Local Planning for Terror and Disaster E-Book

Leonard A. Cole

• Herausgeber: John Wiley & Sons
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch

Seitenzahl: 567

Veröffentlichungsjahr: 2012

Beschreibung

Local Planning for Terror and Disaster gives voice to experts in key fields involved with local preparedness, assessing the quality of preparedness in each field, and offering directions for improvement. Introductory chapters provide overviews of terror medicine, security and communications, which are indispensable to successful preparedness, while subsequent chapters concentrate on a particular field and how responders from that field communicate and interact with others during and after an event. Thus, a chapter by a physician discusses not only the doctor's role but how that role is, or should be, coordinated with emergency medical technicians and police. Similarly, chapters by law enforcement figures also review police responsibilities and interactions with nurses, EMTs, volunteers and other relevant responders. Developed from topics at recent Symposia on Terror Medicine and Security, Local Planning also encompasses aspects of emergency and disaster medicine, as well as techniques for diagnosis, rescue, coordination and security that are distinctive to a terrorist attack. Each chapter also includes a case study that demonstrates preparedness, or lack thereof, for a real or hypothetical event, including lessons learned, next steps, and areas for improvement in this global era which increasingly calls for preparedness at a local level.

Leseprobe

Contents

Cover

Title Page

Copyright

Contributors

Prologue

Acknowledgments

Part I: Introduction: The Known and the Unknown

Chapter 1: Preparedness, Uncertainty, and Terror Medicine

THE BOMBING OF BUS NUMBER 30

THE KNOWN, THE UNKNOWN, AND THE BLACK SWAN

TERROR MEDICINE

ROADMAP FOR THIS BOOK

Chapter 2: Bioterrorism and the Communication of Uncertainty

THE 2001 ANTHRAX ATTACKS

THE MAIL AS A DISEASE CARRIER

WHO ARE THE RISK COMMUNICATORS?

COMMUNICATING RISK ABOUT BIOTERRORISM

CONCLUSION AND SALIENT OBSERVATIONS

Chapter 3: Responding to Disaster and Terrorism: The Central Role of Communication

