1
Preparing and Responding to Mass-Casualty Terrorist Attacks - a
Comparative Analysis of the Response to Five Terrorist Attacks
Targeting Rail Bound Traffic
Veronica Strandberg - Department of Political Science & Research Center for Disaster
Medicine, Umeå University
Paper presented at the 2012
Swedish National Conference on Peace and Conflict Research
Panel: Complex conflicts and crisis governance
14-15 June, Gothenburg
Work in progress! Please do not quote or cite without authors permission
This is a paper at a very early stage! Comments welcome to [email protected]
___________________________________________________________________________
ABSTRACT
The threat of terrorism is a worldwide concern, often discussed in the context of global change and complex
threats, risks and crises. This paper’s point of departure is ongoing scholarly discussions on the contemporary
terrorism paradigm, which revolves around ways in which terrorists organize, the potential for an increase in
religiously motivated terrorism, and a presumed shift towards more indiscriminate killing through the use of new
tactics and weapons. Special focus is paid to a particular transportation sector, rail bound traffic. The paper
focuses on this because empirical observation suggests that rail bound traffic is extremely vulnerable and at high
risk for terrorist attacks. This paper sets out to explore high profile attacks targeting train and subways in Tokyo
1995, Madrid 2004, London 2005, Mumbai 2006, Moscow/ St. Petersburg 2009. All these attacks bear the
marks of contemporary terrorism, and they posed tremendous challenges for the crisis management response. To
plan and respond to different crises is highly difficult, and is often described as something, unique, complex and
uncertain. The institutional design of crisis management systems differ between countries depending on context,
history, political traditions and so forth. Several researchers have observed that slowly, national governments are
being aware how critically important an institutionalized crisis management capacity is, not at least since new
forms of crises appear on the horizon. This paper aims to compare different crisis management systems, the
response to the events as well as lessons learned from the major attacks in order to answer the pressing question
of how to design a crisis management system that can prepare, respond, mitigate, recover and learn from a
terrorist attack on the rail bound sector.
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INTRODUCTION
Terrorist groups have repeatedly targeted train and subway systems. The public transport
sector, rail bound traffic included, has become a theater of operations for terrorists, aiming at
causing mass-casualty events (Jenkins 2001). How to plan for and carry out effective crisis
management response (commonly referred to as emergency management) to major terrorist
attacks targeting rail bound traffic is at the center for the analysis in this article. Coordinated
bombings, suicide attacks, explosions in confined spaces, attacks during rush hours in order to
maximize the number of injured and fatalities are some components of terrorist attacks that
often are understood as a contemporary or even a “new” form of terrorism (see for example
Hoffman 2006, Simon & Benjamin 2000). Some terrible, yet, clear examples of how rail
bound traffic has become a perfect target for terrorists, aiming at mass-casualty attacks, are
high impact cases such as the sarin gas attack targeting Tokyo’s subway system in 1995.
Further examples are; coordinated bombings on commuter systems in Madrid 2004 and
Mumbai 2006, and suicide attacks targeting the subway system in London 2005, as well as a
bomb attack targeting a high-speed train, running between Moscow and St. Petersburg in
2009.
This article draws mainly on two bodies of research, the field of terrorism studies and
disaster- and crisis management research. Furthermore, in this article, it is argued that crises
and terrorism in particular, are undertaking some fundamental transformations, implying
changes also in crisis management policy as well as in practical approaches to crises.
Accordingly, the overall aim of this article is to investigate governments´ and main
responding agencies response to these highly complex terrorist attacks on trains and subways,
and by doing so, contributing to our knowledge and best practices when responding to mass-
casualty events targeting a vulnerable transportation sector. The analysis will be carried out
by applying a holistic perspective to crisis management, addressing different levels and time
phases. To concretize; the article will investigate the immediate tactical/operational response
to the five cases of attacks, thereafter the multi-organizational response on a strategic level
will be analyzed, and finally the article will reflect on a system level, addressing possible
explaining mechanisms behind the different response outcomes of the attacks.
McEntire (2002:267) establishes that an increasingly amount of attention is paid to the future
of crisis management; both new theoretical perspectives as well as policy guides are required.
