What should medical professionals know about terror car-rammings? - study

A little-studied phenomenon from a medical perspective, terrorists’ vehicle-ramming attacks were analyzed by Israeli researchers.

A blue car is seen after ramming a police barricade outside the US Capitol building in an incident that reportedly resulted in the death of one Capitol police officer, the injury of another officer and the death of the driver as a result of police gunfire on Capitol Hill in Washington. (photo credit: Carlos Barria/Reuters)
A blue car is seen after ramming a police barricade outside the US Capitol building in an incident that reportedly resulted in the death of one Capitol police officer, the injury of another officer and the death of the driver as a result of police gunfire on Capitol Hill in Washington.
(photo credit: Carlos Barria/Reuters)

There aren’t many countries where vehicle-rammings by terrorists are routinely carried out to kill and maim, but Israel is one of them. However, they are being used more frequently by terrorist organizations around the world because of the simplicity of their execution. 

One occurred in New York City in 1917, when a truck killed eight, and another in Nice, France, in 2016, when a truck ran over and killed 84 people. 

Medical research on vehicular terrorism

Little medical or surgical research has been done on such assaults and their harm to victims. 

Dr. Avi Benov of the Israel Defense Forces’ (IDF) Medical Corps, Dr. Avishai Tsur of Sheba Medical Center and colleagues at Meir and Shamir Medical Centers and Tel Aviv University’s and Bar-Ilan University’s Faculties of Medicine published “Patterns in Vehicle-Ramming Attacks” in the Israel Medical Association Journal (IMAJ). 

Most studies on the subject investigated the perpetrators, neglecting possible patterns in the characteristics of such attacks that could guide appropriate medical response, they wrote.

 The scene of a car ramming and stabbing attack outside the big shopping center in Beer Sheva, southern Israel, on March 22, 2022.  (credit: FLASH90) The scene of a car ramming and stabbing attack outside the big shopping center in Beer Sheva, southern Israel, on March 22, 2022. (credit: FLASH90)
The team included all vehicle-ramming attacks recorded in the IDF’s Trauma Registry (IDF-TR) between 2015 and 2019. Since 2019, including this year, there have been more. The registry doesn’t include attacks in which only civilian medical teams took part in treatment, so the study doesn’t fully represent all such attacks on Israelis, they added. 

Who is hurt in car-rammings? 

Within 72 hours of completing treatment, the teams enter data on each event to describe the incident, the casualty and the injuries to conduct and guide policy. 

During the study period, there were 36 vehicle-ramming attacks in Israel with a total of 113 people injured or killed. The median number of dead in each attack was three, they wrote. 

The most prevalent day of the week for such attacks was Friday (the Muslim sabbath) in the afternoons, followed by Tuesday, Wednesday and Thursday. They were least likely to occur on Mondays.  and in the afternoon. Most of the injuries were to the legs, head, arms, back, chest, face, abdomen, pelvis and neck. Ten died before reaching a hospital. Seventy-four percent of the victims were male, and 79% were soldiers. Their mean age was 22. 

The researchers suggested that medical teams responding to a vehicle-ramming attack should be prepared for a mass-casualty incident with severe injuries, including deaths. Such teams should be sent to the area even when the number of victims has not yet been determined. Although the head and extremities are most likely to be hurt, teams should look for injuries in all parts of the body, they advised.