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PubMed2005

The United States twenty-year experience with bombing incidents: implications for terrorism preparedness and medical response.

BACKGROUND: Terrorist bombings remain a significant threat in the United States. However, minimal longitudinal data exists regarding the medical and public health impact because of bombings. METHODS: We conducted a retrospective analysis of the number of incidents, injuries, and deaths because of explosive, incendiary, premature, and attempted bombings from January 1983 to December 2002. Morbidity and mortality by motives, target locations, and materials used were evaluated. RESULTS: In the United States, 36,110 bombing incidents, 5,931 injuries, and 699 deaths were reported. There were 21,237 (58.8%) explosive bombings, 6,185 (17.1%) incendiary bombings, 1,107 (3.1%) premature bombings, and 7,581 (21.0%) attempted bombings. For explosive bombings with known motives, 72.9% of injuries and 73.8% of deaths were because of homicide. For incendiary bombings with known motives, 68.2% of injuries were because of extortion and revenge, and 53.5% of deaths were due to homicide. Private residences accounted for 29.0% of incidents, 31.5% of injuries, and 55.5% of deaths. Government installations accounted for 4.4% of incidents but were the site of 12.7% of injuries and 25.5% of deaths. In bombings with known materials, nitrate-based fertilizers accounted for 36.2% of injuries and 30.4% of deaths, and smokeless powder and black powder accounted for 33.2% of injuries and 27.1% of deaths. CONCLUSIONS: Illegal bombings and related injuries commonly occur in the United States. Because of the easy availability of bombing materials, government agencies and healthcare providers should prepare for potential mass-casualty bombings.

Blast Injuries↗
PubMed1999

A prospective study of long-term health outcomes among Oklahoma City bombing survivors.

A follow-up study was conducted to identify long-term physical and emotional outcomes among Oklahoma City bombing survivors. Baseline data were gathered by the Oklahoma State Department of Health in 1995. Follow-up data were gathered by telephone interviews of survivors from 1-1/2 to 3 years after the bombing. The frequency of medical diagnoses, symptoms, medical cost, physical and social life changes, and services utilized since the bombing were assessed. A total of 494 persons were interviewed, 92 percent had been physically injured in the bombing. Seventy-nine percent of persons interviewed rated their general health status as "good," "very good," or "excellent." Overall, one-fourth to one-third of survivors reported being newly diagnosed with audiologic changes, anxiety, and depression since the bombing. One-third of persons reported preexisting medical conditions that had worsened since the bombing including depression (26%) and asthma/bronchitis (22%). The most frequently reported posttraumatic stress disorder symptoms were "being jumpy or easily startled" and "recurring distressful thoughts of the bombing." The most frequently utilized medical services were psychological counseling (63%) and audiology services (48%). Total costs were estimated of $ 5.7 million. Overall, persons who had been hospitalized with bombing injuries reported higher rates of diagnoses, symptoms, and services utilization. These findings suggest that a large proportion of survivors of a terrorist bombing, especially those seriously injured, will experience long-term physical and/or emotional outcomes and increased need for treatment for bombing-related medical conditions. All survivors should be carefully assessed over time for auditory damage, depression, anxiety, and posttraumatic stress disorder.

Adolescent↗
PubMed2004

Surveillance of mortality among atomic bomb survivors living in the United States using the National Death Index.

BACKGROUND: The National Death Index is a useful source to establish the death of an individual and to determine the cause of death. We identified deaths in atomic bomb survivors in the United States who were lost to follow-up through the National Death Index, and examined the completeness of mortality ascertainment in atomic bomb survivors in the US through the National Death Index. METHODS: Since 1977, biennial medical examinations of atomic bomb survivors in the US have been conducted. The 1,073 atomic bomb survivors in the US included 764 individuals who had medical examinations at least once in sixteen years from 1977 through 1993 and 309 individuals who reported atomic bomb survivorship to medical examination project themselves. Of the 1,073 survivors living in the US, 471 people who participated in the ninth health examinations of atomic bomb survivors living in the US in 1993 were removed, and two people among the remaining 602 individuals had no information about their birth dates and Social Security numbers. An investigation of those deceased between 1979 and 1993 was conducted among 600 of the atomic bomb survivors in the US. Death certificates for atomic bomb survivors in the US were requested from the National Death Index. A comparison was made between the information on the death certificates acquired through the National Death Index and the data ascertained from the medical examination project conducted from 1979 through 1993. RESULTS: Forty-nine death certificates were obtained using the National Death Index. By sex, the dominant cause of death in females was malignant neoplasm, accounting for 53%. In males, it was circulatory disease, accounting for 37%. The National Death Index and the medical examination project determined that 57 deaths had occurred between 1979 and 1993. The sensitivity and specificity of the National Death Index is 86% and 97% respectively. CONCLUSION: It is suggested that the National Death Index is useful to follow up mortality among atomic bomb survivors in the US.

