Terrorist bombings. Lessons learned from Belfast to Beirut

Area of Science:

• Disaster medicine
• Trauma surgery
• Public health

Background:

• Management of mass casualties from disasters is challenging due to limited experience.
• Terrorist bombings provide a model to study injury patterns and survival factors.

Purpose of the Study:

• To analyze injury and mortality patterns from terrorist bombings.
• To determine factors influencing casualty survival in mass casualty events.
• To evaluate triage efficiency in mass casualty incidents.

Main Methods:

• Systematic review of published data on terrorist bombings.
• Analysis of 3357 casualties from 220 global incidents.
• Injury severity assessment and mortality rate calculation.
• Multiple linear regression to analyze triage efficiency and mortality.

Main Results:

• 87% immediate survivors, 1.4% overall mortality.
• Critical mortality rate was 12.4% among critically injured.
• High overtriage (59%) and low undertriage (0.05%) rates observed.
• Direct relationship between overtriage and critical mortality (r2 = .845).
• Inverse relationship between triage discrimination and critical mortality (r2 = 0.855).
• Head injuries predominated fatalities; abdominal injuries had highest specific mortality (19%).

Conclusions:

• Accurate triage is a key determinant of survival for critically injured disaster casualties.
• Explosive force, time to treatment, and injury site correlate with outcomes.
• Analysis of past bombing incidents informs future disaster preparedness to minimize mortality.