Terrorist Explosive Attacks in Hilla Medical Concerns

Abstract

ABSTRACT

Objectives: To highlights the types of injuries characterizing blast  explosions. To make clinicians more familiar with blast effects for improving the  recognition and management of such injuries. 

Methods: Four of the many attacks of terrorist explosions that occurred in Hilla, the center of Babylon governorate, in Iraq, their casualties were retrospectively studied. The data were collected from the records of Hilla Teaching General Hospital, in addition to the information obtained from the otolaryngologists  regarding ear injuries diagnosed in the clinics. The patient characteristics regarding age, sex, types of wounds, surgical interventions, hospital stays were studied. The characteristics of the site of explosion whether open or confined and the mechanism of explosion; by bus or suicide bomber were also considered.

Results: The total number of victims injured in the four explosions were 627, 604 males (96.33%), 23 females (3.67%). The total number of deaths was 193, 184 males (95.33%), 9 females (4.67%). The total number of wounded was 434, 420  males (96.77%), 14 females (3.23). The bombing resulted in 150 (77.7%) immediate fatalities, 43 (22.3%) early and late deaths combined. Evidence of pulmonary contusion or laceration without rib fractures and chest wall injuries was found in 6 cases. These injuries are characteristics of blast effect. High percentage (67%) of burns was noticed in Ibn Al Nima Mosque explosion which was a confined place.

Conclusions: To reduce complications in critical injuries examination should focus on evidence for a significant blast exposure such as ruptured tympanic membranes, or subcutaneous emphysema and barotraumas so that blast lung injury can be early diagnosed and timely managed. If wounded patient exposed to blast effect, and his clinical examination revealed conjunctival hemorrhage, ophthalmologist should carefully examine him to exclude eye penetration. Explosion in a confined space resulted in high immediate mortality while an explosion in a confined space associated with structural collapse caused the highest total mortality (immediate and intra hospital mortality combined). If high percentage of burns was found among explosion victims, one  should think of  incendiary devices such as C4 having been involved.

Keywords: Blast injuries, Explosive devices, Mass casualties, Suicide bombing.

Iraqi Medical Journal Vol. 56, No.1, June 2010; p.44-49