1
|
Rahman GR, Liang SY, Tian L, Sin SS, Jasani GN. Trends and Characteristics of Terrorist Attacks Against Nightclub Venues Over 5 Decades. Disaster Med Public Health Prep 2024; 18:e12. [PMID: 38287687 DOI: 10.1017/dmp.2023.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Nightclubs are entertainment and hospitality venues historically vulnerable to terrorist attacks. This study identified and characterized terrorist attacks targeting nightclubs and discotheques documented in the Global Terrorism Database (GTD) over a 50-y period. METHODS A search of the Global Terrorism Database (GTD) was conducted from 1970 to 2019. Precoded variables for target type "business" and target subtype "entertainment/cultural/stadium/casino" were used to identify attacks potentially involving nightclubs. Nightclub venues were specifically identified using the search terms "club," "nightclub," and "discotheque." Two authors manually reviewed each entry to confirm the appropriateness for inclusion. Descriptive statistics were performed using R (3.6.1). RESULTS A total of 114 terrorist attacks targeting nightclub venues were identified from January 1, 1970, through December 31, 2019. Seventy-four (64.9%) attacks involved nightclubs, while forty (35.1%) attacks involved discotheques. A bombing or explosion was involved in 84 (73.7%) attacks, followed by armed assault in 14 (12.3%) attacks. The highest number of attacks occurred in Western Europe and Sub-Saharan Africa. In total, 284 persons died, and 1175 persons were wounded in attacks against nightclub venues. CONCLUSIONS While terrorist attacks against nightclub venues are infrequent, the risk for mass casualties and injuries can be significant, mainly when explosives and armed assaults are used.
Collapse
Affiliation(s)
- Grace R Rahman
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Stephen Y Liang
- Department of Emergency Medicine and Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Linlin Tian
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Steve S Sin
- National Consortium for the Study of Terrorism and Responses to Terrorism, University of Maryland, College Park, MD, USA
| | - Gregory N Jasani
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Joarder M, Noureddine El Moussaoui H, Das A, Williamson F, Wullschleger M. Impact of time and distance on outcomes following tourniquet use in civilian and military settings: A scoping review. Injury 2023; 54:1236-1245. [PMID: 36697284 DOI: 10.1016/j.injury.2023.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/01/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The last two decades have seen the reintroduction of tourniquets into guidelines for the management of acute limb trauma requiring hemorrhage control. Evidence supporting tourniquet application has demonstrated low complication rates in modern military settings involving rapid evacuation timeframes. It is unclear how these findings translate to patients who have prolonged transport times from injury in rural settings. This scoping review investigates the relationship between time and distance on metabolic complications, limb salvage and mortality following tourniquet use in civilian and military settings. METHODS A systematic search strategy was conducted using PubMed, Embase, and SafetyLit databases. Study characteristics, setting, mechanism of injury, prehospital time, tourniquet time, distance, limb salvage, metabolic response, mortality, and tourniquet removal details were extracted from eligible studies. Descriptive statistics were recorded, and studies were grouped by ischemia time (< 2 h, 2-4 h, or > 4 h). RESULTS The search identified 3103 studies, from which 86 studies were included in this scoping review. Of the 86 studies, 55 studies were primarily in civilian environments and 32 were based in military settings. One study included both settings. Blast injury was the most common mechanism of injury sustained by patients in military settings (72.8% [5968/8200]) followed by penetrating injury (23.5% [1926/8200]). In contrast, in civilian settings penetrating injury was the most common mechanism (47.7% [1633/3426]) followed by blunt injury (36.4% [1246/3426]). Tourniquet time was reported in 66/86 studies. Tourniquet time over four hours was associated with reduced limb salvage rates (57.1%) and higher mortality rates (7.1%) compared with a tourniquet time of less than two hours. The overall limb salvage and mortality rates were 69.6% and 6.7% respectively. Metabolic outcomes were reported in 28/86 studies with smaller sample sizes and inconsistencies in which parameters were reported. CONCLUSION This scoping review presents literature describing comparatively safe tourniquet application when used for less than two hours duration. However, there is limited research describing prolonged tourniquet application or when used for protracted distances, such that the impact of tourniquet release time on metabolic outcomes and complications remains unclear. Prospective studies utilizing the development of an international database to provide this dataset is required.
