Primary Triage, Evacuation Priorities, and Rapid Primary Distribution between Adjacent Hospitals—Lessons Learned from a Suicide Bomber Attack in Downtown Tel-Aviv

Abstract

Introduction:Terrorist attacks have occurred in Tel-Aviv that have caused mass-casualties.The objective of this study was to draw lessons from the medical response to an event that occurred on 19 January 2006, near the central bus station, Tel-Aviv, Israel. The lessons pertain to the management of primary triage, evacuation priorities, and rapid primary distribution between adjacent hospitals and the operational mode of the participating hospitals during the event.Methods:Data were collected in formal debriefings both during and after the event. Data were analyzed to learn about medical response components, interactions, and main outcomes. The event is described according to Disastrous Incidents Systematic AnalysiS Through—Components, Interactions and Results (DISAST-CIR) methodology.Results:A total of 38 wounded were evacuated from the scene, including one severely injured, two moderately injured, and 35 mildly injured. The severe casualty was the first to be evacuated 14 minutes after the explosion. All of the casualties were evacuated from the scene within 29 minutes. Patients were distributed between three adjacent hospitals including one non-Level-1 Trauma Center that received mild casualties. Twenty were evacuated to the nearby, Level-1 Sourasky Medical Center, including the only severely injured patient. Nine mildly injured patients were evacuated to the Sheba Medical Center and nine to Wolfson Hospital, a non-Level-1 Trauma Center hospital. All the receiving hospitals were operated according to the mass-casualty incident doctrine.Conclusions:When a mass-casualty incident occurs in the vicinity of more than one hospital, primary triage, evacuation priority decision-making, and rapid distribution of casualties between all of the adjacent hospitals enables efficient and effective containment of the event.

Performance indicators for initial regional medical response to major incidents: a possible quality control tool

“…Delays in decisions concerning distribution of victims might not be fatal in a minor incident, but can be crucial in situations with a more rapid course of events with a risk of overloading the nearest hospital [6,25-27]. Several studies on incidents involving casualties show that effective casualty distribution plays a vital role in disaster management, especially if the incident occurs in a rural area where resources are limited [5,7,27,28].…”

“…Several studies on incidents involving casualties show that effective casualty distribution plays a vital role in disaster management, especially if the incident occurs in a rural area where resources are limited [5,7,27,28]. …”

A single, improvised "Kassam" rocket explosion can cause a mass casualty incident: a potential threat for future international terrorism?

“…This may be caused by different bomb build and the spread of the soldiers over a larger area than the crowds in open market places, malls or hotels in which suicide bombers detonated themselves 6 – 8 10 – 11 13. In three suicide bomber explosions the prevalence of moderately and severely injured casualties was between 3% and 10%, probably because the suicide bomber was discovered by the security forces before he could approach the crowd and detonated himself far away from it 9 12 15…”

Indoor fire in a nursing home: evaluation of the medical response to a mass casualty incident based on a standardized protocol

“…A systematic review compared different available protocols of standardized reporting [14] and we chose this protocol because it was developed to report real incidents, has a practical approach, is freely available, has been published [1,15,16] and has been used previously [10,17,18]. Other protocols are more extensive but less practical, such as the Utstein template [19], the DISAST-CIR, a protocol used by the Israeli Defense Force Home Front and Ministry of Health [20][21][22][23][24][25][26][27][28] and two unused protocols [29,30]. None of these protocols have been tested on Internal and external validity [14].…”