Advertisement

Emergency service experience following the terrorist attack in Mogadishu, 14 October 2017, a scene of lay rescuer triage

Published:December 08, 2020DOI:https://doi.org/10.1016/j.ajem.2020.12.005

      Abstract

      Background

      A suicide bomber attack occurred in Somalia's capital city of Mogadishu on October 14, 2017. Over 500 people died, making it the third largest suicide bombing attack in world history. In this study, we aimed to share our experience and to discuss the importance of triage and prehospital care systems.

      Methods

      These retrospective data included data from patients who suffered from severe explosions. Patient triage was performed using the START (Simple Triage and Rapid Treatment) triage algorithm at the entrance of the hospital. The patients included in the study were classified according to their age, sex, triage code, location of their major injury, department to which they were admitted, and discharge and/or exit status.

      Results

      The patients included 188 (74.6%) males, and the mean age was 30.94 ± 12.23 years (range, 1–80 years). Eighty-six (34.1%) patients were marked with a red code indicating major injury, and 138 (54.8%) patients had superficial injuries. A total of 173 (68.7%) patients were managed in the emergency department (ED), and 7 (2.8%) patients died in the first 24 h. Multiple trauma injuries were detected in 43 (17.1%) patients, and 31 (12.3%) patients were admitted to the orthopedics department.

