1
|
Korkmaz İ, Çelikkaya M, Atıcı A, Dirican E. Imaging in paediatric blast injuries: musculoskeletal injuries in the Syrian Civil War. Clin Radiol 2022; 77:522-528. [DOI: 10.1016/j.crad.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
|
2
|
Abstract
Summary Suicide bombers often target crowds. This commentary discusses the additional features required in a medical response beyond conventional mass casualty care, including forensic documentation, preservation of evidence, suspect tissue identification and viral status, victim counselling and postexposure prophylaxis. We propose a pathway for care of victims of a suicide bomb, adapting elements from protocols for child abuse, sexual assault and needle-stick exposure.
Collapse
|
3
|
Securing the Emergency Department During Terrorism Incidents: Lessons Learned From the Boston Marathon Bombings. Disaster Med Public Health Prep 2019; 13:791-798. [PMID: 30857570 DOI: 10.1017/dmp.2018.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Terrorist incidents that target hospitals magnify morbidity and mortality. Before a real or perceived terrorist mass casualty incident threatens a hospital and its providers, it is essential to have protocols in place to minimize damage to the infrastructure, morbidity, and mortality. In the years following the Boston Marathon bombings, much has been written about the heroic efforts of survivors and responders. Far less has been published about near misses due to lack of experience responding to a mass casualty incident resulting from terrorism. After an extensive review of the medical literature and published media in English, Spanish, and Hebrew, we were unable to identify a similar event. To the best of our knowledge, this is the first reported experience of a bomb threat caused evacuation of an emergency department in the United States while actively responding to multiple casualty terrorist incidents. We summarized the chronology of the events that led to a bomb threat being identified and the subsequent evacuation of the emergency department. We then reviewed the problematic nature of our response and described evidence-based policy changes based on data from health care, law enforcement, and counterterrorism. (Disaster Med Public Health Preparedness. 2019;13:791-798).
Collapse
|
4
|
Masukume G, O’Neill SM, Khashan AS, Kenny LC, Grech V. The Terrorist Attacks and the Human Live Birth Sex Ratio: a Systematic Review and Meta-Analysis. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 60:59-65. [DOI: 10.14712/18059694.2017.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aim: The live birth sex ratio is defined as male/total births (M/F). Terrorist attacks have been associated with a transient decline in M/F 3–5 months later with an excess of male losses in ongoing pregnancies. The early 21st century is replete with religious/politically instigated attacks. This study estimated the pooled effect size between exposure to attacks and M/F. Registration number CRD42016041220. Methods: PubMed and Scopus were searched for ecological studies that evaluated the relationship between terrorist attacks from 1/1/2000 to 16/6/2016 and M/F. An overall pooled odds ratio (OR) for the main outcome was generated using the generic inverse variance method. Results: Five studies were included: 2011 Norway attacks; 2012 Sandy Hook Elementary School shooting; 2001 September 11 attacks; 2004 Madrid and 2005 London bombings. OR at 0.97 95% CI (0.94–1.00) (I2 = 63%) showed a small statistically significant 3% decline in the odds (p = 0.03) of having a male live birth 3–5 months later. For lone wolf attacks there was a 10% reduction, OR 0.90 95% CI (0.86–0.95) (p = 0.0001). Conclusion: Terrorist (especially lone wolf) attacks were significantly associated with reduced odds of having a live male birth. Pregnancy loss remains an important Public Health challenge. Systematic reviews and meta-analyses considering other calamities are warranted.