Adult↗
PubMed1996

A long-term cohort study of the atomic-bomb survivors.

The Atomic Bomb Casualty Commission (ABCC), the predecessor of the Radiation Effects Research Foundation (RERF), was established in 1947 to conduct long-term, comprehensive epidemiological and genetic studies of the atomic-bomb (A-bomb) survivors. Today this study still depends upon the voluntary cooperation of several tens of thousands of survivors of the bombings of Hiroshima and Nagasaki. An in-depth follow-up study of mortality in the study population of 120,000 persons, including A-bomb survivors and controls, has continued since 1950. The study of tumor incidence was initiated through record linkage with a tumor registry system in Hiroshima and Nagasaki in 1958. In the same year, biennial medical examinations of 20,000 individuals began. Follow-up studies also have been conducted on in-utero-exposed persons and first-generation offspring of the survivors. On the basis of these studies spanning nearly half a century, we know that the occurrence of leukemia and cancers associated with A-bomb radiation is higher than among the non-exposed. Among the A-bomb survivors, radiation cataracts, hyperparathyroidism, delayed growth and development, and chromosomal aberrations also occur more often. However, to date no evidence exists of genetic effects in the children of A-bomb survivors. It should be kept in mind that such study results could never be obtained without the cooperation of A-bomb survivors.

Aged↗
PubMed2004

Using STR analysis to detect human DNA from exploded pipe bomb devices.

This study investigated the possibility of recovering a bomb assembler's DNA from an exploded pipe bomb device. Metal and polyvinyl chloride (PVC) pipes were examined to determine if one surface type would allow better DNA recovery than the other. Ten subjects each handled components of one metal and one PVC pipe bomb. The bombs were exploded, the fragments were collected and swabbed using the double swab technique, and the samples were extracted, quantified, amplified, and genotyped using polymerase chain reaction/short tandem repeat (PCR/STR). Of the 20 bombs handled by the subjects, four bombs gave reportable results that matched the subject's known DNA profiles. An additional eight profiles, also matching the subject's known DNA profiles, were generated but were below the reportable threshold. There was no difference in the success rate of obtaining DNA profiles related to the use of either PVC or metal in the manufacture of the pipe bomb. The variables that appeared to have the greatest influence on the success of generating a DNA profile were the amount of fragmentation and subsequent recovery of the bomb fragments. It is suspected that successful DNA profiling could also be dependent upon the bomb assembler's propensity to slough skin cells on objects they handled.

Alleles↗
PubMed2006

Effective dose of A-bomb radiation in Hiroshima and Nagasaki as assessed by chromosomal effectiveness of spectrum energy photons and neutrons.

