EMERGENCY MEDICAL RESPONSE TO TERRORISM

8/14/2019 EMERGENCY MEDICAL RESPONSE TO TERRORISM

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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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EMERGENCY MEDICAL RESPONSE TO TERRORISM

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