title: A four-step approach for establishment of a national medical response to mega-terrorism.
abstract: A simplified, four-step approach was used to establish a medical management and response plan to mega-terrorism in Israel. The basic steps of this approach are: (1) analysis of a scenario based on past incidents; (2) description of relevant capabilities of the medical system; (3) analysis of gaps between the scenario and the expected response; and (4) development of an operational framework. Analyses of both the scenario and medical abilities led to the recommendation of an evidence-based contingency plan for mega-terrorism. An important lesson learned from the analyses is that a shortage in medical first responders would require the administration of advanced life support (ALS) by paramedics at the scene, along with simultaneous, rapid evacuation of urgent casualties to nearby hospitals by medics practicing basic life support (BLS). Ambulances and helicopters should triage casualties from inner to outer circle hospitals secondarily, preferentially Level-1 trauma centers. In conclusion, this four-step approach based on scenario analysis, mapping of medical capabilities, detection of bottlenecks, and establishment of a unique operational framework, can help other medical systems develop a response plan to mega-terrorist attacks.
authors.affiliation: Home Front Command Medical Department, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Leiba
authors.forename: Amir
authors.initials: A
authors.lastname: Blumenfeld
authors.forename: Ariel
authors.initials: A
authors.lastname: Hourvitz
authors.forename: Gali
authors.initials: G
authors.lastname: Weiss
authors.forename: Michal
authors.initials: M
authors.lastname: Peres
authors.forename: Dagan
authors.initials: D
authors.lastname: Schwartz
authors.forename: Avishay
authors.initials: A
authors.lastname: Goldberg
authors.forename: Yehezkel
authors.initials: Y
authors.lastname: Levi
authors.forename: Yaron
authors.initials: Y
authors.lastname: Bar-Dayan
mesh_terms: D022561:Advanced Cardiac Life Support; D004189:Disaster Planning / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D007557:Israel; D009313:National Health Programs / Q000458:organization & administration*; D023481:Terrorism; D014187:Transportation of Patients; D014218:Triage