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?