Mass Casualty Terrorist Bombings: Comparison of Outcomes by Bombing Type

Abstract

Purpose:To investigate the use of laryngeal mask (LM) in Prehospital Emergency Medicine, to document the experiences with the device, and to develop a staff-training program. Materials: From 01 January 2000 through 31 December 2002, doctors and paramedics placed the LM in victims of respiratory or cardio-respiratory arrests or victims of multiple traumatic injuries. Paramedics were trained in LM placement for a total of 12 hours (video, manikin). Methods: The following information was recorded for each patient: (1) Vital signs (systolic and diastolic arterial blood pressures (SAP, DAP), heart rate (HR); ventilatory rate (RR), pulse oximetry readings (SpO 2 ); Glasgow Coma Scale score, (GCS)), Rapid Acute Physiology Score (RAPS) on-site and at the Emergency Department, Hector Emergency Scale (HES), and therapeutic interventions. Results:The LM was placed in 221 cases (140 cardio-respiratory, 70 respiratory arrests, 9 multi-trauma patients, and 2 burn episodes). In 147 episodes, it was placed by paramedics without a doctor present, and in 77 cases with a doctor present. In 94% of the cases, the LM was placed in the first attempt.For the 140 victims of cardio-respiratory arrests, 47 patients had return of spontaneous circulation (ROSC, heart rhythm and arterial pressure). In these cases, the mean SpO 2 and GCS on-site and at hospital arrival were: SpO 2 = 31.8% -> 87% ; and GCS = 3 -» 13 respectively. In those patients with respiratory arrests: SpO 2 = 61% -» 96.5% and GCS = 7 -» 14. In victims of multi-trauma, the intubation was impossible in four patients. For another four patients, the LM was a temporary airway, and in three cases, the patient was intubated via the LM with handle after general Anesthesia (SpO 2 = 65% -> 97% and GCS = 6 -> 12). No aspiration was observed in patients who recovered from respiratory and cardio-respiratory arrests as well as in multi-trauma patients. Conclusions:This 3-year experience shows that crew training is easy and practice using the device indicates that only rarely are there sides effects. The LM is a valuable tool during the recovery process and for establishing a temporary airway in the prehospital setting. Objectives: The aim of the study was to use a visual analogue scale (VAS) to measure pain severity in the prehospital setting, and to compare changes in pain score with a clinically significant benchmark reduction of 20 mm. Methods: This prospective, observational study used a VAS to record pain severity for patients requiring ambulance transport. Patients used a VAS to score pain severity during the initial patient assessment process (T Q ), and again at the hospital of destination (T end ). This study reports mean changes in score, and the percentage of cases in which the difference between T Q and Tend in the study population achieves or exceeds the 20 mm benchmark. A survey also was administered to ambulance officers participating in this study to identify attitudes, values, and beliefs that may influence their use of the VAS.Results: A total of 262 patients were enr...

Development of an Animal Model for Burn-Blast Combined Injury and Cardiopulmonary System Changes in the Early Shock Stage

“…About 35,000 cases were attributed to explosions during the war in Iraq and Afghanistan [19]. Meanwhile, the numerous terrorist acts worldwide, especially suicide bomb attacks, have resulted in more than 200,000 explosion-related deaths [20]. Previous studies had confirmed that the mortality of burn-blast combined injury patients was significantly higher than that of burn or blast injury patients.…”

On the human consequences of terrorism

“…Arnould et al (2004) report median deaths and injuries for six different types of bombings using worldwide data covering 43 events. They are the data entered in the first two rows of columns (1)-(6).…”

An Experimental Architecture for Observation of Triage Related Decision Making

“…Injuries sustained by simulated casualties reflect the most common injuries seen in mass casualty incidents involving blunt trauma injuries. Injury statistics of casualties from railway, aviation, and automotive crashes, fires, and terrorist bombings were reviewed to determine the most common blunt trauma injuries sustained in these disasters [13][14][15][16][17]. The most common blunt trauma injuries found in these disasters were soft tissue injuries, fractures, and head injuries.…”