To address this issue, Centers for Disease Control and Prevention (CDC), in collaboration with partners from the Terrorism Injuries Information, Dissemination and Exchange (TIIDE) Project, as well as other experts in the field, have developed fact sheets for health care providers that provide detailed information on the treatment of blast injuries.
After a Terrorist Bombing: Health and Safety Information for Emergency Care Providers
Immediately after the event
- Inform individuals in the area not to rush to the site of the blast, as secondary attacks can occur. Instruct bystanders to move away from the area and to avoid crowds, unattended cars and trucks, public transportation, and damaged buildings.
- Bombs and explosions can cause unique patterns of injury seldom seen outside combat.
- Most injuries in a bombing are not life-threatening and are due to blunt and penetrating trauma from flying debris or bomb fragments.
- Primary blast injury to the lung may require complex ventilatory, fluid, and support management.
- Wounds can be grossly contaminated. Consider delayed primary closure and assess tetanus status.
- Communication with bombing victims may be difficult, as they often experience ringing in the ears and/or sudden temporary or permanent hearing loss.
- Explosions in closed spaces, such as in subways or buses, or combined with a building or structural collapse, result in a greater number of severe injuries and deaths.
- Expect half of all initial casualties to seek medical care over a one-hour period.
- Those less injured bypass EMS triage and go directly to the closest hospitals and arrive before the more severely injured.
- Hospitals and roads closest to the blast(s) will quickly become crowded, as a large number or surge of friends and loved ones will arrive at the closest hospital within minutes of the event. When possible, individuals with minor injuries should be directed to hospitals outside the immediate area of the blast.
- All bombing events have the potential for chemical and/or radiological contamination. Triage and life saving treatment should never be delayed because of the possibility of radioactive contamination of the victim. In general, the risk of exposure to caregivers is small.
- Universal precautions effectively protect against radiological secondary contamination of first responders and first receivers.
- For those with injuries resulting in nonintact skin or mucous membrane exposure, administer hepatitis B immunization (within 7 days) and age-appropriate tetanus toxoid vaccine (if not current).
Hours or days after the event
- Even if the bomb or explosion doesn’t cause physical injuries, it can cause fear, confusion, and uncertainty. It is normal to have strong feelings after responding to such an event. You may feel sad, helpless, anxious, dazed, or even numb. These are all normal reactions to stress.
- Taking care of yourself will help you to stay focused on hazards at the site
and to maintain the constant vigilance you need for your own safety.
- Pace yourself. Rescue and recovery efforts at the site may continue for days or weeks.
- Take frequent rest breaks. Rescue and recovery operations take place in extremely dangerous work environments. Mental fatigue over long shifts can place emergency responders at greatly increased risk for injury.
- Watch out for each other. Co-workers may be intently focused on a particular task and may not notice a hazard nearby or behind.
- Be conscious of those around you. Responders who are exhausted, feeling stressed, or even temporarily distracted may place themselves and others at risk.
- Recognize and accept what you cannot change—the chain of command, organizational structure, waiting, equipment failures, etc.
- There is no simple fix to make things better right away. But there are
actions that can help you, your family, and your community heal. Try to:
- Follow a normal routine as much as possible.
- Eat healthy meals. Be careful not to skip meals or to overeat.
- Exercise and stay active.
- Help other people in your community as a volunteer. Stay busy.
- Accept help from family, friends, co-workers, or clergy. Talk about your feelings with them.
- Limit your time around the sights and sounds of what happened. Don’t dwell on TV, radio, or newspaper reports on the tragedy.
- If you or someone you know is having trouble dealing with the tragedy, ask for help. Talk to a counselor, your doctor, or community organization, such as the suicide prevention hotline (1-800-273-TALK) or the American Red Cross (1-866-GET-INFO).
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