Collapse
|
5
|
Almogy G, Kedar A, Bala M. When a vehicle becomes a weapon: intentional vehicular assaults in Israel. Scand J Trauma Resusc Emerg Med 2016; 24:149. [PMID: 28031040 PMCID: PMC5192584 DOI: 10.1186/s13049-016-0338-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background We have recently witnessed an epidemic of intentional vehicular assaults (IVA) aimed at pedestrians. We hypothesized that IVA are associated with a specific injury pattern and severity. Methods Retrospective analysis of prospectively acquired data of patients injured following IVA from October 2008 to May 2016 who were admitted to the Hadassah Level I trauma center in Jerusalem, Israel. Comparison of injury parameters and outcome caused by vehicular attacks to non-intentional pedestrian trauma (PT). Measured outcomes included ISS, AIS, injury pattern, ICU and blood requirements, participating teams, length of stay, and mortality. Results There were 26 patients in the IVA group. Mean age in the IVA group was significantly younger and there were more males compared to the PT group (24.7 ± 13.3 years vs. 48.3 ± 21.3, and 81% vs. 52%, respectively, p < 0.01). Lower extremity (77% of patients), followed by head (58%) and facial (54%) injuries were most commonly injured in the IVA group, and this was significantly different from the pattern of injury in the PT group (54, 35, and 28%, respectively, p < 0.05). Mean ISS and median head AIS were significantly higher in the IVA group compared with the PT group (23.2 ± 12.8 vs. 15.4 ± 13.8, p = 0.012, and 4.5 vs. 3, p = 0.003, respectively). ICU admission and blood requirement were significantly higher in the IVA group (69% vs. 38%, and 50% vs. 19%, p < 0.01). Mortality was significantly higher in the IVA group (4 patients, 15%, vs. 3 patients, 4%, respectively, p = 0.036) and was caused by severe head trauma in all cases. Discussion The severity of injury and mortality rate following IVA are higher compared with pedestrian injury. The pattern of injury following IVA is significantly different from non-intentional pedestrian trauma. Conclusions IVA results in higher mortality than conventional pedestrian trauma secondary to more severe head injury. More hospital resources are required following IVA than following conventional road traffic accidents.
Collapse
Affiliation(s)
- Gidon Almogy
- Department of Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Asaf Kedar
- Department of Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Miklosh Bala
- Department of Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
6
|
Hansen BT, Østergaard SD, Sønderskov KM, Dinesen PT. Increased Incidence Rate of Trauma- and Stressor-Related Disorders in Denmark After the September 11, 2001, Terrorist Attacks in the United States. Am J Epidemiol 2016; 184:494-500. [PMID: 27608664 DOI: 10.1093/aje/kww089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/16/2016] [Indexed: 11/13/2022] Open
Abstract
The terrorist attacks that occurred on September 11, 2001 (hereafter referred to as 9/11) in the United States had a profound impact on the physical and mental health of Americans, but the effects beyond the United States are largely unknown. To understand the wider aftermath, we examined the consequences of the 9/11 attacks on mental disorders in the Kingdom of Denmark. Utilizing population data from the Danish Psychiatric Central Research Register from 1995 to 2012, we used a time-series intervention approach to estimate the change in the incidence rate of mental disorders after the 9/11 attacks. Based on analyses of 1,448,250 contacts with psychiatric services, we found that the attacks were followed by an immediate 16% increase in the incidence rate of trauma- and stressor-related disorders. This surge dissipated approximately a year after 9/11. In contrast, no similar increases were found for other disorders. This is consistent with the prominent role of external stressors in the etiology of trauma- and stressor-related disorders. The results indicate that the effects of 9/11 on mental disorders extended across the Atlantic Ocean to Denmark. Thus, the impact of terrorist attacks on mental health is likely not limited to inhabitants of the country under attack; it also extends to people far away and without immediate relation to it.
Collapse
|
7
|
Yu M, Lv Q, Ding H, Zeng X, Cao J, Liu J, Fan H, Hou S. Evaluation of blast injury patients from the 2015 Tianjin explosions in China. Burns 2016; 42:1133-1140. [PMID: 27311537 DOI: 10.1016/j.burns.2016.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/23/2016] [Accepted: 03/13/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To perform a descriptive analysis of blast injury patients from the Tianjin explosions that occurred August 12, 2015 and provide a reference for triage and treatment of patients in similar situations in the future. METHODS The medical records of patients with blast injuries admitted to our hospital following the 2015 Tianjin explosions were retrospectively reviewed. The results were compared with the literature for other recent mass casualty events. RESULTS The 75 patients with blast injuries included 58 men (77.3%) and 17 women (22.7%), who had an average age of 36.39±12.3 years. Multidimensional injuries affecting almost every organ system were observed in these patients. The distribution of the types of blast injuries included 36 (48.0%) with primary blast injuries, 63 (84.0%) with secondary injuries, 33 (44.0%) with tertiary injuries and 32 (42.6%) with quaternary injuries. A total of 52 (69.3%) patients suffered more than two types of blast injury. Burns affecting different areas and different depths were present in 41.3% of the patients with blast injuries, and these were divided into the following four groups: a minor group (18.7%), a moderate group (10.7%), a severe group (5.3%), and an extra severe group (6.7%). The total body surface area (TBSA) affected by the burn ranged from 1% to 75%. Additionally, 6.7% of the patients were diagnosed with an inhalational injury, and 2.7% of the patients were diagnosed with chemical poisoning. There were significant differences in the department distribution (especially in the burn unit and ophthalmology department) and ICU treatment between civilians and firefighters. CONCLUSION Various types of injury, with overlapping injuries present in many patients, were observed in the victims after the Tianjin explosions. An evaluation of the distribution of blast injuries is important for optimizing strategies to triage and treat survivors after mass casualty events.
Collapse
Affiliation(s)
- Mengyang Yu
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Qi Lv
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Hui Ding
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Xihuan Zeng
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Juan Cao
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Jinyang Liu
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Haojun Fan
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China.
| | - Shike Hou
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China.
| |
Collapse
|
8
|
Rozenfeld M, Peleg K. Categorization of terrorist explosion settings - Is it that simple? Injury 2016; 47:1358-9. [PMID: 27079232 DOI: 10.1016/j.injury.2016.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Michael Rozenfeld
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, School of Public Health, Tel-Aviv, Israel
| | - Kobi Peleg
- Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, School of Public Health, Tel-Aviv, Israel.
| |
Collapse
|
9
|
Edwards DS, McMenemy L, Stapley SA, Patel HDL, Clasper JC. 40 years of terrorist bombings - A meta-analysis of the casualty and injury profile. Injury 2016; 47:646-52. [PMID: 26830126 DOI: 10.1016/j.injury.2015.12.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/23/2015] [Accepted: 12/26/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Terrorists have used the explosive device successfully globally, with their effects extending beyond the resulting injuries. Suicide bombings, in particular, are being increasingly deployed due to the devastating effect of a combination of high lethality and target accuracy. The aim of this study was to identify trends and analyse the demographics and casualty figures of terrorist bombings worldwide. METHODS Analysis of the Global Terrorism Database (GTD) and a PubMed/Embase literature search (keywords "terrorist", and/or "suicide", and/or "bombing") from 1970 to 2014 was performed. RESULTS 58,095 terrorist explosions worldwide were identified in the GTD. 5.08% were suicide bombings. Incidents per year are increasing (P<0.01). Mean casualty statistics per incidents was 1.14 deaths and 3.45 wounded from non-suicide incidents, and 10.16 and 24.16 from suicide bombings (p<0.05). The kill:wounded ratio was statistically higher in suicide attacks than non-suicide attacks, 1:1.3 and 1:1.24 respectively (p<0.05). The Middle East witnessed the most incidents (26.9%), with Europe (13.2%) ranked 4th. The literature search identified 41 publications reporting 167 incidents of which 3.9% detailed building collapse (BC), 60.8% confined space (CS), 23.5% open space (OS) and 11.8% semi-confined space (SC) attacks. 60.4% reported on suicide terrorist attacks. Overall 32 deaths and 180 injuries per incident were seen, however significantly more deaths occurred in explosions associated with a BC. Comparing OS and CS no difference in the deaths per incident was seen, 14.2(SD±17.828) and 15.63 (SD±10.071) respectively. However OS explosions resulted in significantly more injuries, 192.7 (SD±141.147), compared to CS, 79.20 (SD±59.8). Extremity related wounds were the commonest injuries seen (32%). DISCUSSION/CONCLUSION Terrorist bombings continue to be a threat and are increasing particularly in the Middle East. Initial reports, generated immediately at the scene by experienced coordination, on the type of detonation (suicide versus non-suicide), the environment of detonation (confined, open, building collapse) and the number of fatalities, and utilising the Kill:Wounded ratios found in this meta-analysis, can be used to predict the number of casualties and their likely injury profile of survivors to guide the immediate response by the medical services and the workload in the coming days.
