Disasters follow no rules. No one can predict the complexity, time, or location of the next disaster. Traditionally, medical providers have held the erroneous belief that all disasters are different, especially those involving terrorism.
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All disasters, regardless of etiology, have similar medical and public health consequences. Disasters differ in the degree to which these consequences occur and the degree to which they disrupt the medical and public health infrastructure of the disaster scene.
The key principle of disaster medical care is to do the greatest good for the greatest number of patients, while the objective of conventional medical care is to do the greatest good for the individual patient.
Terrorism is the most challenging mass casualty incident for emergency responders. The spectrum of terrorist threats is limitless, ranging from suicide bombers, conventional explosives, and military weapons to weapons of mass destruction (nuclear, biological, or chemical). Terrorist events have the greatest potential of all man-made disasters to generate large numbers of casualties and fatalities.
Explosions and bombings related to terrorism continue to be the most frequent cause of mass casualties in man-made disasters.
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Bus Bombing in London, July 7, 2005
The majority of terrorist bombings consist of relatively small explosives that produce low casualty rates. However, when strategically placed in buildings, pipelines, or moving vehicles, their impact can be much greater. Terrorists have also begun to use larger devices that traditionally have been confined to military operations. The high morbidity and mortality is related not only to the intensity of the blast, but to the subsequent structural damage that leads to collapse of buildings, a common phenomenon in large explosions.