Terrorism and Response Strategies

Terrorism poses a threat to nations and cultures everywhere, and the US Department of Justice defines it as an act involving violence or danger to human life, intended to intimidate or coerce a civilian population, influence policy, or affect a government.

International terrorism is committed by people associated with or inspired by a defined terrorist organization or nation, while domestic terrorism is committed by people hoping to further ideological causes relevant to national issues.

Only a small percentage of groups turn to terrorism, including violent religious groups, doomsday cults, extremist political groups, violent separatist groups, cyber terrorists, and single-issue groups.

Domestic terrorism trends include lone wolf attacks, which are difficult to predict and have been devastating in recent years, such as the 2015 Emmanuel Church shooting, 2016 Pulse Nightclub shooting, and 2017 Las Vegas shooting.

The Hartford Consensus provides recommendations for responding to active shooter events, including threat suppression, hemorrhage control, rapid extrication, and transport to definitive care, with an emphasis on early hemorrhage control and re-evaluation.

The pneumonic "THREAT" is used to remember the principles of response: threat suppression, hemorrhage control, rapid extrication, assessment by medical providers, and transport to definitive care.

Weapons of mass destruction (WMDs) are designed to bring about mass death, casualties, and damage to property and infrastructure, and can be biological, nuclear, incendiary, chemical, or explosive.

Terrorist groups have favored tactics using explosive devices, and attempts to use chemical or biological weapons have been unsuccessful.

Chemical agents are manufactured substances that can have devastating effects on living organisms, and biologic agents cause disease through viruses, bacteria, and toxins.

Radiologic or nuclear terrorism is possible, with nations holding close ties with terrorist groups and obtaining nuclear capabilities.

Indicators for a terrorist event include the type of location, number of patients, patient statements, and pre-incident indicators, and responders should be aware of their surroundings and possible risks.

Responders should stage their vehicle at a safe distance from the incident, wait for law enforcement to secure the scene, and establish a staging area where trained responders in appropriate PPE can handle the WMD incident.

Protection from WMD agents involves preventing contact with the agent, and responders should inform dispatch of the event, additional resources required, and the estimated number of patients.

Scene safety is crucial, with terrorists known to plant additional explosives to injure responders and secure media coverage, and responders should constantly reassess scene safety.