When it comes to a blasting event, nothing is simple. The blast is generally unexpected and overwhelming for first responders, but simplicity is crucial to ensuring effective, timely treatment for those injured. Israeli hospitals and responders, who have experienced more than a few terrorist bombings in their short history, have an effective blast response plan with one overriding theme: If it is not simple, it won't be done.
This maxim from J. Brent Myers, MD, the medical director for the Wake County EMS System in Raleigh, NC, was at the heart of his lecture at the American College of Emergency Physicians' Scientific Assembly this past October. “There is too much to do in too short of a period,” he said. “If you make it complicated, nothing will happen.”
The Israeli response to a blast is quite different from the U.S. plan, but the United States can easily adopt many of the country's strategies, according to Dr. Myers. “In Israel, there are three safety disciplines like there are here — fire, police, and EMS,” he said. “However, EMS is the largest of the three public disciplines. All of their EMTs are assigned an ambulance just as in our country many police officers are assigned a patrol car, and they take it home for surge response. This gives them a very rapid surge if there is a blast. Israeli EMTs all carry pagers that describe the current situation.”
When too few responders are available in the chaos following a blast, victims are put in the back of the ambulance and driven to the hospital without any prehospital care. The focus is on getting victims to the hospital, Dr. Meyers said. It doesn't matter to which hospital victims are transported because Israeli EDs are all laid out the same way. Israel also developed a decontamination process different from the American one.
Decontamination in Israel uses hoses so decontamination is as quick as running to the hose and turning it on.
Our tent system is too slow, Dr. Myers said. “I always thought by the time you have the tents set up, those who need it would be dead and those who don't need it would have left,” he said.
“We worry about modesty in the [United States], but if you have been exposed to toxins, worrying about getting naked won't be a big concern,” Dr. Myers said. Despite the many bombings in Israel, responders have not used the decontamination system at all since 1968.
Israel also developed a response plan for bombings that puts an ambulance on the scene within five minutes. “The first evacuation will be six minutes later, and within a half hour, all of the red-tagged individuals will be off the scene. Within an hour, they are done.
“One hospital responded to 22 separate bus bombings so they were able to categorize experiences. Mean casualties are 10 with a range of four to 20. There is an admit rate of around 40 percent. This is a standard bus bombing,” he said.
ICUs can expect about a third of patients, Dr. Myers said, and while mortality will be low, length of stay is around 10 days. “Not many facilities in the [United States] can add 10 or so patients to a crowded ICU.”
In a nutshell, be ready, Dr. Meyers said. “The notion of waiting to see what you have before you hit the panic button in the hospital is false. You don't have time to do that,” he said, pointing to a June 2009 blast at a Slim Jim factory on the outskirts of Raleigh, the result of poorly replaced boiler gas lines. Ten transport units and three city buses were initially deployed, and 44 patients were transported. Only one person with serious burns died. The outcome was the result of a well developed and tested blast plan.
“The notion that we are going to have a perfect response to a blast is not true,” Dr. Myers concluded. “We need to be able to be prepared to receive 30 to 40 patients within an hour, 25 percent of whom will need an ICU bed for around 10 days.”
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