The effective dose of combined spectrum energy neutrons and high energy spectrum gamma-rays in A-bomb survivors in Hiroshima and Nagasaki has long been a matter of discussion. The reason is largely due to the paucity of biological data for high energy photons, particularly for those with an energy of tens of MeV. To circumvent this problem, a mathematical formalism was developed for the photon energy dependency of chromosomal effectiveness by reviewing a large number of data sets published in the literature on dicentric chromosome formation in human lymphocytes. The chromosomal effectiveness was expressed by a simple multiparametric function of photon energy, which made it possible to estimate the effective dose of spectrum energy photons and differential evaluation in the field of mixed neutron and gamma-ray exposure with an internal reference radiation. The effective dose of reactor-produced spectrum energy neutrons was insensitive to the fine structure of the energy distribution and was accessible by a generalized formula applicable to the A-bomb neutrons. Energy spectra of all sources of A-bomb gamma-rays at different tissue depths were simulated by a Monte Carlo calculation applied on an ICRU sphere. Using kerma-weighted chromosomal effectiveness of A-bomb spectrum energy photons, the effective dose of A-bomb neutrons was determined, where the relative biological effectiveness (RBE) of neutrons was expressed by a dose-dependent variable RBE, RBE(gamma, D (n)), against A-bomb gamma-rays as an internal reference radiation. When the newly estimated variable RBE(gamma, D (n)) was applied to the chromosome data of A-bomb survivors in Hiroshima and Nagasaki, the city difference was completely eliminated. The revised effective dose was about 35% larger in Hiroshima, 19% larger in Nagasaki and 26% larger for the combined cohort compared with that based on a constant RBE of 10. Since the differences are significantly large, the proposed effective dose might have an impact on the magnitude of the risk estimates deduced from the A-bomb survivor cohort.

Adult↗
PubMed2006

Snx5, as a Mind bomb-binding protein, is expressed in hematopoietic and endothelial precursor cells in zebrafish.

Notch signaling has an evolutionarily conserved function for cell fate determination and stem cell maintenance. Previously, we identified a novel component of the Notch signaling pathway in zebrafish, mind bomb, which encodes an E3 ubiquitin ligase essential for Notch signal activation. Further studies showed that Mind bomb(-/-) mouse embryos exhibited pan-Notch phenotypes in various tissues, suggesting that Mind bomb function is conserved in mammals. Therefore we sought to understand the various molecular partners of Mind bomb using yeast two-hybrid screening. In this search we identified Sorting nexin 5 (Snx5) as a novel interacting partner of Mind bomb. Furthermore we demonstrated that Snx5 colocalizes with Mind bomb in early endosomal compartments, suggesting that Snx5 is important for Mind bomb trafficking. In addition, we identified zebrafish orthologue of Snx5 and showed that snx5 is predominantly expressed in hematopoietic and endothelial precursor cells in zebrafish. We also found defects in hematopoiesis and blood vessel development in snx5 morpholino-injected embryos. Taken together, we show that Snx5, a novel interacting partner of Mind bomb, may have an essential role for cell fate determination in early development.

Animals↗
PubMed2002

Comparisons of lung tumour mortality risk in the Japanese A-bomb survivors and in the Colorado Plateau uranium miners: support for the ICRP lung model.

PURPOSES: To estimate the ratio of risks for exposure to radon progeny relative to low-LET radiation based on human lung cancer data, taking account of possible time and age variations in radiation-induced lung cancer risk. MATERIALS AND METHODS: Fitting two sorts of time- and age-adjusted relative risk models to a case-control dataset nested within the Colorado Plateau uranium miner cohort and to the Japanese atomic (A)-bomb survivor mortality data. RESULTS: If all A-bomb survivors are compared with the Colorado data, there are statistically significant (two-sided p < 0.05) differences between the two datasets in the pattern of the variation of relative risk with time after exposure, age at exposure and attained age. The excess relative risk decreases much faster with time, age at exposure and attained age in the Colorado uranium miners than in the Japanese A-bomb survivors. If only male A-bomb survivors are compared with the Colorado data, there are no longer statistically significant differences between the two datasets in the pattern of variation of relative risk with time after exposure, age at exposure or attained age. There are no statistically significant differences between the male and female A-bomb survivors in the speed of reduction of relative risk with time after exposure, age at exposure or attained age, although there are indications of rather faster reduction of relative risk with time and age among male survivors than among female survivors. The implicit risk conversion factor for exposure to radon progeny relative to the A-bomb radiation in the male survivors is 1.8 x 10(-2) Sv WLM(-1) (95% CI 6.1 x10(-3), 1.1 x 10(-1)) using a model with exponential adjustments for the effects of radiation for time since exposure and age at exposure, and 1.9 x 10(-2) Sv WLM(-1) (95% CI 6.2 x 10(-3), 1.6 x 10(-1)) using a model with adjustments for the effects of radiation proportional to powers of time since exposure and attained age. Estimates of the risk conversion factor calculated using variant assumptions as to the definition of lung cancer in the Colorado data, or by excluding miners for whom exposure estimates may be less reliable, are very similar. The absence of information on cigarette smoking in the Japanese A-bomb survivors, and the possibility that this may confound the time trends in radiation-induced lung cancer risk in that cohort, imply that these findings should be interpreted with caution. CONCLUSIONS: There are no statistically significant differences between the male A-bomb survivors data and the Colorado miner data in the pattern of variation of relative risk with time after exposure and age at exposure. The risk conversion factor is very close to the value suggested by the latest ICRP lung model, albeit with substantial uncertainties.

