Chapter 5:

The Threat of Terrorism and Weapons of Mass Destruction

errorism is the most challenging mass casualty incident for emergency responders. The spectrum of terrorist threats is limitless, ranging from suicide bombers, conventional explosives, and military weapons to weapons of mass destruction (nuclear, biological, or chemical). Terrorist events have the greatest potential of all man-made disasters to generate large numbers of casualties and fatalities.

Terrorists are not limited by conventional technology or weaponry. The spectrum of events occurring during the second World Trade Center bombing on September 11, 2001, was beyond anyone’s imagination. The terrorists used fully fueled jumbo jets as “flying bombs,” generating massive destruction of life and property. If the first World Trade Center bombing attack February 1993 had
materialized as the terrorists planned, one tower would have collapsed onto the other, causing 50,000 casualties.

Boston DMAT member view devastation at Ground Zero, World Trade Center

One of the unique features of a terrorist threat, especially involving weapons of mass destruction, is that psychogenic casualties usually predominate. Terrorists do not have to kill people to achieve their goals: they just have to create a climate of fear and panic to overwhelm the medical infrastructure. In the March 1995 sarin attacks in Tokyo, 5,000 casualties were referred to hospitals. Of these, fewer than 1,000 were suffering from the physical effects of the sarin gas with the remaining suffering psychological stress.

The recent anthrax incidents in the United States also dramatically increased the number of individuals presenting to emergency departments with non-specific respiratory symptoms.

Weapons of mass destruction creating “contaminated environments” will be the greatest disaster challenge of all. No longer will emergency responders be able to bring victims into hospitals for fear of further contaminating medical facilities. Medical responders must be equipped to perform triage, provide initial stabilization, and possibly definitive care at staging areas outside traditional hospital facilities.

Personnel in Level A Personal Protective Equipment (PPE) preparing to enter a contaminated environment