FINAL PROGRAMME

The Medical University of Varna

organizes in cooperation with:

the Israeli Institute of Counter-Terrorism (Herzliya),Hadassah University Hospital (Jerusalem),

Rambam University Hospital (Haifa)and the Embassy of Israel to Bulgaria

International Workshop on Anti-Terrorism(Varna, University Hospital “St. Marina”, 15-20 June 2014)

First

SCIENTIFIC, EDUCATIONAL AND QUALIFICATIONAL PROGRAMME

Preamble:

The Workshop is dedicated to the global threats of terrorism world-wide. Bulgaria suffered a bad experience with the terroristic act in Bourgas airport (26 July 2012), as a result of which we had 6 casualties and over 35 injured.

A working team comprising with specialists from the Embassy of Israel in Bulgaria, lead by H.E. The Ambassador, and professors from Varna Medical University, lead by The Rector, assisted the organization of the measures to overcome the consequences after the terroristic bomb attack, together with the group of professionals from the Ministry of Internal, Ministry of Health and the entire Government team sent to Bourgas immediately after the bloody episode, the first one in the new history of Bulgaria.

This was the time when The Rector of Varna Medical University Prof.Dr. Kr.Ivanov, H.E. The Israeli Ambassador Mr. Shaul Kamisa-Raz and the Honorary Consul of Israel to Bulgaria Prof.Dr. Kr.Metodiev, decided to organize a special forum in Varna with the basic idea to improve the coordination, collaboration and management of anti-terroristic measures before, during and after an eventual terroristic attack in any of its possible variants.

The intention is to discuss with, to educate and qualify Bulgarian colleagues to disseminate after the Workshop the know-how and experience of the Israeli leading specialists in this extremely actual and important discipline: anti-terrorism in any aspects.

Now, almost 2 years after the tragedy in Bourgas, we are ready with the Programme of this Workshop and we are proud to announce that the speaker’s list includes the top-level, internationally recognized, anti-terrorist specialists from Israel: representing the Institute of Counter-Terrorism in Herzliya, the University Hospitals Hadassah in Jerusalem and Rambam in Haifa, as well as the Embassy of Israel to Bulgaria and the Medical University of Varna. Speakers: Boaz Ganor, Eitan Azani, Hany Bahouth, Miklosh Bala, Gila Hyams, Julie Benbenishty, Mica Shamir, Krassimir Metodiev

Programme in details - days/hours:

15 June 2014: arrival, registration, accommodation, get-together

16 June 2014:

9.30-10.00 h: opening ceremony, greeting addresses of VIP guests, introductory short presentations of

The Rector Prof.Dr. Kr.Ivanov and H.E. The Ambassador Shaul Kamisa-Raz;

moderator: Prof.Dr. Kr.Metodiev (Honorary Consul of Israel to Bulgaria) Sessions: 16 June 2014: 10.00-12.30 h: first session: The terrorist phenomenon: Speakers: Boaz Ganor, Eitan Azani (Inst. Counter-Terrorism, Herzliya) a. The Evolution of modern terrorism b. Terrorism definition c. Modern terrorism strategy d. Terrorism and counter terrorism formula 12.30-14.00 h: lunch break 14.00-16.30 h: second session: Terrorist actors: Speakers: Boaz Ganor, Eitan Azani (Inst. Counter-Terrorism, Herzliya) a. The hybrid terrorist organization b. Hezbollah c. Al Qaeda and it's affiliates: i. Al-Qaeda global infrastructure- AQ central; AQIM; AQAP; ISIS; Al Shabab; AQ Affiliates ii. Al-Qaeda – grand strategy - 7 phases strategy iii. Al-Qaeda operational strategy and Modus operandi – general models and case studies 16.30-17.00 h: coffee break

17.00-18.00 h: discussions, wrap up first day (Boaz Ganor and Eitan Azani) 17 June 2014: 9.30-11.00 h: third session: Terrorists modus operandi: Speakers: Boaz Ganor, Eitan Azani (Inst. Counter-Terrorism, Herzliya) a. General Data- terror attacks b. The suicide attacks phenomenon 11.00-11.30 h: coffee break 11.30-13.00 h: c. Non conventional terrorism – CBRN (including Al Qaeda and WMD- Motivation; Religious justification and capabilities) d. Cyber terror- the use of the internet as: an operational platform; virtual training camp; source for intelligence; virtual laboratory for IED's and poison 13.00-14.30 h: lunch break 14.30-17.00 h: fourth session: International processes and terrorism: Speakers: Boaz Ganor, Eitan Azani (Inst. Counter-Terrorism, Herzliya) a. The revolutions in the middle east (The "Arab spring") and its implications on local and global terrorism b. Radical Dawa infrastructure and groups - in the EU - General c. The threat of terrorism to the health systems – the counterfeit medicine case study 17.00-17.30 h: coffee break 17.30-18.30 h: discussions, wrap up second day (Boaz Ganor and Eitan Azani) 18 June 2014: 9.30-11.00 h: fifth session: Medical aspects of Anti-Terrorism – Part I: Speakers: Hany Bahouth, Miklosh Bala, Gila Hyams, Julie Benbenishty, Mica Shamir (University Hospitals: Hadassah-Jerusalem and Rambam-Haifa) a. Opening remarks b. Mass casualty Definition and general guidelines c. Mass casualty - terror related events in Israel and the Israeli Trauma system d. Videos and demonstrations 11.00-11.30 h: coffee break 11.30-13.00 h: e. MCE Pre-hospital Aspect f. Mass casualty trauma life support g. Hospital Triage MCE management