LEARNING FROM PAST INCIDENTS

THE MANY FACETS OF EMERGENCY COMMUNICTION: JAPAN 2011

EFFECTIVE COMMUNICATION: PRINCIPLES FROM RESEARCH AND EXPERIENCE

SPECIAL CONSIDERATIONS AND CHALLENGES

CRISIS AND EMERGENCY RISK COMMUNICATION RESOURCES

CONCLUSION

Part II: Healthcare Professionals

Chapter 4: The Role of the Emergency Physician

HURRICANE KATRINA

FUNDAMENTALS OF EMERGENCY TRIAGE BY THE EMERGENCY PHYSICIAN

PREHOSPITAL MEDICAL CARE AND THE EMERGENCY PHYSICIAN

EMERGENCY MEDICAL CARE SPECIFIC TO DISASTER SITUATIONS

EMERGENCY MANAGEMENT KNOWLEDGE, SKILLS, AND RESPONSIBILITIES

TRAINING AND EXERCISE FOR DISASTER PREPAREDNESS

CONCLUSION

Chapter 5: The Role of the Nurse

THE OLYMPIC PARK BOMBING

NURSES AND INTERDISCIPLINARY RESPONSE EFFORTS

NURSING RESPONSE EFFORTS FOLLOWING THE BOMBING

LESSONS LEARNED

OVERVIEW OF THE ROLE OF NURSING DURING DISASTERS

CONCLUSION

Chapter 6: The Role of the Dentist

THE BEIRUT BARRACKS ATTACKS

DENTISTS AS KEY RESPONDERS

DEVELOPING THE DENTAL SCHOOL CURRICULUM

FITTING INTO THE CONSTELLATION OF HEALTHCARE PROFESSIONALS

CONCLUSION

Chapter 7: The Role of the Emergency Medical Technician

THE DC METRO CRASH

OVERVIEW

TRIAGE

COMMUNICATIONS

ROLES AND RESPONSIBILITIES OF EMS WITHIN AN ICS STRUCTURE

RECOVERY FROM THE INCIDENT

CONCLUDING OBSERVATIONS

Chapter 8: The Role of the Mental Health Professional

THE 9/11 ATTACKS

EARLY MENTAL HEALTH RESPONSES

DISASTER MENTAL HEALTH

DISASTER BEHAVIORAL HEALTH INTERVENTIONS

POST-DISASTER STRESSORS AFFECTING PSYCHOSOCIAL OUTCOMES

RANGE OF EARLY DISASTER BEHAVIORAL HEALTH INTERVENTIONS

LESSONS LEARNED: THE NEED FOR EFFECTIVE OUTREACH AND MEDIA CAMPAIGNS

CONCLUSION

Part III: Institutional Management

Chapter 9: The Role of the Manager of Mass Casualty and Disaster Events

THE WEDDING HALL COLLAPSE

BACKGROUND

ADMISSION AREAS, SECONDARY TRIAGE, THE “TRIAGE HOSPITAL”

POTENTIAL PITFALLS DURING MCE MANAGEMENT

PREPARATION

CONCLUSION

Chapter 10: THE ROLE OF PUBLIC HEALTH

THE MADRID TRAIN BOMBINGS

OTHER BOMBINGS AND GLOBAL LESSONS

OVERVIEW OF TERRORISM/DISASTER SCENARIOS AND PUBLIC HEALTH RESPONSE

RELEVANT PUBLIC HEALTH PROFESSIONALS AND PREPAREDNESS

CONCLUSION

Chapter 11: The Role of the Hospital Receiver

EARTHQUAKE, HURRICANE, FLOOD

PREPAREDNESS AND THE FIRST RECEIVER

ACUTE CARE HOSPITAL READINESS

THE HOSPITAL RECEIVER: DEFINITION AND ROLES

THE RECEIVER ROLE OF THE HOSPITAL

MEDICAL STAFF TRAINING

CONCLUSION

Chapter 12: Managing Traumatic Stress

GOIÂNIA, BRAZIL

BEHAVIORAL CONSIDERATIONS IN EMERGENCY MANAGEMENT

THE DISASTER BEHAVIORAL HEALTH SYSTEM

DISASTER BEHAVIORAL HEALTH FUNCTIONS

ADVANCING THE FIELD OF DISASTER BEHAVIORAL HEALTH

CONCLUSION

Part IV: Support and Security

Chapter 13: The Role of the On-Scene Bystander and Survivor

DIZENGOFF SHOPPING MALL

OVERVIEW

ASSESSMENTS

PLANS AND EXERCISES THAT INCLUDE BYSTANDER INTERACTION

COMMUNICATIONS AND OTHER CAPABILITIES

CONCLUSION

Chapter 14: The Role of the Trained Volunteer

HURRICANES AND THEIR AFTERMATH

OVERVIEW OF TRAINED DISASTER VOLUNTEERISM

KEEPING THE TRAINED VOLUNTEER INTERESTED

READINESS

ADDITIONAL PARTNERS FOR TRAINED VOLUNTEER INVOLVEMENT

PLANS AND EXERCISES THAT FOSTER INTERACTION

COORDINATION AND COMMUNICATIONS WITH TRAINED VOLUNTEERS

CONCLUSION

RESOURCES

Chapter 15: Bioterrorism, Biosecurity, and the Laboratory

DIAGNOSIS ANTHRAX

BIOLOGICAL ATTACK: THE CONTEXT

BIOLOGICAL DEFENSE PROGRAMS IN THE UNITED STATES IN 2001

DISTINCTIVE NATURE OF A BIOLOGICAL EVENT

THREE KEY BIORESPONDER GROUPS

BIODEFENSE AND PREPAREDNESS: LOOKING FORWARD

Chapter 16: The Role of the Law Enforcement Officer

9/11, THE BEGINNING

UNDERSTANDING TERRORISM FROM THE LOCAL POLICE PERSPECTIVE

PREVENTING AND MITIGATING TERRORIST ATTACKS: THE ROLE OF THE LOCAL POLICE

CONCLUSION

Chapter 17: A Model Case of Counterterrorism: Thwarting a Subway Bombing

THE PLOT TO BOMB THE NEW YORK SUBWAY

ARREST AND INCARCERATION

IMPLICATONS FOR DOMESTIC TERRORISM

THE STRUCTURE OF COOPERATION AND COORDINATION

CONCLUSION

Chapter 18: The Newest Security Threat: Cyber-Conflict

THE US AIR FORCE AND THE HURRICANE KATRINA KILL ZONE

PRIMER ON CYBER

US GOVERNMENT ORGANIZATION

CHALLENGES IN SURVEILLANCE

CONCLUSION

Part V: Conclusion

Chapter 19: Preparedness, Black Swans, and Salient Themes

PREPARING FOR BLACK SWANS

SALIENT THEMES AND OBSERVATIONS

A FINAL OBSERVATION ABOUT PREPAREDNESS

CONCLUSION

Index

Copyright © 2012 by Wiley-Blackwell. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data

