Clinical review: The Israeli experience: conventional terrorism and critical care

Gabriella Aschkenasy-Steuer¹, Micha Shamir², Avraham Rivkind³, Rami Mosheiff⁴, Yigal Shushan⁵, Guy Rosenthal⁶, Yoav Mintz⁷, Charles Weissman⁸, Charles L Sprung⁹ and Yoram G Weiss¹⁰

¹Resident in Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

²Senior Anesthesiologist, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

³Associate Professor of Surgery, Department of Surgery, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

⁴Associate Professor of Orthopedics, Department of Orthopedic Surgery, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

⁵Senior Clinical Lecturer in Neurosurgery, Department of Neurosurgery, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

⁶Senior Neurosurgeon, Department of Neurosurgery, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

⁷Instructor in Surgery, Department of Surgery, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

⁸Professor of Medicine and Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

⁹Professor of Medicine, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University School of Medicine, Hadassah Medical Organization, Jerusalem, Israel

¹⁰Senior Lecturer in Anesthesia and Critical Care Medicine, Hadassah Hebrew University Medical School, Jerusalem, Israel and Adjunct Assistant Professor in Anesthesia and Critical Care Medicine, University of Pennsylvania Medical School, Philadelphia, PA, USA

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Critical Care 2005, 9:490-499doi:10.1186/cc3762


Published:	29 June 2005

Abstract

Over the past four years there have been 93 multiple-casualty terrorist attacks in Israel, 33 of them in Jerusalem. The Hadassah-Hebrew University Medical Center is the only Level I trauma center in Jerusalem and has therefore gained important experience in caring for critically injured patients. To do so we have developed a highly flexible operational system for managing the general intensive care unit (GICU). The focus of this review will be on the organizational steps needed to provide operational flexibility, emphasizing the importance of forward deployment of intensive care unit personnel to the trauma bay and emergency room and the existence of a chain of command to limit chaos. A retrospective review of the hospital's response to multiple-casualty terror incidents occurring between 1 October 2000 and 1 September 2004 was performed. Information was assembled from the medical center's trauma registry and from GICU patient admission and discharge records. Patients are described with regard to the severity and type of injury. The organizational work within intensive care is described. Finally, specific issues related to the diagnosis and management of lung, brain, orthopedic and abdominal injuries, caused by bomb blast events associated with shrapnel, are described. This review emphasizes the importance of a multidisciplinary team approach in caring for these patients.