13.00-14.00 h: lunch break 14.00-15.30 h: h. Preparing the ER for a MCE i. Nursing system management of MCE j. Hospital setup during MCE: first 8 hours 15.30-16.00 h: coffee break 16.00-17.30 h: k. Mega- Mass Casualty event l. Lessons learned the Hard Way: War and Terror; Attacks and Debriefing

17.30-18.30 h: discussions, wrap up third day (Hany Bahouth, Miklosh Bala, Gila Hyams, Julie Benbenishty, Mica Shamir) 19 June 2014: 9.30-11.00 h: sixth session: Medical aspects of Anti-Terrorism – Part II: Speakers: Hany Bahouth, Miklosh Bala, Gila Hyams, Julie Benbenishty, Mica Shamir, Krassimir Metodiev (University Hospitals: Hadassah-Jerusalem and Rambam-Haifa; Medical University-Varna) a. Non-conventional Disasters - Chemical, biological, and radiological disaster b. Risk infections and bioterrorism: overview, current situation c. Blast injuries: Evaluation, management and intensive care treatment 11.00-11.30 h: coffee break 11.30-13.00 h: d. Ethical challenges and dilemmas e. Emotional and stress related consequence Patients, staff, adolescence PTSD

13.00-14.00 h: lunch break 14.00-16.00 h: f. Interactive drill g. Debriefing and conclusions e. Training instructions, demonstrations and practical aspects 16.00-16.30 h: coffee break

16.30-18.00 h: discussions, wrap up fourth day, wrap up the entire Workshop (Hany Bahouth, Miklosh Bala, Gila Hyams, Julie Benbenishty, Mica Shamir, Krassimir Metodiev) 18.00-18.30 h: closing ceremony, final conclusive words and distribution of Certificate for attendance and qualification (Rector Prof.Dr. Kr.Ivanov, Ambassador Shaul Kamisa-Raz)

Venue of the Workshop: Main Auditorium “Prof. V.Ivanov”, University Hospital “St. Marina”, Varna Contributions: TBA Contact person, information, feed-back: Prof.Dr. Kr.Metodiev, Honorary Consul of Israel to Bulgaria, 9002 Varna, 55 M.Drinov str., Medical University, Rectorate Building e-mail: kr.metod@yahoo.com and kr.metod@gmail.com Tel/fax: +359-52-634107 and 677114, Mobile: +359-888-712407 and +359-878-694803

Additional information and educational solutions for next qualification workshops on anti-terrorism in Bulgaria: Professional Practice Gaps to be addressed (the reasons for the selected topics) The gap in organizational skills needed from your hospital staff in order to prepare your organization for a mass casualty disaster. This Workshop will provide suggestions of our work lists, and the personnel needed who provide the knowledge and skills for our level 1 trauma center, based on our experience. The utilization of your own resources to meet the needs during mass casualty event- your trauma team, your ER, OR and administration staff in order to close the gap between resources and casualty needs. Developing working relations with municipality, public health, police, fire and the local media in order to better facilitate needs during mass causality incidents in your home town, based on our experience and working relationships and how we have benefitted. We will discuss the basic principles of how to treat blast, crush and penetrating injuries in a mass casualty situation where you might possibly have 20-50 injured in your hospital at the same time. This includes care in ER, OR ICU and Rehabilitation, based on our long term experience handling multiple mass casualty urban incidents. We will discuss the complexities and sensitivities of combining and collaborating with forensic medicine teams as well as security, police and army at the same time you are treating your severe multiple casualties. This includes the added factor of the wounded and the staff from multi-cultural backgrounds, as any urban area contains. How to keep your staff resilient and prevent secondary PTSD or burnout. The participants in this Workshop will share our practice tools which we use the build resilience and compassion in our clinical areas based on our experience and outcomes. What is waiting in the future? This talk will assess the future threats waiting to happen to the entire world.

