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3 results

  • Chapter 20 - Civil Unrest and Terrorism Involving Mass Gathering Events

  • Edited by William J. Brady, University of Virginia, Mark R. Sochor, University of Virginia, Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida, John C. Maino II, Michigan International Speedway, Brooklyn, K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
  • Book:
    Mass Gathering Medicine
    Published online:
    11 April 2024
    Print publication:
    18 April 2024, pp 284-304

  • Summary

    Civil unrest or terrorism at mass gathering events can erupt with significant violence and multiple casualties. These are high-risk situations, not only because of physical casualties, but also because of ethical, political and psychological sequelae. Beyond specialized planning, multi-agency drills and proficient tactical medicine training, medical teams should co-create secured access and egress, alternative medical responses and rapidly-adapting coordination and secure communications with other agencies. Civil protests can escalate, especially when extremist groups infiltrate them. Multi-site violence and assaults can evolve, particularly in terroristic attacks. Key lessons include unrelenting vigilance until all participants have left the mass gathering scene in its entirety. Violence (bombs, shootings, vehicle attacks) will often erupt when mass gatherings are dispersing and considered over. Terrorists can also purposely target medical personnel or incite one event (fire, bomb, shooting) to create crushing stampedes or to herd crowds into more vulnerable areas where they can be further attacked more directly with other modern weapons. Terrorists often attack from elevated perches or generate “protracted suicide” incidents while holding hostages, including many severely-wounded. The resulting frustration, anger and guilt commonly can consume medical rescuers when beholding slaughtered innocents or simply because they were (appropriately) staged during containment of on-going violence.

  • Gaps in Prehospital Care for Patients Exposed to a Chemical Attack – A Systematic Review

  • Stephane Bourassa, Emmanuelle Paquette-Raynard, Daniel Noebert, Marc Dauphin, Pelumi Samuel Akinola, Jason Marseilles, Philippe Jouvet, Jacinthe Leclerc
  • Journal:
    Prehospital and Disaster Medicine / Volume 37 / Issue 2 / April 2022
    Published online by Cambridge University Press:
    11 March 2022, pp. 230-239
    Print publication:
    April 2022
    • Article
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  • Introduction:

    The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. The aim of this systematic review was to identify the knowledge gaps that relate to an efficient extraction and care of mass casualties caused by exposure to chemicals.

    Methods:

    This systematic review was conducted from November 2018 through September 2020 in compliance with Cochrane guidelines. Five databases were used (MEDLINE, Web of Science Core Collection, Embase, Cochrane, and CINAHL) to retrieve studies describing interventions performed to treat victims of chemical attacks (protection, decontamination, and treatment). The outcomes were patient’s health condition leading to his/her stabilization (primary) and death (secondary) due to interventions applied (medical, protection, and decontamination).

    Results:

    Of the 2,301 papers found through the search strategy, only four publications met the eligibility criteria. According to these studies, the confirmed chemical poisoning cases in acute settings resulting from the attacks in Matsumoto (1994), Tokyo (1995), and Damascus (2014) accounted for 1,333 casualties including 11 deaths. No study reported comprehensive prehospital clinical data in acute settings. No mention was made of the integration of specialized capabilities in medical interventions such as personal protective equipment (PPE) and decontamination to prevent a secondary exposure. Unfortunately, it was not possible to perform the planned meta-analysis.

    Conclusions:

    This study demonstrated gaps in clinical knowledge application regarding the medical extraction of casualties exposed during a chemical attack. Further research is required to optimize clinical practice integrating mixed capabilities (protection and decontamination) for the patient and medical staff.