PHYSICAL INJURIES AND FATALITIES RESULTING FROM THE OKLAHOMA-CITY BOMBING

Objective.-To provide an epidemiologic description of physical injurie s and fatalities resulting from the April 19, 1995, bombing of the Alf red P. Murrah Federal Building in Oklahoma City. Design and Setting.-D escriptive epidemiologic study of all persons injured by the bombing a nd of all at-risk occupants of the federal building and 4 adjacent bui ldings. Data were gathered from hospital emergency and medical records departments, medical examiner records. and surveys of area physicians . building occupants, and survivors. Study Population.-All persons kno wn to have been exposed to the blast. Main Outcome Measures.-Character istics of fatalities and injuries, injury maps, and injury rates by bu ilding location. Results.-A total of 759 persons sustained injuries. 1 67 persons died. 83 survivors were hospitalized, and 509 persons were treated as outpatients, Of the 361 persons who were in the federal bui lding, 319 (88%) were injured, of whom 163 (45%) died. including 19 ch ildren. Persons in the collapsed part of the federal building were sig nificantly more likely to die (153/175, 87%) than those in other parts of the building (10/186, 5%) (risk ratio [RR], 16.3, 95% confidence i nterval [CI], 8.9-29.8). In 4 adjacent buildings, injury rates varied from 38% to 100%; 3 persons in these buildings and 1 person in an outd oor location died. The mast frequent cause of death was multiple injur ies. Among survivors, soft tissue injuries, fractures, sprains, strain s, and head injuries were most common: these injuries were most often caused by flying glass and other debris and collapsed ceilings. Conclu sions.-The Oklahoma City bombing resulted in the largest number of fat alities of any terrorist act in the United Stales, and there were 4 ti mes as many nonfatal injuries as fatalities, Disaster management plans should include the possibility of terrorist bombing, and medical prep aredness should anticipate that most injuries will be nonfatal, The ro le of building collapse in fatal injuries and the role of glass and ot her flying debris in minor to moderate injuries should be considered i n the design of buildings at high risk of being bombed so as to reduce injuries.