Toothpaste grenades.  Bombs in iPads?  Exploding clothing!  How scared I am.  Not the typical Dr. Seuss rhyme we grew up reading.  U.S. officials announced on Tuesday, Sept. 23, that one of the reasons for the recent bombing on Islamic State (ISIS) and Khorasan Group member locations in Syria and Iraq was because of intelligence that indicated these groups had obtained materials for improvised explosive devices (IEDs) that could be concealed in handheld devices such as smart phones and tablets as well as clothing dipped in explosive material.  These could then be used in coordinated, multiple “lone wolf” attacks.  See the story on CNN.

As physicians, how do we prepare to treat victims of possible terror attacks?  Hospitals have run terrorist simulation disaster drills for years, and the new information coming from the White House indicates that targets might not just be big cities.  Coincidently, September is National Preparedness Month, with a large focus on how citizens can plan and be ready for any type of attack.  First responders, including healthcare workers, will be more effective if they know that their own families are ready for such a disaster.  Having your own emergency supply kit, as well as a family emergency plan, will be part of that readiness.  Israeli physicians have been dealing with these issues for decades.

Blast injuries will be a common issue for survivors, as we saw in the Boston Marathon bombing.  The Centers for Disease Control has created Fact Sheets for Blast Injuries specifically for healthcare professionals.  Half of the victims will seek medical care within one hour, and there will be higher morbidity/mortality in confined spaces such as buildings or buses.  Multiple penetrating injuries and blunt trauma are often seen.  Primary blast injuries are due to the over-pressurization blast wave, which leads to tympanic membrane injuries, lung damage, air embolization and hollow viscous injury.  Secondary injuries are usually due to penetrating trauma due to flying debris.  Tertiary injuries are caused by the “blast wind,” leading to fractures and amputations.  Quaternary effects are caused by burns, chemical exposure and crush injuries.

In addition to the significant care that is focused on the physical injuries due to a terror attack, the psychological well-being of the survivors and the healthcare responders is just as important.  The cognitive, emotional and behavioral changes, including stress reactions, are significant.  It is crucial to allow survivors to talk about their reactions and validate their feelings and concerns.  Post-traumatic stress disorder, depression and anxiety will be best treated long term with the appropriate mental health professional.  If you happen to be an emergency care provider in such an event, key facts to remember for yourself include pacing yourself, taking breaks and rest when needed, paying attention to the surroundings, which may cause further risk of damage, and recognizing things that you may not be able to change.  See the CDC’s links on coping with a traumatic event, mass casualties and health and safety after a bombing.

The unsettling irony of the past few days is that I took my son to the wireless phone store on Sunday and replaced his old phone with a brand new iPhone 6.  Bigger screen!  Larger battery!  Sleek, smooth and deadly if placed in the wrong hands.  I am officially freaked out now.  I might just have to blog about synchronized swimming sometime soon...


Stuart J. Glassman, MD

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