How To Avoid a Disaster of a Disaster

24. April 2013 0

Book Review on: Leonard A. Cole and Nancy D. Connell: Local Planning for Terror and Disaster; Robbie Friedmann: 28 Letters

Two explosions at the finish line of the Boston Marathon 2013 - picture: screenshot from youtube

Two explosions at the finish line of the Boston Marathon 2013 – picture: screenshot from youtube

Cole and Connell are to be congratulated for a reader handbook, a compilation of essays running the entire spectrum of emergency team players who must in a moment’s flash meet head on a  Major Casualty Event (MCE) either a terrorist attack (bioterrorism or cyber terrorism as well) or a natural disaster. These essays are the outcome of two conferences bringing together a distinguished set of experts who cover a variety of events. However, these essays are not your mundane volume of conference proceedings. The editors have gone to great lengths and have taken great care in selecting the authors who contribute and have expertise in the subject matter.

One of the greatest challenges they bring to our attention is maintaining a balance between living within a hair’s breath of death daily and at the same time the ability to embrace life. Ironically, in the midst of reading Cole’s and Connell’s book, I received an email from a mutual colleague, Dr. Robbie Friedmann, notifying his colleagues of his just published book, 28 Letters. Full disclosure, I met both Dr. Cole and Dr. Friedmann through the annual counter terrorism conference in Herzliya, Israel at the Interdisciplinary Center for Counter Terrorism. I highly recommend the conference and both of the following books but here I am getting ahead of the story.

Local Planning for Terror and Disaster. From Bioterrorism to Earthquakes does a great service in describing and outlining a history of how to deal with major trauma episodes. As the author of The Banality of Suicide Terrorism, my forthcoming book Cracking the Code to Global Terrorism, as well as an expert on PTSD, I read the book with great interest.

I found the essays to be insightful ranging from underscoring the failure to hear and understand the “chatter” and also a warning before the catastrophe of 9/11 as well as a failure of imagination by counter terrorist experts. Terror and disaster are fundamentally horrifying and hence not only concretely chaotic but psychologically disorganizing. Planning for terror means being proactive. One must be on the offense.

As a kid I learned first aid in school and in Girl Scouts, knowing that it can save lives. Education is key as an ongoing effort along with repeated drilling and exercises which should involve the entire spectrum of players in the community including bystanders. What follows are some examples of some significant contributions.

The introductory essay by Cole on Preparedness, Uncertainty and Terror Medicine drives home the point of the difficult taste at hand to think outside the box of the most horrendous scenarios in order to save lives. It is a mind boggling paradox. Connell along with Cole conclude with Preparedness, Black Swans and Salient Themes. Panayotis Yannakogeorgos’ essay on cyber terrorism is a must read for it is much more difficult to conceptualize for many cyber attacks.

Steve Crimando’s essay concerning the radiation emergency in Goianas, Brazil clearly stresses the challenging set of problems of an emerging society and diverse cultures where literacy is not a given. It is understandable how a disaster spreads so quickly without a given infrastructure to meet such a disaster head on. As the world becoming increasingly more mobile and global, connectedness is both a plus and a minus also entailing the real necessity of communicating across a multitude of languages. One point which could have been made is when working in developing countries, we are often confronted with the illiteracy of shame honor cultures. A dynamic where terror is intimately intertwined with shame and loss of honor and an automatic trigger for uncontrollable rage.

A gem of an essay is penned by David L. Glazer concerning the role of the dentist in a terror event. While we all may know of the importance of forensic dentistry in the identification of victims especially for 9/11, few of us probably know about the heroic efforts which two dentists played as first responders at the suicide truck bombing of the  U.S. Marine Barracks in Beirut in 1983. The physician on site, Dr. Hudson, was murdered in the blast. Drs. Ware and Bigelow were tasked with setting in motion the medical plan in which they had been previously trained by Dr. Hudson and give him credit for helping them save lives. Yet the story does not end here as Glazer maps the importance of dentists as considered to be first responders on the first line of defense in terror related MCE, especially bioterrorism. Because of their expertise and diverse knowledge, they can be easily mobilized for they are well versed on diseases and lesions. In their offices, for example, they are like mini-hospitals which could serve as a great help with a surge of patients that have to be triaged in a rapid manner. In addition, he proposes a special curriculum be developed and students trained in it. This is innovative thinking which should not go to waste. The public needs to be aware with such a plan so that there is no resistance to dentists as first responders and they will facilitate rapid implementation of strategic responses to protect the public.

