Oklahoma City. New York. The Pentagon. Bali. Madrid. London. Sandy Springs. Atlanta. Etobicoke. Etobicoke?

Most of the place names listed above conjure up graphic images. Maybe some are not familiar to you. But they all draw attention to events that we should be familiar with, at least at a rudimentary level. They are all sites of terrorist campaigns and bombings. They are similar in many ways, but they also represent divergences in what we come to think of when we think of terrorist acts.

At the time of this writing, it is close to a month following the terrorist bombings in London, England. In the aftermath of three explosions that ripped through the Underground and on a double-decker bus in Tavistock Square, 52 people were killed and an estimated 700 were injured. Two other planned detonations did not occur.

We seem so far-removed from these events. And yet, as emergency responders we know that we are not. The next call might be the call.

The very first call that I ever responded to was as a Humber College student doing my first ride-out shift on the ambulance with my preceptor crew. It was October 14, 1982. I had just turned 20 less than a month earlier. It was a cool Thursday night and I was working part-time as a lifeguard and pool supervisor at Memorial Pool in Etobicoke, a suburban Toronto community in the west end of the city. My ambulance preceptor crew was on night shift and I had arranged to meet them after I closed up the indoor pool and fitness club at 10 p.m. I arrived at the station around 10:30, and after an orientation to the ambulance and equipment we went back into the crew room and sat down in time to watch Johnny Carson do his opening monologue on the Tonight Show. About fifteen or twenty minutes later we heard a loud noise that sounded like it was coming from the garage. Thinking that maybe somebody had gotten into the station and was tampering with the vehicles, the three of us walked out there, but found nothing except the two parked ambulances. A few minutes later we were dispatched to what turned out to be a massive explosion on City View Drive in the Highway 27 and Dixon Road area of Etobicoke. It turned out that the noise that rocked the night and interrupted Johnny’s monologue in our crew quarters was the sound of five hundred pounds of dynamite exploding in front of the Litton Systems plant in Etobicoke, eight kilometers away! Seven people were injured in that explosion, some quite seriously. Fortunately, no lives were lost. It turned out that this incident was a terrorist act committed by a home grown Canadian group that called themselves Direct Action. They were self-professed urban guerrillas and their target that night was the disruption of operations at Litton Systems. Litton Industries developed and manufactured the guidance system for the American Cruise Missile, and Direct Action (later dubbed the Squamish Five) opposed said development. As it also turned out, the Squamish Five were not a very well informed group, as the guidance system was actually being developed in another plant a few kilometers away! But, hey… who ever said terrorists had to be bright.

The bombing of the Alfred P. Murrah Federal Building in Oklahoma City on April 19, 1995, was also the act of a home grown terrorist and his cronies. It was the largest domestic terrorist attack in the history of the United States, and the second deadliest terrorist attack in that nation’s history. One hundred and sixty-eight people died in that bombing that resulted from the detonation of a simple, but very lethal, bomb made from ANFO—an ammonium nitrate and fuel oil mixture.

January 16, 1997, started out nicely enough in Sandy Springs, the largest suburb of Atlanta. Until around 9 a.m., that is. That’s when a bomb was detonated—likely by fuse—by convicted bomber, Eric Rudolph, at the Northside Family Planning Clinic. This bomb had been placed on the back porch of the building and did not injure anybody, but caused extensive property damage. Of significant note is that a second bomb detonated at 10:37 a.m. in a flower bed near a dumpster at the front of the building. I remember watching this explosion on CNN and realizing I had just witnessed a significant life lesson. This second bomb was different than the first. It was detonated by a timer and was intended to take out police officers and others who were gathered to investigate and report on the earlier bombing. Also unlike the first bomb, this one contained shrapnel, and was designed to kill and maim responders.