The reason for such an observation is the changing nature of crises and changes in how
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terrorist attacks are being carried out, thus, it is in this context the response to the five case
studies under analysis must be interpreted. The attacks in Tokyo, Madrid, London, Mumbai
and Moscow/St. Petersburg , to a varying degree, bear the marks of a transformed form of
terrorism, they also exemplify the rise of transboundary crises, (Ansell, Boin & Keller:
2010:195). Boin (2009:367) establishes, “the world of crises and disasters is shifting”.
Clearly, the notion of change is of crucial importance here. Several researchers argue that
changes in crises, pose new challenges to national governments and policy makers. As Boin
(2004:165) observes; “slowly – very slowly - national governments are being aware how
critically important an institutionalized crisis management capacity is since new forms of
crisis appear on the horizon.” Hence, as already outlined, such an institutionalized crisis
management capacity will be studied from different levels.
Research reveals that there is a worldwide growing concern within the medical community
regarding the current capacity and preparedness to deal with the victims of manmade mass-
casualty incidents (Turégano-Fuentes 2008:1169). True mass casualty events are from a first
responder’s perspective very challenging situations, by definition, “they involve such large
numbers of victims, or such severe or unique injuries that local medical resources cannot fully
cope with them” (Gutierrez de Ceballos 2004:105). Yet, considering a terrorist event such as a
major terrorist attack on train and subways, additional complexities add to the response.
Factors to consider are for example, unique injury patterns caused by bombings, presence of
secondary devices, rapid removal of injured. One can refer to Shapira, Hammond & Cole
(2009) that interestingly observe that the nature of terrorist events, and the effects on the
victims, has prompted novel approaches to rescue operations, their treatment and coordination
of services. This puzzle is at the center in the first part of this article, mainly focusing on a
tactical/operational level in the immediate response to the terrorist attacks. The research
question posed is: how did the main operational responding agencies respond to the terrorist
attacks in Tokyo, Madrid, London, Mumbai and Moscow/St. Petersburg, what were the main
challenges encountered and how were these addressed? Moreover, this article argues that
additional complexity in the response will be added in cases of terrorist incidents, therefore,
this article also sets out to identify challenges in the response that is particularly related to the
nature of terrorism.
Terrorism perceives often as a complex problem that requires multiagency solutions
(Eyerman & Strom: 2008:106). During the last ten years, an increased attention to multi-
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organizational crisis management has been observed (Eyerman & Strom: 2008:91, Uhr 2009).
Even though multi-organizational collaboration suggests as the recipe for effective crisis
management, it is also associated with inherent difficulties. Coordination stands out as
fundamental for success; yet, lack of such function can lead to failure in crisis management.
With other words, coordination represents a double-edged sword. Here, one can refer to the
concept of institutional complexity, which according to Stern (2003:15), includes both
horizontal and vertical dimensions. The former concerns the fact that multiple agencies at the
same level of government tend to hold that they have a stake in the crisis. The vertical
dimension focuses on the involvement of actors across levels of governments. A crisis begins
a certain location, often at a local level, however, the crisis may be “up scaled” into a national
or even an international level. This complexity of multi-organizational collaboration will be
the focus in the second part of the article, addressing a strategic level of the response work to
the five terrorist events. It relates to the following research question, how was multi-
organizational collaboration carried out in the response to the attacks in Tokyo, Madrid,
London, Mumbai and Moscow/St Petersburg?
The attacks under analysis share some striking features; above all, they follow the dramaturgy
of contemporary, high impact terrorist events, causing complex mass-casualty situations,
including aspects such as coordinated bombings during rush hours, suicide attacks and
secondary explosions. Yet, the crisis management responses to these events have come out
differently. I place these examples of contemporary terrorist attacks in a broader crisis
management context at a system level. While the operational level correlates to an immediate
response, and the strategic level takes on a wider time perspective by also incorporating
aspects such as preplanning, the system level zooms further by reflecting on long standing
processes such as development of overarching frameworks for government’s response, legal
frameworks, multi-agency cultures and security awareness. This last part of the article aims to
answer the question: what are the main explaining mechanisms behind the different response
outcomes in Tokyo, Madrid, London, Mumbai and Moscow/St Petersburg?