Local planning for terror and disaster : from bioterrorism to earthquakes / Leonard A. Cole, Nancy D. Connell, editors. p. cm. Includes index. ISBN 978-1-118-11286-1 (pbk.) 1. Emergency management–Case studies. 2. Disaster relief–Case studies. 3. Disaster medicine–Case studies. I. Cole, Leonard A., 1933– II. Connell, Nancy D., 1952– HV551.2.L63 2012 363.34′561–dc23 2012015250

CONTRIBUTORS

Bruria Adini, PhD, is Senior Consultant to the Israeli Ministry of Health and a member of the Department of Emergency Medicine at Ben-Gurion University of the Negev. An expert on emergency disaster training, during her service in the Israel Defense Forces she headed the Medical Corps’ emergency hospitalization branch, which was responsible for emergency preparedness of all general hospitals.

Limor Aharonson-Daniel, PhD, heads the Department of Emergency Medicine and is the founding director of the PREPARED Center for Emergency Response Research at Ben-Gurion University of the Negev in Israel. She has published extensively on injury research methods and on disaster preparedness assessment.

Isaac Ashkenazi, MD, MSc, MPA, MNS, is Director of Urban Terrorism Preparedness at the National Preparedness Leadership Institute, Harvard University. He is also Professor of Disaster Medicine and an international expert on Crisis Management and Leadership at Ben Gurion University of the Negev in Israel and is former Surgeon General for the Israel Defense Forces Home Front Command.

Steven M. Becker, PhD, is Professor of Community and Environmental Health, College of Health Sciences, at Old Dominion University in Virginia. A leading authority on the public health and risk communication aspects of disasters, emergencies, and terrorism, he was a member of a Radiological Emergency Assistance Mission invited to Japan after the March 2011 earthquake-tsunami disaster and the Fukushima Dai-ichi nuclear accident.

Lisa M. Brown, PhD, is a licensed clinical psychologist and Associate Professor in the School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida. She is especially knowledgeable about challenges to non-profit organizations and government agencies during catastrophic events, and her research focus is on disaster planning, response, and recovery for individuals and communities.

Ronald V. Clarke, PhD, University Professor at Rutgers and a Visiting Professor at University College, London, worked for 15 years in the British government's criminological research department before moving to the United States. He is the founding editor of Crime Prevention Studies and his publications include Superhighway Robbery: Preventing E-commerce Crime (Willan Publishing, 2003) and Outsmarting the Terrorists (Praeger, 2006), both with Graeme Newman.

Leonard A. Cole, PhD, DDS, is an Adjunct Professor of Political Science at Rutgers University–Newark and Director of the Program on Terror Medicine and Security at the UMDNJ Center for BioDefense. His numerous publications on terrorism-related subjects include The Anthrax Letters (revised edition, Skyhorse, 2009) and Essentials of Terror Medicine (co-editor, Springer, 2009).

Nancy D. Connell, PhD, is Professor of Infectious Disease at the Medical School of the University of Medicine and Dentistry of New Jersey. She is Director of the UMDNJ Center for BioDefense, has authored many scientific articles, and has served on several panels concerning biosecurity, including the National Academy of Sciences committee that reviewed the FBI's scientific investigation of the 2001 anthrax mailings.

Henry P. Cortacans, MA, a Certified Emergency Manager and Nationally Registered Paramedic, is the State Planner for the New Jersey EMS Task Force. He was a responder to the 9/11 attacks and the US Airways Flight 1549 Miracle on the Hudson and is a recipient of the Interagency Disaster Preparedness Award Certificate of Merit from the International Association of Emergency Managers.

Steven M. Crimando, MA, BCETS, CTS, CHS-V, is an expert on the application of the behavioral sciences in homeland security, violence prevention, and disaster management. His focus is on the emotional and behavioral aspects associated with mass violence, including chemical, biological, and radiological threats, active shooter response, and collective violence related to group and crowd behavior.

