EMS needs planning, preparation to mitigate the effects of terrorist attacks

In June 2016 the National Academy of Medicine released a discussion paper that looked at the challenges of an EMS response to a major terror attack. In the paper, "Health and Medical Response to Active Shooter and Bombing Events," members of the National Academies of Sciences, Engineering, and Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Disasters described potential best practices on how to respond effectively to sudden, dramatic mass casualty events, based on data gleaned from recent attacks in Europe and the U.S.

Most of us are still relatively complacent about what we would do in case of a Boston or Aurora style attack in our community. Indeed, chances are very remote that such attacks will occur.

However, in such cases, the actions of dispatch centers and field personnel may play a critical role in the victims' chances of survival. It is common sense that EMS, fire and law enforcement personnel should jointly prepare and train for a variety of sudden mass casualty events.

Work together, train together
As the National Academy of Medicine discussion paper implies, a variety of political, fiscal and bureaucratic barriers exist to hinder the development of such plans. Both government and private sector agencies charged with public safety and public health must put aside territorial differences and work together to determine who will respond, how teams will operate and where patients should be transported, all in a very short operational period.

Bleeding control is a major priority when managing large numbers of injured patients after an attack. In many situations, direct pressure bandages and tourniquets can rapidly control bleeding, and free up field providers to provide care to other injured victims.

Unfortunately, ambulances and engine companies often do not carry enough trauma supplies to handle more than a few victims simultaneously. Disaster caches or trailers can be helpful, but only if they can be rapidly moved to the scene within minutes of the initial dispatch.

Rural and remote areas
Rural regions face especially difficult challenges in a mass casualty response. Underfunded agencies and scattered resources can hinder an adequate response.

One simple solution is to have policies in place that initiate mutual aid from neighboring agencies automatically at the initial response, rather than waiting precious minutes for the first responding units to arrive. This would include air medical services, volunteer organizations and even agencies that are a fair distance away from the incident, but would be expected to respond in large scale events.

The delay in sending an appropriate response level can result in lives lost. Dispatch protocols should be developed that result in an adequate number of units and personnel being sent to initial reports of a major event, similar to fire service alarm assignments.

This can reduce the human judgment factor during dispatch and improve the chances of getting off on the right foot early in the incident. If it turns out that the incident is smaller than reported, no harm is created in downgrading the response.

Cooperation with receiving facilities
Emergency departments and hospitals will not be immune to the effects of a large scale event. Not only do such facilities have to be able to rapidly scale up their internal disaster response, they must also work in cooperation with each other to spread the multitude of patients around the region.

While field operations may perform the initial sorting and destination decisions, resources such as staff, blood products and equipment may be rapidly depleted, necessitating a rapid region-wide response by other facilities and organizations. Again, interagency agreements, policies and procedures should be in place to facilitate complex decision making processes.

No one wants to think about a major violent event happening in their community. As EMS providers, we have to prepare for the worst, and hope for the best. As the National Academy of Medicine paper points out, continuous planning and preparation will be the major tools used by field providers and agencies alike in mitigating the effects of a terror attack.

Health and Medical Response to Active Shooter and Bombing Events

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