A New Paradigm of Injuries From Terrorist Explosions as a Function of Explosion Setting Type.

Objective: Examine the impact of setting on the magnitude and pattern of civilian injuries from terrorist explosions. This may help surgical staffs anticipate the resources required to treat victims of terrorist attacks.

Methods: A retrospective study of 823 patients from 65 explosive events of the Second Intifada (2000-2005) in the National Trauma Registry. After verification all the events were divided into 5 categories: explosions inside buildings (CS), explosions near buildings (SO), explosions inside buses (IB), explosions near buses (AB), and explosions in an open space (OS). The categories were then compared in terms of sustained injuries, utilization of hospital resources and clinical outcomes.

Results: CS and IB scenarios were found to cause the most severe injuries, demanded the most hospital resources and had the worst outcomes, but had several important differences in injury profiles. AB setting proved to be a stand-alone scenario with the lowest severity, possibly due to protection provided to the passengers by the bus. The high volume of blast injuries in SO scenario supports the idea that the explosion wave could be reflected onto the people standing outside a building next to its wall. OS patients had the lowest proportion of blast trauma and burns.

Conclusions: The existing taxonomy of terrorist bombings, which distinguishes explosions in open spaces from those occurring in closed environments, does not fully differentiate patterns of injury that follow blasts in intermediate environments. Expanding the framework from 2 categories to 5 appears to provide greater precision and may be clinically useful to health care providers.