Indicators of the need for ICU admission following suicide bombing attacks

KABUL AIRPORT SUICIDE BOMBING ATTACK: MASS CASUALTY MANAGEMENT AT THE EMERGENCY'NGO HOSPITAL

BACKGROUND

Terrorist attacks with large numbers of civilian victims are not uncommon in war-torn countries, and present a unique challenge for health care facilities with limited resources. However, these events are largely under-reported and little is known about how the mass casualty events (MCE) are handled outside of a military setting.

METHODS

This study is a retrospective analysis of the MCE which ensued the Kabul Airport suicide attack (26th August 2021) at the Kabul EMERGENCY'NGO Hospital (Afghanistan).

RESULTS

Within six hours 93 causalities presented at our hospital. Out of them, 36 severe injured were admitted. Mean age was 30.8 years (SD 10.1). The most common injury mechanism was shell fragments. The most common injury site was head (63%; 23/36), followed by limbs (55.5%; 20/36) and thoracoabdominal region (30.5%; 11/36). Combined injuries occurred in 38.9% of cases. Patients receiving surgery presented more combined injuries in comparison with patients receiving only medical treatment (47.1% vs 31.6%). Thoraco-abdomen (25.0% vs 15.4%) and/or extremity injury (42.9% vs 28.6%) were more prevalent in the surgical group. Thirty major surgical procedures were carried out on 17 patients in the nine hours following the first arrival. The rate of Intensive Care Unit/High Dependency Unit admission was 36.1% and the 30-day in-hospital mortality was 16.6% (6/36). All deaths were recorded in the first 24 hours and none of them received surgery.

CONCLUSIONS

A large number of wounded patients must be anticipated after suicide bombing attacks. The authors report the challenges faced and key aspects of their management of MCEs.

LEVEL OF EVIDENCE

Retrospective analysis/incident management.

Injuries From Explosions: More Differences Than Similarities Between Various Types

OBJECTIVE

To compare injury patterns of different types of explosions.

METHODS

A retrospective study of 4508 patients hospitalized due to explosions recorded in the Israel National Trauma Registry between January 1997 and December 2018. The events were divided into 4 groups: terror-related, war-related, civilian intentional explosions, and civilian unintentional explosions. The groups were compared in terms of injuries sustained, utilization of hospital resources, and clinical outcomes.

RESULTS

Civilian intentional and terror-related explosions were found to be similar in most aspects except for factors directly influencing mortality and a larger volume of severely injured body regions among terror-victims. Comparisons between other groups produced some parallels, albeit less consistent. Civilian intentional explosions and civilian unintentional explosions were different from each other in most aspects. The latter group also differed from others by its high volume of life-threatening burns and a higher proportion of children casualties.

CONCLUSIONS

While consistent similarities between explosion casualties exist, especially between victims of intentional civilian and terror-related explosions, the general rule is that clinical experience with a type of explosion cannot be directly transferred to other types.

Suicide Bombing Terrorism

INTRODUCTION

While suicide bombings in the context of warfare have existed throughout history, there was an exponential rise in such attacks in the decade following the initiation of the War on Terror. The health care implications of such attacks are a growing concern across the emergency response sector, and this study is an epidemiological examination of all terrorism-related bombings sustained from 1970-2019, comparing the rates of fatal injuries (FI) and non-fatal injuries (NFI) between suicide bombing attacks (SBA) versus non-suicide bombing attacks (NSBA).

METHOD

Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD database was downloaded and searched using the internal database search functions for all events that occurred from January 1, 1970 - December 31, 2019. Bombing/explosion as a primary "attack type" and explosives as a primary "weapon type" were selected for the purpose of this study, and events were further sub-classified as either "suicide attack" or "non-suicide attack." Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

FINDINGS

There were 82,217 bombing/explosion terrorist attacks using explosives documented during the study period with 135,807 fatalities and 352,500 NFI.A total of 5,416 events (6.59% of all events) were sub-classified as SBA causing 52,317 FI (38.52% of all FI) and 107,062 NFI (30.37% of all NFI).Mean SBA FI was 9.66 per event and mean SBA NFI was 19.77 per event compared to a mean NSBA FI of 1.09 per event and mean NSBA NFI of 3.20 per event.

CONCLUSION

Suicide bombing attacks are a unique terrorist methodology that can inflict wide-spread psychological damage as well as significantly higher death and injury tolls when compared to more traditional NSBA. They have been increasing in popularity amongst terrorist organizations and groups, and Counter-Terrorism Medicine (CTM) specialists need to be aware of the unique injury patterns and potential risk mitigation strategies associated with SBA depending on the target type, location, and gender of the perpetrator.

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

OBJECTIVE

To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging.

METHODS

This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury.

RESULTS

Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries.

CONCLUSION

Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries.

ADVANCES IN KNOWLEDGE

Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries.