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Preparedness for mass-casualty attacks on public transportation
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Public transportation constitutes a vulnerable sector in modern day society with a high probability of generating mass casualties if attacked. By preparing for mass-casualty attacks (MCAs), response can become more effective and public transportation can become a less rewarding target. However, preparedness for attacks, much like response, implies resource constraints, and this dissertation pinpoints some major dilemmas that inhibit achieving preparedness for MCAs on public transportation in Sweden.

Aim: The aim of this dissertation was to investigate preparedness for mass-casualty attacks on public transportation. This allowed for identification of major challenges for preparedness and response with a particular focus on the Swedish context.

Methods: Study I included 477 MCAs identified through searches of the Global Terrorism Database, journals, newspapers and websites, which were examined with descriptive statistics. Study II thematically analyzed 105 articles attained by systematic searches of the PubMed and Scopus databases. Study III and IV statistically analyzed data from 864 responses to a purposive-designed questionnaire, from operational personnel of the Swedish emergency organizations. Study V entailed validation of a finite element (FE) simulation model of a bombing in a train carriage compared to the bombings in Madrid 2004.

Results: International trends of MCAs (≥ 10 fatally injured and/or ≥ 100 non-fatally injured) on public transportation, during the years 1970-2009 (I) showed that the average number of injured increased considerably, despite a quite stable incidence rate since the 1980s. High numbers of injured people were connected to attacks on terminal buildings, multiple targets and complex tactical approaches. Few MCAs occurred in Europe, but the average number of fatalities per incident and injured per incident were the second highest among regions. The literature study (II) of previous on-scene management showed that commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage and treatment, which require collaborative planning and specific training. The study regarding the Swedish emergency organizations’ perceptions of terrorist attacks (III) showed significant differences on perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence in knowledge of tasks to be performed on scene. The police respondents stood out; e.g., fewer police personnel had high estimates of their organizations’ management capability and knowledge of tasks on-scene compared to the other organizations. The study of factors that influence responders’ perceptions of preparedness for terrorism (IV) showed that these were influenced by the responders’ sex, work experience, organizational affiliation, various training arrangements and access to personal protective equipment (PPE). Investing in amenable factors, such as terrorism-related management training and provision of PPE, could improve responders’ perceptions of preparedness for terrorism. A finite-element (FE) model of an explosion in a train carriage (V) was developed and showed that FE modeling techniques could effectively model damage and injuries for explosions with applicability for preparedness and injury mitigation efforts, but, also, there was room for improvement of the model in terms of injuries.

Conclusion: Achieving preparedness for MCAs on public transportation is a multiple choice balancing act between ostensible dilemmas regarding investments, disaster plans, training, response strategies, collaboration and inventions.

Abstract [sv]

Bakgrund: Kollektivtrafik utgör en sårbar sektor i dagens samhälle, med hög sannolikhet att generera en situation med många drabbade vid attentat. Genom att förbereda för masskadeattentat (MCA) kan hanteringen bli effektivare och kollektivtrafiken utgöra ett mindre givande mål. Beredskap för attentat, liksom själva hanteringen, innefattar dock resursbegränsningar och denna avhandling belyser somliga avgörande utmaningar som hämmar utvecklandet av beredskap för MCA mot kollektivtrafiken i Sverige.

 

Syfte: Syftet med avhandlingen var att undersöka beredskapen för masskadeattentat mot kollektivtrafik. Detta möjliggjorde identifiering av stora utmaningar för beredskap och insatser, med särskilt fokus på den svenska kontexten.

 

Metoder: Studie I innefattade 477 MCA som identifierades genom sökningar i Global Terrorism Database, vetenskapliga tidskrifter, tidningar och webbsidor, som sedan undersöktes med deskriptiv statistik. I Studie II genomfördes en tematisk analys av 105 artiklar, funna genom systematiska sökningar i databaserna PubMed och Scopus. I Studie III och IV genomfördes statistisk analys av data från 864 respondenter till en ändamålsenligt utformad enkät, utskickad till operativ personal inom blåljusorganisationerna. Studie V innebar validering av en finita element (FE)-modell av en explosion i en tågvagn genom jämförelse med bombningarna i Madrid 2004.

