Mass Casualty Response in the 2008 Mumbai Terrorist Attacks

2011 ◽  
Vol 5 (4) ◽  
pp. 273-279 ◽  
Author(s):  
Nobhojit Roy ◽  
Vikas Kapil ◽  
Italo Subbarao ◽  
Isaac Ashkenazi
Keyword(s):  
Case Fatality ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Terrorist Attacks ◽  
Long Term Effects ◽  
Surgical Interventions ◽  
International Media ◽  
Terror Attacks ◽  
Critical Measure ◽  
Security Checks

ABSTRACTObjectives: The November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists.Methods: A retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants.Results: Among the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries).Conclusions: The use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar “Mumbai-style” attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.(Disaster Med Public Health Preparedness. 2011;5:273–279)

scholarly journals (A212) The 2008 Mumbai Terrorist Attacks and the Changing Pattern of Violent Injuries

2011 ◽  
Vol 26 (S1) ◽  
pp. s58-s59
Author(s):  
Y. Tanwar ◽  
V. Kaushik ◽  
N. Roy ◽  
S. Sinha ◽  
B. Guru
Keyword(s):  
Case Fatality ◽  
Public Hospitals ◽  
Terrorist Attacks ◽  
Financial Loss ◽  
Physical Damage ◽  
The Public ◽  
Case Fatality Ratio ◽  
The Common ◽  
Security Checks ◽  
Violent Events

IntroductionThe 26–29 November 2008, terrorist attacks in Mumbai, have been referred to as “India's 9/11”. Violent events in Mumbai over the past six decades were researched to understand the changing pattern of violent injuries.MethodsA complex, retrospective, descriptive study on terrorist events was performed, using event reports, legal reports, newspaper reports, and police and hospital lists. The distribution of victims to various city hospitals, the critical radius, surge capacity, and nature of interventions required were assessed. The profile of those killed in the attacks was noted by sex, nationality, and occupation. Besides the overall mortality and case-fatality ratio, the critical mortality was calculated based on the death rates among the critically injured.ResultsIn 51 violent events in Mumbai over a 60-year period (1950–2009), 1,582 people were killed and 4,145 were injured. In the Mumbai terrorist attacks of 2008, the financial loss due to direct physical damage was INR 847,612,971 (US$18.5 million). Among those killed, the average age was 33.4 years, 80% were male, and 12% were foreign nationals. The case-fatality ratio for this event was 36.2% and the mortality among the critically injured (critical mortality rate) was 11%. Among the injured, 79% were male and the average age was 33.21 years (three months–85 years); 38.5% of patients arriving at the hospitals required major surgical intervention.ConclusionsThe injuries of violent events in Mumbai have been changing due to the use of heavy firepower and explosives. Strengthening the public hospitals for trauma care is a medical counter-terrorism response for future terrorist attacks. These attacks have affected the lives of the common person in Mumbai, in terms of increased security checks, alerts, and fear of further attacks. These are areas of further research.

Triage in Complex, Coordinated Terrorist Attacks

2019 ◽  
Vol 34 (04) ◽  
pp. 442-448 ◽  
Author(s):  
Matt Pepper ◽  
Frank Archer ◽  
John Moloney
Keyword(s):  
Physiological Stress ◽  
Mass Casualty ◽  
Terrorist Attacks ◽  
Mass Violence ◽  
Patient Movement ◽  
Terror Attacks ◽  
Physiological Variables ◽  
Large Numbers ◽  
Life Saving ◽  
San Bernardino

AbstractIntroduction:Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed.Methods:Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs).Discussion:Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and “tactical triage.”Conclusion:Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.

scholarly journals Lessons learned from terror attacks: thematic priorities and development since 2001—results from a systematic review

2022 ◽  
Author(s):  
Nora Schorscher ◽  
Maximilian Kippnich ◽  
Patrick Meybohm ◽  
Thomas Wurmb
Keyword(s):  
Systematic Review ◽  
Scientific Evidence ◽  
Time Frame ◽  
Lessons Learned ◽  
International Terrorism ◽  
Terrorist Attacks ◽  
Eligibility Criteria ◽  
Terror Attacks ◽  
Time Period ◽  
The Difference

Abstract Purpose The threat of national and international terrorism remains high. Preparation is the key requirement for the resilience of hospitals and out-of-hospital rescue forces. The scientific evidence for defining medical and tactical strategies often feeds on the analysis of real incidents and the lessons learned derived from them. This systematic review of the literature aims to identify and systematically report lessons learned from terrorist attacks since 2001. Methods PubMed was used as a database using predefined search strategies and eligibility criteria. All countries that are part of the Organization for Economic Cooperation and Development (OECD) were included. The time frame was set between 2001 and 2018. Results Finally 68 articles were included in the review. From these, 616 lessons learned were extracted and summarized into 15 categories. The data shows that despite the difference in attacks, countries, and casualties involved, many of the lessons learned are similar. We also found that the pattern of lessons learned is repeated continuously over the time period studied. Conclusions The lessons from terrorist attacks since 2001 follow a certain pattern and remained constant over time. Therefore, it seems to be more accurate to talk about lessons identified rather than lessons learned. To save as many victims as possible, protect rescue forces from harm, and to prepare hospitals at the best possible level it is important to implement the lessons identified in training and preparation.

