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34 A systematic literature review of the pre-hospital lessons identified following mass casualty deliberate bombing incidents
  1. Thomas Cooke1,
  2. Adam Chesters2,
  3. Gareth Grier3
  1. 1Barts and the London School of Medicine and Dentistry
  2. 2Cambridge University Hospitals NHS Trust
  3. 3Barts Health


Background Since the end of World War II, there has been an emergence of explosives used amongst civilian populations resulting in mass-casualty incidents. The development of pre-hospital medical systems, worldwide, has resulted in an increased response at these incidents. However, information about the pre-hospital medical response is sparse and not collated. This review aimed to collect and appraise the literature on the pre-hospital management of mass-casualty bombing incidents. The primary objective was to identify and discuss the common themes highlighted as problems in the pre-hospital medical response. The secondary objectives reviewed the injury patterns in victims and psychological impacts on pre-hospital responders.

Methods A systematic literature search on the PubMed, SCOPUS and Web of Science databases took place. It included literature published from the 1 st of January 2000 to April 3rd 2017, with the last search performed on April 3rd 2017. Literature was included if it offered description, analysis, reflection or review of the bombing incidents.

Figure 1

The minimum number of recorded deaths and injuries from 11 deliberate mass casualty bombing incidents (note: two simultaneous marauding terrorist firearm attack and bombing incidents excluded)

Figure 2

Percentage of included literature identifying the following themes as problems in the pre-hospitals medical response

Results 1345 articles were found, with 54 included in analysis. 13 mass-casualty bombing incidents were described. Two of these included marauding terrorist firearm attacks (MTFA). In the 11 bombing-only incidents the death of 592–642 people and injury of 3,842–5229 more is described, with a further 301 deaths and 604 injuries from bombings with MTFA attacks. Quality appraisal showed a variation in reporting among incidents and a lack of uniform reporting.

Conclusions Functioning and reliable communication, alongside regular training exercises with other emergency services, is important in the pre-hospital response. This is aided through accurate triage, in a safe area, to ensure even casualty distribution. A visible and established command and control enables scenes to be led effectively. Access to suitable and adequate supplies of equipment fosters improvement in patient outcomes. Awareness of secondary devices, as well as chemical, radiological and nuclear exposure, is vital in ensuring responder safety. A variety of injury patterns was found. Finally, psychological complications and support systems amongst pre-hospital responders varied.

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