Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature

Abstract

As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the ‘scene and survivors’. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of ‘terrorism’, and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required.

Review of On-Scene Management of Mass-Casualty Attacks

“…Regarding the strength of evidence of the management challenges, articles related to direct and indirect threats to safety on scene, [54] and issues concerning blast injuries with implications during assessment, triage, and treatment had higher scientific quality [10,11,78,80,101]. The scientific quality of the articles varied, partly due to the difficulties of studying an issue where circumstances and occurrence cannot be foretold or controlled (effecting study design).…”

“…In a systematic review, Thompson et al further showed that while the scene of a terrorist attack includes direct threats, the published literature suggests that dominant causes of mortality and morbidity in responders after such incidents have been due to indirect environmental hazards [54].…”

Massenanfall von Verletzten – Besonderheiten von „bedrohlichen Lagen“

“…Es werden stationäre, dynamische und multiple Szenarien unterschieden. Eine besondere Bedrohung bedeutet der "Second Hit": Dabei sind Hilfs-und Einsatzkräfte, die nach einem Anschlag an die Einsatzstelle eilen, durch eine zweite oder dritte Attacke bedroht [8].…”

Incidence and prevalence of antibody to hepatitis C virus in FDNY first responders before and after work at the World Trade Center disaster site

“…Terrorist events, such as the World Trade Center (WTC) attacks, present unique challenges to responders who can be exposed to both direct terrorist threats and indirect threats from environmental hazards such as airborne particles, structural collapses, fires, psychological stress and blood‐borne pathogens . A relatively low HCV prevalence among firefighters and EMS performing their usual duties does not preclude the possibility of a spike in blood‐borne infections in relation to work at mass casualty events, based on the particulars of the disaster.…”