As has been proved literally hundreds of times in Iraq, Israel, and elsewhere, the detonation of an explosive device by a suicide bomber can occur, without warning, anywhere in the world – including the United States. When, not if, such an attack takes place on American soil, the jurisdiction directly victimized will be expected to be fully prepared to deal with it. More specifically, the community’s first responders – firefighters, police officers, and emergency medical technicians, primarily, who will in all likelihood be the first trained personnel on the scene – must be trained and ready to save lives, stabilize the incident scene, and minimize the short- and long-term impact of the suicide bombing in general.
Those who activate the explosive device will pick the date, time, place, and method of attack – and may decide to maximize the destructive effect by lacing their weapon with an extremely toxic chemical or radioactive material, making it a so-called “dirty bomb.” Because of this possibility, responders who are approaching the scene should position themselves upwind and wear an acceptable level of personal protective equipment, including respiratory protection devices. Caution in obviously necessary – but so is speed. It is particularly important, for example, that the first emergency responders on the scene enter the incident area as rapidly as possible to immediately remove any injured patients.
Thanks in large part to the efforts of U.S. and allied intelligence agencies, there have been no new terrorist attacks on U.S. soil since the bombing of the World Trade Center, and the Pentagon, on 11 September 2001. It is only natural, therefore, as time passes, that memories fade and the nation’s first responders are lulled into a false sense of security and the belief that another 9/11 event either will not occur or, at worst, is very unlikely. That sense of complacency may well be the first responders’ greatest enemy.
Last Week, and Five Years Ago
Several other incidents of self annihilation by terrorists have in fact been attempted. The arrest last week It is only natural that memories fade and first responders are lulled into a false sense of security; that sense of complacency may well be the first responders’ greatest enemy. of the terrorists plotting to carry out a dozen or more suicide bombings on U.S. passenger aircraft en route from London’s Heathrow Airport to the United States was a helpful reminder that as far back as December 2001 Richard Reid, a British citizen, had planned to detonate a shoe bomb containing plastic explosives while over the Atlantic Ocean on a commercial flight from Paris to Miami.
First responders who are trained in managing mass-casualty incidents, and in patient triage, may believe that they are now properly prepared – much more so, certainly, than in September 2001. But U.S. decision makers, and the American people, are entitled to ask if the nation’s first responders are, in fact, truly prepared for the grotesque mutilation, carnage, dismemberment, and repulsive odors emanating from the explosion site that will be facing those who are treating the victims of a suicide-bomb attack.
The successful attack, by American citizens, on the Murrah Building in Oklahoma City, was not a suicide attack per se – but it proved that there are few if any public buildings or critical-infrastructure facilities within the United States that are 100 percent safe from terrorist attacks in general. Suicide attacks, by definition, are more difficult to guard against than attacks in which the terrorists themselves hope to survive. And it is obviously more difficult to protect any community from several attacks occurring more or less at the same time. In short, well-planned and well-implemented multiple attacks by suicide bombers similar to the attacks against the public transportation systems in London, Madrid, and Mumbai could occur in the United States as well.
Immediately If Not Sooner
Gary Briese, executive director of the International Association of Fire Chiefs – and, not incidentally, one of the nation’s earliest prognosticators of the probability of terrorist attacks within the United States itself – subscribes to what is called the “20 minute rule” for the care and evacuation of patients. The approach suggested by Briese, and many other experts, emphasizes that the victims be removed from the bomb site, and the incident scene, as quickly as possible – i.e., within 20 minutes or less – and be transported to the closest available trauma center. To meet that ambitious goal, though, hazmat responders must rapidly enter the explosion site to verify the presence (or, preferably, absence) of possible WMD (weapons of mass destruction) materials, a difficult task that requires the use of specialized detectors. If such materials are present, decontamination of the site will probably be necessary.
For operational purposes, perhaps the most important question that will be asked, if and when a suicide bomb explodes in a crowded venue, is what the first incident commander arriving on the scene should decide about victim rescue. If he or she decides - because of the potential presence of a secondary device – not to proceed immediately into the debris field to rescue and remove injured victims, the question is still valid: At what point in time will such a decision be made and carried out? The time for preplanning responders’ incident activities, and for developing operational guidelines, has to be prior to an incident, not after another suicide bombing takes place.
Following are some suggested action guidelines for first responders arriving at the scene of a suicide bombing or similar incident:
- Approach and position themselves upwind, 300 feet or more from the edge of the debris field;
- Isolate the area and deny entry by those who are not first responders – and by first responders who are not wearing the personal protective equipment they need;
- Search the incident area as rapidly, as safely, and as thoroughly as possible for secondary suicide bombs and/or other explosive devices;
- Immediately – i.e., in 20 minutes or less – remove injured victims and transport them to an appropriate medical facility; and
- Extinguish any uncontrolled fires in the area.
The following reference works are highly recommended for those seeking additional information on this important subject: Suicide Bombings: The New Chaos (International Association of Fire Chiefs, 2005); The Cult of the Suicide Bomber (Robert Baer, June 2006); and Radiological Standard Operating Guidelines for First Responders (Metropolitan Washington Government Council of Governments, July 2006).