Management of victims in a mass casualty incident caused by a terrorist bombing: treatment algorithms for stable, unstable, and in extremis victims.

Bombs aimed at civilian populations are the most common weapon used by terrorists throughout the world. Over the last decade, we have been involved in the management of more than 20 mass casualty incidents, most of which were caused by terrorist bombings. Commonly, in these events, there may be many victims and many deaths. However, only a few of the survivors will suffer from life-threatening injuries. Appropriate and timely treatment may impact their survival. Due to the complex mechanism of injury seen in these scenarios, treatment of victims injured by explosions is somewhat different from that exercised in blunt and penetrating trauma from other causes. The intention of this article was to outline the initial medical treatment of the injured victim arriving at the emergency department during a mass casualty incident caused by a terrorist bombing. Treatment protocols for stable, unstable, and in extremis patients are presented.