Adult↗
PubMed2002

The impact of the 1995 Oklahoma City bombing on the partners of firefighters.

This study explored the impact of the 1995 Oklahoma City, Oklahoma, bombing on the spouses and significant others of a volunteer sample of Oklahoma City firefighters who participated in the bombing rescue effort. Twenty-seven partners of Oklahoma City firefighters participated in this study, conducted 42 to 44 months after the bombing. These partners were assessed using a structured diagnostic interview and a companion interview to examine exposure, rates of psychiatric disorders and symptoms, functioning, health, and relationships. Coping and perception of the firefighter partner's response were also examined. Some of the women were exposed directly; most knew someone who had been involved in the disaster, and all reported exposure through the media. The rate of psychiatric disorders in the women following the disaster was 22%, essentially unchanged from before the incident. One developed bomb-related posttraumatic stress disorder (PTSD). Most were satisfied with their work performance; 15% reported that their health had worsened since the bombing, and more than one third reported permanent changes in relationships as a result of the bombing. Most coped by turning to friends or relatives, with less than 10% seeking professional help. Many described symptoms in their firefighter mate; all reported that their mate had been affected by the experience, and one half said their mate had fully recovered. The mates of these firefighters fared relatively well in terms of psychiatric disorders, symptoms, and ability to function. The prevalence of bomb-related posttraumatic stress disorder was considerably lower in this sample than in samples of individuals more directly exposed to the bombing, although some reported changes in relationships and health. The results suggest the need for further study of the impact of interpersonal exposure in those who provide support for rescue-and-recovery workers in major terrorist incidents.

Adaptation, Psychological↗
PubMed2001

Comparison of the risks of cancer incidence and mortality following radiation therapy for benign and malignant disease with the cancer risks observed in the Japanese A-bomb survivors.

PURPOSES: To compare the radiation-associated relative risks of cancer incidence and mortality in groups exposed to ionizing radiation in the course of treatment for a variety of malignant and non-malignant conditions with those in the Japanese A-bomb survivor cancer incidence and mortality data. MATERIALS AND METHODS: Comparison of the excess relative risk coefficients derived from published information for each study with the excess relative risk coefficient in comparable (age at exposure, time since exposure, sex) matched subsets of the Japanese A-bomb survivor cancer incidence and mortality data. RESULTS: Sixty-five studies of persons who have received appreciable doses of ionizing radiation in the course of treatment and for whom there is adequate ascertainment of cancer incidence or mortality are identified, from which 116 cancer-site-specific estimates of excess relative risk are derived. Relative risks tend to be lower in the medical series than in the Japanese A-bomb survivors. The most marked discrepancies between the relative risks in the medical series and in the A-bomb survivors are for leukaemia, where 12 of the 17 medical studies have significantly lower relative risks than those observed in the Japanese data. However, the ratio between the relative risks in the medical studies and in the Japanese data tends to diminish with increasing average or maximal therapy dose. This is observed for all cancer sites and is particularly marked for leukaemia. After taking account of cell sterilization and dose fractionation the apparent differences between the relative risks for leukaemia in the Japanese A-bomb survivors and in the medical series largely disappear. This suggests that cell sterilization largely accounts for the discrepancy between the relative risks in the Japanese data and the medical studies. Other factors, such as the differences in underlying cancer risks between the Japanese A-bomb survivors and the medical series, and dose-fractionation effects, may also contribute. CONCLUSIONS: The relative risks of cancer in studies of persons exposed to appreciable doses of ionizing radiation in the course of treatment for a variety of malignant and non-malignant conditions are generally less than those in comparable subsets of the Japanese A-bomb survivor cancer incidence and mortality data. Cell sterilization effects can largely explain the discrepancy between the Japanese and the medical series.

