Considerations for Surviving a Terrorist Bombing

The purpose of this post is to give you some basics for surviving a terrorist attack, primarily a bombing, as recently seen in the Boston attack.

The first thing to mention is AVOIDANCE. This is the best form of threat mitigation. If you can avoid large public events then you are going a long way to avoiding being caught in a terrorist attack, or even an active shooter event. But for the purposes here we will assume that you are a civilian caught in such an incident, unprepared and unequipped, including being unarmed. You could, for instance, be at the Mall when explosions go off, or anywhere out in public.

The next thing to mention is MINDSET and DENIAL. Consider for a moment how many of those marathon runners, who had trained for months and busted their asses for four hours and 25.5 miles or so, wondered how the sudden detonation would affect their run time and if they would be able to finish the race? The vital survival factor here is that you must AVOID DENIAL. When the incident goes off, your day has taken a left turn, and it will make you late for that Metro connection to the important meeting you have at work. Don’t try and make the incident fit back into the day you had planned in your head. The day has taken a left turn and you must adapt to the new circumstances and face the reality of what actions you have to take.

The next thing is that you must ACT. You are responsible for your own fate, and that of family members with you. Don’t expect others to save you and don’t go into sheep mode. Often, people don’t panic in survival situations, they just DO NOTHING unless ordered or specifically instructed to move to an exit or whatever.

The other side of the above is avoid the sheep-like  feeling that you need to do SOMETHING to help and follow others who are heading into the seat of the explosion or whatever because they feel the need. This goes hand in hand with feelings of self-pity and general outpourings of ‘woe is me’ often seen by those giving on the spot interviews with the media. Suck it up buttercup; shit just happened, so drive on. Drink more water. Get on with adapting to the new circumstances and surviving.

There are two things you must immediately consider if an explosion goes off: SECONDARIES and COME-ON. Given that, here is your immediate response:

If the explosions go off near where you are, immediately get into cover; cover your family/loved ones/kids with your body. Try and find some hard cover, even if it is just a curbside. Get into a doorway if possible but avoid glass and things like plate glass storefront windows. Get down; cover your wife/kids and remain in place. A good example is the Boston Bombings: if you had taken off down the street, you might well have been caught up in the second bombing. Don’t rubber neck and don’t go to windows to look out at what just happened.

The IEDs at the Boston  incident were small devices, pipe bomb style affairs, made more potent with the addition of ‘shipyard confetti’ to create a large amount of shrapnel probably accounting for the relatively few deaths and large amounts of wounded and traumatic amputations and the like. You could be dealing with much larger explosions, such as a car bomb like the attempted Times Square attack.

You will then want to try and move out of the way of the incident. You don’t know if there are secondary devices planted that may go off at any moment. Your allies at this point will be distance and line of sight. Try and put distance between you and the device and put hard cover like buildings in the way also. Given that terrorists will have planned the attack you should look around from your position of cover and look for a better way out than running up and down the street. Think about going through a store out the back, maybe a restaurant which will always have an open back door out to the back area etc. You want to think about distance and cover and taking a route that will not funnel you through areas where the terrorists will have potentially predicted crowds will run. Don’t go with the sheep.

This brings us on to SECONDARIES. I write from years of experience in Northern Ireland, Iraq and Afghanistan. Often secondary devices will be planted to target first responders, likely places for incident Control Points (ICPs) and also casualty collection points (CCPs). This means that a secondary device can be placed very close to the original device, to target those going onto the scene to help wounded, or at another location, the terrorists having studied the SOPs of the security forces/first responders. For example, devices usually have safety distances depending on the size of the device, such as a pipe bomb in a trash can up in size to a truck bomb. Security teams cordoning the site will push back those standard distances and then establish their locations for the cordon and the ICP etc. They will often be tempted to put these locations at road junctions, which are vulnerable points. These actions can be predicted and will often determine secondary placement.

This is why some devices will be used as a COME-ON for secondary attacks, such as a further explosive device or even a shoot, making it a complex attack. A shoot may be unlikely in our environment but you need to consider it as possibility. More likely is a secondary device, in a parked car or trash can etc. Sad thing is that most law enforcement in the US is not experienced at this kind of incident and may very likely fall into this kind of secondary/come-on style trap. So if you find yourself somehow controlled or herded into an area, or a CCP, then you need to look to your own survival. Think about finding a covered position, but you may be limited if a wounded loved one is being attended to by first responders at an obvious vulnerable point. In that case, do your 5 and 20 meter checks. Look around. Look in trash cans; look for any suspicious items in the area near to you. If you find something bring it to the attention and move away. You are only a civilian remember, so law enforcement may well not listen to you.

