New Aspects in Mass CasualtiesNeue Szenarien beim Großschaden
05 September 2002 (online)
The present overview comprises the most relevant contributions presented in January 2002 during a scientific workshop on the management of terroristic attacks using biological and other mass destruction weapons. The workshop was organized by the Department of Anesthesiology and Intensive Care Medicine of The Gilead-Hospital at Bielefeld-Bethel. The purpose of the meeting was to update medical, administrative, and organisational capabilities and limitations in case of terroristic attacks. Thus, specialists from various medical disciplines and hospitals as well as urban and governmental representatives participated. The meeting was held under the recent impression of September 11, 2001, and the following real or supposed anthrax-attacks - a scenario, which is nearly forgotten by now. The contribution of C.G. Meyer and J. May from the Institute of Tropical Medicine at Hamburg (Bernhard-Nocht-Institut) deals with bioterroristic attacks using infectious agents (B-weapons). In spite of a long historical tradition, biological weapons have not gained major military relevance. This can be explained by their delayed onset of action and the hidden and widespread outbreak with possible threat of own forces. However, terrorists do not primarily aim for somatic damage. They rather use biological weapons for generating fear and horror, and to create panic. Thus, terrorists specifically aim on a hidden and delayed outbreak, which may not be controlled at all. We should keep in mind the panic reactions which occurred even at presumed anthrax-attacks. Besides anthrax, the authors also discuss botulism and the pathogens of plague, tularemia, pox and hemorrhagic fevers.
A burns-specialist, a toxicologist, and a head of a fire-department participated in the paper of H.A. Adams et al. The authors describe the organisational basics of medical crisis-management and defense in catastrophes and major accidents with mass casualties. In such scenarios, the Senior Emergency Physician and his Assisting Organizer-in-chief are in charge of the whole medical management. They have to free themselves from their usual individual medical tasks and they must spend all efforts to provide equal help to as much of the patients as possible. Simultaneously, further damage must be prevented from people not yet impaired. Realization of these principles will be the major challenge in case of terrorist attacks. The authors highlight the possible scenarios involved with terroristic attacks using either nuclear, biological, or chemical weapons (NBC-weapons) and the basics of medical management. Altogether, the existing equipment and forces to deal with terroristic NBC-attacks are limited, but not at zero. W. Du Bois, town councillor of environment, health and safety of the city of Bielefeld, highlights the specifics of his field of responsibility in case of a terroristic NBC-attack. His contribution evaluates the recent available equipment and the preventive arrangements. This contribution of an urban politician elucidates the activities behind the scene and points out the burden of the political responsible. In summary, the editors of this mini-symposium hope to introduce in a scenario, which, for God's sake, may not become true. Otherwise, only thoughtful and determined action can help and will prevent panic. The best panic prophylaxis is foresighted reflection  - and this is the major goal of this mini-symposium.
- 1 Bochnik H J.
Panikreaktion Einzelner und Panik als Massenphänomen - Verstehen, Vermeiden, Bekämpfen.In: Hempelmann, G., H. A. Adams, P. Sefrin (Hrsg.). Notfallmedizin. Band 3 des Lehrbuchs ¿Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie¿ (Hrsg. v. G. Hempelmann, C. Krier, J. Schulte am Esch). Stuttgart New York, Thieme 1999: 604-611
Priv. Doz. Dr. Christian G. Meyer
Bernhard-Nocht- Institut für Tropenmedizin