World Journal of Surgery

, Volume 32, Issue 6, pp 1168–1175 | Cite as

Injury Patterns from Major Urban Terrorist Bombings in Trains: The Madrid Experience

  • Fernando Turégano-Fuentes
  • P. Caba-Doussoux
  • J. M. Jover-Navalón
  • E. Martín-Pérez
  • D. Fernández-Luengas
  • L. Díez-Valladares
  • D. Pérez-Díaz
  • P. Yuste-García
  • H. Guadalajara Labajo
  • R. Ríos-Blanco
  • F. Hernando-Trancho
  • F. García-Moreno Nisa
  • M. Sanz-Sánchez
  • C. García-Fuentes
  • A. Martínez-Virto
  • J. L. León-Baltasar
  • J. Vazquez-Estévez
Article

Abstract

Background

Terrorist urban mass casualty incidents (MCI) in the last 3 years have targeted commuter trains at rush hour, producing large numbers of casualties. Civilian care providers are usually not familiar with the types of blast injuries sustained by victims of these MCI.

Methods

We focus on the injury patterns sustained by casualties of the Madrid, 11 March 2004, terrorist bombings, at the seven hospitals that received most victims. Data were gathered of casualties who had injuries other than superficial bruises, transient hearing loss from barotrauma without eardrum perforation, and/or emotional shock. The degree of severity in critical patients was assessed with the ISS.

Results

The bombings resulted in 177 immediate fatalities, 9 early deaths, and 5 late deaths. Most survivors had noncritical injuries, but 72 (14%) of 512 casualties assessed had an Injury Severity Score (ISS) >15. The critical mortality rate was of 19.5%. The most frequently injured body regions were the head-neck and face. Almost 50% of casualties had ear-drum perforation, and 60% of them were bilateral. There were 43 documented cases of blast lung injury, with a survival rate of 88.3%. Maxillofacial and open long-bone fractures were most prevalent. Gustillo’s grade III of severity predominated in tibia-fibular and humeral fractures. Upper thoracic fractures (D1–6 segment) represented 65% of all vertebral fractures and were associated with severe blast to the torso. Severe burns were uncommon. Eye injuries were frequent, although most were of a mild-to-moderate severity. Abdominal visceral lesions were present in 25 (5%) patients. A multidisciplinary approach was necessary in most operated patients, and orthopedic trauma procedures accounted for 50% of the caseload in the first 24 h.

Conclusions

Ninety-three percent of the fatalities of the Madrid trains terrorist bombings were immediate, and most survivors had noncritical injuries. Closed doors increased the immediate fatality rate in the trains. Severely wounded casualties presented specific patterns of injuries, some of them life-threatening and unusual in other types of trauma mechanisms. Ear-lobe amputations and upper thoracic spine fractures were markers of critical injuries.

Keywords

Injury Severity Score Mass Casualty Incident Primary Blast Terrorist Bombing Royal London Hospital 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors thank Dr. Michael Stein for his very helpful discussion of the manuscript.

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Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Fernando Turégano-Fuentes
    • 1
  • P. Caba-Doussoux
    • 2
  • J. M. Jover-Navalón
    • 3
  • E. Martín-Pérez
    • 4
  • D. Fernández-Luengas
    • 5
  • L. Díez-Valladares
    • 6
  • D. Pérez-Díaz
    • 1
  • P. Yuste-García
    • 2
  • H. Guadalajara Labajo
    • 5
  • R. Ríos-Blanco
    • 3
  • F. Hernando-Trancho
    • 6
  • F. García-Moreno Nisa
    • 7
  • M. Sanz-Sánchez
    • 1
  • C. García-Fuentes
    • 2
  • A. Martínez-Virto
    • 5
  • J. L. León-Baltasar
    • 2
  • J. Vazquez-Estévez
    • 1
  1. 1.Department of General SurgeryHospital Gregorio MarañónMadridSpain
  2. 2.Hospital 12 de OctubreMadridSpain
  3. 3.Hospital de GetafeMadridSpain
  4. 4.Hospital de la PrincesaMadridSpain
  5. 5.Hospital La PazMadridSpain
  6. 6.Hospital ClínicoMadridSpain
  7. 7.Hospital Ramón y CajalMadridSpain

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