Search

Children are the most vulnerable sub-population in mass casualty events (MCEs), however, characteristics of MCE related injuries among children have not been well described.The aim of our study was to characterize childhood injuries resulting from MCEs in Israel including parameters such as magnitude, injury mechanism and severity and use of hospital resources.We conducted a descriptive study of MCE related injuries among hospitalized children (0-17 years) between the years 1998-2007 and recorded in the Israel Trauma Registry (ITR). The main outcome measures included: body region, injury severity (ISS) and mortality rates.A total of 267 children (mean age 11.3 years, 52% girls) were hospitalized for injuries caused by 75 (47%) of the 158 MCEs recorded during the study period. The mechanisms of MCE related injury were as follows: terror-related (63%); motor vehicle collision (buses or train) (32%); a collapsed building (3%); and other mechanisms (2%). Injuries among teenagers (ages 10-17 years) were twice as high as those of younger children [ages 0-9 years), (67% and 33%, respectively (p0.05). Head and neck (67%) were the most common body regions to be injured, followed by upper and Lower extremities (62%). Most children sustained mild injuries (55% ISS 1-8), however, a significant percentage had severe to fatal injuries (29% ISSor =16). Severe injuries were significantly more frequent among children injured in MCEs compared to non-MCE injuries: ISS 16 (29% vs. 8%, respectively p0.0001), in-hospital mortaLity (3.4% vs. 0.4%, respectively, p0.0001), underwent surgical procedures (50% vs. 20%, respectively, p0.05), ICU admission rate (31% vs. 6%, p0.0001), and longer hospital stay (median LOS 8.9 vs. 3.5 days, respectively p0.0001).Morbidity and mortality are significantly higher among children who are injured in MCEs than by other mechanisms. Improved pediatric pre-hospital care and hospital resources as well may enhance future pediatric MCE-related injury outcomes.

The expected worldwide increases in injuries from traffic crashes, violence and war will not only affect the individual but the health care system. A current and comprehensive understanding of the causes of injury will serve to identify at-risk populations, create injury prevention programs and provide more effective treatment for those injured.The present study uses data from the Israel National Trauma Registry (2000-2006) to characterize trauma injuries resulting in hospitalization. Injuries were assessed according to cause: unintentional, intentionaL as a result of terror or war and other intentional injuries.The study included 155,496 hospitaLized patients from 11 of the major trauma centers in Israel (unintentional = 142,028; intentional = 13,468). Approximately 20% of unintentional injuries were reLated to terror or war. We observed a linear increase for other intentional injuries from 5.8% in 2000 to 6.9% in 2009 (chi2 = 20.0; p0.001). No specific time trend was observed for terror or war-related injuries or unintentional injuries. Rates of hospitaLization according to age were similar for both groups of intentional injuries. The rate of severe to critical injuries (injury severity score 16+) was highest among terror and war injuries (24%) compared to other intentional injuries (16%) or unintentional injuries (8%). In-hospital mortality was highest among patients with terror or war injuries.This study shows that injuries from terror and war are more complex and severe than other intentionaL or unintentional injuries. Characterizing injuries by cause is necessary for appropriate injury management and care.

The activities of Magen David Adom (MDA) during the 2nd Lebanese War led to a series of conclusions (some established during the fighting) regarding the operational concept of the organization, the response to the needs of the team members, and the resource requirements. The fighting led to an update in the operational concept, moving to the smaller based operational unit--the station, creating a flexible concept, enabling response to various simultaneous scenes, quickly generating a common situational awareness, and relocation of resources to the more relevant events. TechnoLogy must support the operational concept. The response to stress-related victims should be part of the operational concept during conflict. Debriefing and learning processes are part of the response and enable adaptation to the changing reality. A comprehensive response to the needs of the team members is required, by relocation of family members, meeting the daily needs and preventing stress-related reactions among them. A rotation of leave of absence, central management of human resources and the management of volunteers--spontaneous and those who return to active work, are other components of this issue. The required resources--personal protective equipment, collective protection, command control and communications equipment, the supplies level and the different vehicles required for the operation, are important issues in the operational program of the organization. Collecting blood, maintaining a strategic stockpile and protecting the units, are all part of MDA missions.

