Original Research |
Author Affiliations: Dr Roy is with the Jamsetji Tata Centre for Disaster Management, Tata Institute of Social Sciences, Mumbai; Dr Kapil is with the National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention; Dr Subbarao is with the Public Health Readiness Office, American Medical Association; and Prof Ashkenazi is with the Urban Terrorism Preparedness Project, National Preparedness Leadership Initiative, Harvard University.
Objectives: The November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists.
Methods: A retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants.
Results: Among the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries).
Conclusions: The use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar "Mumbai-style" attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.
Key Words: Mumbai • terrorist attack • India • surgical services • resilience • bystanders • delivery of health care • disaster response • emergency service, hospital • india • mass casualty incidents • mortality • resilience, psychological • surgery department, hospital • terrorism • world health