Collapse
Affiliation(s)
- D S Edwards
- Royal Centre for Defence Medicine; The Royal British Legion Centre for Blast Injury Studies, Imperial College London.
| | - L McMenemy
- Royal Centre for Defence Medicine; The Royal British Legion Centre for Blast Injury Studies, Imperial College London
| | | | | | - J C Clasper
- Royal Centre for Defence Medicine; The Royal British Legion Centre for Blast Injury Studies, Imperial College London; Defence Medical Group (South East), Frimley Park, UK
| |
Collapse
|
10
|
Hu Q, Chai J, Hu S, Fan J, Wang HW, Ma L, Duan HJ, Liu L, Yang H, Li BL, Wang YH. Development of an Animal Model for Burn-Blast Combined Injury and Cardiopulmonary System Changes in the Early Shock Stage. Indian J Surg 2014; 77:977-84. [PMID: 27011494 DOI: 10.1007/s12262-014-1095-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/27/2014] [Indexed: 01/23/2023] Open
Abstract
The purposes of this study were to establish an animal model for burn-blast combined injury research and elaborate cardiopulmonary system changes in the early shock stage. In this study, royal demolition explosive or RDX (hexagon, ring trimethylene nitramine) was used as an explosive source, and the injury conditions of the canine test subjects at various distances to the explosion (30, 50, and 70 cm) were observed by gross anatomy and pathology to determine a larger animal model of moderate blast injury. The canines were then subjected to a 35 % total body surface area (TBSA) full-thickness flame injury using napalm, which completed the development of a burn-blast combined injury model. Based on this model, the hemodynamic changes and arterial blood gas analysis after the burn-blast combined injury were measured to identify the cardiopulmonary system characteristics. In this research, RDX explosion and flame injury were used to develop a severe burn-blast injury animal model that was stable, close to reality, and easily controllable. The hemodynamic and arterial blood gas changes in the canine subjects after burn-blast injury changed distinctly from the burn and blast injuries. Blood pressure and cardiac output fluctuated, and the preload was significantly reduced, whereas the afterload significantly increased. Meanwhile, the oxygen saturation (SO2) decreased markedly with carbon dioxide partial pressure (PCO2), and lactic acid (Lac) rose, and oxygen partial pressure (PO2) reduced. These changes suggested that immediate clinical treatment is important during burn-blast injury both to stabilize cardiac function and supply blood volume and to reduce the vascular permeability, thereby preventing acute pneumonedema or other complications.