Collapse
Affiliation(s)
- Maisah Joarder
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
| | - Hussein Noureddine El Moussaoui
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Arpita Das
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Frances Williamson
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Trauma Service, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Martin Wullschleger
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Trauma Service, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| |
Collapse
|
3
|
Ronconi RWF, Moreira LH, de Lima CJ, Neto OP, Osorio RAL. Tourniquets, types and techniques in emergency prehospital care: A narrative review. Med Eng Phys 2023; 111:103923. [PMID: 36792231 DOI: 10.1016/j.medengphy.2022.103923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/19/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Massive uncontrolled hemorrhage is an important cause of preventable death in trauma. Therefore, applying an arterial tourniquet (TQ) is recommended as a pre-hospital measure to control bleeding after severe traumatic bleeding. Limb TQ applies circumferential compression proximally to the injury site to compress the arteries, resulting in blood flow and consequently hemorrhage interruption. The use of commercial tourniquets (C-TQ), which are designed, tested, and registered to control hemorrhages in pre-hospital care, is a consensus. However, they are still uncommon in many prehospital emergency services and the overall level of evidence in most studies is low. This narrative review aimed to characterize the importance of tourniquets use in prehospital emergency care and its application techniques. Furthermore, it proposes to stimulate the development of new devices, more accessible and easier to use, to suggest new directions of studies and medical education demands, with manikin and simulation development.
Collapse
Affiliation(s)
- Roger William Freire Ronconi
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil; Tacmed Brasil, Taubaté, São Paulo, Brazil.
| | - Livia Helena Moreira
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil
| | - Carlos José de Lima
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil
| | - Osmar Pinto Neto
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil; Arena235 Research Lab, São José dos Campos, São Paulo, Brazil
| | - Rodrigo Alexis Lazo Osorio
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil
| |
Collapse
|
4
|
Tatebe LC, Schlanser V, Hampton D, Chang G, Hanson I, Doherty J, Issa N, Ghandour H, Kingsley S, Stewart A, Anstadt M, Dennis A. The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation. J Trauma Acute Care Surg 2022; 92:890-896. [PMID: 34882594 DOI: 10.1097/ta.0000000000003491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As tourniquets have become more prevalent, device use has been questioned. This study sought to characterize the incidence, indication, and efficacy of tourniquet placement in acute trauma resuscitation. METHODS Nine regional level 1 trauma centers prospectively enrolled for 12 months adult patients (18 years or older) who had a tourniquet placed. Age, sex, mechanism, tourniquet type, indication, applying personnel, location placed, level of occlusion, and degree of hemostasis were collected. Major vascular injury, imaging and operations performed, and outcomes were assessed. Analyses were performed with significance at p < 0.05. RESULTS A total of 216 tourniquet applications were reported on 209 patients. There were significantly more male patients (183 [88%]) and penetrating injuries (186 [89%]) with gunshots being most common (127 [61%]). Commercial tourniquets were most often used (205 [95%]). Ninety-two percent were placed in the prehospital setting (by fire/paramedics, 56%; police, 33%; bystanders, 2%). The most common indications were pooling (47%) and pulsatile (32%) hemorrhage. Only 2% were for amputation. The most frequent location was high proximal extremity (70%). Four percent were placed over the wound, and 0.5% were distal to the wound. Only 61% of applications were arterial occlusive. Median application time was 30 minutes (interquartile range, 20-40 minutes). Imaging was performed in 54% of patients. Overall, 36% had a named arterial injury. Tourniquet application failed to achieve hemostasis in 22% of patients with a named vascular injury. There was no difference in hemostasis between those with and without vascular injury (p = 0.12) or between who placed the tourniquet (p = 0.07). Seventy patients (34%) required vascular operations. Thirty-four percent of patients were discharged home without admission. CONCLUSION Discerning which injuries require tourniquets over pressure dressings remains elusive. Trained responders had high rates of superfluous and inadequate deployments. As tourniquets continue to be disseminated, emphasis should be placed on improving education, device development, and quality control. LEVEL OF EVIDENCE Prognostic/Epidemiologic, Level III.
