Responding to Terrorist incidents: An EMS Perspective part 2

Scene Safety and Situational Awareness
Scene safety is always the top priority on any EMS call, and this cannot be overstated when responding to a potential terrorist incident. Major incident training ingrains in us that we must “prioritize [our] own personal safety above that of the scene and survivors” ( Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature – PMC ). In practical terms, this means do not rush in blindly. Take a moment to size up the scene from a distance. If there are ongoing gunshots, unidentified explosives, fire, or structural instability, hold staging at a safe distance and wait for law enforcement or fire crews to declare the area secure. In fact, traditional protocol for EMS has long been to stage away from potentially violent incidents until an all-clear is given by police (Fire/EMS at Active-Shooter Incidents) (Fire/EMS at Active-Shooter Incidents). You might park several blocks away, out of line-of-sight of any threat, until confirmation comes via radio that the attacker is neutralized or the bomb squad has cleared any explosives.
Upon arrival (or even enroute), maintain a high index of suspicion for secondary threats. Unfortunately, terrorists have been known to target first responders with secondary devices or follow-up attacks. While thankfully rare in the U.S., there have been instances – such as the 1997 Atlanta Olympic Park bombing – where a secondary bomb detonated after the initial blast, injuring public safety personnel who were on scene ( Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature – PMC ). Modern responder guidelines explicitly remind us to “consider secondary devices at the primary incident scene and secondary scenes in close proximity” ( Source ). This means that even after an explosion, remain vigilant for additional suspicious packages or hazards. If you see an odd device, a backpack, or wires in the area, treat it seriously – notify command and evacuate the area if instructed, rather than assuming the danger is over.
Situational awareness also extends to environmental hazards. Terrorist incidents often create chaotic environments with multiple dangers. Studies of past attacks show that emergency responders have been exposed to “both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress” ( Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature – PMC ). For example, a bomb in a building might leave jagged metal and broken glass everywhere, fires spewing toxic smoke, or even a partial building collapse. A protest-turned-riot might have active fires (as in our Tesla arson scenario) or violent crowds still on scene. Assess these threats before you commit to patient care: Is there a risk of a building wall giving way? Could there be toxic fumes from a chemical device? Are there aggressive individuals who might attack responders? If any life-threatening hazards are present and not mitigated, hold off. Remember, we can’t help others if we become casualties ourselves. Don’t be afraid to pull back and await additional resources (like HazMat teams, bomb squads, or police backup) to render the scene safe.

In summary, slow down and size-up. Ensure the threat is neutralized and use all your senses: look for unusual objects or behaviors, listen for ongoing gunfire or hissing gas, and even smell of chemical odors. Scene safety is a continuous process throughout the call, keep scanning for new dangers as the incident unfolds. Your safety, and that of your team, is the foundation of an effective response.

Communication and Incident Command Protocols
In a terrorist incident, communication is critical – both for your personal safety and for effective multi-agency coordination. Upon recognizing that you may be dealing with a terror-related event, immediately communicate relevant information to dispatch and incoming units. For example, if you arrive to find multiple burn victims and evidence of an explosion, relay a concise scene report: “Multiple victims, possible explosion, potential terrorism – staging at X location, awaiting law enforcement to secure scene.” This alerts everyone that this is more than a routine call and that special protocols (like staging and additional resources) are in effect.
Expect that the response will escalate quickly. Law enforcement (local police, and possibly federal agents like FBI or ATF), fire, bomb squad, and additional EMS units will converge. The Incident Command System (ICS) will be utilized to manage the chaos. Under ICS, agencies establish a clear chain of command and communication structure for the incident. In a complex scenario like a bombing or active attacker, it’s common to set up a Unified Command – meaning police, fire, and EMS commanders will coordinate jointly from a Command Post ( Source ). As an EMS provider on the ground, you will likely plug into this structure, taking directions from the EMS branch director or the incident commander. Follow your agency’s incident command protocols: check in with the on-scene Incident Commander (or Medical Group Supervisor if one is assigned) and stay on the designated tactical channel for EMS operations.
Maintain open lines of communication with other responding agencies but also use discipline in what you say over the radio. Sensitive details (e.g. a suspected terrorist’s identity or specific security vulnerabilities) should be communicated through secure channels or in person to command, not broadcast widely. Stick to operational info: number of patients, hazards observed, resources needed, etc. Ensure you use common terminology that other agencies understand. The NFPA 3000 standard and emergency service best practices emphasize having “common communications capabilities and a common lexicon for seamless, integrated operations” ( Source ). This means using agreed-upon terms for zones (Hot Zone, Warm Zone, Cold Zone), calling things what they are (say “improvised explosive device” instead of a local slang), and clarifying locations clearly. If you’re not sure what terminology the police are using, ask; miscommunication can cost lives in these fast-moving events.
Another aspect of communication is calling for appropriate resources early. If this is potentially terrorism, you’ll likely need more of everything: ambulances, maybe air medics, specialized teams (HazMat, tactical medics), etc. Don’t hesitate to request additional units and alert the nearest trauma centers of a possible mass-casualty incident (MCI). Implement your MCI protocols if multiple patients are present, this will organize communication by using triage tags, establishing a medical staging area, and so on. Good communication at an incident like this also includes face-to-face whenever possible for critical discussions (for example, between the EMS group supervisor and the police tactical team leader, to decide when it’s safe to move in).
In summary: Use ICS to your advantage. Clear, calm communication and a structured command system will bring order to the chaos. By establishing unified command with law enforcement and fire early, you ensure that everyone – dispatch, incoming units, hospitals, and other agencies – stays informed and coordinated in the response ( Source ). In a terrorist incident, this unified approach can save lives by speeding up decision-making and avoiding confusion.