ multiple casualty incidents, Israeli hospitals’ surge capacity can be more accurately defined by a fixed number of casualties in order to address the vast majority of terror

Conflict of interest statement

None of the authors, or their relatives, has received any sort of benefit from any commercial or non-commercial company or institution for his contribution for the study.

Ethical board review statement

The study was performed following an appropriate approval from the Israeli Defense force Ethical Board.

References (28)

  • E.R. Frykberg

    Principles of mass casualty management following terrorist disasters

    Ann Surg

    (2004)
  • E.R. Frykberg et al.

    Disaster in Beirut: an application of mass casualty incidents

    Mil med

    (1987)
  • W.M. Guscott et al.

    The Bali bombings and the evolving mental health response to disaster in Australia: lessons from Darwin

    J Psychiatr Ment Health Nurs

    (2007)
  • J. Hanoch et al.

    A. Stab wounds associated with terrorist activities in Israel

    JAMA

    (1996)
  • View full text