Impact of terrorism on the US. Measures, the US has laid out in order to address this issue - Essay Example

? MHE 514 Module 3 – SLP: Terrorism Outline David Robles TUI 27 June Terrorism I. Terrorism Events Terrorism is an activity which is directly attributed to activities of man which endanger civilians; its main purpose is to achieve religious or political goals. It is designed to attract the attention of those directly affected by the activities and those who witness the event. Terrorism is often also meant to send a message about the importance and urgency of their terrorist motives. People employed the use of this term widely until a few decades ago, using it to refer to terrorists with political, social, religious, or any other agendas who would cause harm to people and property in order to make their voices heard. However, it has recently come to refer mostly to religious terrorists – those who try to make their religious agendas heard by causing destruction and harm (Weinberg, 2006). Terrorist attacks have been troubling several countries for the past decade leaving victims and other individuals involved in damage or contingency control physically and mentally traumatized. For these people, there is a need to understand this fabricated disaster in order to enable mental recovery from the trauma and to help prevent its recurrence. In effect, there is now an apparent need to consider the in-depth analysis of this disaster, encompassing its causes as well as its effects and implications. Various activities are considered ‘terrorist,’ including the bombing of targeted civilian populations; the use of biological agents like anthrax; the use of chemical agents; the use of nerve gas; and the use of radiological dispersion devices. These activities are carried out for political and religious purposes and to gain the attention of authorities and other individuals to the apparent injustices which these terrorists are experiencing from the society. II.      Lessons Learned from the Events There are various lessons which have been gained from these activities. For one, injuries from bomb explosions may be categorized based on the cause of the injury. Primary blast injuries may be caused by the blast waves; secondary blasts may be caused by projectiles; tertiary blasts may be caused by victims being thrown against stationary objects; and quarternary blasts may be caused by fires and heat from the blasts (Shapira, Hammond and Cole, 2009). In effect, the injuries or impact of an explosion would depend largely on the distance of an individual from the explosion. Those who are nearer to ‘ground zero’ would likely receive more severe injuries and those farther away would likely receive the more minor injuries. The management of these injuries is based on the proper identification of the degree of injuries and the determination of parties who need medical care and still survive. There are various clinical presentations of anthrax as an agent of bioterrorism. These are: cutaneous, gastrointestinal, and inhalation (Roy, 2005). The cutaneous anthrax is characterized by painless pruritic papules, vesicles, or ulcers, as well as black eschar; it may also include fever, malaise, and headache. Gastrointestinal anthrax is caused by the ingestion of meat products infected by anthrax. In this case, the spores are actually imbedded in the oropharyngeal and abdominal tract. The symptoms of this method include nausea, vomiting, fever, and severe abdominal pain. Lastly, inhalation anthrax is the most fatal form of the disease and as such causes the most concern among authorities. This mode of contact makes the contamination with the spores faster through their inhalation inside the lungs. Once inside, these spores germinate and release toxins into the lungs (Roy, 2005). In effect, anthrax poses a significant amount of danger because it can be delivered to the body in different ways. There are thousands of known chemical agents regularly being used by many people around the world, and some of these are actually used as tools for terror. Various incidents have proven how terrorists have access to funds, raw materials, and technology – tools which they can use to carry out chemical-based attacks (Marrs, Maynard, and Sidell, 2007). Due to their considerable resources, attempts to stop these terrorists from using chemical agents have gone through various difficulties. These chemical agents have evolved throughout the years, but for now, the more popular and common agents include phosgene, mustard gas, oximes, ricin, and similar agents (Newmark, 2004). As for nerve agents, there are known therapies for these, mostly the organosphosphonate nerve agents, however for these agents to work, these victims must be quickly given appropriate treatment immediately (Newmark, 2004). Most of these nerve agents often used in terrorist attacks include the Tabun, Sarin, Soman, and the VX. As for nuclear radiation symptoms, these usually appear at the time of the explosion and after contamination from the dust fallout (De Lorenzo, 2003). No effective treatments are available in reversing the impact of exposure to radiation. The most effective treatments available are mostly on the management of symptoms. This is an unfortunate circumstance as cell death often manifests in the body of victims of exposure (Fraser, 2008). Radiation sickness may manifest in various ways, including, nausea and vomiting, diarrhea, skin burns, weakness, fatigue, loss of appetite, fainting, dehydration, inflammation, bleeding from the nose, mouth, gums, or rectum, low red blood cell count, and hair loss (Fraser, 2008). Based on the above considerations, terrorism has now taken on a more contemporary means of perpetuating fear. These methods have transcended the use of guns, bombs, and other conventional tools of warfare. All these methods of perpetuating terror make the prevention and management of terrorism difficult. III. Skills Gained from an Understanding of the Events There are various skills gained from the understanding of terrorist events. Due to