UF Surgeon Calls On Medical Personnel To Revamp Terrorist Disaster Plan

September 6, 2002

GAINESVILLE, Fla. — As the anniversary of the attacks on the World Trade Center and the Pentagon nears, the U.S. medical community remains ill-equipped to anticipate and manage mass casualties wrought by deliberate terrorist acts on American soil, a University of Florida surgeon warns.

The confusion and naiveté that reigned in the aftermath of history-making events like Sept. 11 and the Oklahoma City bombing should serve as a wake-up call, before another disaster occurs, writes Dr. Eric R. Frykberg, in the current issue of the Journal of Trauma: Injury, Infection and Critical Care.

Although the medical care provided after these catastrophes was often admirable, even heroic, problems arose from inadequate emergency planning-a significant shortcoming that wasted valuable medical resources and in future scenarios could possibly cost lives, says Frykberg, a UF professor of surgery and a member of the Level I Trauma Center at Shands Jacksonville Medical Center.

Medical management of terrorist acts like explosions is complicated by the fact that few physicians have handled true disasters-those involving large numbers of civilians with such unique or serious injuries that local medical resources are severely taxed. And the drafting of hospitals’ emergency plans is typically relegated to nonmedical personnel who also have limited experience with these situations, Frykberg says.

“The biggest mistakes we know are made and continue to occur because we don’t pay attention to what others have been through, and as a result many existing disaster plans are totally useless and unrealistic,” says Frykberg, who, as a former lieutenant in the U.S. Navy Medical Corps, helped treat the first 65 military personnel injured in the 1983 suicide truck bombing of the Marine barracks in Beirut, Lebanon. “Most people put together disaster plans and drills with no concept of what a real disaster involves.

“We’re not well-prepared to deal with mass casualty events because up to now, from a medical point of view, we’ve always felt invulnerable,” he adds. “We think we always handle things like this, but a true mass-casualty situation is not like your typical Saturday night influx of multiple casualties into an urban trauma center. There are certain things you have to change in your approach, and it’s important for surgeons and trauma experts to be aware of that.”

On Sept. 11, with phone lines swamped and medical centers lacking adequate backup communications systems, medical students in New York City were sent on foot from hospital to hospital to check on the availability of beds, he notes. Calls for blood donation, although made with noble intentions, proved detrimental. And in Oklahoma City, a nurse was killed when she responded to the scene of the bombing to help rescue survivors.

“We should know: Blood is seldom needed in these situations,” Frykberg says. “As is typical of bombings, the most seriously injured are killed after the initial impact of the explosion. Very few survivors will have major injuries. After Sept. 11, thousands of blood products were donated to the Red Cross within the first two weeks, and several thousand units had to be thrown out. It was a waste of resources. People come to hospitals to give blood, and personnel had to be diverted from more important tasks to deal with them.

“Everyone wants to do something to be of help, but even medical personnel do the wrong thing because they don’t know any better,” he adds. “In Oklahoma City and in New York City, many doctors and nurses left their hospitals and started running to the scene. That’s irrational if you think about it, to leave a major concentration of medical resources-urban medical centers just blocks away-to set up tents at the scene. The first responders, firefighters, police and emergency medical technicians, are trained to be in areas of danger. Other health-care personnel are not. They’re putting themselves at risk, and they are risking the lives of surviving casualties.”

U.S. trauma specialists must take the lead in developing improved disaster plans and educational initiatives, Frykberg says, and should learn from countries such as Israel and from military medical forces.

Proper training and systematic planning for the orderly triage, stabilization and evacuation of casualties through a chain of treatment stations and hospitals in times of war have allowed the military to cope with massive casualty burdens “that would overwhelm the ordinary civilian community,” he wrote.

In disasters, health-care practitioners need to remember to shift from focusing on “the greatest good for each individual to the greatest good for the greatest number,” Frykberg says.

“Typically in everyday medical care everyone who’s injured goes to the hospital, and we use our maximum resources on each patient,” he says. “That’s great we can do that. The challenge in a mass casualty situation is in keeping most patients out of the hospital, not bringing them in. A change in mindset has to occur. Otherwise it will overwhelm the hospital’s ability to sort out the relatively few injuries that need major treatment from the tremendous number that don’t. If you don’t handle it properly, existing evidence clearly shows this can lead to unnecessary loss of lives.”

Although explosions and bombings are the most common instruments of terrorism, trauma specialists aren’t the only ones who should be concerned, Frykberg adds. Infectious disease experts, radiation biologists, toxicologists and emergency room physicians also should be schooled in proper disaster response because of potential threats like bioterrorism or chemical and radiation events.

“The best part of preparing for the future is just understanding the past,” he says. “By definition, disasters are rare, and the only way we can learn from them is through the experiences of others. Otherwise we’ll make the same mistakes over and over.”