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In a Moment’s Notice: Surge Capacity in Terrorist Bombings

Image: Cover of In a Moment’s Notice: Surge Capacity in Terrorist BombingsExplosive devices and high-velocity firearms are the most common weapons used by terrorists. The morbidity and mortality inflicted in two European capitals, Madrid, Spain, and London, England, in 2004 and 2005 respectively, demonstrates the impact of detonating explosives in densely populated civilian areas. Explosions can produce instantaneous havoc, resulting in numerous casualties with complex, technically challenging injuries not commonly seen after natural disasters. Because many patients self-evacuate after a terrorist attack and prehospital care may be difficult to coordinate, hospitals near the scene can expect to receive a large influx, or surge, of victims after a terrorist strike. This rapid surge of victims typically occurs within minutes. Such a surge differs dramatically from the gradual influx of patients after infectious disease outbreaks or environmental emergencies such as heat waves. In addition, injuries to workers involved in rescue and recovery can lead to a secondary wave of patients.

Health care and public health specialists should anticipate profound challenges in adequately caring for the surge of victims following a terrorist bombing. The health care system, especially emergency care, is already strained by routine daily volumes. Furthermore, emergency departments (EDs), inpatient units, and intensive care units (ICUs) of acute care hospitals are chronically overcrowded and resource constrained.

To address the challenges posed by such an event, the CDC’s Injury Center convened expert panels in October 2005, January 2006, and June 2009. These panels included experts in emergency medical services (EMS), emergency medicine, trauma surgery, burn surgery, pediatrics, otolaryngology, intensive care medicine, hospital medicine, radiology, pharmacology, nursing, hospital administration, bloodbanking, and public health. The panels were tasked with identifying creative strategies that could be adopted in a timely manner to address medical care surge issues from terrorism, and the panel experts focused on rapidly managing large numbers of bombing casualties.

This document reflects the recommendations of the expert panels. It includes a description of system-wide and discipline-specific challenges as well as recommendations to address these issues. Solutions for the discipline-specific challenges have been incorporated into easy-to-use templates that can assist various disciplines in managing surge needs for injuries. The needs and resources of each community must be considered to effectively plan for a surge of patients into an already overburdened health care system.

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