Dose-Response Relationship, Radiation↗
PubMed2006

Forensic findings from the Nairobi U.S. Embassy terrorist bombing.

BACKGROUND: The 1998 terrorist bombing of the US-Embassy in Nairobi resulted in the highest number of civilian deaths ever recorded from a single urban terrorist bombing in global history. OBJECTIVE: To present forensic findings from the Nairobi terrorist bombing and discuss some contributory factors to the high-fatality witnessed. DESIGN: Desriptive retrospective study. SETTING: Office of the Chief Government Pathologist of Kenya. RESULTS: A total of 211 persons were confirmed to have died as a direct result of the bomb blast. Out of the 201 cases examined in this paper, 198 (99%) died on the day of the blast. Sixty percent of the deceased were males and 85% were aged between 21 and 50 years. Most of the deceased were visually identified (95%). The rest required fingerprinting (3%), DNA testing (2%), and forensic odontology (1%). Ninety six percent of the victims (194 cases) had primary blast injuries. The typical triad of blast fragmentation injuries was found in only 47% of the cases. Eighty nine percent (179 cases) had injuries in multiple anatomical regions. The most common cause of death was head injury (30%). CONCLUSION: The anatomical pattern of injuries and other pathological findings among fatalities from this terrorist bombing are similar to those recorded from other bombing incidents worldwide. Contributory factors to the high fatality include the collapse of a densely populated building, the TNT-equivalent force of the bomb, the confined site of detonation, and probably the lack of a proper disaster response system.

Adolescent↗
PubMed1989

Mortality statistics of major causes of death among atomic bomb survivors in Hiroshima Prefecture from 1968 to 1982.

A comparative study was made on mortality during a 15-year period from 1968 to 1982 between atomic bomb survivors resident in Hiroshima Prefecture and non-exposed controls. The mortality rate for all causes of death was lower in atomic bomb survivors than in the non-exposed, but the rate was higher among those directly exposed within about 1 km than in the non-exposed. The mortality rate for malignant neoplasms was higher in atomic bomb survivors than in the non-exposed, but that for cerebrovascular disease and heart disease was lower. In examining the rate for malignant neoplasms by site, the sites showing a high mortality rate among atomic bomb survivors were almost identical to the results of the Life Span Study. For these sites, the shorter the exposure distance the higher was the mortality rate. The rate for malignant neoplasms of the uterus and stomach, and leukemia was unnaturally high among early entrants whose period after issuance of atomic bomb survivor's health handbook was short. In observing the atomic bomb survivors by the level of family destruction due to the bombing as a socio-economic factor, a tendency was observed for the mortality rate for malignant neoplasms, diseases of blood and blood-forming organs, and peptic ulcer, to be higher among survivors with severe family destruction.

Cause of Death↗
PubMed1988

Life-threatening complications of cardiac operations and occurrence of myocardial catecholamine bombs.

Myocardial catecholamine bombs (huge local intra-axonal accumulations of catecholamine, mainly norepinephrine, within cardiac tissue) were observed in (right auricular) myocardial biopsy specimens in 16 of 65 adult patients selected randomly from a series of elective cardiac operations. The occurrence of catecholamine bombs was in highly significant correlation (p less than 0.001) with the occurrence of life-threatening complications of cardiac operations (life-threatening arrhythmias [ventricular tachycardias, ventricular fibrillation, asystole], clinically evident perioperative myocardial infarction/postoperative low-output syndrome, death). There was a very close correlation between the occurrence of catecholamine bombs and life-threatening arrhythmias. Life-threatening arrhythmias occurred in 13 patients. Eight of them belonged to the group of 16 patients with catecholamine bombs and five belonged to the group of 49 patients with no bombs; the difference (8/16 versus 5/49) is very clear (p less than 0.001). It was our experience that dangerous arrhythmias related to catecholamine bombs may occur as late as during the second postoperative week. We believe our observations are of considerable clinical importance, because catecholamine bombs are easily identified by fluorescence microscopic examination of right auricular myocardial specimens retrieved intraoperatively, and patients at high risk can then be selected (during the operation) for more extensive and prolonged surveillance and possibly prophylactic treatment.