 

Resultat: I den internationella utvecklingen av MCA (≥ 10 dödsfall eller ≥ 100 icke-dödligt skadade) mot kollektivtrafik, under åren 1970-2009 (I) visade det sig att det genomsnittliga antalet skadade ökade kraftigt, trots en tämligen stabil incidens av antalet händelser sedan 1980-talet. Skadadeutfallet var ofta stort vid angrepp på terminalbyggnader, multipla mål och användning av komplexa taktiska metoder. Få MCA inträffade i Europa, men det genomsnittliga antalet dödsfall per fall och skadade per fall var den näst högsta bland regioner. Litteraturstudien (II) av skadeplatshantering vid tidigare attentat visade att vanligt förekommande utmaningar under oavsiktliga masskadehändelser utökades under MCA med särskilda svårigheter kring säkerhet, bedömning, triage och behandling, vilket i sin tur kräver gemensam planering och särskild utbildning. Studien om de svenska blåljusorganisationernas uppfattningar om terroristattacker (III) visade signifikanta skillnader på uppfattningar om sannolikhet av olika händelser, viljan att respondera, beräknad hanteringskapacitet och förlitan till kunskap om uppgifter som ska utföras på skadeplats. Polisernas svar utmärkte sig; t.ex. hade färre inom polisen höga uppskattningar av sin organisations hanteringskapacitet och sin egen kunskap om uppgifter på plats, jämfört med de andra organisationerna. Studien av vilka faktorer som påverkade respondenternas uppfattning om beredskap för terrorism (IV) visade att uppfattningar påverkades av deras kön, arbetslivserfarenhet, organisationstillhörighet, olika former av utbildning och tillgång till personlig skyddsutrustning. Investeringar i åtgärder såsom terrorism-relaterad träning och personlig skyddsutrustning skulle kunna förbättra uppfattning om beredskap för terrorism inom blåljusorganisationerna. En FE modell av en explosion i en tågvagn (V) utvecklades och visade att FE metoden skulle kunna modellera materiella skador och personskador av explosioner, med tillämpning för beredskap och skadelindrande åtgärder, men visade också att det fanns utrymme för förbättring av modellen avseende personskador.

 

Slutsats: Förverkligandet av beredskap för masskadeattentat mot kollektivtrafik utgör en balansgång i beslutstagande mellan vad som förefaller vara dilemman om investeringar, krisplaner, utbildning, responsstrategier, samverkan och innovationer.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2016. , 64 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1778
Keyword [en]
antagonism, disaster medicine, emergency response, emergency organizations, mass transit, preparedness, rescue work, security, terrorism
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-117263ISBN: 978-91-7601-407-3 (print)OAI: oai:DiVA.org:umu-117263DiVA: diva2:906767
Public defence
2016-03-18, Hörsal D, målpunkt T, 9 tr, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Projects
Preparedness for mass-casualty attacks on public transportation
Funder
Swedish National Board of Health and Welfare
Available from: 2016-02-26 Created: 2016-02-25 Last updated: 2016-03-15Bibliographically approved
List of papers
1. Mass-casualty attacks on public transportation
Open this publication in new window or tab >>Mass-casualty attacks on public transportation
2014 (English)In: Journal of Transportation Security, ISSN 1938-7741, E-ISSN 1938-775X, Vol. 7, 1-16 p.Article in journal (Refereed) Published
Abstract [en]

The 21st century has provided many examples of the devastating effects attacks can have when public transportation has been targeted or used as weapons. Four hundred and seventy seven mass-casualty attacks (≥10 fatally injured and/or ≥100 non-fatally injured) against public transportation and terminal buildings during the years 1970–2009 were studied with data from the Global Terrorism Database in addition to open media sources, scientific journals, and books. Asia was the most frequently targeted region, followed by the Middle East & North African region and Sub Saharan Africa. Airplanes were the most frequently attacked mode of transport during the 1970s, but were surpassed by buses in the mid-80s. There was also an alarming increase in attacks against terminal buildings during 2000–2009. The two most common types of attacks were bombings and armed assault. Complex tactical approaches so as to achieve as much carnage as possible were apparent—e.g., maximizing the number of exposed people, enhancing weapon effects, approaching victims one-by-one, combining several attack types, and targeting rescue personnel. These approaches were more predominant during the last two decades and attacks against rescue personnel were exclusive to the 21st century. The average number of injured increased considerably, despite a quite stable incidence rate since the 1980s. High numbers of non-fatally injured people were connected to attacks on terminal buildings, multiple targets and complex tactical approaches. These incidents, with more and more non-fatally injured, challenge our societal response structures and thus require more research.

