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A Four-Step Approach for Establishment of a National Medical Response to Mega-Terrorism

Part of: Prehospital and Disaster Medicine Counterterrorism Collection

Published online by Cambridge University Press:  28 June 2012

Adi Leiba ,
Amir Blumenfeld ,
Ariel Hourvitz ,
Gali Weiss ,
Michal Peres ,
Dagan Schwartz ,
Avishay Goldberg ,
Yehezkel Levi  and
Yaron Bar-Dayan
Adi Leiba
Affiliation:
Home Front Command Medical Department, Israel
Amir Blumenfeld
Affiliation:
Israeli Medical Corps, Surgeon General Headquarters, Trauma Branch, Israel
Ariel Hourvitz
Affiliation:
Home Front Command Medical Department, Israel
Gali Weiss
Affiliation:
Home Front Command Medical Department, Israel
Michal Peres
Affiliation:
Home Front Command Medical Department, Israel
Dagan Schwartz
Affiliation:
Israeli Emergency Medical Service (Israeli Shield of David), Israel
Avishay Goldberg
Affiliation:
Faculty of Health Sciences, Department of Emergency Medicine, Ben Gurion University, Beer-Sheva, Israel
Yehezkel Levi
Affiliation:
Israeli Medical Corps, Surgeon General Headquarters, Trauma Branch, Israel
Yaron Bar-Dayan*
Affiliation:
Home Front Command Medical Department, Israel
*
Col. Dr. Y. Bar-Dayan MD, MHA Chief Medical Officer, IDF Home Front Command, 16 Dolev St. Neve Savion, Or-Yeshiva, Israel E-mail: [email protected]
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Abstract

A simplified, four-step approach was used to establish a medical management and response plan to mega-terrorism in Israel. The basic steps of this approach are: (1) analysis of a scenario based on past incidents; (2) description of relevant capabilities of the medical system; (3) analysis of gaps between the scenario and the expected response; and (4) development of anoperational framework.

Analyses of both the scenario and medical abilities led to the recommendation of an evidence-based contingency plan for mega-terrorism. An important lesson learned from the analyses is that a shortage in medical first responders would require the administration of advanced life support (ALS) by paramedics at the scene, along with simultaneous, rapid evacuation of urgent casualties to nearby hospitals by medics practicing basic life support (BLS). Ambulances and helicopters should triage casualties from inner to outer circle hospitals secondarily, preferentially Level-1 trauma centers.

In conclusion, this fourstep approach based on scenario analysis, mapping of medical capabilities, detection of bottlenecks, and establishment of a unique operational framework, can help other medical systems develop a response plan to megaterrorist attacks.

Keywords

evacuationmass-casualty incidentmega-terrorismterrorism
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 21 , Issue 6 , December 2006 , pp. 436 - 440
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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References

1.Leiba, A, Blumenfeld, A, Hourvitz, A et al: Lessons learned from crossborder medical response to terrorist bombings in Tabba and ReselSatan, Egypt, on 07 October 2004. Prehosp Disaster Med 2005;20(4):253–257.CrossRefGoogle ScholarPubMed
2.Leiba, A, Halperin, A, Bar-Dayan, Y: The case study of the terrorist bombing of in Tel-Aviv market: Putting all the golden eggs in one basket might save lives. International Journal of Disaster Medicine 2(4):157–160.CrossRefGoogle Scholar
3.Leiba, A, Halpern, P, Priel, IE et al: A terrorist suicide bombing at the nightclub in TelAviv: Analyzing medical response to a nighttime, weekend, multicasualty incident scenario. J Emerg Nurs 2006;32(4)294–298.CrossRefGoogle Scholar
4.Holden, PJ: The London attacks—A chronicle: Improvising in an emergency. N Engl J Med 2005;353(6):541–543.CrossRefGoogle ScholarPubMed
5.Peral Gutierrez de Ceballos, J, Turégano Fuentes, F, Perez Diaz, D et al: Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings. Crit Care Med 2005;33 (1 Suppl):s107–s112.CrossRefGoogle Scholar
6.Bar Dayan, Y, Leiba, A, Blumenfeld, A et al: National medical response to megaattacks by terrorists. Prehosp Disast Med 2005;20(2):s43–s44 (Abstract).CrossRefGoogle Scholar
7.DePalma, RG, Burris, DG, Champion, HR, Hodgson, MJ: Blast Injuries. N Engl J Med 2005;352(13):1335–1342.CrossRefGoogle ScholarPubMed
8.Katz, E, Ofek, B, Adler, J et al: Primary blast injury after a bomb explosion in a civilian bus. Ann Surg 1989;209(4):484–488.CrossRefGoogle Scholar
9.Einav, S, Feigenberg, Z, Weissman, C et al: Evacuation priorities in mass casualty terrorrelated events: Implications for contingency planning. Ann Surg 2004; 239(3):304–310.Google Scholar
10.Klausner, JM, Rozin, RR: The evacuation hospitals in civilian disasters. Isr J Med Sci 1986;22:365–369.Google ScholarPubMed
11.Okumura, T, Suzuki, K, Fukuda, A et al: The Tokyo subway sarin attack: Disaster management, Part 2: Hospital response. Acad Emerg Med 1998;5(6):618–624.CrossRefGoogle ScholarPubMed
12.Leiba, A, Goldberg, A, , Hourvitz et al: Lessons from clinical anthrax drills: Evaluation of knowledge and preparedness for a bioterrorist threat in Israeli emergency departments. Ann Emerg Med 2006;48(2):194–199.CrossRefGoogle ScholarPubMed
13.Arnold, JL, Halperin, P, Tsai, MC, Smithline, H: Mass casualty terrorist bombings: A comparison of outcomes by bombing type. Ann Emerg Med 2004;43(2):263–273.CrossRefGoogle ScholarPubMed
14.Centers for Disease Control and Prevention: Deaths in World Trade Center terrorist attacks—New York City. 2001. MMWR 2002;51(16):8–16.Google Scholar
15.Lioy, PJ, Weisel, CP, Millette, JR et al: Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) i n lower Manhattan after the collapse of the WTC 11 September 2001. Environ Health Perspect 2002;110(7):703–714.CrossRefGoogle Scholar
16.Durodie, B, Wessely, S: Resilience or panic? The public and terrorist attack. Lancet 2002;360(9349):1901–1902.CrossRefGoogle ScholarPubMed