MEDICAL RESPONSE TO TERRORISM: PREPAREDNESS AND CLINICAL PRACTICE

Abstract

MEDICAL RESPONSE TO TERRORISM: PREPAREDNESS AND CLINICAL PRACTICE Editors: Daniel C. Keyes, MD, MPH; Jonathan L. Burstein, MD, FACEP; Richard B. Schwartz, MD, FACEP; Raymond E. Swienton, MD, FACEP Bibliographic Data: Lippincott Williams & Wilkins, 2005. ISBN: 0-7817-4986-7, 449 pages, hard cover, $99.00. Reviewer's Expert Opinion: Description: This book is more than just a guide to recognizing and treating casualties of purposeful threats like smallpox, botulism, pipe bombs, and nuclear devices; it places a strong emphasis upon the “preparing” to meet these dangers. Accordingly, part of the book comprises chapters detailing individual threats, and part instructs the reader in the principles of preparedness, from the hospital to the national scale. Purpose: The authors' purpose is to teach medical and allied professionals about the various threats posed by terrorists as well as how best to prepare to meet them. They point out that medical personnel are not only uniquely vulnerable - the very unacceptability of attacking healthcare workers can make them an attractive target - but are also critically important as early responders. The book treats these topics comprehensively and takes its place alongside books of a somewhat different emphasis, such as those concentrating upon toxicology or disaster medicine. It brings together relevant topics from many fields that otherwise may seem peripherally related, and is a worthy and comprehensive guide. Audience: The authors intend the book to be read not only by medical professionals but also by administrators and lay disaster planners. With the exception of a few chapters that are written in a more florid style, the text is a comfortable read, and many sections will probably interest even those readers with little medical background. The contributors are many and distinguished, including recognized authorities in toxicology and officials in the CDC and U.S. Department of Homeland Security, as well as medical professionals from countries that are particularly plagued by terrorism and who presumably have firsthand experience. Features: Included is an extensive discussion of various agents of terrorism, including chemical, biological, nuclear, and explosive, as well as lesser-known agents like “calmative agents” and some that are smaller-scale, such as Molotov cocktails. Sequelae such as PTSD and crush syndrome are covered. The book also touches upon such interesting and lesser-discussed topics as agricultural terrorism, forensic medicine, and decontamination strategies. Nearly half the chapters contain highly practical information on preparing to face terrorism, discussing the needs of different contexts such as scenes, hospitals, and mass gatherings; how to handle the media; approaches to homeland security; civilian liaisons with the military; and communication strategies. The book's strengths lie in its broad range of topics and in its resolutely practical focus, including outstanding tables and abundant references that include helpful web sites. It is a book one would want on hand in an emergency, as well as long before. Several review questions follow each chapter, but may not have been necessary, given the high ratio of material to questions. There are several “case studies,” treating in more detail the Colombian and Israeli experiences, as well as one that was not mentioned in the table of contents, a one-paragraph personal testimony that felt somewhat extraneous. More long case studies would have been interesting. The book suffers from uneven editing, with some clearly superfluous chapter subheadings, redundant introductions to terrorism in many individual chapters, and - in one instance that it may be picayune to point out - a misquotation as well as misspelling of T. S. Eliot. The occasional author employed overly exuberant prose. However, the book rarely descends into dry academic expostulation and is an interesting read throughout. Assessment: This is a worthy companion to related texts such as Disaster Medicine, by Hogan and Burstein, eds. (Lippincott Williams & Wilkins, 2002), and Goldfrank'sToxicologic Emergencies, 7th edition, Goldfrank et al., eds. (McGraw-Hill, 2002). It is up-to-date, relevant, and - its greatest strength - practical. Reviewer: Jennifer M. Blair, MD University of Chicago Pritzker School of Medicine