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