Terrorist attacks, including mass shootings and bombings, have dramatic physical and emotional impact on a community. Terrorists often use inexpensive but deadly bullets and bombs to maximize the number of casualties and the lethality of injuries compared to conventional blunt trauma. Significantly increased severity of injuries have been observed in terrorist bombing incidents compared to “conventional” casualty incidents. A recent analysis of mass shooting events noted a wounding pattern different from military experience with very few cases of life-threatening extremity hemorrhage; therefore, extrication and transfer to definitive care needs to be a priority in addition to any in-place care provided.
Preventing these types of events is the optimal goal, but when an event occurs a rapid and effective response coordinated between agencies is required to optimize patient outcomes. In this discussion paper, members of the National Academies of Sciences, Engineering, and Medicine’s Forum on Medical and Public Health Preparedness for Catastrophic Disasters examine some of the issues and potential best practices during responses to terrorist incidents. This paper is designed to explore the key issues and is not intended as a comprehensive or expert review of each topic area. This paper should serve as a prompt for responders and planners to consider areas where their community could address potential gaps.
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