Prehospital and Critical Care Responses to Terrorist Attacks

For retrieval medicine specialists and pre hospital care providers, terrorist attack is one the new threat! Terrorist attack is not an accident: It is a human activity whose purpose is to kill, injure, the maximum casualties to disrupt society, to spread the feeling of fear of panic and insecurity in the population. Terrorism is not blind, it is an organized strategy, much more complex than any natural or technological disaster. To oppose an aggressive strategy a static plan is not enough, you must develop a counter strategy comprehensive and adaptable to multiple scenarios. Effective leadership, combining the expertise of the Police, Rescue and Emergency Care allows a customized solution using the elements prepared in advance. One of the worst threats is the multiple sites multi-modal attack, like in Mumbai or in Paris. To face such a complex situation you may need: - Improvement of pre hospital and in hospital organization for massive casualties. Alert shared by all services, close coordination between Rescue Police and Emergency care, backup on a regional basis, strategic allocation of resources and keeping reserve for the next attack are some of the options that may be extremely helpful. - Improvement of care for injuries related to military weapons: Major penetrating trauma caused by powerful (kamikaze) bombings and assaults riffles. Management of these victims is very different of the care of a multiple trauma patient after a traffic accident. Adaptation of the principles of the military “damage control” to civilian practice is mandatory. From the scene to the operating room and the critical care unit all actions must be coordinated to prevent the death triad: Hypothermia, coagulopathy and acidosis. The action of Health Care Services is not limited to medical care, it is also a first step of resilience: By maintaining the quality and the organization of care despite surprise, violence and aggression you oppose directly the objectives of terrorism.