Dian Dowling Evans, PhD, FNP-BC, is an Assistant Clinical Professor in the Nell Hodgson Woodruff School of Nursing at Emory University where she directs the graduate Emergency Nurse Practitioner specialty program. She has been practicing clinically as an emergency nurse practitioner since 1990 and has published on a wide range of emergency and advanced practice nursing topics.

Henry Falk, MD, MPH, consultant to the Office of Noncommunicable Disease, Injury and Environmental Health at the Centers for Disease Control and Prevention, is an Adjunct Professor of Environmental Health at the Emory University Rollins School of Public Health. Formerly he was the Director of the National Center for Environmental Health at the CDC, and of the Agency for Toxic Substances and Disease Registry.

David L. Glotzer, DDS, is a Clinical Professor at the Department of Cariology and Comprehensive Care, New York University College of Dentistry (NYUCD). He is a former Colonel in the US Army, and since 9/11 he has published on and helped lead an NYUCD initiative to define a role for dentists in public health response to major terrorist and disaster situations.

James W. Gordon, MPAS, PA-C, is Director of Physician Assistant/Nurse Practitioner Education at Emory University School of Medicine. He is Medical Officer for a Disaster Medical Assistance Team (part of the National Disaster Medical System), was a responder at the 1996 Olympic Park bombing, and was the medical point man on two Mount Everest expeditions.

Gerard A. Jacobs, PhD, is Director of the Disaster Mental Health Institute and a Professor in the Clinical Psychology Training Program at the University of South Dakota. He has helped develop disaster mental health and psychological support programs (such as community-based psychological first aid) throughout the world and was the recipient in 2007 of the American Psychological Association's International Humanitarian Award.

Donald H. Jenkins, MD, FACS, Associate Professor of Surgery and Director of Trauma at the Mayo Clinic in Rochester, Minnesota, is Vice-Chair of the National Trauma Institute. A former Colonel in the US Air Force, he served as Medical Director of the Trauma System for the US Central Command (including Afghanistan and Iraq).

Laura H. Kahn, MD, MPH, MPP, a general internist, is a research scholar with the Program on Science and Global Security at the Woodrow Wilson School of Public and International Affairs, Princeton University. She is the author of Who's in Charge? Leadership During Epidemics, Bioterror Attacks, and other Public Health Crises (Praeger Security International, 2009), is a monthly columnist for the Bulletin of the Atomic Scientists, and is co-founder of the One Health Initiative.

Emily G. Kidd, MD, is an Assistant Professor at the University of Texas Health Science Center at San Antonio and the Assistant Medical Director for the San Antonio Fire Department. She is also the Project Director for the Texas Disaster Medical System, a statewide collaboration of public health and acute medical care initiatives to improve disaster response across the state of Texas.

Craig A. Manifold, DO, is an Assistant Professor at the University of Texas Health Science Center at San Antonio and the Medical Director for the San Antonio Fire Department. He has deployed with the US Air Force and Texas Air National Guard in support of numerous large-scale medical operations and was the lead physician for relief operations during Hurricanes Katrina, Rita, Gustav, and Ike.

Brendan McCluskey, JD, MPA, CEM, is Executive Director of Emergency Management and Occupational Health and Safety at the University of Medicine and Dentistry of New Jersey. He previously served as an Emergency Medical Technician and paramedic and as Deputy Director, UMDNJ Center for BioDefense at the New Jersey Medical School.

Mark A. Merlin, DO, an emergency physician and Adjunct Associate Professor at the University of Medicine and Dentistry of New Jersey, is the Medical Director of the New Jersey EMS Task Force. He is also EMS/Disaster Medicine Fellowship Director at Newark Beth Israel Medical Center/Barnabas Health in Newark, New Jersey, and has published numerous papers on prehospital care.

Njoki Mwarumba, PhD candidate at Oklahoma State University, earned a BA in Communications and Community Development in Kenya. Her doctoral studies are in OSU's Fire and Emergency Management Program with a focus on complex emergencies in least developed countries.

James Netterwald, PhD, a medical technologist accredited by the American Society for Clinical Pathology, is President and CEO of BioPharmaComm, LLC. He has published articles on issues ranging from genomics and biotechnologies to drug discovery and development process.