5
FIVE MAJOR ATTACKS TARGETING RAIL BOUND TRAFFIC
The sarin gas attack targeting Tokyo’s subway system is often mentioned as a defining attack
by its introduction of unconventional weapons into the arena of terrorism (Ganor 2009:16).
On 20 March 1995, the cult, Aum Shinrikyo released sarin gas simultaneously on five subway
trains, on three separate subway lines. The attack resulted in 12 fatalities and a very high
number of injured, more than 5500. From a historical perspective, it became the largest crisis
caused by a nerve gas in peacetime, something that was highly unexpected since Tokyo’s
subway system was regarded as one of the safest in the world (Okumura 1998:613). Aum
Shinrikyo classifies as a religious terrorist organization and is being described as an
“apocalyptic and millenarian cult, controlled by a messianic figure, Ahoko Ashara” (Cameron
1999:277,279).
Since 9/11, the global jihadi terrorism has come to define much of the discussions on
terrorism. Of special concern has been the fact that the jihadi terrorism is believed to represent
a transformation in international terrorism, concerning both scale and motive (Ganor
2009:16). This concern later realized by major transport bombings in Europe. On 11 March
2004, Madrid’s commuter system suffered a large-scale terrorist attack, 10 bombs detonated
within a couple of minutes in four different commuter trains. The attack occurred during rush
hour and killed 191 persons, and injured more than 2000 (Gutierrez de Ceballos 2005:104),
thereby it produced the largest loss of life in a single attack on European soil in modern
history (Turégano-Fuentes 2008:1169). Islamic extremists influenced by Al-Qaida were held
responsible for the bombings, the group Abu Hafs al-Masri Brigades claimed responsibility,
however it is uncertain whether the claim was valid or not (Global Terrorism Database 2012).
One year later, in 2005, in London, another major attack on rail bound traffic took place. In a
short time span, three bombs exploded on underground trains and a fourth bomb detonated on
a double-decker bus. In all, 56 persons were killed and around 700 injured in these suicide
attacks. Several groups claimed responsibility, including Abu Hafs al-Masri Brigades and the
Secret Organization of al-Qaida in Europe (Global Terrorism Database 2012).
At the end of the twentieth century, a change in terms of geography occurred in international
terrorism. Focus from the traditional epicenter of the Middle East shifted to central and South
Asia (Ganor 2009:14). With this development, in combination with the fact that India has one
of the largest railway systems in the world, carrying around 20 million of passengers on a
daily basis (Government of India Ministry of Railways 2012:4), it is not surprising that India
has suffered several major terrorist attacks on their railway system. On 7 December 2006, the
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railway hub Mumbai was struck by a series of bomb explosions. Bombs detonated inside first
class trains at seven different stations, causing the death of 187 civilians, injuring 817. The
bombings were attributed to Lashkar-e Taiba (Rand Cooperation Database 2012).
The fifth case of a major terrorist attack on rail bound traffic, took place in November 2009,
in Russia, when jihadists from the North Causasus Resistance detonated bombs on Nevsky
Express. The explosion caused four carriages of the luxurious high-speed train to derail,
killing at least 26, injuring more than 100 (Daily Mail 2009/11/29). Nevsky Express runs
between Moscow and St. Petersburg, thus, unlike the four attacks already described, this event
did not take place in an urban setting, but in a remote area with deep forest (the New York
Times 2009/11/29). The geographic location posed profound challenges in terms of crisis
management. Worth noting is also that a second, fortunately less powerful, explosion took
place the second day while the response operation still was going on (Daily Mail 2009/11/29).
No one was hurt in the second explosion but it illustrates an articulated fear that terrorists use
secondary attacks in order to increase destruction and fear.
