Are We Ready for Suicide Bombings?

A call comes over the radio: “EMS 12, EMS 4, Supervisor 1: All units head to the downtown area. We are receiving reports of a possible explosion with an unknown number of injuries.” You start heading toward the business and financial district and are still a few minutes out when you hear a supervisor arrive on scene. He immediately calls for additional units. The background noise from the scene almost drowns out his transmission—it sounds like a large crowd has gathered. A minute later, he is yelling that he wants all units to “step it up” and asks dispatch to have more police respond.

You arrive on scene to find chaos. There are body parts, glass and metal scattered about, and it seems like no one is in charge. Twenty feet or so in front of your rig, you see what you think is a human head on the street. You and your partner make your way to the lobby of a large bank, where the majority of the wounded lie in various states of injury. You are triaging patients when someone grabs you by the arm. You turn to see your supervisor. “It was a suicide bombing,” he tells you. “Police are evacuating the area because of a possible secondary device.”

A suicide bombing can be one of the most efficient and effective ways to penetrate a target, create injuries and generate press coverage. Television news frequently broadcasts scenes of chaos and destruction caused by bombings in buses, theaters and restaurants overseas. What type of impact would a similar event cause in the United States?

While great emphasis has been placed in the last few years on training prehospital providers to respond to incidents involving weapons of mass destruction (WMD), the same cannot be said of training for other, smaller-scale, yet potentially just as devastating acts of violence. Unfortunately, despite the escalation of terrorist acts and the spread of these events to locations outside of the Middle East, some EMS systems in the U.S. still believe “it can’t happen here.” Is your EMS agency ready to respond to a suicide bombing? This article will provide EMS providers and managers with a basic level of awareness about these devastating incidents.

Overview

A suicide bomber is an individual who carries an improvised explosive device (IED) on his person to detonate with the intent of taking his own life, as well as those of bystanders. These persons are dedicated to acting and can choose the time and place they strike. Experience with suicide bombers in the Middle East has demonstrated that their targets can include buses, clubs, restaurants, hospitals, police stations and other public locations where large groups gather. The bomber can be of either gender, and ages have ranged from adult to early adolescence. The IED is designed so that it can be hidden inside clothing, belts, handbags, vests or other easily carried containers. One recent incident involved a bomber who was carrying approximately 15 lbs. of explosives sewn into his underwear.

Targets

Suicide bombers choose targets that have a significant impact psychologically, due to the type of location attacked, or in the actual number of those injured or killed. These targets can be “hard” or “soft” (see Table 1). A hard target is an area with restricted access and some level of consistent security, such as a military base, airport or power station. A soft target is a place or entity that has easy access and is not as well-guarded or secure as a hard target. These are usually areas designed for public congregation, including malls, outdoor cafes, restaurants and schools. Other targets carry particular importance regardless of their security level or accessibility. These can include special events, large public gatherings, houses of worship (all religions) and public transportation (rail, ground and air).

Secondary Devices