Terrorism Preparedness—

Newtown Surgeon Studies Mass Casualty Incident Response

By Andrew Gorosko

A Newtown trauma surgeon is providing information to Danbury Hospital surgical and emergency medicine staffers on how best to manage the treatment of patients who are the victims of mass casualty incidents, such as terrorist attacks, based on knowledge that he gained while on a recent trip to Israel.

Besides providing Danbury Hospital personnel with such information, Steven J. Tenenbaum, MD, said he is willing to speak to doctors at other hospitals on the topic.

“It will be interesting to see how people respond here,” the doctor said of medical personnel’s reaction to information on medical preparedness for potential terrorist acts.

Last October, Dr Tenenbaum made a trip to Israel, with about two dozen physician members of the American Physicians Fellowship for Medicine in Israel (APF), to learn how medical personnel in that country respond to mass casualty incidents, such as terrorist attacks. The APF and the Israel Ministry of Health jointly sponsored the instructional program.

The course provided participants with a range of medical information that would help doctors deal with mass casualty situations in the United States, said Dr Tenenbaum.

The program included briefings from Israel’s senior Health Ministry officials on preparations for responding to civilian emergencies and disasters, based on the knowledge that has been gained from Israel’s experience with war and terrorist attacks. APF members were briefed on psychological preparedness for such incidents, as well as on coping with stress and terror.

Medical responses to nuclear, biological, and chemical warfare also were topics at the instructional sessions.

APF doctors visited a school of military medicine to discuss battlefield triage and treatment protocols, said Dr Tenenbaum.

The training included disaster drills at the Israel Medical Simulation Center. The doctors also observed an emergency drill at a Tel Aviv hospital.

The physicians visited Israel’s Nahariyah Hospital and the Kiryat Shmona underground medical clinic to learn about community preparedness.

In an interview at his Danbury office, Dr Tenenbaum said that he has been to Israel many times, but had not been there for 20 years, until his visit last October. The doctor, who has family members living in Israel, said he believes that US medical staffers are not as well prepared to deal with the casualties stemming from terrorist attacks as are Israeli medical people. Thus, he decided to make the trip to Israel for the training.

“They were teaching us to be teachers,” the doctor said of the APF course in Israel.

The level of preparedness exhibited by Israeli medical and military personnel sets a good model for the US in responding to terrorist attacks, such the events of September 11, 2001, the doctor said.

“Israel has always had to deal with a threat,” he noted. But “there is a hopefulness for a certain degree of normalcy,” he added.

Preparedness

A state of preparedness makes dealing with a terrorist attacks less harrowing, Dr Tenenbaum said. Being prepared for disasters is “empowering,” allowing people to continue living their lives in the face of threatening circumstances, he said. “The level of preparedness [in Israel] is unbelievable,” he said, adding that Israeli medical personnel approach treatment through a technologically based system of health care. 

Israeli medical personnel consider the use of chemical nerve agents in terrorist attacks to be a very real threat, Dr Tenenbaum said. Such agents, when aerosolized, permeate victims’ clothing, posing the need for thorough cleansing to purge the toxic substances from the victim. The APF physicians observed drills that demonstrated how to best handle such contamination problems, he said.

A particular threat is posed by the nerve gas known as Sarin, Dr Tenenbaum said. “It’s terrible, it’s terrible,” he stressed. Sarin is a colorless, odorless nerve agent that is much more lethal than cyanide gas.

Israeli medical personnel perform many more emergency drills than do their US counterparts, said Dr Tenenbaum. After the Israelis conduct a drill, they have a debriefing session to determine what went wrong and what went right during that drill, in seeking to improve performance, he said. Such debriefing sessions would well serve US medical staffers after their drills, he added.

In their training, Israeli medical staffers employ technologically based medical simulations to better prepare for disasters. Sophisticated electronic manikins are used to simulate patients who are suffering various maladies in drills conducted to help doctors best learn how to treat such patients, he said.

Doctors’ performance in such simulations is critiqued by a panel of experts. The exercises are graded on quantitative criteria.

Unlike Israel, which has faced a longstanding threat of terrorist attacks, US medical personnel have had a different mindset than Israelis concerning such situations, Dr Tenenbaum said.

“We live in a very reactive society,” he said. The doctor said he does not expect that the medical approach to dealing with terrorist attacks will change in the United States, unless the country is confronted by threats similar to those experienced in Israel.

Dr Tenenbaum said that for each individual physical injury experienced by Israelis during terrorist attacks, there are many more people who experience stress reactions.

Dr Tenenbaum said he plans to again visit Israel this year to get more training on how US medical personnel can best prepare to treat the victims of terrorist attacks.

The doctor said that, if needed, he and other APF physicians would travel to Israel during times of emergency to serve as substitute physicians for Israeli doctors who normally treat civilians there.

The APF’s mission is advancing the state of medical education, research, and health care in Israel.