I argue that these five cases are defining attacks in several ways that need further exploration
– from a comparative perspective. Four defining characteristics assign to contemporary
terrorism. Today’s terrorists are assumed to act increasingly transnationally and in loosely
organized networks, they are inspired by religion, they seek weapons capable of attacking as
many people as possible, and finally, terrorist are increasingly indiscriminate in who they kill
(see for example Laqueur 2003, Hoffman 2006 and for critique of the paradigm Duyvesteyn
2004, Tucker 2001). When sarin gas was released in Tokyo’s subway, it signaled a defining
moment, renewing the attention to religious motivated terrorism, and in particular with regard
to the risk of groups using weapons of mass destruction. The rise of mass casualty bombings
also makes a defining aspect in the development of contemporary terrorism – which the
attacks Madrid, London, Mumbai and Moscow/St. Petersburg later illustrated. The key to
each of this new developments, according to Quillen (2002: 279-280) lay in the ability and
desire to kill large number of people. It is without doubt a challenge to respond to these
events. A comparative case study approach allows for informative comparisons, contributing
to our understanding of the practical and strategic response. Far from every national
government, crisis management systems, or individual first responders, have had exposure to
major terrorist events. Moreover, as Smith (2009) emphasizes, the emergence of new “low
probability-high consequences events”, sometimes referred to as “black swans” (Taleb 2007)
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calls for new techniques and analytical frameworks for dealing with these particular complex
events. This article aims to contribute in such a direction.
This article mainly builds on previous research, some attacks, such as Tokyo, Madrid and
London are well addressed in research, while the events in Mumbai and Moscow/St
Petersburg are more sparsely researched. For the purpose of this article, interviews were
conducted with representatives from different responding agencies to the attacks in Madrid,
London and Moscow/St Petersburg, these are complementary to previous research. When
available, official documents, such as national governments official reports or evaluations of
the response have been used. Lastly, a main source for information on the terrorist attacks has
been various terrorist incidence databases.
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It should be underlined that literature on crisis management (as well as on terrorism), is rather
under theorized. One pressing question that engages scholars within this field is the issue of a
potential general theory of crisis management. The key concern revolves around how general
such a theory can be. Crises differ widely but there might be some general patterns or
structures that underlie crises and can be generally applicable to prediction, treatment and
prevention (Mitroff, Pauchant, Shrivastava 2006:48). When analyzing the response at
different levels and from different time perspectives, one touches immediately on the question
of effective or successful crisis management. Clearly, it relates to a second question of how
we can measure crisis management response. Researchers (see for example Mitroff &
Pearson 1993, Quarantelli 1997), within the crisis management field have suggested criteria
for measuring response. However, Pearson and Clair (1998) underline the difficulty in
differentiating effective from ineffective crisis management. Also within the disaster medicine
field, often considered a descriptive discipline, researchers argue that there are clear
challenges in comparing outcomes from different types of incidents. Ruter, Örtenwall &
Wiktström (2004:52), exemplify such difficulties well by pointing at an often-recurring
conclusion: “shortcomings in communication”. Such a general conclusion must be specified,
for example, was it a technical problem or a coordination problem? Clearly, there are
challenges associated with analyzing outcomes of a response, regarding both the process as
well as the result. Yet in order to answer the questions posed in this article, one need to relate
to these challenges, the empirical part takes on a structure, using a large number of points of
comparisons. These points, or components in the response, are all recurring in the literature as
key ingredients in crisis management. Informative are performance indicators regarding
medical management (see for example Ruter, Örtenwall & Wiktström : 2004 on development
of 20 measurable indicators), both on a tactical on site - and a strategic level. It is important to
note that the most frequently described problems in major incidents often ascribe to
management at a strategic level (Ruter, Örtenwall & Wiktström 2004:53). Performance
indicators at the strategic level, as the communication example illustrated, can be harder to
measure than indicators at a tactical level, at which the time before the first victim is
evacuated serves as one example of a measurable indicator.
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CRISIS MANAGEMENT AT A TACTICAL/OPERATIONAL LEVEL
When a large-scale crisis hits a society, such as a terrorist attack, the immediate crisis
management response is of outmost importance. An effective crisis management depends on
first responders. According to Boin (2007), these key actors must feel capable to “operate in
the dark” taking on challenging tasks, preplanned rescue work as well as seize initiatives
along the way as known command structures may collapse. Allocation of materials,
equipment, and accurate information are challenges. Moreover, first responders need to have
the capacity to assess when crisis management plans need to be activated, and when rendered
useless. All these elements are crucial in order for providing the best response available to the
victims. Following part addresses this first response, taking both the out-of hospital as well as
the in-hospital response into consideration.