Collapse
Affiliation(s)
- Quan Hu
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Jiake Chai
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Sen Hu
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Jun Fan
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Hong-Wei Wang
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Li Ma
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Hong-Jie Duan
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Lingying Liu
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Hongming Yang
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Bai-Ling Li
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| | - Yi-He Wang
- Department of Burn and Plastic Surgery, Burns Institute, The First Affiliated Hospital of PLA General Hospital, 100048 Beijing, China
| |
Collapse
|
11
|
|
12
|
Browne LR, Keeney GE, Spahr CD, Lerner EB, Atabaki SM, Drayna P, Cooper A. Trauma Care for Children in the Field. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2014. [DOI: 10.1016/j.cpem.2014.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Penetrating and orthopaedic trauma from blast versus gunshots caused by terrorism: Israel's National Experience. J Orthop Trauma 2011; 25:145-9. [PMID: 21278606 DOI: 10.1097/bot.0b013e3181e7f177] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluation of the demographics, features, and outcomes of musculoskeletal injury patterns caused by terrorism in the civil setting and comparing injuries from explosions with gunshot injuries. DESIGN Retrospective cohort analysis of a prospective database. SETTING National trauma registry consisting of all the six Level I and four Level II trauma centers. PATIENTS A total of 1245 casualties with terror-related musculoskeletal trauma. Five hundred fifty-one had high-velocity gunshot wound and 694 blast wounded (BW) caused by explosion. MAIN OUTCOME MEASUREMENTS Demographic and injury data analyzed for age, gender, New Injury Severity Score, and associated injuries. Outcome of were analyzed according to length of hospital stay, intensive care unit stay, surgical procedures, and mortality. RESULTS Severe injuries (New Injury Severity Score 16 or greater) were more common in the BW group (P < 0.01). In the BW group, a significantly higher proportion of casualties had associated injuries (73% versus 43%), intensive care unit care, longer length of stay, and mortality. Orthopaedic injuries were similar among the two groups with more open extremity fractures in the gunshot wound group and less significant injuries in the BW group. With casualties matched to the same New Injury Severity Score groups, the ones with the musculoskeletal injuries had longer hospitalization than those without. CONCLUSIONS Musculoskeletal injury caused by blast is associated with multiple penetrating injuries, differing from more "conventional" penetrating trauma such as caused by gunshot injuries. Although the treatment of specific injuries caused by both mechanisms is essentially similar, the systemic effect of the blast must be taken into consideration in anticipation of an increased overall injury severity.
Collapse
|
14
|
Caro DHJ. Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers. Int J Emerg Med 2010; 3:357-65. [PMID: 21373305 PMCID: PMC3047861 DOI: 10.1007/s12245-010-0252-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 10/20/2010] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA. Aims This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services. Methods This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature. Results This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems. Conclusions Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations.
Collapse
Affiliation(s)
- Denis H. J. Caro
- Telfer School of Management/École de Gestion Telfer, University of Ottawa/Université d’Ottawa, 5141 Desmarais Building, 55 Laurier East, Ottawa, ON K1N 6N5 Canada
| |
Collapse
|
15
|
The Pattern of Thoracic Trauma After Suicide Terrorist Bombing Attacks. ACTA ACUST UNITED AC 2010; 69:1022-8; discussion 1028-9. [DOI: 10.1097/ta.0b013e3181f35c71] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
16
|
Abstract
Health-care providers are increasingly faced with the possibility of needing to care for people injured in explosions, but can often, however, feel undertrained for the unique aspects of the patient's presentation and management. Although most blast-related injuries (eg, fragmentation injuries from improvised explosive devices and standard military explosives) can be managed in a similar manner to typical penetrating or blunt traumatic injuries, injuries caused by the blast pressure wave itself cannot. The blast pressure wave exerts forces mainly at air-tissue interfaces within the body, and the pulmonary, gastrointestinal, and auditory systems are at greatest risk. Arterial air emboli arising from severe pulmonary injury can cause ischaemic complications-especially in the brain, heart, and intestinal tract. Attributable, in part, to the scene chaos that undoubtedly exists, poor triage and missed diagnosis of blast injuries are substantial concerns because injuries can be subtle or their presentation can be delayed. Management of these injuries can be a challenge, compounded by potentially conflicting treatment goals. This Seminar aims to provide a thorough overview of these unique primary blast injuries and their management.
Collapse
Affiliation(s)
- Stephen J Wolf
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
| | | | | | | | | |
Collapse
|