Post on 31-May-2018
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Emergency
Medicine
Response to
Terrorism
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Terrorism
prepared
By Dr. Hiwa omer ahmedAssistant Professor in General
Surgery
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Emergency Medicine Response to
Terrorism
Jim Holliman, MD FACEP
Pennsylvania State University
Hershey, Pennsylvania, USA
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Introduction:
Unfortunately, in recent years therehas been an increase in majorterrorist incidents. It is important
for all emergency health carepersonnel to be familiar withappropriate medical response toterrorist incidents, and emergency
health care facilities should havewell-rehearsed plans in place todeal with terrorist incidents.
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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 purposefulattack on basically innocent or
non-involved victims.
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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.
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Incidence:
The U.S. State Department has
reported that in each of the lastseveral years there have been
over 300 major internationalterrorist incidents annually.
The risk also of use of chemical
and/or biological weapons by
terrorists has been demonstrated
recently several times.
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With the collapse of the Soviet Union in the
early 1990s and the subsequent severe
economic problems there, it has beenfeared that many of the scientists and
workers involved with this extensive
bioweapons program are now employed byterrorist organizations. For example, the
Aum Shinrikyo cult purchased the
manufacturing plans for the nerve gasSarin from one of the Russians previously
involved in chemical weapons
development.
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The relatively low cost of
chemical and biologicalweapons with their potential to
inflict huge numbers ofcasualties in unprotected
civilian populations makesthese weapons attractive to
terrorist organizations.
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Another problem that has surfaced in
the last decade is the occurrence of hoax
events of biologic weapons use. In 1998alone 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.
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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 thedeliberate targeting of responding
EMS personnel.
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The first responding EMS unitshould always follow the two
in, two out rule. The secondmajor principle for responding
EMS personnel to follow is
called LACES. This involves:
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Lookout. Awareness.
Communications and Backupsystem.
Escapes. Safety zones.
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Other rules for the respondingEMS personnel to follow include
relocating at least 160 meters
away from any suspicious
appearing package and at least
300 meters away from anysuspicious vehicle.
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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 benecessary. If live filming of an event
is occurring and the terrorists are
watching the live reports, they mayobtain information enabling then to
commit further harm at the scene.
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Next, if possible chemical,
radiologic, or biologic contamination
is identified on scenedecontamination of victims should
be established. Again here, an
important principle is for the EMS
and other scene personnel to
maintain proper self protection usingappropriate suits and precautions,
so that they do not also become
victims.
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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 responsibilitieshas been to develop stockpiles of
vaccines for immunization against
biological or chemical agents.
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Cyber-terrorism:
One aspect of terrorism whichhas not been discussed much in the
medical literature is cyber-terrorism. This
constitutes the use of unauthorized entreinto computerized systems to causeDamage
Render uselessPromulgate incorrect or inaccurate data
operations.
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The cyber vulnerability of our
medical facility computer systems
to terrorism is relatively new
threat for which health care
systems should plan.
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Lesson Learned from
the World Trade
Center Disaster
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Lesson Learned from the World Trade
Center Disaster
Jim Holliman, MD FACEP
Pennsylvania State University
Hershey,Pennsylvania, USA
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The objectives of these manuscriptare 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 withthese responses.
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Some general lessons learned from thisdisaster are that:
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- The U.S. public is not safe from
acts by major outside terroristorganization.
- There is broad international
sympathy and support for the victims
of this type of disaster.
- Domestic volunteer help andcooperation can be huge in response
to this kind of an event.
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The sequence of events which occur in the
WTC disaster where as follows:
08:42 AM American Airlines Flight 11 hit theNorth 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)
collapsed23:45 PM The last injured non-rescuer victim
of the disaster presented at nearby St.
Vincents Hospital
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Lesson 1:
Emergency
personnel are brave,but therefore are at
risk for death orinjury.
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Lesson 2:The need for backup
communicationsand command
center.
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Lesson 3:
There is a need for
better individualunit
communication
links
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Lesson 4:Telephone
systems fail earlyin a disaster.
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Lesson 5:
Computer
communication maystill function despite
phone system
malfunction
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Lesson 6:
Better monitoring and
recording of specificpersonnel responding
into a danger zone isneeded.
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Lesson 7:
Special rescue
arrangements areneeded for the top
floor of very highbuildings.
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Lesson 8:
After a large building
collapse, mostsecondary injuries
are due to dust and
smoke
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Lesson 9:Hospital E.D.
preplanning and
conducting disasterdrills pays off.
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Lesson 10:E.D. caseload from
disaster has an
initial surge, thentapers off.
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Lesson 11:
Better communicationand use of incident
command system is
needed for fieldmedical units.
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Lesson 12:
Medical personnelwill readily volunteer
in a disaster.
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Lesson 13:Volunteers should
wait to be called in
by local authorities.
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Lesson 14:Disaster declaration
needs to account forvolunteers medical
licenses.
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Lesson 15:
Even well designed
modern buildingscannot resist fire
from jet fuel-laden
large aircraft
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Lesson 16:Post incident stress
debriefing is
important.
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Note: These are abstracts of the lectures
reviewed by Hiwa Omer Ahmed,
Assistant Professor in general surgery.
For presentation in Sundays clinicalpresentations of American-Iraqi
Association of Surgeons in Suleymani
Teaching Hospital on 24th August 2003
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