TOKYO MADRID LONDON MUMBAI MOSCOW/ST
PETERSBURG
OUT-OF HOSPITAL RESPONSE
Fatalities 12 191
56 187 27
Injured 5500 1800
700 871 132
Time of attack 07.48-08.00 07.39- 07.42 08.50 (trains)
09.47 (bus)
18.24 – 18.35 21.35
Number of
attack sites
5 4 4 7 1
Initial confusion
over the cause of
the attack
Yes – during the
first hour, calls came
from all 15 affected stations, at the time
TMACC did not
realized it was one cause. (Okumura
1998)
No indication of
competing views, it
was quickly confirmed that
there were four
sites caused by terrorism. (Gomez
2007)
Yes - Initially, an
electrical power surge
was reported, also a train derailment was
reported (Lockey 2005)
Yes – confusion over
cause remained, villagers
reported a loud slap, indicating an explosion
(Reuters 2009) also
speculations over an electrical fault.
Ambulances 131 (Okumura 1998)
291 (Ceb 2004) 200 vehicles, 400 staff (eyerman 6 strom 2008)
Except ambulances going to S.t Petersburg,
there were 40-50
ambulances at a collection point in
Novgorod.
Firefighters Fire department
responsible for 182 emergency medical
teams and 1,650
emergency medical technicians
(Okumura 1998)
200 (Ceb 2004) 250 (eyerman & strom
2008)
Volunteers 500 (Ceb 2004) Played an important
role (LRRR:3)
1000 volunteers
turned up at the
main hospital
Not in an organized way
due to the location,
nearby villagers
performed the initial reponse
Prehospital
triage
Triage was done by
emergency medical services (under
responsibility of the
fire department) however a large
number victims
went to hospitals
No form of triage
system using for example color
markings was used
(Bolling 2007)
Yes, Edgware Road and
Tavistock by ambulance service and
medically trained
bystanders, Aldgate and King´s Cross by
London HEMS staff
No triage system
in place
Villagers became first
responders, had to sort out the dead from the
living (the New York
Times (2009-09-28) No systematic approach
seemed to be in place in
the later rescue
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themselves (Okumura 1998)
work(interview)
Over triage 68% (at (
GMUGH)(frykberg 2005)
63%
(Aylwin 2006)
8% (at King
Edward VII Memorial
Hospital (lancet)
Field hospitals Emergency rescue
quarters were established at the
sites, no
decontamination of victims on site
(Okumura 1998)
Within 30 min at
the four incident sites
(Gomez 2007)
Lightly injured persons
were taken to hospitals by bus, stopped when
the bus bomb took
place (fors 2006)
No A mobile hospital was
set up close to the scene
Immediately
dead at scene
177 (9%) (Fuentes 2008)
53 (7%) (Aylwin 2006)
Critical
mortality rate
19,5 %
(Fuentes 2008)
15%
(Aylwin 2006)
“Immediate
fatalities + non
critical injuries”
82.5% as mild cases , 16.7 moderately
0,78, 5 patients –
severely
YES YES YES YES
Waited for
cbrne experts to
arrive
No No No (fors 35) No No
Articulated
strategy to avoid
overstretching of
resources
No, instead all aviable resources
were sent to the first
incident site
Yes (Fors 2006) No
Evacuation of
commuters
The underground was
evacuated in 44 min.
This was the second evacuation of the entire
network in living
memory, previous was in 1991.
250 000 persons were evacuated
Total time for
evacuation of all
casualties
In 2.39 hours
(Gomez 2007)
Within 3 hours
(home office 2006)
IN-HOSPITAL TREATMENT
Number of
persons taken to
hospital
688 transport
4000 by foot
775
(Fuentes 2008)
350
(Lockey 2005)
90
(BBC) 50 to hospitals in St.
