The basic elements of communication in response to terrorist events must be understood. Four broad areas of great concern are identified for those organizations involved in the preparation for handling terrorist events or in the actual management of the event itself. Public service agencies that actualize situation containment, as well as initial victim management and mobilization, are important elements in effective communication during a terrorist event. Communications surrounding victim evaluation and care institutions are responsible for the health care needs of those affected by the incident. Well-defined protocols and responsibilities to communicate the request for outside support beyond local resources, such as military or other agencies, are vital. The release of information to the media is a key element in effective communication during and surrounding a terrorism incident Table 32-1.

All responding providers have specific needs as well as related needs for the flow of information regarding these events. Related issues include obtaining resources for care of victims and supplies for various purposes such as provider protection, victim transportation, and containment of the event. Unique needs include staging of the event on scene, identifying the scope of the event, locating injured victims, bringing additional resources to bear, or communicating to the public for various reasons, including the prevention of further citizen exposure to the event. Some additional examples for prompt information flow include hospital notification
and coordination, locating family members, dealing with the “worried well” and the “walking wounded” or for patients with routine needs, and providing supplemental resources. The list is, by necessity, incomplete.

The method(s) of communication during terrorist events employ the routine channels utilized in day-to-day life (2). The exceptions, of course, occur in the event of local resources being supplemented by federal agencies such as the FBI or the military, all outside the usual routine of municipalities. Such an event, though, may require a significant, even massive, upscaling of the level of information being transferred to various recipients. In the 9/11 bombing of the World Trade Center, for example, a vast increase in traffic within the member agencies responding to the event, to outside agencies in calls for assistance, and to the media and world at large flowed as a result of the event (3).

In the war on terrorism declared by President George W. Bush in 2001, an essential part of the endeavor is found in the increased requirements for communities to carefully examine and identify potential terrorism targets in their territories. Where possible, the potential for destruction of these targets—or the risk of harm to citizens utilizing them—may possibly be ameliorated by thoughtful planning.

Large sporting events, for example, such as those held in stadiums, present a huge potential as terrorist targets. Even minor explosives or gas releases could trigger both initial direct harm from the noxious agent as well as substantial victims through panic. Careful advance thought about crowd control methods that may help contain the spread of panic and mass fleeing from the event would be essential. However, it may be difficult to know what information is appropriate to convey to a frightened crowd should a release of a toxic agent occur, for example. It must be remembered that well-meaning building control officials in the bombing of the World Trade Centers announced over the public address system that evacuation was not necessary, leading many people to return to or remain within the (alleged) safety of the buildings that were soon to collapse. Thus thinking about the basics of communications concerning terrorist events naturally follows three basic paths: prevention, management, and amelioration.

The issue of the preservation of personal liberty in the context of providing the greatest good for the community has perhaps never been more vital than now. Community preparedness, however, requires a heightened level of awareness that begins with a framework of alertness and communication (4). This foundation is formed by municipal agents and involves citizens in a variety of ways. For example, especially during times of heightened alert from the Department of Homeland Security, increased screening of personal items—even the screening of the individuals themselves—entering into gathering areas, although onerous to some, plays an important role in protecting the greater good. This inspection is an element of the communication plan, requiring prompt notification of the appropriate public safety agencies in the event of positive identification of a hazard (5).

This requirement for communication methods for prevention must be extrapolated across the community landscape: from stadiums to churches to fire departments to EMS agencies. Key people in gatherings must be identified who can seamlessly interface with public safety, fire, and EMS. Methods of communication must be identified, and drills must be conducted.

Terrorist targets can either be anticipated or may not be obvious. The era of suicide bombers—a method of causing maximal effect with a minimal loss of life on behalf of the terrorist organization—makes a school bus full of children a target. Proper communication preparation for such an event might require a key point individual who is responsible for screening entrants to the vehicle. Clearly, though, preparation ultimately may have only a limited impact in terms of decreasing the scope of an incident.

An important example of such preparation is in changes that have been taken regarding parking around municipal buildings. The severity of the blast wave from the truck parked outside the Murrah Federal Building in Oklahoma City affected the framework of the structure, blasting floors upward, which then collapsed into rubble. Prevention of such destruction by vehicles has required substantial rethinking of parking plans for a host of structures. The prevention of destruction, in this case, requires municipal planning and agreement followed by communication to users of the parking areas in real time, plus the enforcement required to assure adherence to these plans.

The assassins who stalked the streets of Maryland, Virginia, and Washington, D.C., in 2002 proved very difficult to apprehend in spite of intense community awareness and media coverage. Yet comprehensive communications across multiple jurisdictions provided the final clues to the identity of the individuals and their vehicle. Media was employed as an active agent in the process of tracking and identification. Then it was left to an observant citizen at a late night hour in a roadside rest area to spot the snipers sleeping in their vehicle, bringing to a quiet end a nearly month-long terrorist event that had caused millions of people to be pierced with fear. Had not the alert Alabama officials’ investigation of an apparently random liquor store robbery and murder a month prior produced vital evidence linking this event to subsequent investigative findings, it may only be speculated what the ultimate number of persons injured or killed may have been—and how long terror would have continued to grip the citizens of those states.