      Conclusion

      Disaster management in a terrorist event requires rapid transport, appropriate triage, effective surgical approaches, and specific postoperative care. In this event, almost all patients were brought to the ED by lay rescuers. Appropriate triage algorithms for the public can be designed; for instance, green code: walking patient; yellow code: patient who is moving and asking for help; red code: unmoving or less mobile patient who is breathing; black code: nonbreathing patient.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Organization WH
        Disasters and emergencies. Definitions Training Package. WHO/EHA PanAfrican Emergency Training Centre, Addis Ababa Retrieved August. 2002;10.
        2006
        • Marshall T.
        Forensic aspects of terrorism.
        Ann Acad Med Singapore. 1984; 13: 32-36
        • Taviloğlu K.
        • Ertekin C.
        Current status and future options for trauma and emergency surgery in Turkey.
        TJTES. 2008; 14: 10-13
        • Al-Madhari A.
        • Keller A.
        Review of disaster definitions.
        Prehosp Disaster Med. 1997; 12: 17-21
        • Schwab M.
        • Noji E.
        Disaster planning and operation in the emergency department. Principles and practice of emergency medicine Baltimore: Williams and Wilkins.
        1999: 1804-1821
        • Alkan N.
        • Elmas I.
        • Karakuş M.
        • Akkay E.
        Problems encountered during natural disasters: a questionnaire study.
        TJTES. 2001; 7: 195-199
        • Kurt N.
        • Küçük H.
        • Celik G.
        • Demirhan R.
        • Gül O.
        • Altaca G.
        Evaluation of patients wounded in the 17 August 1999 Marmara earthquake.
        TJTES. 2001; 7: 49-51
        • Wikipedia
        Mogadishu bombings.
        (Available from:) (Accessed 25/09/2020)
        • Tayfur İ.
        • Afacan M.A.
        • Erdoğan M.Ö.
        • Çolak Ş.
        • Söğüt Ö.
        • Genç B.Y.
        • et al.
        Health results of a coup attempt: evaluation of all patients admitted to hospitals in Istanbul due to injuries sustained during the July 15, 2016 coup attempt.
        TJTES. 2018; 24: 39-42
        • Oldenburger D.
        • Baumann A.
        • Banfield L.
        Characteristics of medical teams in disaster.
        Prehosp Disaster Med. 2017; 32: 195-200
        • Kuncir E.
        • Spencer D.
        • Feldman K.
        • Barrios Jr., C.
        • Miller K.
        • Lush S.
        • et al.
        911 emergency medical services and re-triage to level I trauma centers.
        J Am Coll Surg. 2018; 226: 64-69
        • Teague D.C.
        Mass casualties in the Oklahoma City bombing.
        Clin Orthop Relat Res. 2004; 422: 77-81
        • American College of Surgeons Committee on Trauma
        Prehospital trauma care.
        in: Resources for Optimal Care of the Injured Patient. American College of Surgeons, Chicago, IL2006
        • Adaş G.
        • Turgut N.
        • Akçakaya A.
        Büyük Afetlerde Sağlık Hizmetlerinin Planlanması Organizasyonu ve Triaj.
        Okmeydanı Tıp Dergisi. 2012; 28: 124-134
        • Rodoplu Ü.
        • Arnold J.L.
        • Tokyay R.
        • Ersoy G.
        • Cetiner S.
        • Yücel T.
        Impact of the terrorist bombings of the Neve Shalom and Beth Israel synagogues on a hospital in Istanbul, Turkey.
        Acad Emerg Med. 2005; 12: 135-141
        • Biancolini C.A.
        • Del Bosco C.G.
        • Jorge M.A.
        Argentine Jewish community institution bomb explosion.
        J Trauma Acute Care Surg. 1999; 47: 728
        • Gutierrez de Ceballos J.P.
        • Turégano Fuentes F.
        • Perez Diaz D.
        • Sanz Sanchez M.
        • Martin Llorente C.
        • Guerrero Sanz J.E.
        Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings.
        Crit Care Med. 2005 Jan; 33: S107-S112
        • Bakke H.K.
        • Steinvik T.
        • Angell J.
        • Wisborg T.
        A nationwide survey of first aid training and encounters in Norway.
        BMC Emerg Med. 2016; 17: 1-7
        • Bakke H.K.
        • Steinvik T.
        • Eidissen S.-I.
        • Gilbert M.
        • Wisborg T.
        Bystander first aid in trauma - prevalence and quality: a prospective observational study.
        Acta Anaesthesiol Scand. 2015; 59: 1187-1193
        • Nordberg M.
        • Castrén M.
        • Lindström V.
        Primary trauma triage performed by bystanders: an observation study.
        Prehosp Disaster Med. 2016; 31: 353-357
        • Battistella F.
        • Benfield J.R.
        Blunt and penetrating injuries of the chest wall, pleura and lungs. General thoracic surgery 5th ed Philadelphia: Lippincott Williams & Wilkins.
        2000: 815-831
        • Moore E.E.
        • Knudson M.M.
        • Schwab C.W.
        • Trunkey D.D.
        • Johannigman J.A.
        • Holcomb J.B.
        Military–civilian collaboration in trauma care and the senior visiting surgeon program.
        N Engl J Med. 2007; 357: 2723-2727
        • Como J.J.
        • Smith C.E.
        • Grabinsky A.
        Trauma epidemiology, mechanisms of injury.
        Essent Trauma Anesth. 2012; 1
        • Brismar B.
        • Bergenwald L.
        The terrorist bomb explosion in Bologna, Italy, 1980: an analysis of the effects and injuries sustained.
        J Trauma Acute Care Surg. 1982; 22: 216-220
        • Mallonee S.
        • Shariat S.
        • Stennies G.
        • Waxweiler R.
        • Hogan D.
        • Jordan F.
        Physical injuries and fatalities resulting from the Oklahoma City bombing.
        Jama. 1996; 276: 382-387
        • Arnold J.L.
        • Halpern P.
        • Tsai M.-C.
        • Smithline H.
        Mass casualty terrorist bombings: a comparison of outcomes by bombing type.
        Ann Emerg Med. 2004; 43: 263-273
        • Leibovici D.
        • Gofrit O.N.
        • Stein M.
        • Shapira S.C.
        • Noga Y.
        • Heruti R.J.
        • et al.
        Blast injuries: bus versus open-air bombings--a comparative study of injuries in survivors of open-air versus confined-space explosions.
        J Trauma Acute Care Surg. 1996; 41: 1030-1035