Among all these pieces of advice to move out via non-standard routes, do 5/20 meter checks and all that, just be mindful that you yourself do not appear to be suspicious and be wary of trigger happy law enforcement. If they challenge, you, stop and comply. They may well be panicking and unsure so don’t give them a chance to shoot you.
So far we have taken immediate cover, perhaps improving our position, assessed the situation and looked for a covered non-obvious route to exit the scene. We have avoided being herded and if we can’t do so we have remained aware of our surroundings and done 5/20 meter checks as appropriate.

There may be a circumstance where you have been caught by the actual blast and become a casualty, or one of your loved ones has. I have written in more detail about Tactical Combat Casualty Care (TC3) at THIS LINK. Here are some first aid tips:

The three main preventable causes of death in combat or mass casualty situations are: bleeding to death from an extremity, airway obstruction and tension pneumothorax (sucking chest wounds). These are all things you can do something about. You will of course still be relying on rapid evacuation to definitive care at the Emergency Room. In combat and a mass casualty situation, CPR is not appropriate. But it is appropriate for your loved one while first responders deal with those they feel they can save.

A ‘mass casualty situation’ is any situation where the number of casualties exceeds the first responder’s resources. In such a situation, triage is applied. In basic terms, those casualties that will respond to simple interventions to save life are dealt with, others will wait. A first responder will not, for example, get sucked in to doing CPR on one casualty when there are traumatic amputations lying around who can be saved by tourniquets. It’s all about resources and doing the best for the many with what you have available. So casualties will be prioritized but if there are no resources to deal with a serious casualty, perhaps one who is not breathing, then they will be classified as ‘expectant’ which means they are expected to die. This can change as resources arrive; but if your loved one is expectant then you need to do something about it, such as EAR/CPR. So learn how to do it.

The thing to remember is H-A-B-C  for (Massive) Hemorrhage, Airway, Breathing, and Circulation. Purists will tell me that it has changed to M-A-R-C-H (Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia), and they are right, but it means the same thing and you should use what you know and will remember, because you will be thinking with tunnel vision when this happens.

Think initially about self-aid. If you have a CAT tourniquet then great, but you may need to get a tourniquet on your own arm or leg, so do it while you are in the shocked adrenaline phase before the pain comes and before any arteries that may have shut down in shock open up and the blood really starts to flow out of you. Think also what you can do for any wounded family members. Here is quick run-down:

Massive hemorrhage from an extremity: this may be a traumatic amputation or another serious wound: get a tourniquet on it high and tight, this means up in the groin area for a leg wound or in the armpit for an arm wound. Tighten it down until the blood stops flowing. If the limb remains, you should tighten the tourniquet until the pulse in the wrist or foot stops. Use a belt or something about two inches wide, like a strap. Do not use thin stuff like wire or string. You can rig up a windlass with a stick or anything like that to tighten the tourniquet. Do not be deterred by the gore and shock of missing and destroyed limbs, just get it done and worry about it later.

If the massive bleeding is in the groin itself, the armpit, or the neck, then a tourniquet won’t work. Absent combat gauze you just have to try and pack the wound and put pressure on it to reduce the bleeding. If it’s in the neck put plastic on the wound to prevent air getting into the artery, potentially fatal.

If the bleeding is internal in the torso/abdomen then pressure will not work and you can only cover the wound and reassure, hoping for rapid evacuation.

For airway problems, your best bet is to aid by positioning using the chin lift or jaw thrust to open the airway. You have to consider c-spine when doing this but in fact unless they were blown from a height in the blast, a c-spine (neck area) injury is unlikely and the airway obstruction will kill them, so you need to position them to open the airway. If the c-spine is injured, which you can check by putting your hand under their neck when initially assessing them and checking the airway, you will need to have someone hold their head to stabilize the neck until first responders can get a collar on/spine board. That is specifically  when you use the jaw thrust to open the airway, not the chin lift, because it is designed for use with a c-spine injury. 
You won’t have any equipment for a surgical (crike) or mechanical intervention or to suction blood out of the airway, but you can turn them to drain the blood and mess from their mouth. Also consider the recovery position to let this all drain on an ongoing basis once you have done whatever other interventions you have to do.

For sucking chest wounds you need to cover them with plastic, even just a plastic bag or whatever is to hand, to prevent the ingress of air that will create the tension pneumothorax that will lead to progressive respiratory distress and eventually death. Check for an exit wound (more likely with a rifle wound) and cover that with plastic too. Tape the plastic down if you have tape available, or hold it in place  The casualty may also be able to help and initially cover their own wound with their hand and then hold plastic in place..

Once you have done all that you need to cover the casualty to keep them warm and reassure them until you can get the attention of a medic and preferably get them rapidly evacuated to definitive care at the ER. Among all that, don’t forget your surroundings and situation and the fact that there may be secondary devices out there!