Injury patterns in clashes between citizens and security forces during forced evacuation

Introduction: Clashes between state security forces and civilian populations can lead to mass casualty incidents (MCI), challenging emergency medical service (EMS) systems, hospitals and medical management systems. In January 2006, clashes erupted between Israeli security forces and settlers, around the forced evacuation of the Amona outpost. Methods: Data collected during the events and in subsequent formal debriefings were processed to identify the specifics of an MCI caused by forced evacuation. Pre-event preparedness, time and types of injuries encountered were evaluated among evacuated civilians and security forces members, their transport to hospitals, care received and follow-up. The event is described according to DISAST-CIR methodology. Data were entered on MS Excel (2003) and analysis was carried out using SPSS version 12. Results: 4000 police personnel (backed by army forces) clashed for 12 h with approximately 5000 settlers. 229 injured (174 settlers and 55 security personnel) were cared for at six receiving hospitals. A total of 16 were evacuated by aeromedical evacuation, including one severely head-injured policeman. Settlers used sticks, stones and cement blocks, whereas police used mounted riders, batons and shields. Head injuries were the most common injuries among settlers (50%), whereas extremity injuries dominated among security forces members (72.7%). Conclusion: Large-scale clashes between state security forces and citizens may cause numerous injuries, even if firearms and explosives are not used. Despite the fact that almost all injuries were mild, the incident burdened local medical teams, EMS and Jerusalem hospitals. A predominance of head injuries was found among injured settlers and extremity injuries among injured security forces.