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Rethinking the Current "Stage-and-Wait" Paradigm
Morel Ragoler1, Irina Radomislensky1, Eran Dolev2
1National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel.
Secondary explosions occur in about 70 per 1,000 bombing incidents, challenging current "Stage-and-Wait" protocols for Emergency Medical Services (EMS). Rethinking these safety guidelines is crucial for balancing responder safety and timely casualty care.
Area of Science:
- Disaster Medicine
- Emergency Medical Services
- Public Health
Background:
- Terrorist attacks with secondary explosive devices led to the "Stage-and-Wait" protocol, delaying Emergency Medical Services (EMS) entry until scenes are safe.
- Current protocols lack evidence on responder risk and patient outcomes, creating an ethical dilemma between safety and timely care.
- Operational factors, like the timing of bomb squad arrival versus critical injury treatment, complicate decision-making.
Purpose of the Study:
- To investigate the frequency of secondary explosions in terrorist attacks over the past 20 years.
- To explore the ethical challenges and ramifications of current safety protocols.
- To inform a potential evidence-based review of existing guidelines for EMS response to bombing incidents.
Main Methods:
- Utilized the Global Terrorism Database (GTD) as the primary data source.
- Analyzed worldwide bombing incidents over a 20-year period.
Main Results:
- Secondary explosions were identified in approximately 70 per 1,000 bombing incidents.
- This frequency was consistent across various regions and countries studied.
Conclusions:
- The study emphasizes the need to re-evaluate the "Stage-and-Wait" paradigm.
- Recommends multi-sectoral expert conferences to discuss risks (70 per 1,000 incidents) and ethical considerations.
- Advocates for a balanced approach to ensure both EMS responder safety and improved casualty survival rates.
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