July 7, 2005: The morning was no different from any other July morning in London until the terrorists struck and unleashed their poisonous venom on the London public transportation system, killing 52 people and injuring hundreds more. A similar terror attack of unparalleled brutality befell suburban Gulshan, almost exactly 11 years later, with over 20 dead and even more injured. The sheer horror, the barbarity of their act, the vicious cruelty demonstrated, and savage ritual execution only speaks of the descent of the devil himself on the peaceful pizzeria in Dhaka.
Prior to the 7/7 terror attack, the emergency services in London had spent many years in anticipation of such an attack, forming a coordinating body, London Resilience, in the wake of 9/11.
A major incident plan for London hospitals and emergency services were set up, safety measures, concrete blocks, dedicated emergency ambulances including helicopter medical services all were strategically planned, implemented, and then hundreds of emergency medical staff participated in a simulated chemical attack on one of the underground train stations.
So, on 7/7, doctors were mobilised from all over the city to report to work and put their hospitals’ major incident plans into action. A smaller group of specially tasked doctors were mobilised by the Central Ambulance Control (the “gold doctors”) to attend at the scenes of the terror attacks. These doctors included members of London’s pool of “major incident officers” as well as members of the London Helicopter Emergency Medical Service.
Though we in Bangladesh are an inescapable part of 21st century global geo-politics, we seem to be oblivious to the world around us, of the terror wave sweeping globally, threatening to destroy the very essence of humanity. So we have to broaden our horizon of understanding of world affairs, wake up to the reality that we are not immune to this pestilence and be resolute in our preparedness.
This preparedness against terror attacks is to include a “Major Incident Plan” (MIP) in large cities, especially Dhaka, capable of coping with situations of mass casualty where the emergency medical resources, personnel, and equipment are likely to be overwhelmed by the number and severity of casualties. This would require preparedness and involvement of disaster management authority at local, regional, and national levels.
Not taking initiatives against the possibility of a mass casualty situation when the world is at a knife’s edge, with terrorist organisations threatening human existence and very successfully wiping out innocent victims with impunity, is not only callous, but frankly, an abomination
The MIP should be based on looking at some of the specific challenges they present to health services and suggesting possible operational contingency measures as well as considering the co-ordination and communication aspects. An incident that produces mass casualties can significantly challenge any emergency health care system of any country.
Not taking initiatives against the possibility of a mass casualty situation when the world is at a knife’s edge, with terrorist organisations threatening human existence and very successfully wiping out innocent victims with impunity, is not only callous but frankly an abomination.
Let society set the agenda rather than the events, as we have already been threatened by events and our knowledge and experience is thus urging us to be comprehensively prepared.
If an attack happens, no loss of human life cannot be guaranteed, but a well-prepared emergency medical system would without doubt minimise death and disability.
As soon as the crisis unfolds, the “major incident” should immediately be declared by the designated Central Control and all the hospitals within the MIP network be informed. For example, in Dhaka, the MIP should have the Central Control based in the most appropriate location.
The Central Control co-ordinates the arrival of the pre-hospital personnel with required equipment at the scene, directs the military, police, and para-military forces to rapidly and effectively keep clear approach roads to hospitals taking casualty, and ensures that the receiving hospitals are duly alerted and prepared.
Specially tasked doctors working with the ambulance services, should have the capability to provide immediate care of the individual patients with serious injuries. Others would be engaged in management at the scene of evacuating large numbers of casualties to surrounding hospitals (Triage at the scene). Once hospitals are alerted, all staff members of the hospitals should be called in. Patients already in the emergency department are either admitted to wards, or transferred or discharged home in order to clear the way for those injured in the major incident.
The terrorism we are facing may or may not have been born in Bangladesh, though on July 1, it is the terrorists born and bred in Bangladesh that committed the murders. The roots are in madrasas, schools, colleges, universities, and training camps. Indoctrination can happen thousands of miles away, or at home in the villages, in towns and in cities.
Emergency management in response to terrorist attacks has to incorporate working on mitigation. Openness of the government, the education system, and awareness of citizens about vulnerability are also very important. Mitigation courses should be a part of the required curriculum at different levels of education.
Schools in Bangladesh should teach young people how to prepare, plan, and stay informed before and during emergencies. They also have to teach the children how to find opportunities to help with community preparedness because children are not mere passive victims of the disasters; they may save many people’s lives if they are better informed about how they may prevent and what to do in times of disaster.
In the future, Bangladesh, due to its geo-political importance, is likely to face the threat of major disasters and attacks. Bangladesh government needs to be prepared to react effectively.
We have to have a “Major Incident Plan” and we do so on the basis of prediction not certainty. It is important to remember that in time of a disaster, the line between life and death is very thin. Rescue operations can be hampered by delays, communication failures, and tactical confusion mitigated only by advance planning that puts the right resources in the right places.
