Explosive devices and high-velocity firearms are the terrorists’ weapons of choice. The devastation wrought in two European capitals, Madrid and London, demonstrate the impact that can be achieved by detonating explosives among densely packed civilians. In an instant, an explosion can wreak havoc - producing numerous casualties with complex, technically challenging injuries not commonly seen after natural disasters such as floods, tornadoes, or hurricanes.  Because many patients self-evacuate after a terrorist attack, and prehospital care may be difficult to coordinate, hospitals near the scene can expect to receive a large influx - or surge - of victims after a terrorist strike. This rapid surge of victims typically occurs within minutes, exemplified by the Madrid bombings where the closest hospital received 272 patients in 2.5 hours. In addition, injuries to workers involved in recovery procedures can lead to a secondary wave in surge.

To address the challenges posed by such an event, CDC’s National Center for Injury Prevention and Control convened an expert panel in October 2005 and January 2006. The panel included experts in the areas of emergency medical services, emergency medicine, trauma surgery, burn surgery, pediatrics, otolaryngology, intensive care medicine, hospital medicine, radiology, pharmacology, nursing, hospital administration, laboratory medicine (blood bank), and public health. The panel was charged with identifying creative strategies that could be adopted in a timely manner to address surge issues from terrorism. 

This document, which is the result of the expert panel meetings, reflects the opinions and recommendations of the experts. It includes a description of system-wide and discipline-specific challenges as well as recommended solutions to address these challenges.  The proposed solutions for the discipline-specific challenges have been incorporated into easy to use templates that can assist various disciplines in managing surge needs for injuries.

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 In a Moment’s Notice: Surge Capacity in Terrorist Bombings
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