Adult↗
PubMed1987

Radiation-induced cancer and its modifying factor among A-bomb survivors.

The Atomic Bomb Casualty Commission (ABCC) and its successor, the Radiation Effects Research Foundation, have conducted a long-term follow-up study of a cohort of 120,000 atomic bomb (A-bomb) survivors and non-exposed controls since 1950. The most recent findings regarding cancer mortality and incidence in this cohort can be briefly summarized as follows: 1) An increase in leukemia mortality among A-bomb survivors peaked 5-6 years after the bombing and has decreased with time thereafter. In addition to leukemia, the incidence of cancer of the lung, breast, esophagus, stomach, colon, thyroid, ovary, urinary tract, and multiple myeloma increases with dose. At present, there is no indication of an increase in cancer of the rectum or uterus among A-bomb survivors. In general, radiation-induced solid cancers begin to appear after the age at which they are normally prone to develop, and have continued to increase with time in proportion to the natural increase in mortality of the control group. 2) There are factors which modify the effects of radiation, such as age at the time of bombing (ATB) and sex. Sensitivity to radiation, in terms of cancer induction, is higher for persons who were young ATB in general, than for those who were older ATB. 3) There was no increase in childhood cancer among those exposed while in utero, but there is a recent indication of an increase in cancer incidence among these persons as they age. 4) There seems to be no interaction in a multiplicative way between radiation and smoking and lung cancer induction.

Age Factors↗
PubMed2002

Psychiatric sequelae in atomic bomb survivors in Hiroshima and Nagasaki two decades after the explosions.

BACKGROUND: Atomic bomb exposure was an extraordinarily stressful event. Although little epidemiological research has been performed on the psychiatric effects of the bombings, many medical descriptions of the survivors suggest that there was an increase of various symptoms that implied autonomic ataxia or neurosis-like disorders. The psychiatric effects of exposure to the atomic bomb explosions in Hiroshima and Nagasaki were assessed in this study. METHOD: From a self-administered medical questionnaire completed between 1962 and 1965 by 9421 informed and consenting Adult Health Study subjects, some questions congruent with the DSM-IV diagnostic criteria for generalized anxiety disorder and somatization disorder were selected and used as indicators of anxiety symptoms and somatization symptoms. The prevalence of psychiatric symptoms in relation to age, sex, city (Hiroshima vs. Nagasaki), acute radiation symptoms, exposure status (in city or not in city), ground distance from hypocenter, disease history, and death of family members were analyzed. RESULTS: A higher prevalence of anxiety symptoms (odds ratio, 1.73) and somatization symptoms (odds ratio, 1.99) was observed in those with acute radiation symptoms than in those without them. The prevalence of anxiety symptoms and somatization symptoms among people who were in the city at the time of the explosion was significantly higher than among those who were not in the city. Among the former, prevalence was lower among proximally exposed people than among distally exposed people. Symptom prevalences were also affected by age, sex, and city. Although disease history such as neurotic disorder and ulcer were risk factors for anxiety symptoms and somatization symptoms, the increased prevalence of anxiety symptoms and somatization symptoms in association with atomic bomb exposure was independent of disease history and the death of family members. CONCLUSION: The prevalence of anxiety symptoms and somatization symptoms was elevated in atomic bomb survivors even 17-20 years after the bombings had occurred, indicating the long-term nature of the psychiatric effects of the experience. Psychiatric sequelae were independent of physical sequelae.

Adult↗
PubMed2004

The special injury pattern in terrorist bombings.

