Trauma terrorist attacks

Many health care practitioners have the knowledge and skill sets required to care for blunt and penetrating trauma from motor vehicle accidents, falls, gunshot wounds, and the like however, few have cared for survivors of an explosion. Whether the result of an industrial accident or a terrorist attack, explosions produce casualties that will present with blunt and penetrating... 

In the event of a terrorist attack, people will suffer physical and psychological trauma. Physical effects will include the effects of exposure to any explosion—broken bones, burns, shock, lacerations, and so forth. These may be compounded by the presence of radioactive contamination and, in some cases, radiation illness. In addition, any terrorist attack will, by definition, inflict psychological trauma, and medical personnel must be prepared to receive many patients who are worried, panicked, or suffering psychosomatically in spite of being physically well. In the aftermath of a terrorist attack, even a simple headache or anxiety attack may be seen as evidence of radiation sickness. 

The intensity of the trauma may contribute to the development of PTSD (Shalev and Freedman, 2005). Posttraumatic Stress Syndrome rates after terrorist attacks in Israel were higher than rates after motor vehicle accidents. The authors suggest that the highly traumatic nature of a terrorist attack (exposure to death, body parts) may impact the higher rate of PTSD development. Additionally, the authors hypothesized that the longitudinal course of PTSD would be affected by the frequent versus sporadic terrorist attacks however, this was not the case. The authors suggest that there may be some sort of resiliency that develops during an era of continuous terror. Others... 

Treatment is now a very active area of clinical research, with positive treatment outcomes even among torture victims and prospects for improved intervention strategies. However, there is a need to research individual patients responses to current treatment methods to ensure that favorable outcomes are possible for everyone. Psychological treatment of trauma victims is always complicated by an ongoing need for medical treatment and physical rehabilitation, and in the case of terrorist attacks on civilians, it is further complicated by the fact that attacks frequently occur in everyday settings to which the victims are likely to return. A public approach to treatment should thus include education about the role of reminders and environmental changes that minimize unnecessary and avoidable secondary trauma. 

With the steady growth of the production, transport and use of toxic chemicals around the world, there has been an increase in the number of casualties with toxic trauma. Although the end of the Cold War reduced the risk of major chemical attacks, the stockpiles of chemical weapons remained and may have fallen into the hands of terrorists. The release of the nerve agent sarin in the Tokyo metro in 1995 confirmed the ability of terrorist organisations not only to use chemical weapons but also to synthesise them. In summary, mass exposure to toxic substances remains a relatively rare but significant event which has importance for emergency medicine and several other specialities. 

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