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 phenomenon of modern terrorism is being analysed in a multidirectional way. In addition to the knowledge about terrorist groups, about their motivations and tactics of the previous attacks, comes to mind the question of their consequences and especially those that affect people. These terrorist events represent, without doubt, a non-negligible challenge for the healthcare system in which they happen. It applies not only to the medical emergency services with the coordination and communication systems, but also to emergency rooms and specialised hospital wards. Not to mention the issues of long-term care for people with PTSD or forensic issues. The problem is not only the number of casualties, even though they represent a significant challenge (for example: 191 dead and 1475 injured people in the terrorist attack on the train in Madrid on 11.03.2004 or likewise 130 and 456 in Paris on 13.11.2015). The essence of the problem lies in the fact that terrorist attacks “confront civilian medical services with combat field injuries in conditions of a massive scale event”. Another difference is that the damage caused by acts of terror includes a large percentage of serious injuries (currently 25-30% of total injured) and up to 66% of patients with injuries at three and more body areas. These elements determine the need for a change. The medical procedures towards patients during the first hours must rely on the rules of “damage control resuscitation” and “damage control surgery” especially since, on average, 15% of victims will require an immediate surgical intervention. However, the medical aspects of terrorism are not only linked to the medical rescue services or hospital emergency rooms. In fact, the issue touches upon the whole healthcare system, including long-term treatment as well as subsequent consequences (including in the psychological area).


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.


Our website uses cookies to improve your browsing experience