ArticleEmergency medicine journal : EMJ2026
The pager explosions: lessons learnt from a hybrid-warfare mass casualty incident.
Article in Emergency medicine journal : EMJ, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHospitals responding to mass casualty incidents (MCIs) must rapidly scale up operations to accommodate high casualty counts, with little lead time. On 17 September 2024, 4000 pager devices were detonated across Lebanon, injuring 2323 individuals. This paper reports on a single-centre MCI response to this unprecedented hybrid warfare tactic, describing success features and identifying areas for improvement.
methodsA qualitative analysis of 10 debrief meeting minutes held within 2 weeks of the incident, as part of the standard quality improvement process post-MCI response that included an after-action review conducted in accordance with the 2019 WHO guidelines. Group-based debriefs, facilitated by the emergency department (ED) chairperson, addressed different response elements and engaged relevant stakeholders. Conclusions were derived from the qualitative analysis of the meeting minutes.
resultsOur hospital received 182 casualties, 66% of whom were triaged to urgent-level care (yellow), 21% to delayed-level care (green) and 13% to immediate-level care (red), with 35 requiring emergent surgery within the first 12 hours. The MCI response was activated 34 min postincident, initiating security lockdown protocols, expedited patient registration, MCI triage protocol implementation, opening of surge areas and command centre activation. Key success features included: shifting from ED-based response to a whole-hospital mobilisation to accommodate the influx; early secondary triage of urgent-level (yellow) patients for immediate transfer to inpatient wards, resulting in 22.5% being managed in the inpatient setting; and optimised information system workflows for admission and order entry. Recommended improvements include simplifying operating theatre transfer workflows, shifting to paper-based documentation of assessments/interventions, optimising surgical and diagnostic prioritisation processes and developing minimal diagnostic imaging standards of care.
conclusionThis study highlights key successes and challenges of a hospital response to a large hybrid-warfare MCI. Future research on reliability of key success features, specifically use of ED secondary triage protocols, is needed to support wider adoption. In addition, developing minimal imaging standards in MCIs is needed to reduce bottlenecks in this area.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.