EMS Response to a Terrorist Attack

Nancy Caroline, MD, was involved in emergency medical services from its earliest days until her death in 2002. Together with her coworkers in Pittsburgh, PA, she established a system that operated at the paramedic level very early in the development of EMS programs and was asked by the U.S. Department of Transportation to write the modular course materials for standardized training at the paramedical level. During the late 1970s, she authored the original paramedic textbook, Emergency Care in the Streets, which is now in its sixth revision.

For a time, Dr. Caroline left the United States to become the first medical director of Magen David Adom (MDA), Israel's Red Cross equivalent. There she developed a training program that enabled emergency workers to respond to terrorist attacks within minutes. In the Sept/Oct 1978 issue of EMS Magazine, Dr. Caroline shared her memories of the Coastal Road Massacre, which was a Palestinian terrorist attack on March 11, 1978, involving the hijacking of a bus on Israel's Coastal Highway in which 38 Israeli civilians were killed, 13 of them children, and 71 were wounded.

It was shaping up as another quiet afternoon that March 11th, and the dispatcher sitting alone before the central communications board at Magen David Adom headquarters in Tel Aviv noted only a few sporadic calls here and there. A man having difficulty breathing in Tel Aviv. A sick child in Tiberias. A woman in labor in one of the northern kibbutzim. Each of these calls would be dealt with by a regional dispatcher sitting at a similar communications board. The central dispatcher's job was simply to monitor and coordinate any calls which might require a joint response from more than one area. Even the computer, which constantly scanned the network of highway emergency telephones for breakdowns or calls, was strangely silent.

It was a large network of emergency medical services that sat mostly at rest that afternoon. Magen David Adom maintains 70 first aid stations, 130 substations and approximately 700 ambulances--one of the largest such coordinated EMS operations in the world. The facilities are staffed 24 hours a day by a few hundred full-time employees and several thousand volunteers. The system is linked together on five radio frequencies, three of which are distributed regionally; one is shared as a common, nationwide frequency, and one is reserved for times of national emergency. Public access to the system is provided in the large urban centers by a universal emergency telephone number, which immediately connects the caller to his local Magen David Adom station. The smaller population centers use different phone numbers, and access from the highway is provided from computer-monitored telephones activated by simply depressing a button linked directly to the main communications headquarters in Tel Aviv.

At 4:57 p.m., the computer printout at MDA headquarters suddenly began clicking rapidly. The dispatcher glanced at the television display, where a large "A" was now visible on the screen, the signal for an incoming alarm. Telephone post No. 34 on the coastal road had been activated.

While the computer recorded the time and the precise location of the activated call phone, the dispatcher spoke with the caller. The man was very agitated, and it was hard to make out exactly what he was saying. Something about a bus, about shooting, about people wounded on the coastal road near the Zichron Yaacov crossroad.

The quiet afternoon was over. Instantly, the dispatcher went into action, notifying the administrative staff of MDA to report at once to headquarters. Police agencies were contacted, and MDA stations along a 70-mile length of coastline were alerted to stand by.

The computer was clicking furiously now, as more highway phones were being activated by callers reporting wounded motorists. It was still not clear exactly what had happened. The only thing that was clear was that the northern sector of the coastal road was becoming strewn with the bodies of dead and wounded, and the trail of death was advancing steadily southward.