Reviews Book

Physician's Guide to Terrorist Attack

BMJ 2004; 328 doi: (Published 22 April 2004) Cite this as: BMJ 2004;328:1022
  1. Paul Grant, senior house officer (drpaul.grant{at}
  1. emergency department, Timaru Hospital, Timaru, New Zealand

    Paranoia is a wonderful stimulus for the imagination, and after reading this new guide you'll be surprised at the mind boggling ingenuity of 21st century terrorists. The very American interpretation of modern warfare suggests that there will be a move away from traditional theatres of war to more urban and civilian targets. This means that at any moment we can expect our local shopping centre to explode, the very water we drink to be contaminated while we receive anthrax through the post, and “rogue states” to drop dirty nuclear bombs on city centres. Mass transport systems are also highlighted, as attacks on these have the potential for widespread disruption and high numbers of casualties. The Supreme Truth sect's gassing of the Tokyo underground and the recent bombings of commuter trains in Madrid have, unfortunately, become textbook examples.

    Ed Michael Roy

    Humana Press, $89.55, pp 420

    ISBN 1 59259 663 0

    Rating: Embedded ImageEmbedded ImageEmbedded Image

    This well written guide provides in-depth, practical advice for dealing with a whole range of potential terrorist scenarios and, interestingly, for dealing with the psychological aftermath. Using numerous examples, it gives comprehensive and up to date information on the proper diagnostic and treatment methods for dealing with terrorist attacks.

    When Russian special forces stormed a Moscow theatre being held siege by Chechens last year they used a noxious opiate gas that caused rebels and hostages alike to collapse, vomit, and asphyxiate. The government hindered its own health services by refusing to identify the agent used, compromising many lives. In Japan, medical services were slow to respond after the sarin gas attacks, and this cost lives. In contrast, after the attacks on the World Trade Center and the Pentagon in 2001 the emergency services went into overdrive, efficiently putting major incident plans into action. Triaging of survivors—although initially difficult and chaotic—was streamlined, helping to reduce the mortality of such a large attack. This guide outlines the typical initial response to an attack and describes well the disorientating nature of the disorder that results, as well as the problems for hospitals needing to receive mass casualties or even responding to anxious patients fearful of exposure to a biological agent.

    Medical experts with a military background (think Dustin Hoffman in Outbreak) review possible infectious diseases and chemical agents that could be used in terrorist attacks. The book also deals with important issues of an “efficiently lethal” nature: casualties from blasts, nuclear and radiological weapons, guns, and mines. The possibilities for carnage are limitless, but this book provides an action plan for doctors at the front line of a terrorist attack response team and everyone working in an emergency department. It's scary reading but a good defence.

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