Disaster management following explosion


  • B. R. Sharma, MBBS, MD




mass disaster, explosions, blast injury, terrorist attacks, triage, disaster management, forensic evidence


Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims. To address the problem to the maximum benefit of mass disaster victims, we must develop collective forethought and a broad-based consensus on triage and these decisions must reach beyond the hospital emergency department. It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making.

Author Biography

B. R. Sharma, MBBS, MD

Professor, Department of Forensic Medicine and Toxicology, Government Medical College & Hospital, Chandigarh 160030, India.


Slater MS, Trunkey DD: Terrorism in America: An evolving threat. Arch Surg. 1997; 132: 1059-1066.

Stein M, Hirshberg A: Medical consequences of terrorism: The conventional weapon threat. Surg Clin North Am. 1999; 79: 1537-1552.

Caro D: Major disasters. Lancet. 1974; 2: 1309-1310.

Hadden WA, Rutherford WH, Merrett JD: The injuries of terrorist bombing: A study of 1532 consecutive patients. Br J Surg. 1978; 65: 525-531.

Adler J, Golan E, Golan J, et al.: Terrorist bombing experience during 1975–79: Casualties admitted to the Shaare Zedeck Medical Center. Isr J Med Sci. 1983; 19: 189-193.

Cooper GJ, Maynard RL, Cross NL, et al.: Casualties from terrorist bombings. J Trauma. 1983; 23: 955-967.

Sharma BR: Clinical forensic medicine—Management of crime victims from trauma to trial. J Clin Forensic Med. 2003; 10: 267-273.

Stapczynski JS: Blast injuries. Ann Emerg Med. 1982; 3: 287–293.

Phillips YY: Primary blast injuries. Ann Emerg Med. 1986; 15: 1446-1450.

Zuckerman S: Experimental study of blast injuries to the lungs. Lancet. 1940; 2: 219-238.

Rawlins JSP: Physical and pathophysiological effects of blast. Injury. 1977; 9: 313-320.

Hill JF: Blast injury with particular reference to recent terrorist bombing incidents. Ann R Coll Surg Engl. 1979; 61: 4-11.

Clemedsson CJ: Blast injury. Physiol Rev. 1956; 36: 336-354.

Huller J, Bazini Y: Blast injuries of the chest and abdomen. Arch Surg. 1970; 100: 24-30.

Leibovici D, Gofrit ON, Stein M, et al.: Blast injuries: Bus versus openair-bombings—A comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma. 1996; 41: 1030-1035.

Candole CA: Blast injury. Can Med Assoc J. 1967; 96: 207-214.

Brismar B, Bergenwald L: The terrorist bomb explosion in Bologna, Italy, 1980: An analysis of the effects and injuries sustained. J Trauma. 1982; 22: 216-220.

Pyper PC, Graham WJH:Analysis of terrorist injuries treated at Craigavon Area Hospital, Northern Ireland, 1972–1980. Injury. 1982; 14: 332-338.

Scott BA, Fletcher JR, Pulliam MW, et al.: The Beirut terrorist bombing. Neurosurgery. 1986; 18: 107-110.

Frykberg ER, Tepas JJ, Alexander RH: The 1983 Beirut airport terrorist bombing: Injury patterns and implications for disaster management. Am J Surg. 1989; 55: 134-141.

Frykberg ER, Tepas JJ: Terrorist bombings: Lessons learned from Belfast to Beirut. Ann Surg. 1988; 208: 569-576.

Mallonee S, Shariat S, Stennies G, et al.: Physical injuries and fatalities resulting from the Oklahoma City bombing. JAMA. 1996; 276: 382-387.

Rignault DP, Deligny MC: The 1986 terrorist bombing experience in Paris. Ann Surg. 1989; 209: 368-373.

Kennedy TL, Johnston GW: Civilian bomb injuries. Br Med J. 1975; 1: 382-383.

Biancolini CA, DelBosco CG, Jorge MA: Argentine Jewish community institution bomb explosion. J Trauma. 1999; 47: 728-732.

Feliciano DV, Anderson GV, Rozycki GS, et al.: Management of casualties from the bombing at the Centennial Olympics. Am J Surg. 1998; 176: 538-543.

Sklar DP: Casualty patterns in disasters. J World Assoc Emerg Disaster Med. 1987; 3: 49-51.

Rignault DP: Recent progress in surgery for the victims of disaster, terrorism and war.World J Surg. 1992; 16: 885-887.

Sharma BR: Triage in trauma-care system—A forensic view. J Clin Forensic Med. 2005; 12: 64-73.

Champion HR, Sacco WJ: Trauma severity scales. In Maull KI (ed.): Advances in Trauma. Vol 1. Chicago: Yearbook Medical Publishers, 1986: 1-20.

Champion HR, Sacco WJ, Gainer PS, et al.: The effect of medical direction on trauma triage. J Trauma. 1988; 28: 235-239.

Cook CH, Muscarella P, Praba AC, et al.: Reducing overtriage without compromising outcomes in trauma patients. Arch Surg. 2001; 136: 752-756.

American College of Surgeons, Committee on Trauma: Resources for Optimal Care of the Injured Patient. Chicago, IL: American College of Surgeons, 1998.

American College of Surgeons, Committee on Trauma: Field categorization of trauma patients (field triage). Bull Am Coll Surg. 1986; 71: 17-21.

Jacobs LM, Ramp JM, Breay JM: An emergency medical system approach to disaster planning. J Trauma. 1979; 19: 157-162.

Ammons MA, Moore EE, Pons PT, et al.: The role of a regional trauma system in the management of a mass disaster: An analysis of the Keystone Colorado chairlift accident. J Trauma. 1988; 28: 1468-1471.

Berry FB: The medical management of mass casualties: The Scudder oration on trauma. Bull Am Coll Surg. 1956; 41: 60-66.

U.S. Department of Defense: Emergency War Surgery.Washington, DC:U.S. Government Printing Office, 1975.

Jacobs LM, Goody M, Sinclair A: The role of a trauma center in disaster management. J Trauma. 1983; 23: 697-701.

Sharma BR: Development of pre-hospital trauma-care system— An overview. Injury. 2005; 36: 577-585.

Rosenberg B, Sternberg N, Zagher V, et al.: Burns due to terroristic attacks on civilian populations from 1975–1979. Burns. 1982; 9: 21-23.

Sharma BR, Singh H: Role of forensic medicine in mass casualty incident. J Punjab Acad Forensic Med Toxicol. 2006; 6: 25-30.

Klein JS,Weigelt JA: Disaster management: Lessons learned. Surg Clin North Am. 1991; 71: 257-266.

Disaster Victim Identification (DVI): Interpol guidelines.Available at http://www.interpol.int/Public/DiasterVictim/Guide/chapitre4.asp. Accessed March 2007.



How to Cite

Sharma, MBBS, MD, B. R. “Disaster Management Following Explosion”. American Journal of Disaster Medicine, vol. 3, no. 2, Mar. 2008, pp. 113-9, doi:10.5055/ajdm.2008.0015.