clinical

In the Ever More Likely Event of a Terrorist Attack…

I’ve been following the Brussels suicide bombing attacks more closely than I have time for. Terrorists have once again destroyed and disrupted life… but some people were able to help.

Dr. Laura Billiet was just outside the Delta check-in counter when the explosions ripped through. She was unhurt, and immediately set up a triage and first aid station, providing emergency care as best she could, using office supplies (read the article from the Huffpost here).

I can’t stop thinking: What would I do?

I would want to help, but I’m an outpatient primary care doc with no training in tactical emergency casualty care. The Red Cross ACLS course I took as a resident taught me how to perform CPR, but when it’s a pressure-cooker bomb or a crazed shooter, that is not going to help.

Can anyone help in these situations? Yes. It was the immediate application of McGyvered tourniquets that saved lives in the aftermath of the Boston Marathon bombings in 2013. During the Bataclan terror attack in Paris, two tactical emergency physicians entered the fray. This post analysis writeup in Critical Care (2016, 20:37 ) is written in dry reporting style, but I found it riveting:

“While police operators were getting into position within the theater and thus repelling terrorists, two RAID tactical physicians performed triage in the combat zone. They identified about 100 fatalities. Most of the living casualties were identified as invalid. This tactical triage did not aim at identifying relative or absolute emergencies but rather at organizing immediate transfer of the non-invalid patients by themselves to a safe place. A dressing station was located in the theater entrance, far from firearms but still under the threat of explosives. [] In the combat zone, RAID tactical physicians applied tourniquets to 15 invalid patients. A further 15 patients underwent wound compression with hemostatic dressings. Two received subcutaneous morphine and two received tranexamic acid, and two thoracic exsufflations were performed.”

Wow. Obviously I won’t be carrying morphine and tranexamic acid around, but I think all physicians and healthcare providers should have at least some basic training in field trauma triage and management. Sadly, this is what our modern world now requires, with terror attacks every few months. No one knows when they may be called upon to help. We should be able to provide a few basic immediate interventions, because that can make all the difference.

How can this happen? I posed this question to a group of physicians, and many suggested the Advanced Trauma and Life Support courses offered through the American College of Surgeons. I just emailed them asking:

Where do I sign up?

marathon bombing

4 replies »

  1. I’m an allergist (also at MGH) but would love to be able to help in an emergency. If you find out about the class, please let me know.

    I really enjoy your blog – my husband and I juggle 4 kids and jobs and it’s great to hear how another doctor mom balances life! And we love cats!

    Liked by 1 person

    • Hi Rebecca! Thanks so much. It’s so funny- I posted about this on the Facebook PMG board (physician mom group, are you on there?) and it was delightfully controversial. Half of the docs say it doesn’t matter what training you’ve had, it just doesn’t matter or help unless you do it every day. Others sent links to ATLS and other courses, like BDLS (Basic disaster life support). I’m going to look into all of it, even if it’s more for my own reassurance!

      Like

  2. I meant to post a comment to you when I first read this blog post. Better late than never! I just want to add my two cents worth. I know that most people want to help in an emergency situation of any kind, but many don’t because they don’t know what to do. I have found that in any emergency the best thing someone can do to help is “Stay with the Casualty”. Just knowing that someone is there and not leaving them is such a comfort! It is the one thing they remember too. As professionals I know we think we are not doing something, unless it is saving a life, but kindness and caring go a long way! Thanks for letting me share! CLL, CCRN

    Like

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