Responding to Terrorism

Mounting an effective response to a terrorist attack or, just as importantly, managing a possible terrorist incident, is the direct professional responsibility of community physicians, occupational health physicians, accident and emergency staff, general practitioners and doctors in the Armed Forces. This handbook offers such professionals a broad range of clinically relevant information in an immediately accessible format. It collects together data, which is not available in any one other volume, and presents it in a balanced and objective way, while putting the potential risks into perspective. Responding to Terrorism is also relevant to paramedics and nurses in a wide range of disciplines as well as to members of the emergency services.

Introduction
Acknowledgements
Part 1 Terrorism in Perspective – don’t panic!
Terrorism today
Key events in terrorism (including significant anniversaries)
Key terrorist groups and affiliations
Personal safety
Personal protection
Quarantine
Roles and organisation of the antiterrorist agencies
UK
International
Service rank markings (UK)
Useful addresses and contact details
Legal aspects
New legislation
Recognising the suspicious person

Part 2 Responding to a terrorist incident
Reasons for declaring an incident
Initial actions checklist
Declaring a major incident
Organisation of an incident scene
Triage
Agency roles at an incident
Health Service
Fire
Police
Ambulance
Bomb disposal
Nuclear agencies
Medical response to an incident scene
Legal aspects
Forensic aspects
The scene
The patients
Dealing with the media
Debriefing

Part 3 Conventional terrorism
Types of terrorist weapon
Bombs (fire bombs, pipe bombs, suicide bombs etc)
Bullets (high energy, low energy, expanding)
Pathophysiology of wounding
Blast
Ballistics
Initial management
Safety
Resuscitation
Injury patterns in bombings
Primary blast
Fragmentation
Amputations / disruption
Burns
Crush
Psychological
Presentation, management, strategy.
Forensic management

Section 4 Bioterrorism
The nature of a suspected bioterrorist outbreak
How to suspect a deliberate release
Physical features of deliberate release
Diagnostic symptom complexes
What to do about it
Handling a “white powder” incident
Who to contact for further assistance
What to tell the public (before and after the release is confirmed)
Possible agents (presentation, incubation, management etc)
Anthrax
Smallpox
Plague
Botulinum
Tularaemia
Haemorrhagic fever viruses
Pre-exposure prophylaxis
Post-exposure prophylaxis

Section 5 Chemical agents
The nature of a suspected chemical attack
How to suspect a deliberate release of chemicals
Useful symptom complexes for agent recognition
What to do about it
Who to contact for further assistance
What to tell the public – suggestions for first aid
Protective equipment
Personal protective equipment
Collective protection
Possible agents
Nerve agents
Vesicants
Blood agents
Chocking agents
Incapacitating agents
Smokes
Other toxins
Initial management (Specific management is covered under each agent)
Safety
Resuscitation
Decontamination
Specific antidotes
Rescuer safety
Contamination

Section 6 Nuclear and radiation hazards
The nature of nuclear terrorism
Types of radiation
Sources of radioactive substances
The “dirty bomb”
Radiation protection
Pathophysiology of radiation damage
Presentation of radiation injury
Initial response to a radioactive leak
Initial management of casualties
Safety
Decontamination
Resuscitation
Sources of information
Prognosis in radiation injury

Section 7 Medicine and Civil disorder
How crowds behave
How the police handle a crowd
Role of the other emergency services
Keeping safe
Them:
Improvised weapons
Us:
Less lethal weapons
CS gas
Water cannon
Baton rounds
Tasers
Initial treatment on scene
Further Reading

Index