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Updated In A Moment's Notice: Surge Capacity for Terrorist Bombings

Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Explosive 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, exemplified by the Madrid bombings where the closest hospital received 272 patients in 2.5 hours. 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. Without immediate federal assistance, many, if not most, communities would have difficulty caring for a surge of victims resulting from a terrorist bombing event. To address the challenges posed by such an event, the Centers for Disease Control and Prevention 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. They examined challenges that would confront not only the general emergency medical response and health care system, but also select medical disciplines. Although developed for addressing a surge of injuries from a terrorist bombing, the recommendations in this report may also improve the management of a surge from other mass casualty events, including biological, chemical, or nuclear attacks. This document reflects the recommendations of the expert panels. It includes a description of system-wide and discipline-specific challenges …