Prehospital and Disaster Medicine

Table of Contents
VOLUME 18, NUMBER 3
July – September 2003

Editor’s Corner
A Big Push . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Marvin L. Birnbaum, MD, PhD

Position Statement
Melbourne Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
13th Congress of the World Association of Disaster and Emergency Medicine

Editorials
Introduction: Consequences of Terrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Eric K. Noji, MD,MPH

Terrorism, Disasters, and Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
David Alexander, PhD

Special Reports
Ethical Considerations in Emergency Planning, Preparedness, and
Response to Acts of Terrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170
Gregory Luke Larkin, MD,MS, MSPH, FACEP; Jeffrey Arnold,MD, FACEP

Aum Shinriko and the Japanese Law on Bioterrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
Masaaki Sugishima

Educational and Training Systems in Sweden for Prehospital Response to Acts of Terrorism . . .184
Per E.J. Kulling, MD; Jonas E.A. Holst, MD

The Chemical Disaster Response System in Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189
Tetsu Okumura, MD, PhD; Norifumi Ninomiya, MD, PhD; Muneo Ohta, MD, PhD

Lack of Hospital Preparedness for Chemical Terrorism in a Major US City: 1996–2000 . . . . . . . . . .193
Mark E. Keim, MD; Nicki Pesik, MD; Nana A.Y. Twum-Danso, MD,MPH

Decontamination of Mass Casualties—Re-evaluating Existing Dogma . . . . . . . . . . . . . . . . . . . . . . . . .200
Howard W. Levitin, MD, FACEP; Henry J. Siegelson, MD, FACEP; Stanley Dickinson, EMT;
Pinchas Halpern, MD; Yoshikura Haraguchi, MD, PhD; Anthony Nocera,MD, FACEM;
David Turineck, HBSc, MB, BCh, BAO, LRCS(P)I, FACEP

Future Considerations for the Medical Management of Nerve-Agent Intoxication . . . . . . . . . . . . . . .208
Pål Aas, PhD

Public Health Response Actions and the Use of Emergency Operations Centers . . . . . . . . . . . . . . .217
CDR. A. Thomas Mignone, Jr.; CAPT. Robert Davidson

Mass-Casualty,Terrorist Bombings: Epidemiological Outcomes, Resource Utilization, and Time
Course of Emergency Needs (Part I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
Jeffrey L. Arnold, MD; Ming-Che Tsai, MD,MPH; Pinchas Halpern, MD; Howard Smithline, MD;
Edita Stok, MD; Gurkan Ersoy, MD

Mass-Casualty,Terrorist Bombings: Implications for Emergency Department and Hospital
Emergency Response (Part II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
Pinchas Halpern, MD; Tsai, MD,MPH Jeffrey L. Arnold, MD; Edita Stok, MD; Gurkan Ersoy, MD

The Impact of Terrorism on Children: A Two-Year Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242
Yehezkel Waisman, MD; Limor Aharonson-Daniel, PhD; Meirav Mor, MD; Lisa Amir,MD, MPH;
Kobi Peleg, PhD,MPH

Case Report:
Penetrating Cardiac Injury Secondary to a Terrorism-Related Nail Bomb Explosion . . . . . . . . . . . . .249
Yasufumi Asai, MD; Masashi Yoshida, MD; Yoshihiko Kurimoto, MD; Jeffrey L. Arnold,MD

The Spectrum of Human Reactions to Terrorist Attacks with Weapons of Mass Destruction:
Early Management Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253
Cleto DiGiovanni, Jr., MD

Measures of Effectiveness in Large-scale Bioterrorism Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .258
Frederick M. Burkle, Jr.,MD, MPH, FAAP, FACEP

From Complex Emergencies to Terrorism — New Tools for Health-Sector Coordination in
Conflict-Associated Disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .263
David A. Bradt, MD,MPH, FACEM, FAFPHM, FAAEM;
Christina M. Drummond, MBBS, DObst(RCOG), DTM&H, FRACP, MPH, MAE, FAFPHM

Health Implications of Cyber-Terrorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .272
A. Clem, MPH, MSN; Sagar Galwankar, DNB (India), MPH; George Buck, PhD