The morbidity and mortality inflicted in two European capitals, Madrid, Spain, and London, England, in 2004 and 2005 respectively, demonstrates the impact of detonating explosives in densely populated civilian areas. Explosions can produce instantaneous havoc, resulting in numerous casualties with complex, technically challenging injuries not commonly seen after natural disasters. To address the challenges posed by such an event, the Centers for Disease Control and Prevention (CDC)'s National Center for Injury Prevention and Control (NCIPC), Division of Injury Response (DIR) convened expert panels in October 2005, January 2006, and June 2009. These panels included experts in emergency medical services (EMS), emergency medicine, trauma surgery, burn surgery, pediatrics, otolaryngology, intensive care medicine, hospital medicine, radiology, pharmacology, nursing, hospital administration, bloodbanking, and public health. The panels were tasked with identifying creative strategies that could be adopted in a timely manner to address medical care surge issues from terrorism, and the panel experts focused on rapidly managing large numbers of bombing casualties. They examined challenges that would confront not only the general emergency medical response and health care system, but also select medical disciplines. Although developed for addressing a surge of injuries from a terrorist bombing, the recommendations in this report may also improve the management of a surge from other mass casualty events, including biological, chemical, or nuclear attacks. This document reflects the recommendations of the expert panels. It includes a description of system-wide and discipline-specific challenges as well as recommendations to address these issues. Solutions for the discipline-specific challenges have been incorporated into easy-to-use templates that can assist various disciplines in managing surge needs for injuries. The needs and resources of each community must be considered to effectively plan for a surge of patients into an already overburdened health care system.
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