The scenario of a terrorist attack, whether committed with IED or automatic weapons, is one of the most dangerous events that a rescuer can face. The most recent dynamics have shown the unpredictability of these attacks, their strong impact on the population, but also on the chain of command prepared for the management of emergencies. Overall, the police reaction is a fairly oiled mechanism, except in some embarrassing situations caused by the information flow jam or the convulsive desire of the mass media to provide information "at any cost".
Beyond the reactions of the police, subject to an operational protocol varying from country to country, among the first to intervene on the site there are always rescuers: firefighters, doctors and ambulance doctors. As with the armed intervention of anti-terrorism units, the rescue car often follows one modus operandi common variable according to the preparation and the ability - in men and means - of each state reality.
A terrorist attack is always a sudden, violent event, destined to sow panic among the unarmed population which, by now, has become the main objective of any jihadist and non-offensive. The deflagration of an IED, like the indiscriminate blasts of an AK-47, causes wounds of different types whose effects - physical and moral - last over time until they end up in what is commonly called PTSD (Post Traumatic Stress Disorder). Knowing how to manage every moment following the drama therefore becomes fundamental in order to save as many lives as possible, to restore normality as soon as possible, thus avoiding in the survivors a dangerous emotional overload.
A military approach to trauma
In June 2015 the US department of Homeland Security published the manual First Responder Guide for Improving Survivability in Improvised Explosive Device and / or Active Shooter Incidents (click here for the document) dedicated expressly to rescuers facing the effects of a terrorist attack. The guide particularly emphasizes the tools that health personnel must use towards patients, emphasizing how this should refer in particular to TTPs (Tactics, Techniques and Procedures) in force between the Combat Medic of the army (the TCCCs - Tactical Combat Casualty Care). The lesson learned from the military sphere and its applicability in the civil context arose in the 2011 thanks to the Committee for Tactical Emergency Casualty Care (C-TECC) which has transferred, with appropriate modifications, military methods to EMS personnel. EMS employees thus take advantage of military courses particularly dedicated to explosion or firearm trauma. In addition to the strictly medical part, rescuers learn how to move in a scenario where weapons or potential bombers are present and contextually with traditional equipment, they are supplied with bullet-proof vests and ballistic helmets.
According to a study carried out by the American army during the Vietnam War, the main cause of death on a battlefield was the inadequate treatment of bleeding: the danger of hypovolemic shock often led to the death of the soldier. The standards prepared by the C-TECC have specified that today nobody has to die anymore due to uncontrolled bleeding, paying particular attention to the methodologies for a rapid treatment of open wounds and the immediate evacuation to the first hospital facility available. Everything - according to the typical American costume - was synthesized in the acronym THREAT: Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical provider, and Transport to definitive care.
The continuous training of rescuers therefore becomes fundamental: the preparation of scenarios and following the best practices where applying the new teachings is common practice for both professional EMTs and volunteers. The latter, which constitute the founding part of many national first aid systems, reach levels of excellence in Israel where the fight against terrorism involves the entire population.
The Israeli "voluntary" model
The whole world has imprinted in the mind the post 9 / 11 images that have consecrated the courage and dedication of the New York firefighters (FDNY) and the EMS Paramedics teams to eternal memory (Emergency Medical Service); others recall the British paramedics during the 2005 in July and the impressive images of people fleeing the underground receiving first aid. In Israel, certain frames or television footage are on the agenda because Tel Aviv and Jerusalem have long been the regular target of Palestinian terrorists who - according to reasoned planning - undertake real bombing campaigns in Jewish cities. An experience that is by no means enviable, but nevertheless useful to the Israelis to refine a series of intervention techniques and protocols that today serve as examples throughout the world. The Israelis have elaborated the consequences of a terrorist attack in all its multiple aspects, even in the management of media communication consistent with a deontology aimed at not spreading fear further. The place of the attack is isolated without too much fanfare and the main purpose of the rescue is to restore the return to normality as quickly as possible.
As regards physical damage, the explosion of an IED or a suicide bomber has devastating effects and determines a type of trauma that can only be found on the battlefields. As previously mentioned, the damages resulting from an attack are also of a psychological nature, both for the victims and for the rescuers themselves: The coordination of an “after-explosion” scenario can cause a sense of loss even to the most prepared paramedic. A particularly burdensome practice is then that of the recomposition of corpses, their recognition and the subsequent burial which, in the case of some religions, has a very important meaning.
From 1995 Israel, beyond the famous Magen David Adom (Red Star of David), deploying a large army of rescuers (over 3000 volunteers) called ZAKA who have refined their preparation specifically on types of post-attack intervention. In 1989, the founder Yehuda Meshi-Zahav along with his university colleagues, assisted helplessly at the macabre spectacle of an explosion on a bus in which many people were brutally wounded and 17 perished. A few years later, Yehuda set up an organization dedicated to recognizing victims of terrorist attacks, recomposing bodies and burial according to the ritual requirements of the Jewish religion: the acronym ZAKA (Zihui Korbanot Ason) means, in fact, "Identification of victims of disasters".
Today the ZAKA, whose operators are recognizable thanks to the unmistakable yellow bib, boasts an enviable structure and has not stopped its vocation as the first relief organization on terrorist scenarios. In the sections, scattered in every corner of Israel, thousands of volunteers work, including a hundred ultra Orthodox who, not serving in military service, compete differently for the welfare and defense of citizens. The ZAKA volunteers also act as a glue between the various organizations and the complex socio-religious realities in the country. The primitive unity of the ZAKA is the Chased Shel Emet (True virtue) that still today deals at 360 with victims and survivors of attacks. The deceased are treated with extreme caution because the work of reconstruction and identification mostly involves the emotional sphere of the population: who is the victim? Did I know her? Could I be there? In this regard, once the work on the road has been completed, the ZAKA volunteers set themselves up as interlocutors between the authorities and the relatives of the dead, who require a convenient psychological support that puts them in the wake of unwanted post-traumatic effects such as anxiety, fear or panic attacks. On a legal level, the Chased Shel Emet has a privileged relationship with Israeli judicial authorities who draw on their expertise to reconstruct evidence useful for forensic investigations.
Beyond this "historical" section, the ZAKA engages traditional rescue units like the ones Rapid Rescue Unit (which uses motorbikes to get to the site of the emergency more quickly), le Divers Unit (divers) together with the Jet Ski Units dedicated to maritime rescue. The canine section also operates on land (which is trained together with the groups Oketz of the IDF) and that equipped with off-road vehicles (Jeep Unit) to reach inaccessible places. The ZAKA - as mentioned above - pays particular attention to religious minorities: there exists, in fact, the Minorities Unit in which volunteers belonging to the Druze and Bedouin communities meet, as well as Christians and Muslims.
The efficiency of the ZAKA crosses the borders of Israel thanks to the establishment of a special international unit (the ZAKA International Rescue Unit) with groups of volunteers scattered all over the world ready to intervene for any cataclysm.
Faced with so much organization one wonders what the situation in our country is and what would happen if, unfortunately, he was struck by events like Paris or Brussels. The Italian relief system changes according to regional laws and regulations, so it is not standardized. The "first aid" subject is essentially based on the fire brigade or 118 operations centers which independently prepare exercises and courses and following the best practices to inform about new procedures or types of intervention. The individual preparation of rescuers is generally good, they show it every day on the roads of Italian cities, but the gap between tasks and training is still too wide. On this subject, delicate and everything to deepen, we hope to never have to write, especially to avoid that sad and pointless theater - typically Italian - on the hysterical passage of responsibility.
(photo: US Army / US Air Force / ZAKA)
