Konigova R.

Centre of Burn Medicine, 3"i Medical Faculty, Charles University, Prague, Czech Republic

On September 27-28, 2002 in Hamburg an international congress was held. It was organized by several institutions:

Fire and Rescue Services Academy, Hamburg

Institut fur Notfallmedizin des L13K, Hamburg Bundesakademie fur Sicherheitspolitik

Deutsches Komitat fur Katastrophenversorge in collaboration with: Fire Department New York (FDNY)

Emergency Medical Services (NYCEMS) New York Public Health Services

Homeland Defense Committee, Washington, DC

Five hundred and fifty delegates from 14 countries participated at the Congress: Austria, China, Czech Republic, Denmark, Estonia, Finland, Germany, Greece, Italy, Latvia, Lithuania, Netherlands, Singapur, USA.

The Congress was accompanied by an extensive exhibition of medical and technical professional literature, an exhibition of equipment for rescue workers and an exposition of heavy wreckage technique.

The sessions were opened by a detailed report on the terrorist attack on N. Y. by commanders of the N. Y. fire brigades who survived (Ch. R. Blaich and K. J. Scanion) September 11, 2001. Their reports on the rescue operations in the World Trade Centers were devastating recognition that in such extensive catastrophes prevention, triage and treatment are impossible. At first the attempt to evacuate people from the burning first tower to the 70`" floor was partly successful but there was no access to higher floors (110°' floor) and some victims perished after jumping down. Any fire extinction at these heights is impossible. In the meantime the second tower was hit. It collapsed within several minutes on workers of this tower and the civilian population incl. firemen and rescue workers who were sent there to start immediate evacuation of the threatened subjects, but the collapse of the South Tower preceded them. A total of 341 firemen and 2 members of the emergency service were killed. From the photographic documentation it was apparent that everything was covered with impenetrable clouds of dust and smoke and thus it was not possible to find the way - where to help and where to escape. All stages of the catastrophe were recorded on global pictures obtained from helicopters and detailed pictures in the depth of the collapsed ironconcrete blocks.

The subsequent part of the conference was dedicated to reports on the experience of the medical emergency service (EMS). It was a joint report of D. F. Hyde (commander of special operations in N. Y.) and W. M. Kowalczyk (commander of EMS in N. Y.). The last attempts of rescue activities were made 26 hours after the attack. In the lobby of the South Tower there were originally 1500 subjects who tried to hide in the terrible noise and dust after the first hit but perished together with the firemen and two rescue workers. It was also feared that the powerful wall separating the town from Hudson river will collapse, although it would extinguish the places of the deep fire in the inaccessible ruins which threatened the town by dense smoke for another 12 days.

All speakers emphasized the demand to create shortterm emergency plan for 24-48 hours which must be always individually conceived with regard to the threatening situation.

In N. Y. members of the Health Care System and Emergency Medical Service collaborated for a period of 28 days when 525 ambulance cars were operating. Moreover spontaneously so-called Allied Health Care Providers and a Disaster Medical Assistance Team were created who worked in 12-hour shifts. Their task was among others to organize mortuaries for more than 2800 bodies, incl. 227 whole bodies and 22000 parts of bodies and to ensure dignified handling of all.

Another part of the programme was devoted to repeated anthrax threats to workers of the Hart-Building in Washington which was reported by Aileen Marty from the Homeland Defence Committee, Washington D. C. An analysis of a civilian mass disaster caused by chemical substances in Japan was reported by Tereg Bay from California University in IRVINE. He emphasized that the most severe cholinergic syndrome is caused by SARIN (among others such as TABUN, SOMAN, VX). SARIN was used during an attack in the underground in Tokyo in 1995 where 5500 people were intoxicated. An emergency plan for chemical catastrophes did not exist. These socalled nerve poisons exist in a liquid form or aerosol and evaporate later. They are heavier than air and are close to the ground which is important for the liquidation procedure, because people who flee from a building in flames all die. According to his report in the past chemical Yperite attacks in 1984 occurred in the Iran-Iraq war. Organophosphates became a problem of civilian medicine. An interesting lecture of the subsequent part of the programme were reflections of Dr. Hirschmann (Bundesakademie fur Sicherheitspolitik) on terrorism as an international challenge ("Terrorismus als internationale Herausforderung"). He emphasized that during the last 30 years seven changes in the character of terrorist activities occurred:

1. Terrorism has become an international problem. An example is "Al-Quaida" with a multinational structure.
2. The motives of terrorism are multiple and varied. In the eighties the problems were ethnic, religious, national in all cultures, where always a differentiation was made between "we" and "the others" who were considered enemies. We ask what are the contemporary motives?
3. During terrorist activities the strategy of communication assistance by the media is used which spread fear and uncertainty, as practised already in 1972 during Olympic games in Munich.
4. The repertory of means of terrorism expands: bombs and firearms were extended by biological, chemical and nuclear means and also socalled CYBERTERRORISM focused on computer networks and the entire infrastructure of countries.
5. The structure of the organization of terrorism has changed from the originally classically hierarchically arranged groups into linear structures where individual members are ever more frequently and more intensely involved in legal, commercial, financial, insurance, social sectors and thus their activities are not perceptible.
6. The targets of terrorism are no longer focused on elimination of individual representatives of political or social life but are concentrated on symbolic targets which represent certain values, systems and institutions of the enemy incl. his infrastructure.
7. Terrorism is a symptom, not a disease. The disease is the political and social situation with expanding deprivation, and shortage or loss of all perspectives which are becoming a global problem - not a regional one. Terrorism cannot be fought by military means but by changes in the home and foreign policy of European states and those in other parts of the world, in particular the United States. Changes must take place at different levels by meeting an infinite series of tasks to do away with the mentioned global disease or to mitigate it at least.

The conclusion of the Conference emphasized several demands:

1. It recommends to establish an international controlling structure for the organization of international collaboration during the liquidation and rescues activitie after disasters.
2. To cope with the sequelae of disasters is the task of firemen and emergency medical services.
3. The tasks and responsibility of all participants must be clearly defined.
4. Modern information structures are essential.
5. Interdisciplinary collaboration is essential.
6. Conceptual training of members of the resue teams is essential.
7. It is important to develop steadily knowledge, skills and equipment in rescue work.
8. Individual crews of the emergency service must collaborate in all respects.
9. Protection of the population from disasters must acquire new contents.

Lecture was presented at the 8'h annual conference of the Czech Society of Burns Medicine, Czech Medical Association J. E. Purkyne, Brno, Oct. 30-31, 2002.

R. Konigoua, M. D.
Faculty Hospital KrdlousWVinohrady Srobfdroua 50
100 34 Praha 10
Czech Republic