July 2, 2006

Prof Shmuel Shapira (right) provides training to American medical personnel at the Hadassah Medical Center.Dr. Shmuel Shapira has seen the horrible results of terror attacks on its victims far too many times. As deputy director-general of Israel’s Hadassah University Hospital, Shapira has overseen the treatment of over 40 percent of all terror victims in Israel over the last six years – approximately 3,000 patients – a terrible toll.

But the experience and knowledge he and his colleagues have acquired regarding the unique nature of the injuries suffered due to suicide bomb blasts and other forms of terror could save lives, if it is properly communicated to emergency personnel around the world.

That is why Shapira’s dream is to open an International Center for Terror Medicine in Jerusalem to serve as a premier research institute on everything from preventative medicine to the physical and psychological implications of terrorist attacks.

And he is working hard to turn that dream into a reality.

“The neck is not a place for a wristwatch,” observes Shapira from his Jerusalem office as he recounted how the force from a suicide bomber’s blast on an Israeli bus one morning had lodged the bomber’s watch into the neck of a young girl on her way to school. Shapira was describing this case and others to American visitor Bruce Hoffman – a specialist in counterterrorism from the Rand Corporation ? describing the nature of some of the multitudes of injuries that he has come across at Hadassah.

The injuries incurred in a terrorist attack are often vastly different from conventional injuries suffered in accidents or even those sustained by combat soldiers. To name just a few of the challenges, doctors treating victims of suicide bombers routinely deal with blown out lungs, perforated ear drums and the presence of foreign and often unsanitary objects crushed into their victim?s bodies.

Suicide terrorism is not only a threat to Israel – between 9/11 and more recently, bombings in Madrid and London, it’s clear that there’s a global threat that must be dealt with. Yet while significant attention has been paid to crisis management and preparedness in the face of a mega-attack, very little collective information related to the medical ramifications of these kinds of attacks has been analyzed in a comprehensive global manner.

That’s where Shapira’s center would step in. Most hospitals throughout the world operate a trauma registry into which medical personnel enter clinical data about victims admitted through their emergency rooms that doctors use to draw conclusions about for future cases. Yet these registries do not distinguish the elements that are important to understanding how injuries in a terror attack are both sustained and treated, Shapira explained. To close these gaps, he envisions a medical terror registry within the center that would contain descriptions differentiating the type of event that occurred (such as a shooting or an explosion) and whether the victim came in alone or as a group of casualties.

“The most important thing to gain from every medical event is the ability to draw some conclusions or learn some lessons, and in Israel we have improved a lot in this area in the last couple of years,” he told ISRAEL21c.

Noting that the center would focus on education and would not serve as treatment center itself, Shapira plans to include a substantial library of relevant textbooks and articles (he has already published quite a few himself in medical and military journals) that would enhance the medical community’s understanding of terrorism related injuries. The center would also offer workshops and provide curricula to medical professionals.

Joseph M. Henderson, a senior management official for the US Center for Disease Control and Prevention in New York agreed that this type of educational center is sorely needed.

“The thinking about medical events occurs very episodically right now. We are learning a lot, but we are not sharing it, which is sad and unfortunate,” he explained.

The Rand Corporation’s Hoffman offered a laundry list on how wounds sustained in a terrorist attack are so catastrophically different from other types of injuries that they require specialized study and treatment.

Combat soldiers, he noted, often wear body armor, so it is their extremities that bear the brunt of most injuries, whereas civilians are vulnerable to shrapnel wounds all over their bodies. In addition, the heat from military bullets provides a high degree of sterilization in contrast to the often rusty and dirty nuts and bolts that are packed into terrorist bombs, which can then lead to infections. Civilians are also often on crowded buses in which the enclosed area magnifies the force of the explosion in comparison to soldiers who are operate with more distance between them.

The psychological ramifications between civilian and military attacks, of course, are also vastly different. “Public expectations for treatment from the government are much higher when civilians are wounded,” Hoffman explained.

Henderson, who is also on the faculty of Harvard University’s National Preparedness Leadership Initiative which advises the US government on crisis management, believes that there is a government level global interest in understanding the medical ramifications of terrorist attacks.

“There are some very similar effects from terrorist attacks that our leaders need to respond to,” he said.

It is not uncommon in Israel, for example, for doctors to make practical public policy recommendations based on the types of wounds they treat. A case in point goes back to the 1970s when Israel replaced all of its metal garbage cans with plastic containers because of the propensity of the metal cans to turn into secondary lethal weapons of shrapnel upon detonation of the bombs inside them. More lives could be saved today as well if seats on buses were made a few inches higher to protect human necks from low-velocity shrapnel, Shapira noted.

These types of lessons and others have been gleaned from the data Shapira has compiled on the 1099 civilians who have died and 7692 civilians who have been wounded in terrorist stonings, stabbings, shootings and explosions in Israel since September of 2000.

Although the interest in a universal medical research center on terrorist attacks is high, Shapira still needs to raise close to $3 million dollars to open and fund such an institute for the first three years.

In the meantime, he continues to lecture around the world about his expertise. In addition, he conducts “Terrorism and Medicine” workshops for American medical personnel. The one-week, intensive program which takes place at Hadassah is designed for medical practitioners, academics, and emergency response personnel, as well as security and disaster management professionals and policy makers, who want to gain a broader understanding of the threats of terrorism, methods of response, and emergency preparedness.

For Shapira, the workshops are one more element in his overall plan to utilize the vast knowledge Hadassah has acquitted in this field to help emergency personnel everywhere.

“Injuries from terror attacks are threat to the whole civilized world. We want to develop guidelines and standard operating procedures for the entire world community that can be adapted to their own needs.”

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Jason Harris

Jason Harris

Executive Director

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