Graeme R. Newman, PhD, is distinguished teaching professor at the School of Criminal Justice, University at Albany, and Associate Director of the Center for Problem-Oriented Policing. His publications include The Punishment Response (Transaction, 2008), Comparative Deviance (Transaction, 2007) and, with Ronald Clarke, Superhighway Robbery: Preventing E-commerce Crime (Willan Publishing, 2003) and Outsmarting the Terrorists (Praeger, 2006).

Ann E. Norwood, MD, Senior Associate at the Center for Biosecurity of UPMC, is a psychiatrist who retired from the US Army after 26 years of service. A former Chair of the American Psychiatric Association's Committee on Psychiatric Dimensions of Disaster, she has co-edited four books and published numerous articles and chapters on the behavioral health aspects of trauma associated with war, terrorism, and disasters.

Brenda D. Phillips, PhD, is Professor of Emergency Management at Oklahoma State University. She is also a Senior Researcher with the Center for the Study of Disasters and Extreme Events at OSU where she specializes in socially vulnerable populations, volunteer management, and long-term community recovery from disasters.

Peter M. Sandman, PhD, is a self-employed risk communication consultant based in Princeton, New Jersey. He has advised many clients on pre-crisis, mid-crisis, and post-crisis communication, including top officials of the Centers for Disease Control and Prevention during the anthrax crisis.

Shmuel C. Shapira, MD, MPH, is Deputy Director General of Hadassah University Hospital and Director of the School of Military Medicine at the Hebrew University–Hadassah School of Medicine in Jerusalem, Israel. An international authority on trauma, terror medicine, and emergency medicine, he has published extensively on these subjects and is co-editor of Essentials of Terror Medicine (Springer, 2009) and Medical Response to Terror Threats (IOS Press, 2010).

Samuel E. Shartar, BS, RN, CEN, is Senior Administrator of the Office of Critical Event Preparedness and Response (CEPAR) at Emory University. Before joining the CEPAR office, he was the Unit Director for the Emergency Department at Emory University Hospital.

Joshua Sinai, PhD, is an Associate Professor/Research, specializing in terrorism and counterterrorism studies, at the Virginia Tech Research Center in Arlington, Virginia. He previously worked on these issues in the US Department of Homeland Security and in the private sector, where, in his last position, he was detailed to work as a contractor at a government counterterrorism operations center.

Debra Wagner, CVA, NREMT, holds a BA in Criminal Justice and is the State Coordinator for the Oklahoma Medical Reserve Corps. She is a registered EMT and is one of about 1100 people worldwide to have earned professional certification in Volunteer Administration.

Panayotis A. Yannakogeorgos, PhD, is a Cyber Defense Analyst and Faculty Researcher at the Air Force Research Institute. He previously was Instructor and Senior Program Coordinator at the Division of Global Affairs, Rutgers University–Newark, where he was founding publisher and editor of the Journal of Global Change and Governance.

PROLOGUE

In July 2009 and September 2010, symposia on terror medicine and security were held under the auspices of the University of Medicine and Dentistry of New Jersey. The central aim was to give voice to experts in key fields involved with local preparedness, to assess the quality of preparedness and interaction among the fields, and to offer directions for improvement. Distinguished participants from the United States and Israel offered perspectives on a range of issues related to the field of terror medicine. This book has been developed from topics covered at the symposia.

The proceedings were immensely valuable to preparedness and response planning for mass casualty incidents, whether of natural, accidental, or terrorist cause. Support for the forums came from the highest levels of state government. New Jersey's Governor Chris Christie served as honorary chair of the 2010 symposium as did his predecessor, Governor Jon Corzine for the 2009 symposium. A keynote presentation was made by the Director of the New Jersey Office of Homeland Security and Preparedness: Charles McKenna in 2010 and Richard Cañas in 2009.

The symposia were also addressed by the Honorable Daniel Kurtzer, former United States Ambassador to Egypt and to Israel, and were supported by the Israeli Consulate in New York. Presentations were made at one or the other forum by prominent health and security leaders including Lt. Colonel Jerome Hatfield, Deputy Superintendent of Homeland Security, New Jersey State Police; Dr. Clifton Lacy, former New Jersey Commissioner of Health; Major General (res) Yitzak Gershon, former Head of the Israel Home Front Command; and Donald Jenkins, Col. USAF (ret), Mayo Clinic, former Medical Director of Trauma System for the US Central Command (including Afghanistan and Iraq).

