Spontaneous hospitalization in the immediate aftermath of the manchester arena bombing

Abstract

The distribution of the patients among available hospitals is pivotal to effectively manage a terrorist attack. Unfortunately, by the time of the arrival of the first relief unit, victims self‐present to the hospital outside any distribution plan (spontaneous hospitalization). This paper presents an evidence‐based investigation of victims' spontaneous hospitalization and distribution of patients in the immediate aftermath of the Manchester Arena Bombing with a focus on patients who self‐presented at the local hospitals by nonambulance vehicles. Despite the quick arrival of the relief units, 85 patients (61%) made their own way to the hospitals, self‐presenting at an emergency department outside the dispersal framework. Results of this paper show that, differently from the literature, survivors not always decided to go to the closest hospital but, for people living close to the event (less than 15 miles) the decision is to go toward the most familiar hospital close to their home rather than the event. This paper can be used to improve response plans after terrorist attacks that consider victims' behavior and the phenomena of “reverse triage” and “wave of casualties”; without such consideration, in fact, a planned distribution and the consequently management plan effectiveness and efficacy are lower.

Full text

Received: 29 April 2022
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Revised: 24 March 2023
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Accepted: 25 March 2023
DOI: 10.1111/1468-5973.12465
ORIGINAL ARTICLE
Spontaneous hospitalization in the immediate aftermath
of the manchester arena bombing
Andrea Bartolucci
1
|Michele Magni
2
1
Institute of Security and Global Affairs
(ISGA), Leiden University, The Hague,
Netherlands
2
Università Politecnica delle Marche,
Ancona, Italy
Correspondence
Andrea Bartolucci, Institute of Security
and Global Affairs (ISGA), Leiden University,
The Hague, Netherlands.
Email: a.bartolucci@fgga.leidenuniv.nl
Funding information
None
Abstract
The distribution of the patients among available hospitals is pivotal to effectively
manage a terrorist attack. Unfortunately, by the time of the arrival of the first relief
unit, victims self‐present to the hospital outside any distribution plan (spontaneous
hospitalization). This paper presents an evidence‐based investigation of victims'
spontaneous hospitalization and distribution of patients in the immediate aftermath
of the Manchester Arena Bombing with a focus on patients who self‐presented at
the local hospitals by nonambulance vehicles. Despite the quick arrival of the relief
units, 85 patients (61%) made their own way to the hospitals, self‐presenting at an
emergency department outside the dispersal framework. Results of this paper show
that, differently from the literature, survivors not always decided to go to the closest
hospital but, for people living close to the event (less than 15 miles) the decision is to
go toward the most familiar hospital close to their home rather than the event. This
paper can be used to improve response plans after terrorist attacks that consider
victims' behavior and the phenomena of “reverse triage”and “wave of casualties”;
without such consideration, in fact, a planned distribution and the consequently
management plan effectiveness and efficacy are lower.
KEYWORDS
emergency response, Manchester Arena Bombing, patient distribution, spontaneous
hospitalization, terrorist attack
1|INTRODUCTION
As highlighted by Phillips (2009), the main objective of terrorist
attacks is to obtain a political (or other) objective through violent
intimidation; terrorism not only puts people in state of chronic fear
(Schmid, 1988) but also produces injuries and casualties as the
terrorists attempt to maximize the consequences on the population
generated by their attacks.
When a terrorist attack happens, it suddenly impact on the
capacity of the local health system that struggles to cope with the
needs of the affected people; such event, in fact, frequently
generates a multiple‐casualty station and a massive influx of severely
injured people presenting similar clinical and surgical needs
(Stein & Hirshberg, 1999); as reported by Hirsch et al. (2015), after
the Paris terrorist attack in 2015, 302 interventions were performed,
with multiple emergencies requiring immediate surgery (numbers do
not include psychological trauma and delayed admissions). The arrival
of such a big number of patients often overwhelms the emergency
response systems and alters the normal routine (Peleg et al., 2003);
these scenarios, in fact, are characterized by the lack of medical
resources, especially in terms of dedicated personnel and medical
supplies, such as blood banks (Edwards et al., 2016; Repoussis
et al., 2016).
The management and the distribution of the patients among all
the available hospitals can alleviate this burden and achieve better
medical care for victims (Stein & Hirshberg, 1999); therefore, the
coordination of ambulances dispatch is pivotal to provide first aid to
low priority injured people and to bring seriously injured people to
J. Contingencies Crisis Manag. 2023;31:627–634. wileyonlinelibrary.com/journal/jccm © 2023 John Wiley & Sons Ltd.
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