the variety and severity of injuries which may be sustained in bombing incidents, medical professionals need to use efficient triage methods to keep critical mortality rates low (Keyes, 2005). Triage methods include the following: triage sieve, triage sort, preliminary/primary survey, and secondary survey (Advanced Life Support Group, 2005). By understanding the terrorist events, it is possible to gain familiarity with the signs and symptoms of anthrax contamination. Identifying these signs and symptoms are crucial in identifying victims in populated areas (Roy, 2005). Understanding terrorist activities also assist medical professionals in establishing the difference between the accidental and deliberate release of chemicals, as well as the following details in these activities or attacks: single versus multi-scene, single vs. multi-substance, identity of substance, intent to cause harm, source and quantity, available information, safety plans in place, affected areas, consequential disruption, number of casualties, and chemical effects as causes of injury (Marrs, Maynard, and Sidell, 2007). These details establish important information about the attack, information which can help efficient management of the disaster. An accurate understanding of terrorist activities also helps inform concerned authorities that acute nerve agent poisoning can be treated in several ways. For one, it can be treated through decontamination (Newmark, 2004). This is used as a precaution in the hospital setting in order to ensure that responding health professionals in the ER will not be contaminated. It can also be treated through respiratory support (Newmark, 2004). Since nerve gases often imply respiratory death, care must be taken not to give atropine to the patient before ventilator support. Finally, antidotal therapy can also be used with the application of atropine or any other cholinergic blocker available; with the use of an oxime; or with the use of an anticonvulsant (Newmark, 2004). By understanding terrorist activities, the concerned officials would be able to establish that radiation-related symptoms and illnesses may manifest after contamination with radioactive substances utilized by terrorists. Moreover, various psychological effects are likely to manifest from these attacks. As such, victims of terrorist attacks must be handled with utmost care and caution. Their management must include interventions for their physical injuries, radiation illness and radioactive contamination, and for the psychological effects of the attack (Veenema, 2007). IV. Outcome of Terrorism Events in Terms of Coping, Stress, and Trauma Terrorism has various effects in terms in relation to coping, stress and trauma. First and foremost, over-triage has a negative impact on mortality rates during disaster management. It should therefore be avoided as much as possible in order to prevent further unnecessary loss of life. In order to achieve this, high-quality trauma care must be provided to critical patients placed on high priority, based on survival rate (Keyes, 2005). Secondly, the management of anthrax is mostly based on the means of exposure. Each means of exposure has its specific treatment plan and establishing how the anthrax was contacted helps to ensure that the right type of intervention is used (Roy, 2005). Nevertheless, interventions for anthrax include antibiotic therapy, post-exposure prophylaxis, antibiotic therapy for special groups, immunization, and infection control (Roy, 2005). Thirdly, due to the deliberateness of chemical terrorist attacks, medical professionals are more likely to be exposed to conditions which are very much different from accidental chemical release. Such conditions may impact on the efficacy of medical interventions (Marrs, Maynard, and Sidell, 2007). Fourthly, the neurological impact of biological and chemical agents may include lethargy, depression, disorientation, disassociation, depersonalization hallucination, paranoia, and cognitive slowing and these outcomes may be lessened by the following remedies: stress debriefing, community level support groups, mental health assessment and interventions, and terrorism trauma interventions (Benedeck and Grieger, 2009). Finally, the psychological trauma caused by terrorism is more likely to cause psychosomatic suffering on victims. Patients who are likely to worry and have panic attacks may mistake a simple headache as a sign of radiation sickness. Medical professionals must therefore learn how to differentiate from the real and from the imagined illness; and they must be able to educate patients regarding their perceived condition. V. Prevention-Oriented Educational Program for Disaster Response Preparedness or Mitigation There are various prevention-oriented educational programs for disaster response preparedness or mitigation of terrorist attacks. First and foremost, proper triage applications by the health professionals would sufficiently inform them that victims of terror attacks with minor or non-fatal injuries must be assigned and treated in designated areas after assessment. Those who are critically injured have to be prioritized and sent to the appropriate medical facility for treatment. Various studies emphasize the importance of triage in the proper management of mass casualties during terrorist bombings and similar attacks due to the fact that most of these attacks cause massive casualties and critical injuries. Einav and colleagues set forth that only about 20% of victims with critical injuries actually need immediate care. Treating individuals who do not need immediate care can cause delays in care for those who actually need it. In these instances, there may be an over-triage, and over-triage can sometimes cause delays in the recognition and delivery of care for those who have salvageable critical injuries (Frykberg, 2004). It is therefore important to give less importance to the care of expectant survivors who are injured so severely that their eventual survival is not likely. Caring for these patients is considered a