Emergency Medicine Response to Terrorism

prepared By Dr. Hiwa omer ahmed Assistant Professor in General Surgery

Emergency Medicine Response to Terrorism

Jim Holliman, MD FACEP Pennsylvania State University Hershey, Pennsylvania, USA

Introduction:
Unfortunately, in recent years there has been an increase in major terrorist incidents. It is important for all emergency health care personnel to be familiar with appropriate medical response to terrorist incidents, and emergency health care facilities should have well-rehearsed plans in place to deal with terrorist incidents.

U.S. Federal Bureau of Investigation (FBI) defines the terrorism as: “The use of violence or the threat of violence in furtherance of a political or social agenda. Terrorism represents a purposeful attack on basically innocent or non-involved victims”.

Types of terrorist events include the following: • Use of conventional bombs or explosives (the most common). • Multiple gunshots or sniping. • Hostage taking. • Use of chemical weapons. • Use of biological weapons. • Use of nuclear weapons or radioactive materials (radiologic weapons). • “Cyber terrorism”.

Incidence: The U.S. State Department has reported that in each of the last several years there have been over 300 major international terrorist incidents annually. The risk also of use of chemical and/or biological weapons by terrorists has been demonstrated recently several times.

With the collapse of the Soviet Union in the early 1990’s and the subsequent severe economic problems there, it has been feared that many of the scientists and workers involved with this extensive bioweapons program are now employed by terrorist organizations. For example, the Aum Shinrikyo cult purchased the manufacturing plans for the nerve gas Sarin from one of the Russians previously involved in chemical weapons development.

The relatively low cost of chemical and biological weapons with their potential to inflict huge numbers of casualties in unprotected civilian populations makes these weapons attractive to terrorist organizations.

Another problem that has surfaced in the last decade is the occurrence of hoax events of biologic weapons use. In 1998 alone there were 37 such hoax events involving the threatened release of anthrax. Over 5000 pupil were threatened by these events, and over 1200 ended up been empirically treated. It has recently been recognized that most EMS personnel and most emergency departments are not fully properly trained to deal with major terrorist events involving biological or chemical weapons.

Field and scene considerations:
Two increasingly dangerous trends in terrorist events have emerged in the last several years. These are the use of combined different types of weapons and the deliberate targeting of responding EMS personnel.

The first responding EMS unit should always follow the “two in, two out” rule. The second major principle for responding EMS personnel to follow is called LACES. This involves:

• Lookout. • Awareness. • Communications and Backup system. • Escapes. • Safety zones.

Other rules for the responding EMS personnel to follow include relocating at least 160 meters away from any suspicious appearing package and at least 300 meters away from any suspicious vehicle.

One of the next important response principles for EMS personnel is to isolate the scene from further access by the public. Control of responding public media personnel will also be necessary. If live filming of an event is occurring and the terrorists are watching the live reports, they may obtain information enabling then to commit further harm at the scene.

Next, if possible chemical, radiologic, or biologic contamination is identified on scene decontamination of victims should be established. Again here, an important principle is for the EMS and other scene personnel to maintain proper self protection using appropriate suits and precautions, so that they do not also become victims.

Health care system preparedness for terrorist events:
There has been recent extensive planning of the U.S. Federal government level for improving and coordinating response to major terrorist events i.e.: designation of the lead agency for medical response. One of its major responsibilities has been to develop stockpiles of vaccines for immunization against biological or chemical agents.

Cyber-terrorism:
One aspect of terrorism which has not been discussed much in the medical literature is cyber-terrorism. This constitutes the use of unauthorized entrée into computerized systems to cause •Damage •Render useless •Promulgate incorrect or inaccurate data operations.

The “cyber vulnerability” of our medical facility computer systems to terrorism is relatively new threat for which health care systems should plan.

Lesson Learned from the World Trade Center Disaster

Lesson Learned from the World Trade Center Disaster
Jim Holliman, MD FACEP Pennsylvania State University Hershey,Pennsylvania, USA

The objectives of these manuscript are to review the EMS and emergency medicine responses to the September 11, 2001 World Trade Center disaster and to identify what went wrong and what went right with these responses.

Some general lessons learned from this disaster are that:

- The U.S. public is not safe from acts by major outside terrorist organization. - There is broad international sympathy and support for the victims of this type of disaster. - Domestic volunteer help and cooperation can be huge in response to this kind of an event.

The sequence of events which occur in the WTC disaster where as follows: 08:42 AM – American Airlines Flight 11 hit the North Tower 09:00 AM – United Airlines Flight 175 hit the South Tower 10:05 AM – The South Tower collapsed 10:28 AM – The North Tower collapsed 17:25 PM – WTC Building (47 stories high) collapsed 23:45 PM – The last injured non-rescuer victim of the disaster presented at nearby St. Vincent’s Hospital

Lesson 1: Emergency personnel are brave, but therefore are at risk for death or injury.

Lesson 2: The need for backup communications and command center.

Lesson 3: There is a need for better individual unit communication links

Lesson 4: Telephone systems fail early in a disaster.

Lesson 5: Computer communication may still function despite phone system malfunction.

Lesson 6: Better monitoring and recording of specific personnel responding into a danger zone is needed.

Lesson 7: Special rescue arrangements are needed for the top floor of very high buildings.

Lesson 8: After a large building collapse, most secondary injuries are due to dust and smoke.

Lesson 9: Hospital E.D. preplanning and conducting disaster drills pays off.

Lesson 10: E.D. caseload from disaster has an initial surge, then tapers off.

Lesson 11: Better communication and use of incident command system is needed for field medical units.

Lesson 12: Medical personnel will readily volunteer in a disaster.

Lesson 13: Volunteers should wait to be called in by local authorities.

Lesson 14: Disaster declaration needs to account for volunteers medical licenses.

Lesson 15: Even well designed modern buildings cannot resist fire from jet fuel-laden large aircraft.

Lesson 16: Post incident stress debriefing is important.

• Note: These are abstracts of the lectures reviewed by Hiwa Omer Ahmed, Assistant Professor in general surgery. For presentation in Sundays clinical presentations of American-Iraqi Association of Surgeons in Suleymani Teaching Hospital on 24th August 2003

Master your semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master your semester with Scribd & The New York Times

Cancel anytime.