Non-conventional Disasters. The participant will be able to distinguish what the possible threats are, and be able to assess patients for non conventional injuries. At the end of this Workshop you will participate in an interactive drill, which will incorporate all you have learned in this Workshop, you will be able to practically use the new competencies learned. Upon return from this Workshop, you will then be in an expert position to return to your organization and prepare for the next mass casualty incident. It is not a question of "if" but "when". Learning Objectives 1. Overview of mass casualty events (MCE) - Upon completion of this talk the participant should be able to determine the overall and general epidemiology of all factors relevant in a mass casualty event. 2. MCE peacetime preparation - This talk will elaborate on all resources needed to prepare the participants organization for a mass casualty incident. We will analyze together the gaps in equipment, personnel, and surge capacity in order to return to their hospitals to update. 3. Pre-hospital MCE management - this talk focuses on the clinical aspects of pre-hospital care as well as developing communications with pre-hospital teams in order to achieve optimal patient outcomes. The participants will be able to discuss their own management system and together we will determine strategies. 4. Medical management of MCE - Our aim is to share with you all medical and nursing management strategies that are used in controlling a mass casualty incident- Keep in mind that a MCE happens to the entire organization- it is not just the ER's problem! 5. Non-conventional Disasters - Who knows what is waiting for us in the future? Anticipated radiological, nuclear, chemical and biological scenarios will be described. Best possible treatment plans will be explained. 6. Blast injuries the objective of this talk is for the participant to be able to assess each patient's multi-system injuries and adapt tools for best managing the patient long term care. Actual Case scenarios will be discussed and analyzed 7. Emotional and stress related consequence - We will discuss how to keep our teams resilient, what measures should we take and how to keep our experienced staff at the bedside. We will share with the participants our experiences and lessons learned as well as results from 2 longitudinal research studies investigating medical teams in Israel. 8. Interactive drill - This drill will incorporate all the participant have learned from this workshop. Each one will role play a position during an incident which we will de-brief afterwards. This is the most effective way to asses ones learning experience. Upon completion of this Workshop, participants should be able to perform in any capacity before, during and after a local disaster involving multi-casualties. 2. KEY CLINICAL APPLICATIONS Take home messages that are intended to improve practice and can be easily adopted:

Emotional Consequences to Disaster and mass casualties Create effective working patterns and guidelines CHECK LISTS: Peace time preparation from national to local to hospital to departmental level Future threats References Key Clinical Application #1: Emotional Consequences to Disaster and mass casulties Reference 1: Treating Survivors in the Acute Aftermath of Traumatic Events Excerpted with permission, from a chapter written by Arieh Y. Shalev, M.D., to appear in R. Yehuda (Ed.), Treating Trauma Survivors with PTSD: Bridging the Gap Between Intervention Research and Practice. Washington, DC: American Psychiatric Press Reference 2: Posttrauamtic Stress Disorder among hospital surgical physicians exposed to victims of terror: a prospective controlled questionnaire survey. Weiniger, Shalev, Ofek, Freedman,Weissman, Einav J Clin Psychiatry 2006-67;890-896 Key Clinical Application #2: Create effective working patterns and guidelines CHECK LISTS Peace time preparation from National to local to Hospital to departmental level Reference 1: Evacuating Trauma Victims: To the Nearest or the Appropriate Hospital? Shapira , IMAJ 2006;8:129–130 Reference 2: Hospital Management of a Bio-terror Event Shapira, Shemer, Oren IMAJ 2002; 4:493±494 Reference 3: Patterns of Injury in Hospitalized Terrorist Victims Peleg, Aharonson,-Daniel, Michael, Shapira, and the Israeli Trauma Group – American Journal of Emergency 21, ( 4) 2003 Reference 4 A Multicasualty Event: Out-of-hospital and In-hospital Organizational Aspects Avitzour; Libergal; Assaf; Adler; et al Academic Emergency Medicine; 2004; 11, 10; 1102 Key Clinical Application #3: Future threats Reference 1: Facing the New Threats of Terrorism: Radiologists’ Perspectives Based on Experience in Israel Sosna, Sella, Shaham, Shapira, Rivkind, Bloom, Libson, Radiology 2005; 237:28–36

Reference 2: The Logic of Suicide Terrorism; B.Hoffman Volume 291, No. 5.The Atlantic Monthly, 2003 www.rand.org

Reference 3: Terror Politics and Medicine: The Role of LeadershipSHAPIRA, MOR-YOSEF Studies in Conflict & Terrorism, 27:65–71, 2004

Reference 4: Risk infections and possibilities for biomedical terrorism; Philip Elzer, Krassimir Metodiev, IOS Press, NATO Science Series, 2004