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World Journal of Surgery
Published in: World Journal of Surgery 11/2006

01-11-2006

Mortality in Terrorist Attacks: A Unique Modal of Temporal Death Distribution

Authors: S. C. Shapira, MD, MPH, R. Adatto-Levi, MD, M. Avitzour, MPH, A. I. Rivkind, MD, I. Gertsenshtein, Eng, Y. Mintz, MD

Published in: World Journal of Surgery | Issue 11/2006

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Abstract

Background

Terror-related multiple casualty incidents (MCI) in Israel since September 2000 have resulted in a new pattern of injury as a result of the mechanisms of trauma. The objective of this study was to asses the temporal death distribution among the civilian casualties in the Jerusalem vicinity during a 3-year period.

Methods

All terrorist attacks in the Jerusalem district from September 2000 to September 2003 were included in this study. The data of all deaths were processed including the time of the attack, the evacuation time to the hospitals, and the time of death.

Results

During the study period 28 terror-related MCI occurred. A total of 2328 victims were injured and 273 died, for an overall fatality rate of 11.7%. A unique temporal death distribution was identified; 82.8% of the deaths occurred immediately, at the scene of the attack (scene death); of the remaining 17.2% of patients who died in the hospital, half died within 4 hours of arrival (immediate death), one quarter within 5–24 hours (early death), and one quarter later than that (late death). The temporal death distribution was significantly different when classifying the mechanism of trauma to suicide bombings versus shooting. The scene mortality was higher in the suicide bombings than in shooting attacks (86.7% versus 77%, P = 0.039 ). In contrast, the mortality within 1–24 hours was higher in the shooting attacks (17% versus 6.3%, P = 0.05).

Conclusions

Terror-related MCI occurring in civilian settings have a unique temporal death distribution. A very high scene mortality is seen compared to the classical description of Donald Trunkey1 in 1983. The late deaths, which composed 30% of the mortality in civilian settings, comprise only 4.4% of the total mortality in MCIs. A rough estimate of the in-hospital mortality could be achieved after the first 4 hours, allowing the assessment and distribution of hospital resources. Futile care should be identified early and availability of ICU beds can be calculated according to the immediate mortality.
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Metadata
Title
Mortality in Terrorist Attacks: A Unique Modal of Temporal Death Distribution
Authors
S. C. Shapira, MD, MPH
R. Adatto-Levi, MD
M. Avitzour, MPH
A. I. Rivkind, MD
I. Gertsenshtein, Eng
Y. Mintz, MD
Publication date
01-11-2006
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 11/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-006-0048-y

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