Conventional terrorism and critical care

Incidents of conventional weapons terror are increasingly part of the reality of the modern world, and in Israel, 19,948 incidents have been reported from September 2000 to December 2003. Most victims are injured in explosions resulting from suicide bombings. Exposure to the blast (primary mechanism of injury) may produce unique injuries affecting gas-containing organs, including perforation of the eardrums (most common injury); pulmonary blast injury, characterized by alveolar capillary disruption and bronchopleural fistulas; and bowel perforation, which is uncommon and may be delayed from 1 to 14 days after the injury. However, most injuries are the result of penetrating trauma (secondary mechanism) resulting from bomb fragments and nails, bolts, and steel pellets embedded in the bomb striking the victim, and blunt trauma (tertiary mechanism) sustained when the victim is propelled against an object by the blast wind. The severity of the injuries is increased when the blast occurs in a confined space. Victims of terror-inflicted injuries have a high Injury Severity Score (30% >16), a high requirement for intensive care unit admission (22.8% in Israel), and have a more prolonged hospital course and higher mortality than victims of any other form of trauma.