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The shipboard Beirut terrorist bombing experience: a historical account and recommendations for preparedness in events of mass neurological injuries

Zachary S. Hubbard, Fraser Henderson Jr., Rocco A. Armonda, Alejandro M. Spiotta, Robert Rosenbaum, and Fraser Henderson Sr.

On a Sunday morning at 06:22 on October 23, 1983, in Beirut, Lebanon, a semitrailer filled with TNT sped through the guarded barrier into the ground floor of the Civilian Aviation Authority and exploded, killing and wounding US Marines from the 1st Battalion 8th Regiment (2nd Division), as well as the battalion surgeon and deployed corpsmen. The truck bomb explosion, estimated to be the equivalent of 21,000 lbs of TNT, and regarded as the largest nonnuclear explosion since World War II, caused what was then the most lethal single-day death toll for the US Marine Corps since the Battle of Iwo Jima in World War II. Considerable neurological injury resulted from the bombing. Of the 112 survivors, 37 had head injuries, 2 had spinal cord injuries, and 9 had peripheral nerve injuries. Concussion, scalp laceration, and skull fracture were the most common cranial injuries.

Within minutes of the explosion, the Commander Task Force 61/62 Mass Casualty Plan was implemented by personnel aboard the USS Iwo Jima. The wounded were triaged according to standard protocol at the time. Senator Humphreys, chairman of the Preparedness Committee and a corpsman in the Korean War, commented that he had never seen such a well-executed evolution. This was the result of meticulous preparation that included training not only of the medical personnel but also of volunteers from the ship’s company, frequent drilling with other shipboard units, coordination of resources throughout the ship, the presence of a meticulous senior enlisted man who carefully registered each of the wounded, the presence of trained security forces, and a drilled and functioning communication system.

Viewed through the lens of a neurosurgeon, the 1983 bombings and mass casualty event impart important lessons in preparedness. Medical personnel should be trained specifically to handle the kinds of injuries anticipated and should rehearse the mass casualty event on a regular basis using mock-up patients. Neurosurgery staff should participate in training and planning for events alongside other clinicians. Training of nurses, corpsmen, and also nonmedical personnel is essential. In a large-scale evolution, nonmedical personnel may monitor vital signs, work as scribes or stretcher bearers, and run messages. It is incumbent upon medical providers and neurosurgeons in particular to be aware of the potential for mass casualty events and to make necessary preparations.

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Phanor L. Perot Jr.: South Carolina’s father of academic neurosurgery

Fraser Henderson Jr., Fraser Henderson Sr., Zachary Hubbard, David L. Semenoff, Alejandro M. Spiotta, and Sunil J. Patel

Phanor Leonidas Perot Jr., MD, PhD (1928–2011), was a gifted educator and pioneer of academic neurosurgery in South Carolina. As neurosurgical resident and then as a junior faculty member at the Montreal Neurological Institute, he advanced understandings of both epilepsy and spinal cord injury under Wilder Penfield, William Cone, and Theodore Rasmussen. In 1968, he moved to Charleston to lead neurosurgery. From his time spent with master physicians such as Isidor Ravdin and Wilder Penfield, Perot himself became “the ultimate teacher." His research spanned the fields of epilepsy to torticollis to spinal trauma, focusing the most on the basic pathophysiology of spinal cord damage elucidated through somatosensory evoked potentials. His research was distinguished by generous grant funding. By the time he stepped down as chairman in 1997, the division of neurosurgery had become a department and he had served as president of the American Academy of Neurological Surgery and the Society of Neurological Surgeons. Perot taught prolifically at the bedside, and considered the residency program at the Medical University of South Carolina his greatest achievement. Although Dr. Perot never fully retired, he also enjoyed active hobbies of fly-fishing, traveling, and hunting, until his death on February 2, 2011. He influenced many and earned his role in history as the father of academic neurosurgery in South Carolina.