Collapse
Affiliation(s)
- Leah Carey Tatebe
- From the Department of Trauma and Burn Surgery (L.C.T., V.S., A.D.), Cook County Health, Rush University, Midwestern University, Chicago, Illinois; Department of Surgery (D.H.), University of Chicago, Chicago, Illinois; Department of Surgery (G.C., I.H.), Mount Sinai Hospital, Chicago, Illinois; Department of Surgery (J.D.), Advocate Christ Medical Center, Oak Lawn, Illinois; Department of Surgery (N.I.), Northwestern University, Chicago, Illinois; Department of Surgery (H.G., S.K.), Advocate Illinois Masonic Medical Center, Chicago, Illinois; Department of Surgery (A.S.), Advocate Lutheran General Hospital, Park Ridge, Illinois; and Department of Surgery (M.A.), Loyola University, Maywood, Illinois
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Borgers F, Van Boxstael S, Sabbe M. Is tactical combat casualty care in terrorist attacks suitable for civilian first responders? J Trauma Acute Care Surg 2021; 91:e86-e92. [PMID: 34238863 DOI: 10.1097/ta.0000000000003337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Prehospital management of intentional mass casualty incidents is a unique challenge to Emergency Medical Services. Tactical Combat Casualty Care (TCCC) and the use of tourniquets for extremity hemorrhage have already proven to reduce mortality on the battlefield. This literature review aims to determine the place of these military concepts in a civilian high-threat prehospital setting. METHODS The PubMed database was searched for articles published between January 1, 2000, and December 1, 2019, containing descriptions, discussions, or experiences of the application of tourniquets or other TCCC-based interventions in the civilian prehospital setting. Data extraction focused on identifying important common themes in the articles. RESULTS Of the 286 identified articles, 30 were selected for inclusion. According to the Oxford Centre for Evidence-based Medicine Levels of Evidence, overall level of evidence was low. Most articles were observational, retrospective cohort studies without a nontourniquet control group. Outcome measures and variables were variably reported. Two articles specifically analyzed tourniquet use during high-threat situations, and three described their application by law enforcement personnel. Overall, tourniquets were found to be effective in stopping major limb bleeding. Reported mortality was low and related complications appeared to be infrequent. Only four articles mentioned the application of other TCCC-based maneuvers, such as airway and respiratory management. CONCLUSION This literature review shows that tourniquets appear to be safe tools associated with few complications and might be effective in controlling major bleeding in civilian limb trauma. For example, during mass casualty incidents, their use could be justified. Training and equipping ambulance and police services to deal with massive bleeding could likewise improve interoperability and victim survival in a civilian high-threat prehospital setting. More qualitative research is needed to further evaluate the effects of hemorrhage control training for first responders on patient outcomes. Literature describing the application of other TCCC-based principles is limited, which makes it difficult to draw conclusions regarding their use in a civilian setting. LEVEL OF EVIDENCE Systematic review, level III.
Collapse
Affiliation(s)
- Felix Borgers
- From the Department of Anesthesiology (F.B.), University Hospitals Leuven, Leuven, Belgium; Emergency Department (V.B.), ZOL Hospital Genk, Genk, Belgium; and Emergency Department (M.S.), University Hospitals Leuven, Leuven, Belgium
| | | | | |
Collapse
|