Interim Planning Guidance for Preparedness and Response to a Mass Casualty Event Resulting from Terrorist Use of Explosives

Internationally, explosions can produce instantaneous havoc, resulting in numerous patients with complex, technically challenging injuries not commonly seen after natural disasters. Because many patients self-evacuate after a terrorist attack, pre-hospital care may be difficult to coordinate and hospitals near the scene can expect to receive a large influx, or surge, of patients after a terrorist strike.

The threat of terrorism exists at a time when hospitals in the United States are already struggling to care for patients who present during routine operations each day. Hospitals and emergency health care systems are stressed and face enormous challenges. With the occurrence of a mass casualty event (MCE), health systems would be expected to confront these issues in organization and leadership, personnel, infrastructure and capacity, communication, triage and transportation, logistics, and legal and ethical challenges.

This document, which is the result of the expert panel meetings, reflects the opinions and recommendations of the experts. It includes a description of system-wide and discipline-specific challenges as well as recommended solutions to address these challenges.  The proposed solutions for the discipline-specific challenges have been incorporated into easy to use templates that can assist various disciplines in managing surge needs for injuries.

The purpose of this interim guidance is to provide information and insight to assist public policy and health system leaders in preparing for and responding to an MCE caused by terrorist use of explosives (TUE). This document provides practical information to promote comprehensive mass casualty care in the event of a TUE event and focuses on two areas:

• Leadership in preparing for and responding to a TUE event, and
• Effective care of patients in the pre-hospital and hospital environments during a TUE event.

This guidance recognizes the critical role that strategic leadership can have on the success or failure of preparing for and responding to a terrorist bombing. It outlines important leadership strategies for successfully preparing for and managing a TUE mass casualty event, including the concept of meta-leadership.

Critical steps must be taken throughout the response to ensure rapid and efficient patient triage, effective and appropriate distribution of patients to available hospitals and health care facilities, and proper management of the surge of patients at receiving hospitals.

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Additional Resources

• In a Moment’s Notice: Surge Capacity in Terrorist Bombings
• Blast Injury Fact Sheets
• “Bombings: Injury Patterns and Care” interactive training on CD-ROM
• “Bombings: Injury Patterns and Care” PowerPoint on CD-ROM
• “Bombings: Injury Patterns and Care” poster and pocket card
• Blast Injuries: What You Need to Know Webcast
• Blast Injuries: What Clinicians Need to Know (Podcast)
• The Terrorism Injuries Information, Dissemination and Exchange (TIIDE) Project