23RD WONCA Europe Conference

Przemysław Guła

Physician in Air Ambulance Service (HEMS),
past Chair of Battlefield Medicine,
Military Institute of Medicine in Warsaw


The terrorist threat: a challenge for healthcare systems

The presentation shows the phenomenon of 'new' terrorism based on an analysis of the various aspects thereof. Besides the information about terrorist groups, including their motivations and tactics employed in attacks, the presentation also discusses the consequences of terrorist attacks, specifically those that affect people. There is no doubt that terrorist attacks create non-negligible challenges for the healthcare systems of the countries in which they occur. Those challenges are faced not only by the medical emergency services and their coordination and communication systems, but also by emergency rooms and specialised hospital wards. Moreover, there are forensic issues that must be dealt with and many victims of terrorist attacks require long-term PTSD treatment. Although the high number of casualties is a major challenge (e.g. the number of deaths and injuries in the train attack in Madrid on 11 March 2004 were, respectively, 191 and 1475, and the Paris events on 13 November 2015:  130 and 456, respectively), it is not the principal difficulty. That difficulty is the fact that terrorist attacks "confront civilian medical services with combat field injuries in conditions of a mass scale event". Furthermore, acts of terror result in serious injuries in a high percentage of the victims (approximately 25-30%), and up to 66% of those victims suffer damage to three or more body areas. All of the above factors indicate that a change of medical procedures is required.  In the initial hours after an attack, patients' treatment must rely on the rules of "damage control resuscitation" and "damage control surgery", bearing in mind that an average of 15% of victims will require immediate surgical intervention. However, not all medical aspects of dealing with the aftereffects of terrorist attacks are related to medical rescue services or hospital emergency rooms. Terrorism affects the entire healthcare system and, specifically, the long-term treatment of the bodily and mental injuries of the victims.


Przemyslaw Gula is a Polish specialist in orthopedics traumatology. He graduated from the Medical College at the Collegium Medicum of the Jagiellonian University in Krakow. Expert in disaster medicine, rescuer of the Tatra Voluntary Rescue Service, doctor of the Emergency Medical Service, among other member of the TOPR Helicopter Team. He works with the Department of Combat Medicine. Participant of many internships and training in emergency medicine. As a doctor, he participated in many rescue missions. Amng others in India, Turkey and Haiti. He worked several times at a military hospital in the Ghazni base in Afghanistan. Author and co-author of numerous publications in the field of Emergency Medicine and Disasters Medicine.


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