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States of preparedness
Israel shares it expertise on terror’s aftermath with New Jersey’s responders
The shadowy X-ray filled the screen in the conference room at the Robert Wood Johnson University Hospital. It showed black shrapnel from a shattered watch lodged in the throat of a 19-year-old Israeli girl — a lesson in the anatomy of terror.
“This young woman was on a bus on her way to college at
7:30 in the morning. There was a bomber aboard,” said Dr. Charles Weissman, director of the department of anesthesiology and critical care medicine at Hadassah Medical Center in Jerusalem. “The bomb went off, and this is what we found in her neck — a Calvin Klein watch.”
Saving the young woman required a critical care team of vascular surgeons and throat specialists, Weissman told the more than 60 health and safety professionals who filled the room. “It was very scary,” he said. “But don’t worry — she’s going for her master’s now. This is the kind of pattern you’re going to be dealing with in multi-casualty events.”
Weissman’s May 8 presentation — Multi-Casualty Terror Events: Israeli Lessons Learned — was the first in a series of lectures and symposia jointly sponsored by the International Center for Terror Medicine at Robert Wood Johnson in New Brunswick and the Hadassah Medical Organization in Jerusalem.
The center’s macabre but necessary goal is to help New Jersey learn from Israel how best to prepare for terror attacks and their gruesome aftermath.
Dr. Shmuel Shapira, deputy director general at Hadassah and originator of the idea for the center, and Dr. Clifton 
Lacy, president and CEO of Robert Wood Johnson, signed the memorandum of understanding that established the center last spring.
“One of the missions of the center is education regarding best practices in response to events with natural causes and international events like terrorism,” Lacy said in an interview as he and Weissman arrived for the program.
“It’s learning from our experience,” Weissman said, “not only from the medical side, but also from the organizational side. In Jerusalem alone, we’ve had 35 terror events between 2000 and 2005.”
Lacy said the audience reflected the breadth of the challenges. “I see the chair of the College of Pharmacy, a leader in public health, a trauma expert, an expert in critical care nursing,” he said. “So it’s multi-disciplinary — medicine, nursing, pharmacy, first-responders, experts in counterterrorism, emergency-medicine specialists, and some folks from homeland security.”
Lacy said the importance of preparedness became very clear to him when he was serving as commissioner of health and senior services for New Jersey. “Since Robert Wood Johnson University Hospital is one of only three Level 1 Trauma Centers in the state, and with our unique location in the middle of the state, it’s a natural extension to bring our preparedness efforts here,” he said. Lacy told the gathering that the hospital is directly adjacent to the train line and will soon include a cardiovascular and stem cell institute.
The location, he said, gives the hospital “the unique ability to have casualties brought by train directly into the emergency room and our operatories for surgery.”
Hadassah Medical Center, the only Level 1 Trauma Center in Israel, has extensive experience in dealing with the influx of multiple casualties from terror events, Weissman said in his lecture.
“Terror events injure people of all ages, from children to the elderly, and you have to be prepared to care for them,” he said. “You have injuries of many types and severities and a lot of PTSD, post-traumatic stress disorder.”
“The other thing you have to deal with is not only a nervous populace, but a nervous staff,” he added. “They’re all worried about what happened to their relatives and friends at the same time they’re looking to care for their patients.”
Israel has been confronted by three kinds of terror events, according to Weissman — closed-space explosions, such as 10 or 12 kilograms of high explosives blowing up in a crowded bus; open-space explosions, such as those caused by IEDs, improvised explosive devices; and assault rifle attacks.
“These are the kinds of wounds you don’t usually see in a civilian population — blast injuries, burns, shrapnel wounds, blunt injuries,” the physician said. “The bombs are packed with nuts, nails, ball bearings, and screws. These are ejected at tremendous speeds, and they cause tremendous damage. You have to be ready for all these kinds of problems.”
Another issue in terror medicine is infected bombers — bombers with HIV/AIDS or Hepatitis B — and bombs filled with chemical agents. “That could be one of the problems you have to deal with — nuts and bolts soaked in rat poison,” Weissman said.
In addition, you have to worry about secondary bombs timed to go off when the responders arrive, and also about direct threats to the hospital, he said. “You need a multi-disciplinary approach.”
Weissman’s lecture also covered organizational challenges in responding to terror events: How do you get physicians to the hospital when all the roads are blocked? What about the surgeons who rush to the hospital but can’t find a parking space? How do you get ambulances in and out when a decoy ambulance may be rigged with a bomb? How do you integrate the casualties into a hospital already filled with emergency cases and ongoing surgeries? What about triage? How should you organize your command center? “It’s a lot of coordination you need,” he said.
As the program came to a close, Benjamin Krasna, deputy consul general of Israel in New York, confirmed the Israeli government’s commitment to continuing the cooperation inherent in the International Center for Terror Medicine.
“This is an area of unfortunate expertise for Israel,” the diplomat said. “We’d prefer not to be experts in this field. But in this field we can cooperate even more with the United States.
“We’re trying to reach out and share the expertise,” Krasna said. “Hopefully, none of us will ever have to use it.”
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