Shmuel Shapira and Limor Aharonson-Daniel sketch out the role of the manager of mass casualty and disaster events. They remind us of the Wedding Hall Collapse of May 2001 in Jerusalem at the height of suicide bombings which initially lead to responders thinking that it was a terrorist attack. The distinction had to be made quickly for if this were a suicide attack, it would involve a different complex intervention and treatment from that of a disaster, which this was. The authors also raise the painful yet realistic issue of dealing responsibly with a threshold for avoiding treatment. While the Wedding Hall tragedy was not a radiological event, the authors discuss such a possible that  patients “would receive only palliative care. That is because no matter what manner of care whole body exposure to such radiation levels means almost certain death in a matter of weeks.” Their essay also discusses “When a Hospital is directly affected by an event” in the case of Hurricane Katrina.

Bruria Adini’s contribution – The Role of the On-Scene Bystander and Survivor by referring to the suicide bombing outside the Dizengoff Shopping Mall March 4, 1996 here in Tel Aviv. She develops sixteen functions that bystanders and survivors can perform: reporting an event, reconnaissance, assisting in the triage of casualties, caring for the walking wound just to list a few. We often underestimate what we are capable of doing in the moments of MCE.

Response remains crucial for it involves strategical planning with a heavy dose of improvisation. If there is one thing that is missing from this volume, it is a needed essay on how first responders and potential victims themselves must be trained in remaining calm under the most adverse circumstances. This should be an important and required teaching component, say for example, imaging to calm one’s self if the MCE begins to trigger and flood a first responder with extraordinary disorganizing anxiety.

In short, Local Planning for Terror and Disaster. From Bioterrorism to Earthquakes, is required reading for anyone involved in responding to MCE which means all of us, because we could all become first responders. Their advice: never stop training, fantasizing, thinking and planning outside the box for the worst case scenarios to improve on delivery of medical and emergency care.

I now must turn your attention to Dr. Robbie Friedmann’s book: 28 Letters. The Short Life Of Renée (Baba) Friedmann On Not So Calm Waters. Many Israeli studies were cited in Cole’s and Connell’s book. While there was no mention of Holocaust in Local Planning for Terror and Disaster, the Holocaust made Israel become the leader in trauma and terror medicine research. The Holocaust left its imprint on the surviving generations, many of whom chose medicine, psychology and other helping professions. Functioning “behind the scenes” is the trauma and the terror of the murder of six million Jews and those who survived the concentration camps. Friedmann’s parents were survivors though we learn tragically that his mother died six days after he was born.

The number 28 refers to 28 letters which survived of correspondence from his mother to her sister. It is a one way correspondence because we do not know how the sister replied. However it is an exceptional epistolary experience as the letters provided the avenue for the son to discover his mother as a mature adult. He had been raised by his step mother and the secret of his mother dying post partem was kept from him for many years. Friedmann shares with us poignantly, the beauty and the pain of discovering his mother through her correspondence with her sister who was in Israel while she remained trapped in Cluj, Romania awaiting for papers to immigrate to Israel to be reunited with her.

Friedmann relates how it took ten years to compile all the documents including precious photographs as well as the task of translating the letters. This is a unique source for scholars, students and the general public. Friedmann’s story is universal. It is humbling and eloquent. It is a reminder that we must not only try to prepare and plan for the unexpected but in the end we must find truth and freedom. 28 Letters was an enormous undertaking to translate, edit, analyze and write – the book is in Hungarian, English and Hebrew with all documents scanned and presented. I asked Friedmann in an email why he had chosen Blurb to publish his book through the platform of iBooks. He replied that Yad Veshem said there were many memoirs like his and that he could just wait in line to publish it due to the backlog. Fortunately for us, he had the fortitude to self-publish so that no more precious time has been wasted.

By remembering and commemorating past sorrow and tragedies, we free ourselves to recommit to educate the public, plan better and more wisely for future terror and disasters. Our task is to mourn the loss while still embracing life and meeting Mass Casualty Events head on. 28 Letters is an antidote to such wanton mass murder.

Leonard A. Cole and Nancy D. Connell (2012): Local Planning for Terror and Disaster. From Bioterrorism to Earthquakes. Hoboken (U.S.): Wiley-Blackwell, 260 pages, 81.99 Euro. Buy at Amazon.

Robbie Friedmann (2012): 28 Letters. The Short Life Of Renée (Baba) Friedmann On Not So Calm Waters. Available as eBook (11.99 Euro) or printed version (87.03 Euro).

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