Introduction
In many circumstances, a terrorist attack presents challenges that might be different from other emergencies and could lead to life-threatening injuries to the victims. Recent terror incidents across the globe have confirmed the preparedness of bystanders or those caught up in the melee but happen to offer first aid to the victims (Loftus et al., 2018). While the nature of injuries during terrorism may be the same as other catastrophic incidents, the risks posed by the perpetrator will necessitate an enhanced level of first aid planning and preparedness.
In terrorist attack scenes, just like in other catastrophic situations, bystanders can provide first aid to the victims before the arrival of healthcare professionals, first aid providers, or a designated first aider. Owing to the nature of terror acts, the bystanders or the professionals might not have the required infrastructure or equipment typically used in daily practice to provide adequate help. Whereas using improvised techniques modified from everyday items is encouraged, the first aiders should ensure personal safety, remain calm, and avoid panic.
Part of the strategy to attain the desired safety levels, especially in the U.S., is to fight against the aggressor, while other countries, such as the U.K., recommend a run-hide-tell approach. Terror acts are committed by vandals, insurgents, terrorists, criminals, and suicide bombers using a wide range of weapons such as improvised explosive devices, guns, chemical agents, and biological elements. The arsenals can cause immediate and long-term health and environmental effects. The arsenals can generate blasts that lift individuals off the ground and send debris flying.
Common injuries during terrorist attacks include burns, bleeding, fractures, and shock (Loftus et al., 2018). Given the ingenuity of those dedicated to performing acts of terrorism, individuals should “think outside the box” when responding to the unthinkable. Therefore, responding to a terrorist attack using everyday items can preserve life and avert harm.
Burns
Terrorist acts can either cause thermal or chemical burns to the body. For thermal injuries, cooling remains the appropriate mechanism to address the situation. Bottled water can be acquired to irrigate the injured areas and facilitate cooling the burning tissues. Cooling should be restricted to the burnt area to avoid hypothermia (Loftus et al., 2018). Excess water makes the body lose heat quickly than it can generate, with the danger of triggering a perilously reduced body temperature.
Cling film or clean bags from local shops can also be used, especially if the burn is on the limbs. Unlike thermal burns, chemical injuries require a different management approach and materials. Chemical agents can either be alkaline or acidic and require dilution with excess water. Bottled water can be applied to neutralize the effects of the chemical burns.
Bleeding
Bleeding contributes immensely to death, especially in mass fatality cases, and the victim’s survival is anchored in the period of hemorrhage. The situation can get worse in complete exsanguination since it can trigger cardiac arrest. Such situations should not warrant cardiopulmonary resuscitation efforts by the first aider (Loftus et al., 2018). However, survivors of severe bleeding will have reduced clotting factors brought by coagulopathy, acidosis, and hypothermia, necessitating an urgent need to stop further bleeding. Bleeding originating from external body surfaces can be controlled using readily available hemostatic agents and tourniquets.
However, internal hemorrhage presents serious challenges since arterial injuries from gunshots or other weapons cause extreme damage. A double tourniquet application can be explored for severe bleeding emanating from such injuries to reduce blood loss drastically. The action mechanisms of the tourniquet, tied circumferentially to the limb and windlass integrated, generate a pressure that surpasses that of the arteries, reducing the blood flow in the arteries.
Ideally, any grip from a piece of fabric can generate pressure to mimic the effects of a tourniquet and windlass (Loftus et al., 2018). Therefore, in such emergencies, the victim’s clothes, or stockings, coupled with a piece of wood, can be cut and used to recreate the tourniquet and windlass mechanism. A small piece of wood can be inserted into the improvised fabric strip and turned slowly to generate the required tension. The piece of wood should be strong to prevent breakage when turning to realize the desired pressure. The improvised tourniquet should have a windlass concept; otherwise, the possibility of failure is high if not used.
In circumstances that require wound dressing, it is essential to utilize a material that applies pressure and provides the required bulk. For example, diapers, sanitary pads, or nappies can be modified for wound-dressing. These products are readily available in the shops and provide absorbent capability coupled with their non-sticking polymer surfaces (Loftus et al., 2019). The non-plasticized soft polymer surface should be manually applied over the wound with moderate pressure to stop the bleeding.
In emergencies resulting in cavities, tampons can be improvised to pack the wounds since the item is made of compressed absorbent cotton with a non-sticking polymer outer surface. Tampons’ compact and compressed nature facilitates insertion into the formed cavity and blood absorption. Manual pressure should be introduced over the damaged skin to increase the internal pressure and tamponade the oozing blood vessels.
Fractures
Weapons such as improvised explosive devices, guns, and bombs used by terrorists can maintain motion regardless of what they hit. Therefore, terror attacks resulting from such arsenals can lead to polytrauma to the victims. The impact can cause detrimental fractures, visceral disturbance, and severe bleeding. For example, fractures sustained in the pelvic region are highly fatal since damage to the sacral venous plexus leads to sustained hemorrhage. The ruptured iliac vessels, which cause extensive blood loss, should be seen for prompt management.
In many blast-related industries that result in traumatic amputation of lower limbs, pelvic fracture tends to be common (Loftus et al., 2018). Therefore, the main objective of the first aider is to apply a pelvic binder to reduce bleeding caused by the pelvic structure. However, tablecloths, blankets, legwear, or sheets can be improvised to tie the pelvis to manage the hemorrhage. The strong fabrics should sustain the tension and bind the displaced pelvis. An improvised pair of socks or cling film can handle upper limb fractures.
Analgesia
Timely and suitable analgesia in the traumatic injury environment can help enhance patient outcomes. It also helps lower the conditions for postinjury analgesia needs. In cases of terrorist attacks, patients sustain diverse injuries, making wound dressing, cooling of burns, and splinting of fractures essential approaches to lowering the pain and suffering of respective victims. If the terrorist attack occurs in a shopping mall or close to a pharmacy, the first aider can explore appropriate and available materials such as paracetamol to manage the situation (Loftus et al., 2018). Oral morphine regimes and rapid-release suppositories or formulations of anti-inflammatory/ analgesics can also be sourced to effectively manage the pain, since none require an intraosseous or intravenous introduction.
Shock
Shock refers to severe depression in the vital organs coupled with poor circulation of blood to the tissues. Acts of terror can shock individuals with signs ranging from a pale face, clumsy or cold skin, rapid pulse rate, and shallow breathing. It can lead to death, hence the need to attend to the victims promptly to save their lives (Loftus et al., 2018). The first aider can keep the victim’s airways open, let them rest if stable, or refer them to the hospital for further assessment.
Conclusion
In conclusion, improvised everyday items such as pieces of fabric, tampons, diapers, neckties, a pair of socks, and bottled water can help in managing injuries sustained during a terrorist attack. Bystanders can consider and provide first-line responses to the victims before the arrival of first aid professionals. Bottled water can cool injured sites from thermal burns and dilute chemical injuries.
A piece of fabric from the victim’s clothing and a piece of wood can be used to construct the tourniquet and windlass mechanism to reduce bleeding. Items like diapers, sanitary pads, or nappies can be adapted for use as makeshift wound dressings, while tampons can be applied to absorb blood from formed cavities in the body. A piece of the tablecloth, blanket, legwear, or sheet can be applied to bind pelvis fractures and reduce bleeding, while paracetamol can be used as an analgesic.
Reference
Loftus, A., Pynn, H., & Parker, P. (2018). Improvised first aid techniques for terrorist attacks. Emergency Medicine Journal, 35(8), 516-521. Web.