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The Impact of Terrorism on Children: A Two-Year Experience

Published online by Cambridge University Press:  28 June 2012

Yehezkel Waisman ,
Limor Aharonson-Daniel ,
Meirav Mor ,
Lisa Amir  and
Kobi Peleg
Yehezkel Waisman*
Affiliation:
The Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, andSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Limor Aharonson-Daniel
Affiliation:
The Gertner Institute for Epidemiology and Health Services Research, Center for Trauma and Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel
Meirav Mor
Affiliation:
The Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, andSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Lisa Amir
Affiliation:
The Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, andSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Kobi Peleg
Affiliation:
The Gertner Institute for Epidemiology and Health Services Research, Center for Trauma and Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel
*
Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petah Tiqva 49202, Israel, E-mail: waisy@clalit.org.il
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Abstract

Objectives:

To review and analyze the cumulative two-year, Israeli experience with medical care for children victims of terrorism during the prehospital and hospital phases.

Methods:

Data were collected from the: (1) Magen David Adom National Emergency Medical System Registry (prehospital phase); (2) medical records from the authors’ institutions (pediatric triage); and (3) Israel Tr auma Registry (injury characteristics and utilization of in-hospital resources). Statistical analyses were performed as appropriate.

Introduction:

During the recent wave of violence in Israel and the surrounding region, hundreds of children have been exposed to and injured by terrorist attacks. There is a paucity of data on the epidemiology and management of terror-related trauma in the pediatric population and its effects on the healthcare system. This study focuses on four aspects of terrorism-related injuries: (1) tending to victims in the prehospital phase; (2) triage, with a description of a modified, pediatric triage algorithm; (3) characteristics of trauma-related injuries in children; and (4) utilization of in-hospital resources.

Results:

During the study period, 41 mass-casualty events (MCEs) were managed by Magen David Adom. Each event involved on average, 32 regular and nine mobile intensive care unit ambulances with 93 medics, 19 paramedics, and four physicians. Evacuation time was 5–10 minutes in urban areas and 15–20 minutes in rural areas. In most cases, victims were evacuated to multiple facilities. To improve efficiency and speed, the Magen David Adom introduced the use of well-trained “first-responders” and volunteer, off-duty professionals, in addition to “scoop and run” on-the-scene management. Because of differences in physiology and response between children and adults, a pediatric triage algorithm was developed using four categories instead of the usual three. Analysis of the injuries sustained by the 160 children hospitalized after these events indicates that most were caused by blasts and penetration by foreign objects. Sixty-five percent of the children had multiple injuries, and the proportion of critical to fatal injuries was high (18%). Compared to children with non-terrorism-related injuries, the terrorism-related group had a higher rate of surgical interventions, longer hospital stays, and greater needs for rehabilitation services.

Conclusion:

Terrorism-related injuries in children are severe and increase the demand for acute care. The modifications in the management of pedi-atric casualties from terrorism in Israel may contribute to the level of preparedness of medical and paramedical personnel to cope with future events. Further studies of other aspects of traumatic injuries, such as its short- and long-term psychological consequences, will provide a more comprehensive picture of the damage inflicted on children by acts of terrorism.

Keywords

childrendisaster medicinedisaster-planning-organization-admin-istrationemergency medicineemergency medical servicesinjurypedi-atricterrortraumatriage
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 18 , Issue 3: Terrorism-II: Special Reports , September 2003 , pp. 242 - 248
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2003

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