{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T22:03:27Z","timestamp":1761948207114},"reference-count":37,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2012,6,28]],"date-time":"2012-06-28T00:00:00Z","timestamp":1340841600000},"content-version":"unspecified","delay-in-days":3223,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2003,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1049023X00001114_sec01\"><jats:title><jats:bold>Objectives:<\/jats:bold><\/jats:title><jats:p>To review and analyze the cumulative two-year, Israeli experience with medical care for children victims of terrorism during the prehospital and hospital phases.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X00001114_sec02\" sec-type=\"methods\"><jats:title><jats:bold>Methods:<\/jats:bold><\/jats:title><jats:p>Data were collected from the: (1) Magen David Adom National Emergency Medical System Registry (prehospital phase); (2) medical records from the authors\u2019 institutions (pediatric triage); and (3) Israel Tr auma Registry (injury characteristics and utilization of in-hospital resources). Statistical analyses were performed as appropriate.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X00001114_sec03\" sec-type=\"intro\"><jats:title><jats:bold>Introduction:<\/jats:bold><\/jats:title><jats:p>During the recent wave of violence in Israel and the surrounding region, hundreds of children have been exposed to and injured by terrorist attacks. There is a paucity of data on the epidemiology and management of terror-related trauma in the pediatric population and its effects on the healthcare system. This study focuses on four aspects of terrorism-related injuries: (1) tending to victims in the prehospital phase; (2) triage, with a description of a modified, pediatric triage algorithm; (3) characteristics of trauma-related injuries in children; and (4) utilization of in-hospital resources.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X00001114_sec04\" sec-type=\"results\"><jats:title><jats:bold>Results:<\/jats:bold><\/jats:title><jats:p>During the study period, 41 mass-casualty events (MCEs) were managed by Magen David Adom. Each event involved on average, 32 regular and nine mobile intensive care unit ambulances with 93 medics, 19 paramedics, and four physicians. Evacuation time was 5\u201310 minutes in urban areas and 15\u201320 minutes in rural areas. In most cases, victims were evacuated to multiple facilities. To improve efficiency and speed, the Magen David Adom introduced the use of well-trained \u201cfirst-responders\u201d and volunteer, off-duty professionals, in addition to \u201cscoop and run\u201d on-the-scene management. Because of differences in physiology and response between children and adults, a pediatric triage algorithm was developed using four categories instead of the usual three. Analysis of the injuries sustained by the 160 children hospitalized after these events indicates that most were caused by blasts and penetration by foreign objects. Sixty-five percent of the children had multiple injuries, and the proportion of critical to fatal injuries was high (18%). Compared to children with non-terrorism-related injuries, the terrorism-related group had a higher rate of surgical interventions, longer hospital stays, and greater needs for rehabilitation services.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X00001114_sec05\" sec-type=\"conclusion\"><jats:title><jats:bold>Conclusion:<\/jats:bold><\/jats:title><jats:p>Terrorism-related injuries in children are severe and increase the demand for acute care. The modifications in the management of pedi-atric casualties from terrorism in Israel may contribute to the level of preparedness of medical and paramedical personnel to cope with future events. Further studies of other aspects of traumatic injuries, such as its short- and long-term psychological consequences, will provide a more comprehensive picture of the damage inflicted on children by acts of terrorism.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1049023x00001114","type":"journal-article","created":{"date-parts":[[2016,8,24]],"date-time":"2016-08-24T07:46:10Z","timestamp":1472024770000},"page":"242-248","source":"Crossref","is-referenced-by-count":35,"title":["The Impact of Terrorism on Children: A Two-Year Experience"],"prefix":"10.1017","volume":"18","author":[{"given":"Yehezkel","family":"Waisman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Limor","family":"Aharonson-Daniel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meirav","family":"Mor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Amir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kobi","family":"Peleg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2012,6,28]]},"reference":[{"key":"S1049023X00001114_ref032","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540050048022"},{"key":"S1049023X00001114_ref026","first-page":"49","article-title":"EMS incident management: Emergency medical logistics","volume":"28","author":"Maniscalco","year":"1999","journal-title":"Emerg Med Serv"},{"key":"S1049023X00001114_ref023","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"S1049023X00001114_ref011","first-page":"19","article-title":"Field triage: Help or hindrance?","volume":"35","author":"Wesson","year":"1992","journal-title":"Can J Surg"},{"key":"S1049023X00001114_ref010","volume-title":"START: Simple Triage and Rapid Treatment Plan.","author":"Super","year":"1994"},{"key":"S1049023X00001114_ref024","first-page":"58","article-title":"MCI (mass casualty incident) success story. 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Aharonson-Daniel L , Waisman Y , Danon YL , Peleg K and the Israel Tr auma Group: Epidemiology of terror-related versus non-terror-related traumatic injury in children. 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