The threat of terrorism has changed the way law enforcement officers are trained, and now it’s changing the way medical trauma teams are taught. In a new medical specialty called terror medicine, Rutgers New Jersey Medical School has instituted a curriculum on Terror Medicine and Security. NJTV News Anchor Mary Alice Williams recently asked its Director, Leonard Cole, to explain it.
Williams: What exactly is terror medicine?
Cole: It is a term that first evolved in the early part of the new century, the 21st century. It actually came out of Israel when they were having an experience with a lot of terrorist attacks. They developed techniques for medical response in particular that pretty much covered how to get to patients, how to take care of people in ways and with speed that was really not common previous to this incident.
Williams: How does terror medicine differ from standard triage in say a plane crash or accident?
Cole: Terror medicine is really much more inclusive than just the specific incident itself. It has to do with preparedness. It has to do with learning how to manage a potential incident. The nature of the injuries can be different, and ultimately the psychological effects are hugely different.
Williams: So specifically what are you training the students for?
Cole: I’ll give you some examples. The students that I teach, our course is given to fourth year medical students and is a two-week elective. Even though the students themselves are about to go into residencies and specialties, even though they may be going into a variety of different specialties, they’re not all emergency medicine types. Some of them are headed to be psychiatrists, some of them dermatologists, and virtually all of them have a part in this. The best example is to go back to the anthrax incidents we had in the United States soon after 9/11. Anthrax started appearing in the mail, powdered anthrax, and making some people sick and killing some people. Many of the physicians who first saw these patients, patients came to them. They didn’t know why they were feeling ill.
Williams: They had rashes.
Cole: Some had rashes. Others had inhalation effects. Neither they, nor the doctors, understood what was happening for some weeks. So it took a few weeks before we even recognized the symptoms.
Williams: So you’re training them to spot biochemical problems?
Cole: That’s one part of it. Another interesting feature, and this goes back to the Israeli experience, was that a suicide bomber can come up to you fairly close and blast himself or herself and there could be thousands of particles of bolts and nuts and screws that are part of the explosive in the course of an event. Trauma surgeons in the United States have seen all of the types of injuries that can be offered: burn, crush injury, bones broken. Hardly ever do they see that combination in one patient and you would get 20 or 30 people showing almost all these kind of varied effects and you have to determine, what am I going to treat first? Is it something, these penetration wounds, that I should go after? Should I be looking for broken bones? What? There are techniques that have been developed that fall under the category of terror medicine.
Williams: Standard operating procedure, something bad happens, the team goes in and triage is right there on the ground. You don’t necessarily want to leave those patients on the ground, right?
Cole: Absolutely not. There’s a technique called Snap and Run in Israel, where they just grab a patient. I’m talking about they, they may be emergency responders. They’re there, the ambulance drivers, the paramedics want to get them away from the scene of the activity for two good reasons. One is that in all cases, no matter how proficient the emergency responder, the treatments for the patients available in a hospital are infinitely better than the opportunity of treating somebody on the street. But when it is a suspected terrorist attack, you are also dealing with the problem of a possible second bomber, or a third bomber, who wants to blow up the medical responders as well.
Williams: What are the long-term medical implications for doctors who have to treat patients who are victims of a terror attack? Is there a psychological impact that has to be treated?
Cole: It is well-known, again a lot of this came out of the Israeli experience, that say an automobile, a terrible automobile accident, three or four people dead, a few are lying on the street, it has an awful impact. But in most instances when there is an automobile experience, or a burn or a fire, it doesn’t have the deep seeded anxiety that accompanies the possibility of more bombers or more individuals trying to get you, so you have much more need for longterm treatment.
Williams: It’s very difficult to wrap your brain around what just happened as opposed to a car accident.
Cole: It’s as simple as this: when you know someone is trying to kill you there’s a different psychological effect than if you happen to be in an accident, as bad as it may be, that nobody did on purpose.
Williams: Is terrorism medicine being taught around the country?
Cole: Aspect of it are, definitely. But ours, as far as I know, at Rutgers is the only formal course, the Rutgers New Jersey Medical School in Newark. That is the only formalized program. I’ve been talking about it and others have at various conferences and there’s been some moderate interest in perhaps adapting some of what we’ve been doing and adapting it around the country.