One outcome was the familiarization of attendees with terror medicine. This emerging field encompasses aspects of emergency and disaster medicine as well as techniques for diagnosis, rescue, coordination, and security that are distinctive to a terrorist attack. The field is further discussed in Chapter .

Topics at the symposia ranged from treatment of injuries and emotional trauma to the role of the volunteer in a terrorist or disaster incident. At each symposium, experts from the United States and Israel addressed large audiences with a wide array of backgrounds. Attendees included physicians, nurses, dentists, paramedics, and others from the healthcare community, officials from law enforcement and security, and laypeople. Audience responses to the proceedings were uniformly enthusiastic.

The emphasis at the second forum was on local preparedness for terrorism and disaster, which is the focus of this book. Terrorism remains a global threat as evidenced by ongoing events in the Middle East, Europe, and beyond. The shootings in Fort Hood, Texas, in November 2009, were the largest terrorist attack on US soil since 9/11. Elsewhere in the United States, several planned attacks have failed or been thwarted. The continuing threat requires responsible awareness and preparation by both professionals and the general citizenry. Moreover, such preparation could be applicable to accidental or naturally caused disasters as well. Any individual could find himself at the scene of a terrorist or disaster event. With advanced preparation, any of us could be in a position to provide assistance to family members and other victims.

Chapter authors have been drawn from symposium presenters and others who represent a range of disciplines involved in local preparedness. The introductory chapters provide overviews of terror medicine, security, and communications, which are indispensable to successful preparedness. Subsequent chapters concentrate on a particular field and how responders from that field communicate and interact with others during and after an event. Thus, a chapter by a physician discusses not only the doctor's role but how that role is, or should be, coordinated with relevant others, such as emergency medical technicians and police.

Authors were asked to begin their chapters with a case study that demonstrates preparedness, or lack thereof, for a terrorist or disaster event. Their choices turned out to be fascinating and far ranging—from bioterrorism to earthquakes. Narratives of the case studies, often riveting, set the stage for further discussion from the perspective of the responder's field. Each author was asked to follow a common narrative sequence:

1. Recounting of the selected terrorist or disaster event

2. Description of preparedness and response efforts by the chapter's responder group

3. Manner of communication and interaction with other responder groups

4. Discussion of successes and failures of response efforts

5. Lessons learned including challenges, areas for improvement, and suggested next steps

The format was intended to help bind the book, with its many and varied contributors, into a coherent whole. The result, we believe, has been a successful compilation of different professional perspectives all linked by a singular purpose: to prepare for and respond to terror and disaster.

LAC NDC

ACKNOWLEDGMENTS

This book is an outgrowth of symposia in 2009 and 2010 under the Program on Terror Medicine and Security, which is part of the Center for BioDefense at the University of Medicine and Dentistry of New Jersey. We are most grateful that Governor Chris Christie served as honorary chair of the 2010 Symposium, as did his predecessor Jon Corzine for the 2009 event, and for presentations by the Director of the New Jersey Office of Homeland Security, Charles McKenna in 2010 and Richard Cañas in 2009.

Daniel Kurtzer, former United States Ambassador to Egypt and to Israel, addressed both symposia, as did officials of the Israel Consulate in New York, Gil Lainer in 2010 and Benjamin Krasna in 2009. Several of the chapter authors in this volume were presenters at one or the other event, though we are indebted to all symposium participants for broadening our understanding of the emerging field of terror medicine and its relationship to security. Presenters at the 2010 Symposium included Dr. Bruria Adini, Erez Geller, Yitzhak Gershon, Jerome Hatfield, Rowena Madden, Tara Maffei, Brendan McCluskey, Dr. Mark Merlin, Dr. Yuri Millo, Dr. James Pruden, Megan Sullivan, and Sarri Singer. At the 2009 event: Dr. Isaac Ashkenazi, Michael Balboni, Henry Cortacans, Steven Crimando, John Grembowiec, David Gruber, Dr. Clifton Lacy, Dr. Jill Lipoti, Dr. Donald Jenkins, Dr. Tzipi Kahana, Rafi Ron, Estelle Rubinstein, Valerie Sellers, and Andrea Yonah.

