Patient care after terrorist attacks. Experiences from the Berlin Christmas market attack (19 December 2016)

Commercial trucks and passenger automobiles are being increasingly used by terrorists in Europe as weapons to attack crowds of pedestrians. The high destructive potential, ease of access, and social impact have made such attacks attractive to terrorists and are difficult to predict and prevent. While the injuries resulting from these attacks are similar to those seen with any vehicle versus pedestrian accident, the number of casualties and the severity of their injuries require that responding teams be well versed in the management of mass casualties. Rescue teams must consider the possibility of terrorist action in any vehicle versus pedestrian event and be able to respond appropriately. In multiple or mass casualty events, triage, and distribution of severely injured patients to the nearest appropriate facility is critical to optimize resources and outcomes. Rapid and reliable information is absolutely essential to guide resource-based treatment of individual patients, and the application of damage control surgical principles is vital to achieving best possible outcomes in the initial hospital care of severely injured victims of such attacks. This article discusses the treatment of a casualty from the December 2016 Berlin Christmas market attack to highlight the application of these important principles.