|Photo by: REUTERS/NIR ELIAS|
3rd Opinion: The bus bombing in Tel Aviv – revisited
By GABI BARBASH MD MPH
This event wound up having little medical significance, but it carries grave implications politically.
The first message came from my assistant, “Didn’t you hear? There was a bus
bombing a few hundred meters from the hospital, at the corner of Henrietta Szold
and Shaul Hamelech.”
I had not yet heard anything. I was immediately
flooded with memories. It had been 10 years since we had last experienced a
terror attack in Tel Aviv.
As the main metropolitan hospital, the Tel
Aviv Sourasky Medical Center treated more than 1,000 casualties from those
attacks between 1994 and 2003.
There were attacks after which up to 150
casualties streamed into our Emergency Department within less than one hour, and
we admitted them all for immediate medical and surgical care.
protocol for coping with that scenario has been embedded into our medical
center’s way of life ever since, and our mental and physical preparation has
become a matter of routine.
The trauma and mass casualty apparatuses
worked faultlessly on Wednesday. Within minutes, stretchers were positioned at
the entrance to the emergency services to enable immediate unloading of patients
from ambulances and allow the quick return of the ambulances to the
Triage physicians and clerks were positioned at the entrance to
assess the wounded victims’ conditions, and senior trauma surgeons took charge
of the patients’ management.
The operating theater wing was instructed to
put a hold on non-emergency surgeries until the necessity for emergency
procedures was ascertained.
One of the problems we have learned to expect
was dealing with blast injuries that are so characteristic of the bombing of a
vehicle. Explosions within a close space frequently cause internal injuries that
may not be visible externally.
This means that a wounded person can be
correctly treated for minor external injuries only for his condition to suddenly
deteriorate because of internal bleeding.
This time, the explosive
material was relatively small and, despite the fact that it was mixed with metal
components (screws and other small, sharp objects) to increase the extent of
injury, the amount was too small to cause such a blast effect.
emergency room was crowded with many superficially wounded people. Ten years
ago, one of my concerns in our preparedness for mass casualty events that
occurred after working hours was recruiting the critical number of physicians
and nurses necessary to deal with a large number of casualties.
attacks during working hours were a kind of managerial luxury in this setting,
and this week’s bombing was such an event, both because of the relatively
moderate severity of the injuries and because the necessary number of available
physicians were at hand.
I watched the same senior trauma physicians from
the surgical division who ran the emergency ward and trauma unit 10 years ago
lead the admission of the 21 casualties who were brought in on Wednesday
I watched the clinical care of the wounded patients in the
trauma unit: The senior surgeons were accompanied by a group of young residents
and students for whom this was the first exposure to a mass casualty
Given that residency programs last an average of five years and
the nurses’ characteristic turnover, 10 years means a new generation for the
life of a hospital.
I looked at the faces of the medical students and the
interns and saw their shock and amazement as they confronted a terror-driven
mass casualty scene for the first time in their lives.
I thought to
myself, they are still so young — too young — to witness the results of this
crazy, inhuman behavior. For that matter, treating victims of terrorist attacks
who could so easily be family members and friends is never easy on the more
hardened physicians either.
Within one hour, the casualties had been
safely evacuated from the emergency services units, with the exception of two
with mild injuries. The other wounded who needed surgery were already in the
operating theater and those who needed medical treatment were already in the
surgical and orthopedic wards.
As I mentioned to one of the reporters who
interviewed me, this event wound up having little medical significance, but it
carries grave implications politically.
It may testify to a shift from
the indiscriminate terrorist missile attacks on civilians in the South of Israel
to the “historic” targeting of buses on the streets of every city
Finally, I was humbled by the outpouring of support and
concern from emails that I received from our friends all over the
Dr. Gabi Barbash is the CEO of the Tel Aviv Sourasky Medical