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Sun Sep 5 14:14:56 BST 2004

Ken and all

The suicide bomber attack in Beer Sheva was the 2nd major terrorist attack
here.  The first was in February 2002, when a gunman opened automatic fire
from an AK 47 on a bunch of people sitting in a café for lunch, but this was
our  1st  suicide bomber. 

In 2002, I was busy operating a 21 year old girl with several devastating
bullet holes (she is better now) and really could not tell how the event
ran.  This time I was on sick leave because of a fractured Humerus; I came
in as soon as I heard the news or about 20 minutes after the explosion, but
was not on any of the trauma teams. This gave me an opportunity to observe
the activities from the side, as it were.  I have to say that it is a
totally different perspective.  Gadi Shaked ran the Trauma Resuscitation
area, assisted by Michael Bayme. They may have some more and maybe different
insights 

Unlike similar explosions in Jerusalem and Tel Aviv, where the victims were
split between several hospitals, we had to take them all, and consequently
had to triage and treat about 100 wounded.  

Let me share with you some of my sideline observations. 

First of all, the severity of the injuries on the second bus was much less
than that on the 1st  one.  The Driver of the 2nd bus saw the first one
exploding, stopped his bus, and had the wherewithal to open both automatic
doors "just in case".  In the 20 seconds between the two explosions about 10
people managed to get of the bus, and the open doors reduced the blast
effect. Consequently, the majority of the dead were in the 1st bus.  I can
only admire the driver's presence of mind. 

A second point, and important in terms of health planning,  is that there
was only one critically wounded patient, she had exposed brain due to 2ndary
blast, came in with a in GCS of 3, and died soon after arrival, so was
essentially DOA.   A few other cases required surgery – burns, soft tissue
trauma and such, but none of them was critical and all could be safely
delayed. 

 In fact this experience is similar to other terrorist attacks in Israel.
There are many dead, but very few badly wounded.  We had 3 adult trauma
teams (trauma surgeon, surgery resident. anesthesiologist, 2 nurses) ready
in the trauma resuscitation area ( (we also had a pediatric surgery trauma
team ready) ), but only one of the teams had any work, and even that one was
that essentially dead victim.  In contrast, the regular reception area was
swamped with patients with minimal or no physical injury.  So for a short
while we had a surplus of surgeons in the trauma resuscitation area, and a
relative shortage in the minor injury area. 

My impression is that ringing in the ears was the most common minor
complaint.  Overall there were 100 wounded, but most of them were discharged
from the ER.   

Our hospital is drilling such events periodically.  In the drills, the
trauma resuscitation area (which has 6 bays) is always too busy; In real
life, it is seldom that way.   I believe it has to do with the fact that the
blast amplitude is diminishing with the square of the distance from the
focus.  If you are close enough, you die; if you are a little bit further
out you escape with minor injuries.  

I am proud to say that we were well organized, and patient reception was
done very smoothly. About an hour after the explosion, all victims were
triaged and under care.  A big point is that we had one surgeon (A. Gabriel,
also a member of trauma –l) who prioritized the use of  X-rays.  All
requests went to him, and he sorted them out.   This prevented a backlog in
the radiology suit, and ensured that X-rays were done in an orderly and
timely fashion.   I think it is essential that a surgeon, rather than a
radiologist, do this.  It worked exceedingly well.  Only essential x-rays
(few CXR's, a couple of Brain CT's ) were allowed until it was clear that
there were no more victims en route.   

The hospital set up an information center for relatives, and the phone
number was broadcasted by the media.  We were able to shunt all the worried
relatives to the information center.   I can't stress enough the importance
of this function to the smooth running of the event. 

Many people contributed to the smooth running.  Orderlies, nurses, clerks,
were all doing their best. I believe you can count on this when planning for
such a catastrophe.  Everyone pitches in. Maybe that is a good side of all
of this mayhem. 

One last point is that all cell phones crushed.  The only ones that worked
were MIRS type with walkie talkie function, and of course physical lines.
You cannot rely on cell phones for communication when something like this
happens. 

Avi 

  _____  

From: KMATTOX at aol.com [mailto:KMATTOX at aol.com] 
Sent: Saturday, September 04, 2004 6:59 PM
To: avir at mail.bgu.ac.il; StephenS at adhb.govt.nz; ccm-l at list.pitt.edu
Cc: trauma-list at trauma.org
Subject: Beer-Sheba

Avi:   Our hearts go out to the wounded, and the family of those killed in
this suicide bombing.    We also salute the health workers at all levels,.
Beer-Sheba has been spared the suicide bombings to a great part and now
this,.   Your hospital had many injuried.   Since this was new to your
hospital and yet you profited from the country wide preparedness training,
could you share with us what you learned

k

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