Prevention of terrorist events through communication programs is a comprehensive matrix that intermixes agency and public awareness through adept planning and identification of modes of technology, including media participation, sufficient to meet the challenge. No amount of preparation
will be sufficient to prevent all determined malefactors from succeeding in at least a portion of the intended harm to a citizenry. However, clearly defined channels of communication established prospectively among agencies, citizen groups, and media sources can clearly help forestall, or at least ameliorate, the effects of a terrorist event (6).

The spectrum of terror is vast. Broadly it may be said that terrorist events have two main elements: the actual physical impact on the target(s) and the emotional distress in the citizenry resulting from the event. Both elements are critical during the actual management of a terrorist event.

As an event unfolds, the facts of the issue gradually become evident, including any loss of life or injuries, physical damage to areas, and the requirements for bringing the situation under control. The intensity of the situation during such an occurrence veritably assures that great potential exists for a dramatically increased volume of utilization of typical communications media. Anxious family members commonly crowd the telephone lines with calls about loved ones. Well-meaning citizens contact public services such as police and fire departments to report what they have seen. Only a carefully prepared, thoughtful plan for protection of contact among involved member agencies can give significant assurance that information interchange can continue.

The intensity of communications among public service agencies may increase dramatically during a terrorist event, and channels of communication require careful design to allow proper function during an event. Unnecessary traffic must be suppressed. For example, prolonged patient presentations on radios by EMS providers must be restrained by protocol. Just as during a multicasualty incident, the initial physical examination process diminishes from the DOT primary survey to a “triage survey,” such as the “red survey” found in the Advanced Disaster Life Support program; the patient presentation process to medical control should be abbreviated to only the information required to notify hospitals of patient destination and general basics concerning the patients’ conditions.

Community all-hazards management plans include dealing with problems such as biohazard events (whether of a terrorist nature or otherwise) that require prompt activation to assure the best outcome. Thus activation of these plans through facility notification by public service agencies must be carried out early. Busy hospital emergency departments may have to discharge noncritical patients, empty out waiting rooms, place guards outside to prevent unnecessary traffic, establish and provide staffing for decontamination areas, set up hospital central communications centers, and contact additional physician, nursing, and support staff through callback procedures.

This example is on point for this discussion. Should an index case of smallpox present in an urban emergency room, the outpouring of agency notifications, emergency hazards plan activations, and media awareness will be nearly unimaginable. Intense efforts to identify the contacts of the individual, living quarters, recent travel, and otherwise determine how this case came to occur will be undertaken within an intense time frame. The Public Health Department will be activated. Citywide vaccination programs intended to encircle potentially infected persons will become operational. Many cities might initiate a prospectively designed plan to utilize fire department personnel and paramedics to become members of the vaccination team. Centers for vaccination will be established. The city—indeed the world—will be watching with bated breath.

In real time, the utilization of all appropriate communications programs, especially through careful contact with the media, will be essential to prevent community panic, to provide information for vaccination centers, to update the community on the disease progress (if any) in the community, and to optimize the resources available to prevent the spread of the infection while preserving community health (7). However, such an event may naturally be expected to have far-reaching consequences within that urban center, including the possibility of quarantine of the community, limiting of traffic flow in and out of the city until the infection appears to be controlled, and the provision of appropriate medical resources (perhaps such as a separate hospital for infected persons).

Much can be learned from the failure of communications programs to be used optimally during terrorist acts. The sarin nerve gas attacks by the Aum Shinriko against Tokyo in March 1995, resulted in hundreds of exposures of a greater or lesser degree. The number of deaths is somewhat disputed, but clearly in excess of 5,000 people were affected. Photographs of the event show people standing casually in the area of the release of the gas inside the subway. Thousands presented themselves to emergency rooms, over 600 to one facility alone. No decontamination or personal protective equipment was used initially by many of the hospital responders, and it was reported that over 23% of the hospital staff who treated victims sustained exposure themselves (8). Of the more than 1,300 EMS providers who responded to the scene, 10% of them were exposed and developed symptoms. Thus the medical infrastructure itself was threatened by failures in communication.

The reality that communication failures can kill and injure was demonstrated in the failure of police radio channels to interlink with fire and EMS channels in New York. This resulted, at least in part in over 100 fire rescue personnel being trapped and subsequently killed in the collapse of the North Tower of the World Trade Center, over 20 minutes after the pilot of the police helicopter flying above the building saw that the collapse of the building was imminent. Thus operationalizing system communications design, both in equipment and in protocol, is an essential element of limiting risk and exposure to both the citizenry being served and to the rescue/medical providers involved (9).

The terrible disaster that was manifested in the 9/11 events riveted the attention of the world (10). For weeks, little programming on television strayed from the topics around the attacks against the United States, the destruction of property,
and, most importantly, the evolving scope of the loss of life of both citizens and rescue providers. The horror of the death and devastation in Washington, New York, and in the aircraft involved presented a grisly scenario of such enormity that its scope challenged human ability to encompass the grief and shock of the event.