waste of resources. Peleg, et.al., emphasizes on caring for injuries of the moderate severity, not that which is of the greatest severity. It is therefore important for health authorities to implement rapid and accurate triage in order to minimize the mortality of survivors. In this case, it is important for the triage leader to also be a very experienced trauma surgeon. It has become apparent that mortality among those critically injured is often directly attributed to over-triage (Frykberg, 2002). Triage must be carried out outside hospitals as an aggressive screening process in order to allow those who most need urgent attention to avail of immediate and life-saving medical care. This situation sets forth an example of the importance of mass casualty disasters needing a major paradigm change in their routine approach to emergency room care with unlimited resources; in such a case, triage is not often used because all patients are admitted for evaluation without considering their urgency or salvageability (Frykberg, 2004). The overwhelming numbers of urgent injuries in these disasters call for an initial assessment to be immediately performed by smaller medical teams. In relation to care, only minimal and essential care can be given to these patients – in order to keep them alive long enough to be transported to the hospital to receive adequate medical care. These casualties must be smoothly moved from one area or level of care to another; in this case, from the holding areas, then to the ICU, to the operating room, to other hospitals, based on the nature of the injuries (Frykberg, 2004). The length of time which passes from the time the patient is placed in the triage until the time he receives care in the hospital is not exactly known because the communication between those in the triage team and those in the hospital is often broken during these disasters. It is therefore important to establish a plan for relieving medical teams after several hours and for evacuating treated casualties to hospitals to make room for other casualties. The importance of rapid response and care is also crucial in the ORs; in this case, damage control measures have to be carried out first to accommodate as many patients as possible. The surgeons must also be ready to handle the complex wounding patterns to be seen among their patients. They must be ready to handle these complicated and multiple injuries in order to ensure the survival of the blast victims (Frykberg, 2004). The coordinated interaction of hospitals is also important in order to manage the casualty load and to prevent these institutions from being overwhelmed. One of the primary lessons which this paper seeks to emphasize is the fact that all health facilities or hospitals must be fully prepared to deal and handle mass casualties. In effect, hospitals are expected to be fully staffed and equipped to face any mass casualty anytime. Another aspect of disaster management includes educating the public on the effects and the symptoms of exposure to biological agents will make the process of separating exposed individuals from the general population easier. Keeping the public well-informed of the actual dangers of bioterrorism will prevent people from taking unnecessary trips to the hospital (Danieli, Brom, and Sills, 2005). In order to ensure disaster management, medical professionals may be trained in various aspects of managing chemical terrorist attacks, including risk assessment, protection of responding personnel, scene management, medical interventions at the vicinity of the attack, protocols, and exercises (Marrs, Maynard, and Sidell, 2007). Pretreatment may also be considered as a precaution against nerve gas exposure. An example will be the administration of 150 mcg of Huperzine A per day. The public must also be armed with the proper preventive and therapeutic agents in their cars, their homes, and workplaces. Furthermore, there are natural antibiotics and antitoxins which are well documented in medical literature. This may be used as supplementary resources (Ray, 2006). An aeromedical evacuation capability would also be a useful element of preparedness. The AE team must be prepared to handle symptoms of radiation exposure which are delayed, including gastro-intestinal bleeding, diarrhea, electrolyte imbalance, bone marrow failure, and pancytopenia (De Lorenzo, 2003). There must also be contingency plans in the event that landing permission would be refused for aircrafts carrying contaminated victims or in instances of radiation-exposed nuclear casualties. Decontamination is the important first step in the management of casualties of a nuclear terrorist attack (De Lorenzo, 2003). It is also important for every community to have a disaster plan against terrorism, or any other disaster. In order to establish such a plan, the coordination and collaboration of agencies and various disciplines like public health, law enforcement, fire departments, and EMS, utility companies, government and business officials, hospitals, health professionals, schools, and local military institutions must be secured (AMA, 2006). These plans must consider the short and the long-term activities which would include the mobilization of resources in the protection of public health and safety, restoring primary government services, providing relief to the victims (AMA, 2006). These disaster plans must consider the entire population, especially those with special needs, such as the children, the elderly, the pregnant women, the mental health, and the disabled patients. Such a disaster plan must also specify the role of the volunteer citizens who are likely to arrive first at the scene and who may serve as link between incoming EMS personnel and the victims or injured parties (AMA, 2006). Health professionals have an important role in managing disasters; therefore, they must be present during the planning stages of disaster management in order to ensure that all the health needs of the community are addressed (AMA, 2006). These health professionals must also be present