Clinical patterns and hospital response following a point-source explosive mass casualty incident in Beirut, September 2024: a retrospective observational study

Abstract

Background: On 17 September 2024, a mass casualty incident occurred in Beirut following the simultaneous detonation of multiple pager devices, resulting in a distinctive pattern of blast-related injuries. Such point-source explosions pose unique clinical and operational challenges that are not fully captured by conventional mass casualty frameworks.

Methods: This retrospective observational study analysed patients presenting to the Emergency Department of Mount Lebanon Hospital University Medical Centre immediately following the incident. All patients were included for descriptive analysis of patient flow. Detailed clinical, surgical, and outcome data were collected for patients requiring hospital admission within 48 hours. Demographic characteristics, injury patterns, operative interventions, intensive care unit (ICU) admission, and in-hospital outcomes were extracted from electronic medical records. Data were summarised using descriptive statistics.

Results: A total of 184 adult male patients presented to the Emergency Department. Of these, 135 (73.4%) did not require hospital admission and were either transferred to other facilities, discharged after emergency management, or left without being seen. Forty-nine patients (26.6%) required admission, including 11 (22.4%) admitted to the ICU. Injuries predominantly involved the hands (83.7%) and eyes (59.1%), followed by thigh, abdominal, and intracranial injuries. More than half of admitted patients required finger or hand amputation, and one-fifth underwent eye enucleation. Multiple concurrent injuries were common, with over half of patients sustaining trauma to three or more anatomical regions. One in-hospital death occurred (2.0%).

Conclusions: Point-source explosive devices can generate highly concentrated patterns of severe extremity and ocular trauma, placing disproportionate strain on subspecialty services. These findings highlight limitations of standard triage systems and identify the need for adaptable mass casualty planning, subspecialty surge capacity, and integrated psychosocial support in disaster response.