Citation

Nerlander MP, Klein A, Herbst R, Jaffe E. Am. Surg. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Southeastern Surgical Congress)

DOI

10.1177/00031348231219257

PMID

38035626

Abstract

Machiavelli, in his cardinal work The Prince, made the observation that societies that enjoy "years of long peace" become unworried and complacent. In this regard, the terrorist massacre of 1400 Israelis on October 7, 2023, and the Russian invasion of Ukraine on February 22, 2022, have constituted a loss of innocence in Western democracies by demonstrating that peace and the protection of civilian lives cannot be taken for granted. In Israel, the incursion by Hamas terrorists in communities in the Southern District saw the combined use of conventional military maneuver warfare with the deliberate targeting of civilians, including filmed sadistic killings for propaganda purposes. While these tactics were prevalent in the conflict with Islamic State of Iraq and Syria (ISIS), the October massacre was the first time that these occurred in a country part of the Western democratic sphere. The nature of the attack was in stark contrast to the "ow-tech terror" attacks, focusing on soft targets and using vehicles and melee weapons, which have been prolific during the first 2 decades of the 2000s.1,2 In Ukraine, events such as the massacre in Bucha and the deliberate targeting of civilian infrastructure prove that even in conflict between technologically advanced belligerents, the laws of war are not respected.
Terror results in several injured but potentially salvageable patients; the University of Maryland Global Terrorism Database estimates that attacks by ISIS and its precursor organizations caused more than 41 000 injuries and 33 000 fatalities during 2002-15, which is an approximate ratio of 4:3 between wounded and killed.3 Given the unpredictable nature of terrorism and its potential to result in multiple victims, strengthening the ability of lay bystanders to respond effectively is crucial to mitigating damage.4-9
Magen David Adom (MDA) is Israel's national Emergency Medical Service (EMS) and has extensive experience in responding to terrorist attacks in Israel. Historically, lay bystander training has been prolific in terms of first aid, hemorrhage control, and Basic Life Support but there is a lack of concepts teaching lay bystander intervention following terrorism-related Mass Casualty Incidents (MCIs). In these scenarios, effective triage, coordination, and communication with professional first responders are essential to saving lives. To fill this gap, MDA has drawn on its experiences to develop the "First 7 Minutes" (F7M) training which is taught to communities worldwide. An overview of F7M has previously been published as a letter to The American Surgeon.10 Between 2018 and 2020, MDA conducted 90 training sessions with more than 4000 participants before having to be temporarily discontinued due to the advent of the COVID-19 pandemic. F7M focuses on bystander intervention during the first 7 minutes, which is the average time taken for EMS to arrive in the US.11 Launched in 2018, F7M is conducted through international community outreaches where MDA staff travel abroad to facilitate training. Thus far, F7M has been taught in Israel, the US, Australia, South Africa, and Canada. Training sessions last 1 full day, including theoretical lectures in the morning followed by practical exercises during the afternoon. ...

Language: en