Emergency department impact of the Oklahoma city terrorist bombing

Study objective: To collect descriptive epidemiologic injury data on patien ts who suffered acute injuries after the April 19, 1995, Oklahoma City bomb ing and to describe the effect on metropolitan emergency departments. Methods: A retrospective review of the medical records of victims seen for injury or illness related to the bombing at 1 of the 13 study hospitals fro m 9:02 AM to midnight April 19, 1995. Rescue workers and nontransported fat alities were excluded. Results: Three hundred eighty-eight patients met inclusion criteria; 72 (18 .6%) were admitted, 312 (80.4%) were treated and released, 3 (.7%) were dea d on arrival, and 1 had undocumented disposition. Patients requiring admiss ion took longer to arrive to EDs than patients treated and released (P=.006 5). The EDs geographically closest to the blast site (1.5 radial miles) rec eived significantly more victims than more distant EDs (P<.0001). Among the 90 patients with documented prehospital care, the most common intervention s were spinal immobilization (964/90, 71.1%), field dressings (40/90, 44.4% ), and intravenous fluids (32/90, 35.5%). No patients requiring prehospital CPR survived. Patients transported by EMS had higher admission rates than those arriving by any other mode (P<.0001). The most common procedures perf ormed were wound care and intravenous infusion lines. The most common diagn oses were lacerations/contusion, fractures, strains, head injury, abrasions , and soft tissue foreign bodies. Tetanus toroid, antibiotics, and analgesi cs were the most common pharmaceutical agents used. Plain radiology, comput ed tomographic radiology, and the hospital laboratory were the most signifi cantly utilized ancillary services. Conclusion: EMS providers tended to transport the more seriously injured pa tients, who tended to arrive in a second wave at EDs. The closest hospitals received the greatest number of victims by all transport methods. The effe cts on pharmaceutical use and ancillary service were consistent with the ca re of penetrating and blunt trauma. The diagnoses in the ED support previou s reports of the complex but often nonlethal nature of bombing injuries.