Lessons for first responders on the front lines of terrorism

Preparing for the next attack
Our recent research looked at three mass casualty incidents in the U.S. between 2013 and 2015, examining both the health care system and community responses.

We identified several best practices that can help medical and nonmedical first responders handle these incidents more effectively.

First, we must provide co-training for medical and nonmedical first responders. Police and firefighters are already starting to be trained in basic lifesaving skills in non-mass casualty incident contexts. In some communities, such as Atlanta and Irvine, California, police patrols carry automated electronic defibrillator devices as well as Narcan to reverse opioid overdose. Other police departments, such as in Denver, provide staff training in tourniquet application. These efforts should be continued.

Moreover, both medical and nonmedical responders should be trained in scene safety, bystander management, field triage and medical techniques such as effective application of tourniquets. Even many medical professionals lack sufficient training in these skills.

Second, we need to ensure open communication lines. A dedicated radio frequency can facilitate communication among the various responder disciplines, as well as guard against problems caused by cell tower outages. Also, responders can be trained to rely, when necessary, on text messaging, which worked when voice communication did not during the events we studied.

Third, interdisciplinary disaster drills are critical. Communities should conduct regular citywide disaster drills that include EMS, fire and police departments, as well as area hospitals and health care systems. Responders need to test their training and protocols under conditions that simulate some of the complexity and stress of real events. This could include adding components without notice, to simulate the sudden onset of terrorist events.

Such drills will help each group understand how its actions contribute to an integrated multidisciplinary response. They can also promote more effective collaboration during response to an incident.

Finally, we need to build relationships in advance that can be leveraged during emergencies. Our research indicates that one of the most important ingredients of an effective multidisciplinary medical response is strong relationships and trust among key players. Regular exercises and drills can help, but they need to be supported by leaders and organizational cultures.

For example, in recent years, with support from the federal government, many communities across the U.S. have created health care coalitions that provide formal mechanisms – including regular multi-stakeholder meetings and agreements to share critical resources – for coordinating the preparedness and response efforts of first responders, health care providers and private sector partners.

Moreover, given the frequent role of bystanders, professional responders should reach out to community emergency response teams and other organizations. That can help raise citizen awareness of basic lifesaving techniques.

Public support
Effective medical response to terrorism and disasters requires sustained investment. That can be difficult to muster in an era marked by increasing skepticism about public investment and distrust in public institutions.

However, experience suggests that we need collaboration among medical and nonmedical response organizations – and civilians. Through supporting public investments in mass casualty incident preparedness and response, both policymakers and civilians should have the confidence that, even when attacks cannot be prevented, their communities are resilient enough to respond to and recover from them.

Mahshid Abir is Assistant Professor, Department of Emergency Medicine, Director of the Acute Care Research Unit, Affiliated Adjunct and Natural Scientist, RAND Corporation, University of Michigan. Christopher Nelson is Professor of Policy Analysis, Pardee RAND Graduate School. This article is published courtesy of The Conversation (under Creative Commons-Attribution / No derivative).