Lessons learned from terror attacks: thematic priorities and development since 2001—results from a systematic review

Schorscher, Nora; Kippnich, Maximilian; Meybohm, Patrick; Wurmb, Thomas

doi:10.1007/s00068-021-01858-y

Cited by 14 publications

(5 citation statements)

References 79 publications

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“…As it turned out, the perpetrator was acting on his own, but uncertainty and social media rumors about multiple shooters justified TEMS involvement in the Field's mass shooting. In Europe, several tactical concepts have been developed in the post 9/11 era, including France [ 46 ], Spain [ 47 ] and in Germany [ 31 , 48 ]. Similar to MI in general, TEMS is challenged with very low frequency, reflecting the need for micro and full-scale training with joint authorities.…”

Section: Discussionmentioning

confidence: 99%

The Field’s mass shooting: emergency medical services response

Hansen,

Mikkelsen,

Alstrøm

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Major incidents (MI) happen infrequently in Scandinavia and mass shootings are even less frequently occurring. Case reports and research are called for, as literature is scarce. On 3rd July 2022, a mass shooting took place at the shopping mall Field’s in Copenhagen, Denmark. Three people were killed and seven injured by a gunman, firing a rifle inside the mall. A further 21 people suffered minor injuries during the evacuation of the mall. In this case report, we describe the emergency medical services (EMS) incident response and evaluate the EMS´ adherence to the MI management guidelines to identify possible areas of improvement. Case presentation Forty-eight EMS units including five Tactical Emergency Medical Service teams were dispatched to the incident. Four critically injured patients were taken to two trauma hospitals. The deceased patients were declared dead at the scene and remained there for the sake of the investigation. A total of 24 patients with less severe and minor injuries were treated at four different hospitals in connection with the attack. The ambulance resources were inherently limited in the initial phase of the MI, mandating improvisation in medical incident command. Though challenged, Command and Control, Safety, Communication, Assessment, Triage, Treatment, Transport (CSCATTT) principles were followed. Conclusions The EMS response generally adhered to national guidelines for MI. The activation of EMS and the hospital preparedness program was relevant. Important findings were communication shortcomings; inherent lack of readily available ambulance resources in the initial critical phase; uncertainty regarding the number of perpetrators; uncertainty regarding number of casualties and social media rumors that unnecessarily hampered and prolonged the response. The incident command had to use non-standard measures to mitigate potential challenges.

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Section: Discussionmentioning

confidence: 99%

The Field’s mass shooting: emergency medical services response

Hansen,

Mikkelsen,

Alstrøm

et al. 2023

Scand J Trauma Resusc Emerg Med

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“…Challenges with the digital emergency network was experienced both during the Turøy helicopter accident and extreme weather Tor in 2016 [ 41 , 42 ]. The importance of communication and functioning communication tools in MI is well established [ 43 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of prehospital preparedness for major incidents on a national level, with focus on mass casualty incidents

Ugelvik,

Thomassen,

Braut

et al. 2023

Eur J Trauma Emerg Surg

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Purpose To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. Method A national cross-sectional descriptive study of Norway’s prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation. Results Totally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation. Conclusion The study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level.

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“…Similarly, hemorrhage is the most common preventable cause of death in civil emergency medicine, however treatment usually does not involve hemostatic agents 3 . Although blunt trauma and thus non‐compressible torso hemorrhage dominate in many developed countries, the high risk of terrorist bomb attacks still exist, which result in casualties akin to military conflicts, and underline the importance of catastrophic external hemorrhage control 4 . In contrast to the military environment, where casualties are predominantly young and healthy without any underlying disease, studies find there is an increased number of individuals in the general population taking anticoagulants for various reasons.…”

Section: Introductionmentioning

confidence: 99%

Hemostatics in patients with inhibited coagulation—A viscoelastic in‐vitro analysis

et al. 2023

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Background The military has used topical hemostatic agents to successfully treat life‐threatening external bleeding for years. In contrast to the military environment, the general population are increasingly prescribed anticoagulants. There are only few comparative evaluations of topical hemostatic agents with anticoagulated human blood. It is important to understand the impact of these agents on those who take anticoagulants. Study design and Methods Citrated blood of patients treated with enoxaparin, heparin, and acetylsalicylic acid, apixaban or phenprocoumon was incubated with different hemostatic agents (QuikClot Gauze, Celox Granules, Celox Gauze, Chito SAM 100, WoundClot Trauma Gauze, QuikClot Gauze Moulage Trainer and Kerlix) and rotational thromboelastometry was performed with non‐activated thromboelastometry (NATEM reagent). Results All tested agents improved the onset of coagulation in all anticoagulants, mostly to a significant degree. Most significant improvements were produced by QuikClot Gauze and QuikClot Gauze Moulage Trainer, followed by the tested chitosans (Celox Granules, Celox Gauze, Chito SAM 100). Of the anticoagulant groups, the most significant improvements were seen in enoxaparin. This was followed in order by apixaban, heparin, and acetylsalicylic acid, and phenprocoumon. Discussion All the hemostatic agents tested were able to activate the clotting cascade earlier and initiate faster clot formation in anticoagulated blood. A definitive head‐to‐head comparison is not feasible, because of the limitations of an in‐vitro analysis. However, the sometimes‐presented hypothesis that kaolin‐based hemostatic agents are ineffective in anticoagulated blood is inaccurate according to our data. Hemostasis with hemostatic agents appears most challenging with phenprocoumon.

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Lessons learned from terror attacks: thematic priorities and development since 2001—results from a systematic review

Cited by 14 publications

References 79 publications

The Field’s mass shooting: emergency medical services response

The Field’s mass shooting: emergency medical services response

Evaluation of prehospital preparedness for major incidents on a national level, with focus on mass casualty incidents

Hemostatics in patients with inhibited coagulation—A viscoelastic in‐vitro analysis

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