BACKGROUND: The destructive human consequences of terrorist bombing always challenge the medical system in diagnosis, decision making, and patient management. This injury is produced by multiple injury mechanisms, and departs from the conventional description of trauma complexity. Our objective was to characterize and compare terror-bombing victims with casualties of all other kinds of trauma, and to validate the existence of a different, more complex, injury pattern. STUDY DESIGN: A retrospective cohort study was conducted of patient records from October 2000 through June 2003 in the Israeli National Trauma Registry. All were categorized as victims of terrorist bombings or of nonterror-related trauma. Analysis included age, gender, Injury Severity Score, Glasgow Coma Scale, admission blood pressure, injury complexity, surgical interventions, intensive care and hospital lengths of stay, in-hospital mortality, and disposition. This analysis was extended to Injury Severity Score subgroups. RESULTS: Victims of terrorist bombings (n = 906) were compared with 55,033 casualties of nonterror-related trauma. Bombing resulted in significantly different injury complexity, increased severity, and with more body regions involved. Significantly enhanced use of intensive care, prolonged hospital stay, more surgical interventions, and increased hospital mortality are characteristic of these patients. CONCLUSIONS: Terrorist bombings inflict injury of a distinctly different pattern than other means of trauma. The simultaneous combination of different injury mechanisms in explosions results in a multidimensional injury pattern and a complicated clinical course. Hospital preparedness and medical team awareness to the unique nature of the injuries are mandatory for improving the outcomes of these patients.

Adolescent↗
PubMed2003

The London nail bombings: the St. Thomas' Hospital experience.

At 18:00 h on 17 April 1999 a nail bomb exploded outside a supermarket in Brixton, London. This was the first of a series of three identical nail bombs. The injuries were due to penetrating nails, most were relatively minor, with only three patients requiring general anaesthesia for removal of nails and debridement. One 6-year-old child subsequently underwent onward referral for neurosurgical treatment. At 18:40 h on 30 April 1999, the third bomb exploded (there were no casualties at our hospital from the second bomb, that in Brick Lane on 24 April 1999) in the confined environment of the Admiral Duncan public house in Soho. The injuries were much more severe than those seen from the Brixton bomb. Two persons died on the scene and 81 were injured; 27 were transferred to our hospital. Three primary lower limb amputations were performed. Within the first 24h, four patients required ITU care and two onward referral to the regional burns unit. Injuries such as those seen in these two bombings are common in war situations. In peacetime it is rare to see this spectrum of injury and hence surgeons can be unaware of optimal management protocols. Our approach in these patients, based on thorough initial debridement and delayed closure/split skin grafting is similar to that advocated by the International Committee of the Red Cross based on their war surgery experience. We emphasise debridement without any initial reconstructive procedures. We also discuss some logistic problems of major incidents.

Adolescent↗
PubMed2003

Prediction of the occurrence and intensity of post-traumatic stress disorder in victims 32 months after bomb attack.

INTRODUCTION: Our objective was to identify factors that predict occurrence and severity of post-traumatic stress disorder (PTSD) after a terrorism attack. POPULATION: We evaluated 32 victims of a bomb attack in a Paris subway in December 1996 at 6 and 32 months. METHOD: Sociodemographic characteristics, clinical data and physical injuries were used to predict PTSD occurrence and severity in 32 victims. The Watson's PTSD Inventory (PTSD-I) and the Impact of Event Scale (IES) by Horowitz were used to evaluate occurrence and severity of PTSD, respectively. RESULTS: Thirty-nine percent of participants met PTSD criteria at 6 months, 25% still had PTSD at 32 months. Women had PTSD 32 months after the bomb attack more frequently than men. Employment predicted PTSD severity at 32 months. PTSD scores assessed by PTSD-I at 6 months were significantly and positively associated with IES scores at 32-month follow-up (r = 0.55, P = 0.004). Psychotropic drug use before the bomb attack significantly predicted PTSD occurrence and severity at 6 and 32 months. In a linear regression model, physical injuries, employment status and psychotropic drug use before the bomb attack were independent predictors of severity of PTSD at 32 months. CONCLUSIONS: Bomb attack exposure resulted in persisting PTSD in a significant proportion of victims; the severity was predicted at 32 months by physical injuries and psychotropic drug use before the terrorism attack and by the PTSD score few months after the bomb attack.

Adult↗