Yoram Weiss and colleagues from the Hadassah Hebrew University Hospital in Jerusalem, did a retrospective review of the hospital's response to the 33 multiple-casualty terror incidents that occurred in Jerusalem between October 2000 and September 2004. Following the incidents, 541 victims were admitted to the emergency department of the Hadassah Hebrew University Hospital. Out of these, 101 patients were transferred to Intensive Care Units (ICU's).
Weiss et al. recommend, first of all, the close follow-up of all severely injured patients from admission to the emergency department through to radiology and surgery – a concept they call 'forward deployment'. They also advise the set up of a team of senior staff from all departments, who have ultimate responsibility during the whole emergency operation – what they call the 'chain of command'. A senior surgeon directs the injured to the appropriate area of the emergency department, and other senior surgeons accompanied by anaesthesiologists with intensive care training guide the teams in each area. These intensive care professionals follow the most severely injured patients and assume care of them in the ICU.
In addition to these two main guidelines, the authors give details on the way they manage their staff and resources in the hospital before and during events. For example, they make sure that upon warning of a terror attack the emergency department is cleared out, as it is the first port of entry into the hospital during an emergency situation. 'Multiple casualty carts' with equipment for the care of severely injured patients are ready to be used at all times. To help with efficient staff recruitment in case of an emergency, an up-to-date list of all the staff is permanently posted in a prominent place in the hospital. During the emergency response anaesthesiologists with ICU training are present in each area of the emergency department, to perform timely intubations and resuscitations.
The authors also give a set of recommendations regarding the treatment and management of patients with the most common injuries caused by bomb blasts, such as brain injuries, acute lung injuries, orthopaedic injuries and abdominal blast injuries. These are all challenging injuries to treat and are very often combined in survivors of terror attacks.
This press release is based on the article:
The Israeli Experience: Conventional Terrorism and Critical Care
Gabriella Aschkenasy-Steuer, Micha Shamir, Avraham Rivkind, Rami Mosheiff, Yigal Shushan, Guy Rosenthal, Yoav Mintz, Charles Weissman, Charles L. Sprung, Yoram G. Weiss
Critical Care 9: in press
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Critical Care