Israel has gained extensive experience in the mass casuaLty field, especially from dealing with terrorism events. This special issue of "Harefuah" includes articles that describe and analyze several aspects and approaches related to mass casualty event (MCE) preparedness and response strategies, based on Israel's experience. Feigenberg reports that Magen David Adom (MDA) was able to evacuate all urgent injuries during an MCE from the site to a hospital in 28 minutes, on average. Of the MCE casualties, 71% were evacuated directly to level 1 trauma centers. Rafalowski notes that the ability of MDA to implement organizational and operational Learning processes close to the time of the incident, as well as their modular operational approach, which allows flexibility in responding to simultaneous events, are probably among the reasons that have helped MDA reach a high Level of success in dealing with MCEs. Analysis of terrorism injury data demonstrates that these injuries, suffered by both children and adults, are characterized by increased complexity, with higher severity, higher in-patient mortality rates, and significantly greater use of precious hospital resources such as intensive care, operating rooms, CT, and days of hospitalization. Extensive experience dealing with MCEs has brought managerial insights to the entire health system, for instance in the hospitalization system and clinical management of injuries. In her article, Adini defines five major components for assessing the Israeli health system in emergencies. Shasha's article discusses the principles of hospital preparedness while working under fire. The importance of this subject has in recent years helped bring a more academic approach to emergency and disaster management in the world and in Israel, as enacted at Tel Aviv University's Multidisciplinary Master's Program in Emergency and Disaster Management, and also in other universities that focus on specific disciplines. In summary, achieving improvement requires continuous focus on preparedness, integration of new technologies, routine debriefings, and developing new coping strategies, education, training, and drills. These should all be part of daily preparedness routines. Only in this way can a high quality level of preparedness be maintained over time.

In Israel, 280,000 pupils travel daily to school and back home by means of school transportation. In an effort to increase school transportation safety, the installation of lap belts in school transportation vehicles is required since September 1, 2006. In Israel, laws are often passed with good intentions, but frequently without exploring the potential outcomes. Traffic regulation 364a states that "lap belts or other seatbelts" are required in all vehicles used for school transportation. The objective of this study is to review the world-wide literature regarding seatbelts on school buses with an emphasis to identify the risks associated with lap restraints. Over 50 studies, articles and position papers referring to the efficacy of seatbelts, with an emphasis on school transportation, were reviewed. According to the literature, this new traffic regulation could produce more devastating outcomes than previously. Seatbelts were designed to prevent passenger injuries during a motor vehicle crash. Researchers have not proven efficacy of seatbelts in school buses. Lap-only belts have shown to increase the risk of severe injury among children, even in mild crashes. Since young children are not adequately developed to take the force of a lap-only restraint, these belts have been associated with internal injuries, lumbar fracture-dislocations, abdominal contusions and head injuries. The National Highway Traffic Safety Administration (NHTSA) in the USA has reported that lap belts are not effective in preventing injury among children traveling by bus. Children have a two to three fold risk of severe injury when using lap only restraints. On the contrary, lap-shoulder belts may reduce the risk of abdominal injuries by up to 50% relative to lap-only belts. In conclusion, policy makers aimed to implement regulations which will reduce injuries and fatalities. However, neglecting to carry out an in-depth professional review has brought about a regulation requiring lap belts in school buses; a decision which, according to international research studies, can potentially increase the injury risks among pupils.

Road traffic accidents are the cause of approximately one quarter of trauma hospitalizations in Israel. A comparison of figures on severe traffic injuries, as published by the Israeli Central Bureau of Statistics (CBS) and the Israeli Police with data from registries in medical systems, revealed significant disparities.To present gaps between registries and the possible consequences that presenting incomplete data to decision makers may have on their ability to set policy for reducing road traffic accidents.The number of severe injuries according to the CBS, the National Council for Road Safety and the Israeli Police ranges from 3,378 to 2,573 per year, for the period 1998-2000. During the same time period, the national trauma registry that recorded data at only eight hospitals (of the 24 hospitals in the country), noted a total of 4,442 to 4,800 patients per year. The Ministry of Health's data, that includes figures from most of the hospitals in the country, reports between 10,290 to 11,009 road traffic accident hospitalizations per year for this same period of time. The CBS data is the formal national data, hence the database which decision makers use when considering the number of casualties due to road accidents consists of less than half of the actual number of cases. Furthermore, it is not a representative sample. When decisions are made without data, one uses common sense and reason. However, when the decision maker is presented with information, he assumes that these are valid, reliable, representative, well established data and relates to the information as such in the decision making process. If data is misleading, decisions may be ill-advised.Gaps in information are presented, posing a question on the possible effect that the interpretation of partial data by decision makers may have on the decisions they make. It is strongly advocated that collaboration is needed between police and health agencies and that a system for collecting and analyzing data on road traffic casualties be established to combine health and police data. The existence of a reliable, complete and valid database is essential in order to succeed in the important battle to reduce morbidity and mortality from road traffic accidents.