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A Citizen’s Eye View of Public Preparedness

“Is Obama Ready For A Bomb On The Train?”

March 23rd, 2009 · No Comments

That’s the provocative question asked by the headline of an article written by Leonard Marcus, Isaac Ashkenazi, and Barry Dorn from Harvard’s National Preparedness Leadership Initiative with advice for the new Administration. The piece came out in December when this blog was on hiatus but I wanted to post it because the authors point out the important role of citizens in readying the nation for the possibility of a ‘bomb on the train’ or other type of terror incident. As they write in the article:

The last things President Obama will want to confront in his first year in office are the bodies of dead Americans and complaints of ineffective government response following a terrorist attack within the United States. His predecessors both faced terrorism in their first year in office: President Clinton on February 26, 1993 at the World Trade Center and President Bush at the same location and at the Pentagon on September 11, 2001. President Obama may well face a comparable attack.

However, a recent Washington meeting co-sponsored by the Centers for Disease Control and Prevention and Harvard’s National Preparedness Leadership Initiative…brought together homeland security, public health, and hospital officials from Boston, New York, Washington, Chicago, San Francisco, and Los Angeles, U.S. cities with subways and mass transit systems that are “soft targets.” They met with their counterparts from Madrid, London, Tel Aviv, Islamabad, New Delhi, and Mumbai, cities hit by mass casualty conventional attacks that left thousands dead and with preparedness and response systems that learned a great deal from the experience.

Colleagues from Pakistan and India described the panic and resulting chaos that reverberated in hospitals following suicide attacks. They reported on measures taken to restrict hospital hallways to those needing care and limiting the access of anxious relatives and eager politicians who descended on the hospitals and impeded efficient medical care. What should President Obama and other leaders take from these lessons?

Three of the six “lessons” directly involve the public:

3) The real “first responders” are not fire, police, and EMS professionals. They are the second wave of help. It is the crowd of fellow passengers who jump into action, on the scene, and who are able to assist and support victims in those critical first moments following injury. President Obama must ask himself how he can galvanize the populace so that they know what to do if they are present and physically able to help.

4) While official plans outline a well orchestrated series of compliant actions on the part of the population and responders, the immediate aftermath of such a tragedy is pandemonium. People do not wait for ambulances to get to the hospital. The “walking wounded” victims get there on their own, creating a first wave of moderately injured victims. Those who are severely injured and cannot walk, the “horizontal victims,” take longer to get onto stretchers, into the ambulance, and to the hospital. By the time this wave of critically injured patients arrives at the hospital, much capacity has already been consumed. One lesson from abroad: distribute less severely victims to more distant hospitals that are less likely to be overrun by the injured.

5) Think resilience. The intent of these bombings is to bring people down, to destroy our confidence, to foster fear, and to shatter our economy. We know the period after a new President assumes office is one of greater vulnerability. We must all be vigilant. If you find a suspicious package or observe suspicious behavior, report it to authorities. This is a time to be safe, not sorry. Be prepared to get back on your feet if we are hit. It will be difficult. However, returning to normal living is the most defiant of acts following a terrorist bombing. 9/11 was a wake-up call and we have been fortunate that, to date, there has not been a repetition. However, time dulls our memories and complacency sets in with its own dangers. Now is the time for our homeland security, our preparedness, and our response officials to turn their attention to what is a more likely set of threats. While we have little experience here, there is much we can gain from that of our friends abroad, and in the name of humanity, they are generous in their willingness to share what they learned.

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Tags: International · Preparedness Lessons · President Obama

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