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Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv
  1. Y Raiter1,
  2. A Farfel1,
  3. O Lehavi2,
  4. O B Goren2,
  5. A Shamiss3,
  6. Z Priel4,
  7. I Koren5,
  8. B Davidson6,
  9. D Schwartz7,8,
  10. A Goldberg8,
  11. Y Bar-Dayan1,8
  1. 1
    Home Front Command Medical Department, Israel
  2. 2
    Sorasky Medical Center, Tel Aviv, Israel
  3. 3
    Sheba General Medical Center, Israel
  4. 4
    Edith Wolfson Hospital, Holon, Israel
  5. 5
    Rabin Medical Center, Petah Tikva, Israel
  6. 6
    Asaf Ha’rofe Hospital, Ramla, Israel
  7. 7
    Israeli EMS, Magen David Adom, Medical Division, Israel
  8. 8
    Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
  1. Dr Col Y Bar-Dayan, IDF Home Front Command, Department of Disaster and Emergency Medicine and Department of Healthcare Systems Management, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, 16 Dolev St Neve Savion, Or-Yehuda, Israel; bardayan{at}


Background: Terrorist attacks in Israel cause mass events with varying numbers of casualties. A study was undertaken to analyse the medical response to an event which occurred on 17 April 2006 near the central bus station, Tel Aviv, Israel. Lessons are drawn concerning the management of the event, primary triage, evacuation priorities and the rate and characteristics of casualty arrival at the nearby hospitals.

Methods: Data were collected both during and after the event in formal debriefings. Their analysis refers to medical response components, interactions and main outcomes. The event is described according to the DISAST-CIR methodology (Disastrous Incidents Systematic AnalysiS Through – Components, Interactions and Results).

Results: 91 casualties were reported in this event; 85 were evacuated from the scene including 3 already dead on arrival, 9 severely injured, 14 moderately injured and 59 mildly injured. Six were declared dead at the scene. Emergency medical service (EMS) vehicle accumulation was rapid. The casualties were distributed between five hospitals (three level 1 and two level 2 trauma centres). The first evacuated casualty arrived at the hospital within 20 min of the explosion and the last urgent victim was evacuated from the scene after 1 h 14 min. Evacuation occurred in two phases: the first, lasting 1 h 20 min, in which most of the patients with evident trauma were evacuated and the second, lasting 8 h 15 min, in which most patients presented with tinnitus and symptoms of somatisation. The most common injuries were upper and lower limb injuries, diagnosed in 37% of the total injuries, and stress-related disturbances (anxiety, tinnitus, somatisation) diagnosed in 41%.

Conclusion: Rapid accumulation of EMS vehicles, effective primary triage between urgent and non-urgent casualties and primary distribution between five hospitals enabled rapid conclusion of the event, both at the scene and at the receiving hospitals.

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  • Competing interests: None declared.

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