Petersburg (Jones 2009)
Critically ill
persons
transported to
hospital
165 (Bolling2007) 20 (Aylwin 2006)
54 (at the main hospital)
Deshpande
Main receiving
hospital
St. Luke Hospital
Gregorio Maranon University General
Hospital
Royal London Hospital + 6 (Fors 2006)
King Edward VII
Memorial
Hospital
Uneven
distribution of
casualties
Yes- two closets, received by far
most of the victims,
almost 82% of reported cases
(Fuentes
2008:1170).
The maximum number of
casualties brought
to King Edward VII Memorial
Hospital (lancet)
Surge 150/ 500 patients in the first hour (the
major receiving hospital)
50 patients within the first 45
minutes (Despande)
Time incident –
first arrival of
priority patient
to hospital
48 min (first victim
transported by
ambulance) (Okumura
1996:130)
23 min until the
first critically
injured patient was transported
(Gomez)
75 min
(Moon 2007)
30 min
(Moon 2007)
2 hours to get to the
scene (BBC)
In-hospital-
deaths
14 (Fuentes 2008)
11
Critical
mortality rate
19,5 % (Fuentes 2008)
15% (Aylwin 2006)
Most common
injuries
encountered
Symptoms
encountered after chemical exposure;
eye symptoms,
headache, throat pain, dyspnea,
nausea, dizziness
and nose pain (Pangi 2002)
Tympanic
perforation, chest injuries, shrapnel
wounds, fractures,
first-degree or second-degree
burns (Ceb 2004)
Head injury, chest
trauma, fractures, tympanic
membrane
perforations, tinnitus, giddiness
(Despande)
Fractures, bleedings,
pshycological trauma.
Figure 1 The figure shows different points of comparison at a tactical/operational level between the five case
studies.
“The golden hour” describes as ubiquitous in the trauma care literature, indicating the broad
ranging support for the idea that trauma patients have better outcomes if they can receive
definitive care within 60 minutes of the occurrence of their injuries. The concept of the golden
hour has been guiding for much of current trauma systems, clearly stating the urgency in the
situation (Lerner 2001: 758). Accordingly, analysis of a tactical/operational level of crisis
management focuses on the immediate response, including the “golden hour” as well as
subsequent hours. Boin and ´t Hart (2010:360) reflect on recurring challenges encountered in
the response to major crises, these challenges are also informative when analyzing the five
cases in this article. Diagnosing and deciding are two useful concepts, meaning the difficulty
in forming a picture of the nature and extent of the threat or damage. Moreover, from a
strategic perspective, terrorism is primarily seen as a strategy of surprise (Crenshaw 1987),
timing, location and nature of an attack is impossible to anticipate. It is clear that all cases of
attacks on rail bound traffic had surprising elements, and the first responders did not know
what to expect. Four of the five case studies were multi-site attacks, and the nature of such an
event has been articulated as particular challenging. Tokyo faced the scene of five subway
trains affected by sarin gas, Madrid and London had to handle four explosion sites, and
Mumbai was struck at seven locations. To further exemplify complicating aspects; in London,
where casualties emerged from stations and different ends of tunnels, separate incident scenes
emerged. Four explosions in London turned into the declaration of eight separate scenes, all
requiring full emergency response (Lockey 2005). So each site was a serious incident in its
own, in addition came their unprecedented cumulative effect, creating a great portion of
confusion and speculation on the risk of further attacks (London Regional Resilience Report
2005).
Another challenging task is efficient mobilizing and organizing (Boin and ´t Harts 2010), it is
well known that a mass-casualty event often taxes crisis management systems, hospitals,
infrastructure, and exceeds available resources to the extent that optimum trauma care is in
12
danger (Aylwin 2006:2219). Here one can establish differences among the cases, London,
Madrid and Tokyo report to have delivered all available resources almost immediately to the
sites (yet, resources were minimized to extent possible, in order to not overstretch capacity in
case of further attacks). In the case of the bombing of Nevsky express, the situation was
precarious due to its location, around 400 km north-west of Moscow. Rescue operations were
initiated minutes after received information of the attack, yet it took the first responding
agencies nearly three hours to reach the site. Meanwhile nearby villagers came to perform
triage – one of the initial steps in a response, in this case the villagers had to sort the dead
from the living (Barry: 2009). Use of triage differ among the cases, in Mumbai, there was no
systematic triage system. In the case of Madrid and Tokyo, no triage system by color making
was used, even though, as in the case of Madrid, equipment for such a systematic approach
was available. In Tokyo, fire fighters mainly carried out triage, however a majority of the
victims went to hospitals themselves. London appears to have used triage in the most
systematic manner.