Lessons Learned from Cross-border Medical Response to the Terrorist Bombings in Tabba and Ras-el-Satan, Egypt, on 07 October 2004

2005 ◽  
Vol 20 (4) ◽  
pp. 253-257 ◽  
Author(s):  
Adi Leiba ◽  
Amir Blumenfeld ◽  
Ariel Hourvitz ◽  
Gali Weiss ◽  
Michal Peres ◽  
...  
Keyword(s):  
Large Scale ◽  
Time Course ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Border Zone ◽  
Terrorist Attacks ◽  
Trauma Centers ◽  
Medical Response ◽  
Peripheral Areas

AbstractIntroduction:Large-scale, terrorist attacks can happen in peripheral areas, which are located close to a country's borders and far from its main medical facilities and involve multi-national casualties and responders. The objective of this study was to analyze the terrorist suicide bombings that occurred on 07 October 2004, near the Israeli-Egyptian border, as representative of such a complex scenario.Methods:Data from formal debriefings after the event were processed in order to learn about victim outcomes, resource utilization, critical events, and time course of the emergency response.Results:A total of 185 injured survivors were repatriated: four were severely wounded, 13 were moderately injured, and 168 were mildly injured. Thirty-eight people died. A forward medical team landed at the border town's airport, which provided reinforcement in the field and in the local hospital. Israeli and Egyptian search and rescue teams collaborated at the destruction site. One-hundred sixty-eight injured patients arrived at the small border hospital that rapidly organized itself for the mass-casualty incident, operating as an evacuation “staging hospital”. Twenty-three casualties secondarily were distributed to two major trauma centers in the south and the center of Israel, respectively, either by ambulance or by helicopter.Conclusion:Large-scale, terrorist attacks at a peripheral border zone can be handled by international collaboration, reinforcement of medical teams at the site itself and at the peripheral neighboring hospital, rapid rearrangement of an “evacuation hospital”, and efficient transport to trauma centers by ambulances, helicopters, and other aircraft.

Experiences With and Lessons Learned From Developing, Implementing, and Evaluating a Support Program for Older Hearing Aid Users and Their Communication Partners in the Hearing Aid Dispensing Setting

2020 ◽  
Vol 29 (3S) ◽  
pp. 638-647 ◽  
Author(s):  
Janine F. J. Meijerink ◽  
Marieke Pronk ◽  
Sophia E. Kramer
Keyword(s):  
Large Scale ◽  
Hearing Aid ◽  
Critical Discussion ◽  
Lessons Learned ◽  
Research Note ◽  
Support Program ◽  
Large Sample Size ◽  
Long Term Effects ◽  
Communication Program ◽  
Communication Partners

Purpose The SUpport PRogram (SUPR) study was carried out in the context of a private academic partnership and is the first study to evaluate the long-term effects of a communication program (SUPR) for older hearing aid users and their communication partners on a large scale in a hearing aid dispensing setting. The purpose of this research note is to reflect on the lessons that we learned during the different development, implementation, and evaluation phases of the SUPR project. Procedure This research note describes the procedures that were followed during the different phases of the SUPR project and provides a critical discussion to describe the strengths and weaknesses of the approach taken. Conclusion This research note might provide researchers and intervention developers with useful insights as to how aural rehabilitation interventions, such as the SUPR, can be developed by incorporating the needs of the different stakeholders, evaluated by using a robust research design (including a large sample size and a longer term follow-up assessment), and implemented widely by collaborating with a private partner (hearing aid dispensing practice chain).

scholarly journals Terrorist campaigns and the growth of the Muslim population: a reply

2021 ◽  
pp. 1-12
Author(s):  
Clara Egger ◽  
Raul Magni-Berton
Keyword(s):  
Political Violence ◽  
Religious Conversion ◽  
Empirical Support ◽  
Terrorist Attacks ◽  
Muslim Population ◽  
Terror Attacks ◽  
Terrorist Groups ◽  
The One ◽  
The Impact ◽  
The Relationship

Abstract A recently published paper in this journal (Choi, 2021) establishes a statistical link between, on the one hand, Islamist terrorist campaigns – including terrorist attacks and online propaganda – and, on the other the growth of the Muslim population. The author explains this result by stating that successful campaigns lead some individuals to convert to Islam. In this commentary, we intend to reply to this article by focusing on the impact of terrorist attacks on religious conversion. We first show that Choi's results suffer from theoretical flaws – a failure to comprehensively unpack the link between violence and conversion – and methodological shortcomings – a focus on all terrorist groups over a period where Islamist attacks were rare. This leads us to replicate Choi's analysis by distinguishing Islamist and non-Islamist terror attacks on a more adequate timeframe. By doing so, we no longer find empirical support for the relationship between terror attacks and the growth of the Muslim population. However, our analyses suggest that such a hypothesis may hold but only in contexts where the level and intensity of political violence are high.