Staff members of UMDNJ's Center for Continuing and Outreach Education were instrumental in promoting and organizing the symposia. For their unstinting support we thank in particular Patrick Dwyer, Theresa Setteducato, Jessica Young, and Attasha Nurse. From the UMDNJ Foundation, we acknowledge the dedicated efforts of George Heinrich and Elizabeth Ketterlinus.

Drs. Henry Falk and Isaac Ashekenazi, the authors of Chapter , wish to acknowledge colleagues whose work they referred to in their case studies and scenarios including Dr. Richard Hunt, Director of the Division of Injury Response at the CDC's National Center for Injury Prevention and Control, a strong sponsor of CDC guidance materials related to terrorism events and also of the Tale of Cities meetings; Drs. Leonard Marcus and Barry Dorn of the National Preparedness Leadership Institute at Harvard University; Madrid colleagues for their work toward understanding the response to the 2004 train bombings, and particularly Drs. Fernando Turegano-Fuentes and Ervigio Corral Torres for providing the figures in the chapter's depiction of those events.

Dr. Panayotis Yannakogeorgos, who authored Chapter , expresses his gratitude to Jennifer Lizzol for her contribution on the role of the Air Force during the Hurricane Katrina response. Others who read portions of the manuscript or otherwise provided thoughtful suggestions to enhance the project include Dr. David Baker, Team Leader of the Health Protection Agency of the United Kingdom; Howard Butt, State Coordinator for the Citizen Corps in New Jersey; Dr. Scott Compton, Assistant Dean for Educational Evaluation and Research, NJ Medical School; Rowena Madden, Executive Director of the NJ Governor's Office of Volunteerism; John Rollins, Specialist in Terrorism and National Security at the Congressional Research Service. Ruth Cole was an invaluable source of ideas and support at every stage of the project.

Finally, we are indebted to the talented staff at John Wiley Publishers, and especially to Karen Chambers, Life Sciences Editor, and Anna Ehler, Editorial Assistant, for their encouragement and guidance throughout the editorial process.

PART I

INTRODUCTION: THE KNOWN AND THE UNKNOWN

1

PREPAREDNESS, UNCERTAINTY, AND TERROR MEDICINE

LEONARD A. COLE

As mentioned in the Prologue, the chapters in this volume generally begin with a case study of a terrorist or disaster event. This narrative format introduces the main theme of the chapter as related to local preparedness.

In this chapter, the case study derives from attacks on July 7, 2005, when suicide terrorists bombed three London underground trains and one bus. The narrative here focuses on the bus bombing. Despite individual acts of heroism by responders and bystanders, organized response efforts were often wanting.

The lessons of 7/7, as the day is called, can be helpful in preparing for terrorist attacks in communities everywhere. Some of the experiences that day were unanticipated because they had seemed improbable. A range of uncertainties may apply as well to other events, whether they arise from deliberate, accidental, or natural causes. Among the lessons of 7/7 that apply to all such incidents is the importance of anticipating the unexpected.

THE BOMBING OF BUS NUMBER 30

Box-shaped stone homes grace the volcanic peaks of Santorini, an island 200 miles south of Greece. Amid the island's residences, blue-domed churches match the azure of the Aegean Sea a thousand feet below. Thought by some to be the ancient city of Atlantis, Santorini has long been a favorite of romantics.

Days after returning to London from a Santorini holiday, 28-year-old Sam and his fiancé Mandy still felt the island's glow. High on Sam's to-do list was a visit to Tiffany's to buy the promised ring for the woman he adored. Meanwhile, by Thursday morning, July 7, he had resumed his daily routine.1

Headed to the Central London office where he was a software specialist, Sam had settled into a window seat on the upper deck of the Number 30 (Figure 1.1). As the bus traveled east along Euston Road, it passed University College Hospital. An imposing structure of glass and steel, the hospital houses the largest critical care unit in Britain's National Health Service.

Figure 1.1 Bus No. 30 on normal route to Central London. (Credit: Oxyman, Creative Commons Attribution 2.5 Generic License.)

A block farther, beyond the red brick Quaker Friends House, traffic had become uncommonly dense. Diverted from its usual route on Euston, the Number 30 turned right and inched toward Tavistock Square. More commuters than usual were using buses and cars because train service had been suspended. The airwaves were carrying notice of a disruption to the city's underground rail system. It was approaching 9:45 A.M. and neither Sam nor his fellow passengers fully understood the cause of the congestion.