Prehospital and Critical Care Responses to Terrorist Attacks

Pierre Carli expands on the prehospital and critical care responses to terrorist attacks.

For retrieval medicine specialists and prehospital care providers, terrorist attacks are a new and unique threat. As Pierre impresses on you, terrorist attacks are not accidents. They are a targeted human activity whose purpose is to kill, injure, and inflict the maximum amount of human casualty as possible. They do this with the intention of disrupting society, spreading feelings of fear and panic and inflicting feelings of insecurity in the population. Terrorism is not blind.

Terrorist attacks involve organised strategy that is much more complex than any natural or technological disaster. To oppose an aggressive strategy a static plan is not enough. Pierre highlights the need for a counter strategy, comprehensive and adaptable enough to counteract this and deal with a multitude of scenarios. This begins with effective leadership, combining the expertise of the Police, Rescue and Emergency. Prior preparation will allow the best possible emergency response. Terrorist attacks raise the possibility of multi-site, multimodal attacks.

To face such complex situations requires a coordinated response. Pierre discusses improvements of prehospital and in hospital organisation and protocolisation for massive casualties. Alert shared by all services, close coordination between Rescue Police and Emergency care, backup on a regional basis is crucial. Similarly, strategic allocation of resources and keeping reserve for the next attack are some of the options that may be extremely helpful.

Next, there needs to be consideration toward improvements of care for injuries related to military weapons. Injuries that are common in terrorist scenarios are major penetrating trauma and major haemorrhage. These are the results of powerful bombings and assaults riffles. Management of these victims is very different of the care of a multiple trauma patients after traffic accidents. Pierre also discusses adaptations of the principles of the military “damage control” to civilian practice. 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.

Finally, Pierre talks about resilience. The action of Health Care Services is not limited to medical care, it is also the first step of resilience. By maintaining the quality and the organisation of care despite surprise, violence and aggression you oppose directly the objectives of terrorism.

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