in order to ensure that the disaster plans include the elements of effective participation of public health professionals in all response activities (AMA, 2006). In any disaster, community resources would likely be challenged by the influx of individuals seeking medical care. Designating people to the appropriate resources must be properly coordinated with the state, local, and federal authorities. The current systems are not well-coordinated with each other due to state differences in emergency care. It is therefore important to establish standard techniques in the disaster management activities in order to ensure proper care for victims of disasters. In a discussion by Frykberg (2004), the author set forth that one of the first lessons which need to be considered in disaster management is the fact that bombings and shooting massacres are still the most common forms of terrorist attacks. These methods will continue to be used in future terrorist attacks, despite the availability of other forms of attacks. In the US borders, millions of dollars of property damage, as well as hundreds of lives have been lost to terrorist attacks (Slater and Trinkey, 1997). These methods of perpetuating terrorist attacks are the least costly, but the most effective in achieving terrorist goals – which is primarily about causing large-scale casualties. In effect, surgeons, as well as acute trauma specialists must be involved in leadership roles in disaster management, and they must also be involved in the local hospital and community disaster planning setting (Frykberg, 2004). It is also important for health professionals to develop the expertise in the management of explosive injuries, its patterns of severity, as well as the principles of mass casualty management which are very much different from the usual approaches to trauma (Frykberg, 2004). It is also important for authorities involved in disaster management to be less focused on weapons of mass destruction, because the actual bomb threats are more likely to occur as compared to biological or chemical attacks. Vulnerability in dealing with the terrorist attack becomes apparent when communities and government officials are not equipped to deal with terrorist threats. The ability to respond to disasters includes the crisis management process. However, this is only part of the reactive element of preparedness (Wilen, 2002). Prevention is an equal element of preparedness and the balance can be seen with universal cooperation, the incorporation of shared and valid data, as well as open communication and consistent education. Disaster preparedness can be achieved with the cooperation of various governments and agencies in the local, regional, state, and global level, as well as the private and public sectors (Wilen, 2002). These agencies and levels of governance working in close cooperation and coordination with each other can help minimize the impact of terrorist attacks. The September 11 attacks exposed the vulnerabilities of the US in terrorist disaster management. These vulnerabilities have created various responses which focus on prevention; these measures however do not take full advantage of the strengths which the US possesses (Wilen, 2002). Most of the approaches which have been set forth to date seem to be reactive in nature, basically waiting for the terrorist attack to occur and then responding to the attack through crisis management. Although seemingly inadequate, these measures must still be supported by concerned authorities and health professionals. But, on deeper analysis, the US does not have the resources to handle casualties caused by a minor nuclear attack to a group of urban targets simultaneously; it also does not have the capability of handing a terrorist attack caused by smallpox virus exposure in multiple and distant population areas (Wilen, 2002). The US does not have the capability of handling the release of toxic chemicals like that seen with the 1995 Sarin gas release by terrorists in Tokyo. With these deficiencies, it is important for the US to improve its disaster prevention methods and policies. Preparedness in preventing terrorist threats is an important element in avoiding a crisis from occurring or escalating. The focus of the management must not be on reacting to the attack. The focus of the US must be on its strengths; it must then build upon these strengths in order to establish programs which support both reaction to and the prevention of possible terrorist attacks (Wilen, 2002). A significant perspective can arise from the acknowledgement of the American capacity to include information and education systems with computers, supported by American resolve, ingenuity, and courage to defeat terrorism. Being merely reactive to terrorist attacks soon causes support for the needed response to wane; and then the US can sometimes slip back into complacency. The history of the US is marked with these moments. For example, the assassination of President McKinley caused President Roosevelt to implement the conversion of the monetary system to gold standard (Wilen, 2002). The Pearl Harbor attack prompted the US to join World War II; the assassination of President JFK led to the passage of laws on social and civil rights, as well as voting. And most recently, the September 11 attacks caused President Bush to declare a war against terror (Wilen, 2002). This trend of reacting must change and preventive measures must be imposed instead in order to prevent terrorist attacks and ensure adequate measures in place to manage its impact. Conclusion The discussion above sets forth the impact of terrorism on the US, and the current measures which the US has laid out in order to address this issue. Based on the discussion above, there is a need to implement preventive measures against terrorism, to make the response to terrorism less reactive, and more preventive. Health professionals also have a significant role in managing these disasters and improving the outcomes of these attacks. 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