The spectrum of pediatric injuries after a bomb blast

doi:10.1016/S0022-3468(97)90199-8

Journal of Pediatric Surgery

Volume 32, Issue 2, February 1997, Pages 307-311

https://doi.org/10.1016/S0022-3468(97)90199-8 Get rights and content

Abstract

The spectrum of pediatric injuries seen after a bomb blast is poorly documented. The pathophysiology of blast injuries differ significantly from other forms of trauma and typically result in large numbers of distinctly patterned injuries. On April 19, 1995, a truck bomb was detonated directly adjacent to the Alfred P. Murrah Federal Building in Oklahoma City, Oklahoma. A total of 816 adults and children were injured or killed as a direct result of the blast. Twenty infants and children were seated by the window of the second floor day care center at the time of the explosion. The injuries incurred by all children involved in the blast were studied. Nineteen children, 16 of whom were in the day care center, died as a direct result of the blast. The injury patterns among the 19 dead children included a 90% (17 of 19) incidence of skull fractures, 15 of those with cerebral evisceration (skull capping); 37% with abdominal or thoracic injuries; 31% amputations; 47% arm fractures, 26% leg fractures; 21% burns; and 100% with extensive cutaneous contusions, avulsions, and lacerations. Forty-seven children sustained nonfatal injuries with only seven children requiring hospitalization. The injuries sustained by the seven hospitalized children included two open, depressed skull fractures, with partially extruded brain, two closed head injuries, three arm fractures, one leg fracture, one arterial injury, one splenic injury, five tympanic membrane perforations, three corneal abrasions, and four burn cases (1 > 40% body surface area [BSA]). After a bomb blast, pediatric patients sustain a high incidence of cranial injuries. Fractures and traumatic amputations are common. Intraabdominal and thoracic injuries occur frequently in the deceased but infrequently in survivors.

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Cited by (49)

Medical Management at the Health Care Facility
2017, Annals of Emergency Medicine
Citation Excerpt :
Children are frequently victims in blast terrorist attacks. In the Oklahoma City bombing, which involved the child care center in the Alfred P. Murrah Federal Building, the children experienced a high incidence of traumatic amputation, fractures, and cranial injury.40 Experience in Israel has also shown that penetrating truncal injuries are common in children who are victims of vehicular bombings.41
Trauma care for children in the field
2014, Clinical Pediatric Emergency Medicine
Citation Excerpt :
The number of children per event can vary depending on the location, time of day, and type of event. In terrorist blast events on US soil, the number of children has ranged from 0 to 66.29,30 Although still rare, amateur firework–related blast injuries are more common in the United States than terrorist bombings.31-34
Emergency medical care for children has evolved immensely over the past 30 years. During this period, much has been accomplished to improve the quality of care delivered to injured children in the United States. In this article, we will highlight specific examples of how trauma care of children has changed and improved in recent decades. Beginning with the importance of injury prevention, the article will also discuss the specific management of traumatic brain injury, blast injury, and field triage of mass casualty situations before concluding with highlights of other changes and advances that have occurred.
A modern analysis of a historical pediatric disaster: The 1927 Bath school bombing
2010, Journal of Surgical Research
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Historical reviews of disasters are an important source of information for both designing emergency preparedness plans and determining the patterns of injury specific to children. Lessons learned from terrorist attacks around the world have given us a better understanding of the mechanisms and patterns of injury that may be unique to children [5]. An analysis of the Bath school bombings of 1927, the largest pediatric terrorist disaster in U.S. history, provides another opportunity to gain perspective on pediatric patterns of injury and future disaster preparedness.
Children have unique anatomy and physiology that may necessitate a unique approach to a pediatric surge. An analysis of the Bath school bombings of 1927, the largest pediatric terrorist disaster in U.S. history, provides an opportunity to gain perspective on pediatric patterns of injury and future disaster preparedness.
Eighty-nine contemporary newspaper accounts, the official coroner's inquest, interviews, online resources, and the Michigan state archives of the disaster were reviewed with respect to the demographics, pattern of injury, gender, age, duration of hospitalization, relative distance of each classroom from the blast, and severity of injuries sustained using the Injury Severity Scale (ISS).
Eighty-seven children and three teachers were unable to safely evacuate the building; 36 children (41%) were dead on-site, 40 sustained mild injuries (76.9%), nine sustained moderate injuries (17.3%), and one sustained serious injuries (1.9%). Mean ISS scores decreased with increasing relative distance of each classroom from the primary blast, while the classrooms involved in structural collapse had the highest initial mortality and ISS score. Patterns of injury sustained imply a predominance of crush and penetrating trauma.
Mean ISS scores and initial mortality by classroom were a function of proximity to the blast and structural collapse. The pattern of injury closely approximates those of other pediatric disasters such as Columbine, Oklahoma City, and 911. The absence of severe abdominal trauma and one reported hospital mortality may reflect an initial under-triage of patients, possibly due to the medical technology of the times.
Blast injuries
2010, Medical Journal Armed Forces India
Blasts injuries are responsible for about two-thirds of the conventional combat injuries during any military operation and account for a sizeable number during terrorist activities. The pathophysiology, clinical presentation and urgency of management vary significantly in primary blast injuries. These can lead to a wide range of overt and covert injuries, making diagnosis and management difficult. The clinical picture varies from acute respiratory distress to deafness with absence of any external injuries. Such patients are best identified and dealt with by a team of health care professionals well acquainted with battle field injuries.
Early Assessment and Management of Trauma
2010, Ashcraft's Pediatric Surgery
Pediatric Mass Casualty: Triage and Planning for the Prehospital Provider
2009, Clinical Pediatric Emergency Medicine
Citation Excerpt :
Blast injury can be seen in certain MCEs. Injury patterns in children after a blast injury also differ from their adult counterparts and from nonblast pediatric injuries.16,17 These different injury patterns must be recognized by the prehospital provider because explosives remain a weapon of choice among terrorist organizations.
Infants and children are common victims of disaster or mass casualty situations. Prehospital providers provide the initial care and stabilization at the scene of a mass casualty event. There are a number of challenges the prehospital provider faces when caring for children in a mass casualty event, among them are the following: the physiology of children differs from adults, children are particularly vulnerable in a disaster, separation from parents or caregivers may occur, and protocols developed for adults may not work well for children. This article reviews the planning and triage considerations for prehospital providers caring for children in a mass casualty event.

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^☆: Presented at the 27th Annual Meeting of the American Pediatric Surgical Association, San Diego, California, May 20–23, 1996.

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The spectrum of pediatric injuries after a bomb blast☆

Abstract

Ann Emerg Med

Ann Emerg Med

Terrorist bombings—Lessons learned from Belfast to Beirut

Ann Surg

Urban bomb blast injuries: Patterns of injury and treatment

Surg Annu

Investigation of physical injuries directly associated with the Oklahoma City bombing