Medical Responses to Terrorist Incidents P. Sullivan, MA Introduction Terrorism can be considered a forur of lorv-intensitl, conflict. It results from extrerne reactions to sociopolitical conditions. These reactions, through a variety of intellectual and emotional processes, are rnanifest as overt acts of violence. Terrorism irtcludes acts by individuals or organizations rvhich seek to change polit- ical or social conditions, make political or ideological srarements, or obtain funds for sttstaining ongoing terrorist or revolntiotlar), campaigns. Terrorist incidents are increasiugly prevalent. Often, they in'r,olve loss of lives and rnass casualties and have sPecial rnedical dirnensions. As strch, the role of EMS in terrorist incidents needs to be defined clearlr,. The Role of EMS Systemic acts of extraordinary vio- lence such as those associated rvith terrorist attacks and assaults can be defined as either "cornpleted" or- "ongoing". In general, the emergencl' medical respol'rse should not be delir. ered until the incident is completed and the scene is "clear" (e.u., the inci- dent is over and the secondarl,deyices and snipers are rernoved). Hon'ever, there mav be tirtres rvhen a medical resporlse is indicated during an ollgo- ing incident. Exarnples are in Table 1. Each of these require special services and AL\{A\6 must be cleared bv inci- dent comrnand. Expected T;,pes of Injuries Terrorist incidents often are charac- terized by an assatrlt in rvhich bornbs or firearms are used. Terrorist bonrb. ings can result in blast injuries, burns, penetration from multiple fragments, the rvhole gamrrt of blrrnt injuries, crush injuries, avnlsions, and amplrta- tious, Also, the nse of chernical, bio- logical, or nuclear agents (CBN) is possible. A terrorist incident invoh.ing the use of CBN agents should be approached as rvould any "conven- tional" hazardous materials incident. Terrorists prefer rnilitary-type firearms. These weapons include hardrvare such as rnachine-gnns, assault-type rifles, carbines, and other automatic weapons. These rveapons can produce high velocity rnissiles, and their resultant injuries can result in high rnortalitl'and l,ounds of great severitl, and multiplicitt,. The nounds produced by high velocitl' missiles fired from automatic and semiatrto- tnatic r{eaporls are distinctly different and more severe than are those from the lorv-'r.elocity handguns encoun- tered in "norrnal" civilian, lton-corn- bat settings.t Responding, special operations personnel often rvear body arrnor to protect their trunks, protect- ing their vital organs, bur rnaking them more vulnerable to rnaxillo- r Jl r-*- I {h"g i''+r: -:,i -.1 lhr 5tlt \\irrld Congress ol'Ertrcrgerrcv and Disuster \leclicine in Rio De.faneiro, \lat lgij7