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August 7, 1996

Physical Injuries and Fatalities Resulting From the Oklahoma City Bombing

JAMA. 1996;276(5):382-387. doi:10.1001/jama.1996.03540050042021

Objective.  —To provide an epidemiologic description of physical injuries and fatalities resulting from the April 19, 1995, bombing of the Alfred P. Murrah Federal Building in Oklahoma City.

Design and Setting.  —Descriptive epidemiologic study of all persons injured by the bombing and of all at-risk occupants of the federal building and 4 adjacent buildings. Data were gathered from hospital emergency and medical records departments, medical examiner records, and surveys of area physicians, building occupants, and survivors.

Study Population.  —All persons known to have been exposed to the blast.

Main Outcome Measures.  —Characteristics of fatalities and injuries, injury maps, and injury rates by building location.

Results.  —A total of 759 persons sustained injuries, 167 persons died, 83 survivors were hospitalized, and 509 persons were treated as outpatients. Of the 361 persons who were in the federal building, 319 (88%) were injured, of whom 163 (45%) died, including 19 children. Persons in the collapsed part of the federal building were significantly more likely to die (153/175,87%) than those in other parts of the building (10/186,5%) (risk ratio [RR], 16.3; 95% confidence interval [CI], 8.9-29.8). In 4 adjacent buildings, injury rates varied from 38% to 100%; 3 persons in these buildings and 1 person in an outdoor location died. The most frequent cause of death was multiple injuries. Among survivors, soft tissue injuries, fractures, sprains, strains, and head injuries were most common; these injuries were most often caused by flying glass and other debris and collapsed ceilings.

Conclusions.  —The Oklahoma City bombing resulted in the largest number of fatalities of any terrorist act in the United States, and there were 4 times as many nonfatal injuries as fatalities. Disaster management plans should include the possibility of terrorist bombing, and medical preparedness should anticipate that most injuries will be nonfatal. The role of building collapse in fatal injuries and the role of glass and other flying debris in minor to moderate injuries should be considered in the design of buildings at high risk of being bombed so as to reduce injuries.