National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:umu:diva-117254 (URN)10.1007/s12198-013-0125-z (DOI)
Projects
Preparedness for mass-casualty attacks on public transportation
Funder
Swedish National Board of Health and Welfare
Available from: 2016-02-25 Created: 2016-02-25 Last updated: 2017-11-30Bibliographically approved
2. Review of on-scene management of mass-casualty attacks
Open this publication in new window or tab >>Review of on-scene management of mass-casualty attacks
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The scene of a mass-casualty attack (MCA) entails a crime scene, a hazardous space, and a great number of people needing medical assistance. Public transportation has been the target of such attacks and involves a high probability of generating mass casualties. The review aimed to investigate challenges for on-scene responses to MCAs and suggestions made to counter these challenges, with special attention given to attacks on public transportation and associated terminals. Methods: Articles were found through PubMed and Scopus, “relevant articles” as defined by the databases, and a manual search of references. Inclusion criteria were that the article referred to attack(s) and/or a public transportation-related incident and issues concerning formal on-scene response. An appraisal of the articles’ scientific quality was conducted based on an evidence hierarchy model developed for the study. Results: One hundred and five articles were reviewed. Challenges for command and coordination on scene included establishing leadership, inter-agency collaboration, multiple incident sites, and logistics. Safety issues entailed knowledge and use of personal protective equipment, risk awareness and expectations, cordons, dynamic risk assessment, defensive versus offensive approaches, and joining forces. Communication concerns were equipment shortfalls, dialoguing, and providing information. Assessment problems were scene layout and interpreting environmental indicators as well as understanding setting-driven needs for specialist skills and resources. Triage and treatment difficulties included differing triagesystems, directing casualties, uncommon injuries, field hospitals, level of care, providing psychological and pediatric care. Transportation hardships included scene access, distance to hospitals, and distribution of casualties. Conclusion: Commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage, and treatment, which require collaborative planning and specific training.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-117255 (URN)
Projects
Preparedness for mass-casualty attacks on public transportation
Funder
Swedish National Board of Health and Welfare
Note

Submitterad till Journal of Human Security

Available from: 2016-02-25 Created: 2016-02-25 Last updated: 2016-02-25Bibliographically approved
3. Emergency organizations’ diverging perceptions of terrorist attacks
Open this publication in new window or tab >>Emergency organizations’ diverging perceptions of terrorist attacks
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: To analyse how the police, the rescue services and the emergency medical services (EMS) perceive the threat of terrorism and preparedness for a terrorist-induced crisis. It also aims to unravel differences among the emergency organizations and to discuss their potential implications for emergency preparedness. Methodology: Data were collected using a questionnaire distributed to operational personnel from the emergency services in eight Swedish counties; 864 responses were received and analysed. Findings: There were significant differences between the police, rescue and ambulance services regarding perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence with tasks to be performed on scene. Perceived likelihood of events appeared affected by institutional logic; events within their respective domain of responsibility were perceived as more likely. The police stood out in many aspects, with more personnel with experience of violence on duty and a high grading of the probability of terrorist attacks compared to the other organizations. Fewer police had high estimates of their organizations’ management capability and knowledge of tasks on-scene. Practical implications: Differences in perspectives of terrorism preparedness and response among the emergency services were shown, highlighting the importance of enabling inter-organizational insights on safety culture, with risk awareness and management strategies, as well as knowledge of the other organizations’ institutional logics and main tasks, so as to achieve an effective, collaborative response to terrorism-induced crises. Originality: Little research has been conducted comparatively with regard to the emergency services and their perceptions of terrorism-specific threats and preparedness, particularly in the Swedish context. 