Eric Rudolph was also the Atlanta Olympic Park bomber. The detonation of that bomb hidden inside a back pack killed one woman and injured a hundred others who had gathered to see the Olympic Games in Atlanta, Georgia, and were now celebrating the evening in Olympic Park.
Fully understanding terrorism is not the purpose of this article. We all understand and define terrorism our own way, but here is Steve’s definition anyway, derived from multiple sources and years of reading about the subject: Terrorism is the premeditated use of violence against unarmed, non-combatant targets for a political purpose, designed to cause fear and unrest and to influence an audience.

In the olden days, terrorists were often content with small body counts and maximum media exposure. Today’s terrorists are hunting for large numbers of casualties, with a side aim of injuring and killing as many first responders as possible. That was the logic used by the police after the explosions in London, England, for shutting down the cellular network; in part to prevent accidental detonation of secondary devices by the public and first responders attempting to place calls, but also to prevent the detonation of secondary devices by terrorists waiting in the wings.

Motivations of terrorists abound. There is certainly no shortage of reasons to commit terrorist acts. There is religious fanaticism whose purpose is to assert the values and validity of one’s own beliefs over those of another. There are social, political and environmental motivations. Some acts are motivated by the desire for publicity and attention; and some are solely perpetrated for the purpose of seeking revenge. Most, of course, are a mix of several of these. There is no such thing as a purely political act, or a purely religious one.

But what does any of this have to do with me, the paramedic? How does this involve me? After all, I work in Coquitlam, Red Deer, Brandon, Trois Rivieres, Sheet Harbour, North Battleford, Dryden, Cavendish, Shediac, Bonavista, Fort Smith, Haines Junction or Rankin Inlet. Because there is no one single reason for individuals or groups to commit terrorist acts, there is nowhere that is safe from them. Before blowing up a van in front of the Litton Systems plant in Etobicoke, the Squamish Five had blown up a number of large hydro transformers on Vancouver Island and had fire-bombed Red Hot Video outlets in the Vancouver area. The Canadian Bomb Data Centre reports that there have been over 2,000 bombings and attempted bombings in Canada during the past twenty years. On a larger scale, possible targets might include major national landmarks, mass transit terminals, airport operations, water facilities, communications and power infrastructures, major hotels and resorts, major religious sites, entertainment and cultural venues, financial and banking centres, government buildings, and business centres. On a smaller scale the list of targets is virtually unlimited, restricted only by the imaginings and fantasies of any local whack job or disgruntled employee or customer.

What is important, then, is to be prepared. Prepare mentally for the event. Commentators on the London bombings speculate that the reason events were so successfully resolved there is because of the London mindset. They have been mentally hardened to the possibility of terrorists acts against their populace since the Battle of Britain. They were further put to the test during the campaigns of terror by the IRA in the 70s and 80s. And it can and has been said that they have been waiting for their turn since 9-11, Bali and Madrid.

Prepare, too, by examining your own agency’s response plan. Does your agency have sufficient plans to respond to a large scale incident with many casualties? Are staff appropriately trained in field triage of patients at multiple casualty incidents (MCI)? Are senior staff trained and certified by some outside agency in the Incident Command System? Are drills and simulations held that bring together local and regional police, fire, EMS and hospital agencies in a concerted simulation to deal with such incidents? Do you conduct realistic drills dealing with airplane crashes or hijackings, train wrecks, large scale radiation releases, WMD or bio terror incidents, major structural fires or building collapses?

And on a personal level, are you ready to subordinate your pride and ego to take direction from an individual in charge of an incident, all for the greater good? One quality of a great paramedic is the ability to function independently and to trouble shoot alone. But that is not necessarily the characteristic trait of a team player, and team players are what is needed during a large scale terrorist response.

London calls us. And New York, Washington and Madrid. Thousands of voices cry out to us, beseeching us to galvanize our collective will; to search within ourselves for weaknesses to strengthen; within our organizations and our institutions for vulnerabilities to shore up; to find the ways and means to finance systems of preparedness and response and to have the budgetary foresight and wherewithal to secure equipment and resources necessary in the event of terrorist incidents.

London calls us. How will we respond?