scholarly journals The Ebola outbreak, 2013–2016: old lessons for new epidemics

2017 ◽  
Vol 372 (1721) ◽  
pp. 20160297 ◽  
Author(s):  
Cordelia E. M. Coltart ◽  
Benjamin Lindsey ◽  
Isaac Ghinai ◽  
Anne M. Johnson ◽  
David L. Heymann
Keyword(s):  
Decision Making ◽  
West Africa ◽  
Disease Control ◽  
Ebola Virus ◽  
Case Fatality ◽  
West African ◽  
Lessons Learned ◽  
Haemorrhagic Fever ◽  
Chronological Order ◽  
Epidemiological Parameters

Ebola virus causes a severe haemorrhagic fever in humans with high case fatality and significant epidemic potential. The 2013–2016 outbreak in West Africa was unprecedented in scale, being larger than all previous outbreaks combined, with 28 646 reported cases and 11 323 reported deaths. It was also unique in its geographical distribution and multicountry spread. It is vital that the lessons learned from the world's largest Ebola outbreak are not lost. This article aims to provide a detailed description of the evolution of the outbreak. We contextualize this outbreak in relation to previous Ebola outbreaks and outline the theories regarding its origins and emergence. The outbreak is described by country, in chronological order, including epidemiological parameters and implementation of outbreak containment strategies. We then summarize the factors that led to rapid and extensive propagation, as well as highlight the key successes, failures and lessons learned from this outbreak and the response. This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.

SMART

2011 ◽  
pp. 97-113
Author(s):  
Esteban Pino ◽  
Dorothy Curtis ◽  
Thomas Stair ◽  
Lucila Ohno-Machado
Keyword(s):  
Patient Monitoring ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Hospital Environment ◽  
Monitoring Systems ◽  
Technological Advances ◽  
History Of ◽  
History Of Use ◽  
System Prototype ◽  
Disaster Management System

Patient monitoring is important in many contexts: at mass-casualty disaster sites, in improvised emergency wards, and in emergency room waiting areas. Given the positive history of use of monitoring systems in the hospital during surgery, in the recovery room, or in an intensive care unit, the authors sought to use recent technological advances to enable patient monitoring in more diverse circumstances: at home, while traveling, and in some less well-monitored areas of a hospital. This chapter presents the authors’ experiences in designing, implementing and deploying a wireless disaster management system prototype in a real hospital environment. In addition to a review of related systems, the sensors, algorithms and infrastructure used in our implementation are presented. Finally, general guidelines for ubiquitous methodologies and tools are shared based on the lessons learned from the actual implementation.

SMART

2011 ◽  
pp. 261-275
Author(s):  
Esteban Pino ◽  
Dorothy Curtis ◽  
Thomas Stair ◽  
Lucila Ohno-Machado
Keyword(s):  
Patient Monitoring ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Hospital Environment ◽  
Monitoring Systems ◽  
Technological Advances ◽  
History Of ◽  
History Of Use ◽  
System Prototype ◽  
Disaster Management System

Patient monitoring is important in many contexts: at mass-casualty disaster sites, in improvised emergency wards, and in emergency room waiting areas. Given the positive history of use of monitoring systems in the hospital during surgery, in the recovery room, or in an intensive care unit, the authors sought to use recent technological advances to enable patient monitoring in more diverse circumstances: at home, while traveling, and in some less well-monitored areas of a hospital. This paper presents the authors’ experiences designing, implementing and deploying a wireless disaster management system prototype in a real hospital environment. In addition to a review of related systems, the sensors, algorithms and infrastructure used in our implementation are presented. Finally, general guidelines for ubiquitous methodologies and tools are shared based on the lessons learned from the actual implementation.

Emergency Response to Mumbai Terror Attacks

2011 ◽  
pp. 46-58
Author(s):  
Divya Shankar ◽  
Manish Agrawal ◽  
H. Raghav Rao
Keyword(s):  
Activity Theory ◽  
Emergency Response ◽  
Lessons Learned ◽  
Terror Attacks

The Mumbai terror attacks of November 2008 lasted for over 60 hours and resulted in the death of over 172 people. The attack revealed several shortcomings of the emergency response preparedness in Mumbai. This chapter concentrates on the emergency response provided and uses activity theory to analyze it. The authors explore the diverse dimensions of emergency, determine the lessons learned from the incident and evaluate the emergency response. They suggest how operations could be improved thus setting a standard for any future emergency response.

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