National Category
Political Science Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-117256 (URN)
Projects
Preparedness for mass-casualty attacks on public transportation
Funder
Swedish National Board of Health and Welfare
Note

Inskickad till International Journal of Emergency Services

Available from: 2016-02-25 Created: 2016-02-25 Last updated: 2016-03-08
4. Factors influencing responders' perceptions of preparedness for terrorism
Open this publication in new window or tab >>Factors influencing responders' perceptions of preparedness for terrorism
2016 (English)In: Disaster Prevention and Management, ISSN 0965-3562, E-ISSN 1758-6100, Vol. 25, no 4, 520-533 p.Article in journal (Other academic) Published
Abstract [en]

Purpose: The purpose of this paper is to analyse factors influencing perceptions of preparedness in the response to terrorist attacks of operational personnel in Swedish emergency organizations. Design/methodology/approach: Data were collected using a questionnaire distributed to operational personnel from the police, rescue and ambulance services in eight Swedish counties; 864 responses were received and analysed. Findings: Three aspects of the perception of preparedness for terrorist attacks among Swedish emergency responders were studied: willingness to respond; level of confidence with tasks; and estimated management capability. Factors which positively influenced these perceptions were male sex, training in first aid and dealing with mass casualty incidents, terrorism-related management training (MT), table-top simulations, participation in functional exercises, and access to personal protective equipment (PPE); work experience was inversely related. Occupation in police or rescue services was positively associated with willingness to respond whereas occupation within the emergency medical services was positively associated with estimated management capability. Practical implications: These findings show that terrorism-related MT and access to PPE increase the perceptions of preparedness for terrorism among the emergency services, aiding judgements about investments in preparedness by crisis management planners. Originality/value: Limited research in disaster management and hazard preparedness has been conducted in a European context, especially regarding terrorism. Little is known about aspects of preparedness for terrorism in Sweden, particularly from the perspective of the emergency responders.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2016
Keyword
Training, Confidence, Firefighters, Police, Capability, Willingness to respond, Emergency medical services
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Political Science Nursing
Identifiers
urn:nbn:se:umu:diva-117257 (URN)10.1108/DPM-12-2015-0280 (DOI)000381212600007 ()
Projects
Preparedness for mass-casualty attacks on public transportation
Funder
Swedish National Board of Health and Welfare
Note

First published in theses in manuscript form.

Available from: 2016-02-25 Created: 2016-02-25 Last updated: 2017-05-08Bibliographically approved
5. Effectiveness of finite-element modelling of damage and injuries for explosions inside trains
Open this publication in new window or tab >>Effectiveness of finite-element modelling of damage and injuries for explosions inside trains
Show others...
2016 (English)In: Journal of Transportation Safety and Security, ISSN 1943-9962, Vol. 8, 83-100 p.Article in journal (Refereed) Published
Abstract [en]

The rail-bound sector has become a preferred target of terrorist attacks because of its vulnerability, and the most frequent way to carry out these attacks has been the use of explosive devices.The aim of this study is to investigate the effectiveness of modelling detonation effects inside train carriages using explicit finite element techniques. The numerical simulations consider fluid-structure interaction phenomena and several parametric studies are conducted. Carriage damage and injuries to the passengers are examined. Displacements in the model of the carriage structure do not vary greatly for small changes of the charge size, its location, or by open doors. Changing charge size, the location of the detonation, and door setting however had significant impact on the risk of eardrum rupture and fatality. Comparison of the simulation and real life data demonstrate a good agreement between the real and calculated displacements of the carriage, whereas the risk of death and eardrum rupture is slightly higher in the calculations. The model presented can reproduce a reliable actual situation if more parameters that influence injuries of blast waves were considered.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2016
Keyword
blast wave, finite element model, rail bound, risk, security, structural damage
National Category
Mathematics Surgery
Identifiers
urn:nbn:se:umu:diva-117258 (URN)10.1080/19439962.2015.1046619 (DOI)000380366000007 ()
External cooperation:
Projects
Preparedness for mass-casualty attacks on public transportation
Funder
Swedish National Board of Health and Welfare
Note

Supplement: 1

Available from: 2016-02-25 Created: 2016-02-25 Last updated: 2016-09-13Bibliographically approved

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