On- site challenges such as facing large number of casualties, effective triage and rapid
mobilization belong to established procedures. However, during the response to the attacks
several complicating aspects need attention, several of them relate to scene safety. CBRNE
terrorism is often talked about as a worst-case scenario, and preplanning for such situations
are part of most crisis preparedness plans (Fors 2006). Yet, Okumura (1998:623) concludes
that one of the most serious problems in Tokyo 1995, was the lack of chemical disaster
planning, which was later reflected in a high degree of secondary exposure of the hospital
staff to the chemical substance. Almost 10% of all emergency medical technicians showed
acute symptoms, mainly eye symptoms and headache, and it was suspected that they were
exposed in ambulances to the vaporized sarin from the victims. The rescue work is considered
to have been affected since the medical personnel had to receive medical treatment (Okumura
1998:615). Another risk that relates to terrorist events is secondary devices at the incident
scene; Madrid is illustrative in this regard. Ten bombs detonated at four sites, however four
bombs never exploded. In addition, the police collected bags from the sites, without knowing
about its content, one bag with an unexploded bomb was taken and discovered at a police
station (Bolling 2007:256). Secondary devices also affected the response, hospital tents were
established in a near vicinity of the site, and had to be moved when first responders realized
the risk of further explosions (Bolling 2007:253). Secondary devices was also present in
Mumbai, the police safely defused one bomb. Scene safety also relates to secondary bombs,
13
planned to explode near the first bomb site, targeting bystanders or first responders. In the
case of the bombings of the high-speed train between Moscow and St. Petersburg, a smaller
device went of the second day, hurting one of the investigators (BBC 2009/12/02).
Fortunately, this time the second bomb resulted in minor damage, yet it sheds light of the
problem. Security procedures when approaching incident scenes is an area that needs further
attention (Leppäniemi 2009. 30). London is the case where such procedures appear to have
been developed, yet, some complicating aspects were reported. For example, police officers at
some sites were working very strictly to the rules, and hindered thereby other agencies from
gaining access (London Regional Resilience Report 2005:11). A last point relating to scene
safety is the fact that the uncertain security situation calls for rapid scene clearance, (emphasis
on scoop and go) yet that also imply an increased surge in the receiving hospitals.
Turning to the in-hospital response, one needs to pay close attention to that different types of
attacks cause different injury patterns. Bombings are the most frequent used tactic in terrorist
attacks; bombings were also used in four of the five case studies. It is well established in the
literature that bomb attacks result in injuries that are caused by a combination of mechanisms,
such as blast (from changes in atmospheric pressure), penetrating injuries (caused by
shrapnel), blunt (consequence of body displacement caused by expanded gases), and burns.
Head, chest, abdominal, traumatic amputation and blast lung injuries are frequent observed
among critically injured (Frykberg 2004:20). What complicates this picture further, is the fact
that most care providers are not familiar with these types of blast injuries (Turégano -Fuentes
2008:1169 ). One can also add a dimension that relates directly to the modus operandi of
terrorists, suicide bomb attacks (SBA). According to Turégano-Fuentes (2008:1173)
characteristic for SBA injuries are a combination of blunt injuries, multiple penetrating
injuries with extensive soft tissue damage, and burns. This injury pattern was reported from
London 2005, the only case of suicide attack among the five attacks.1
1 Further analysis of the in-hospital treatment will be conducted.
14
CRISIS MANAGEMENT AT A STRATEGIC LEVEL
As stated, the immediate response to a major crisis is extremely important, how individual
first responders, or teams, perform their tasks can make tremendous difference for the victims.
However, an effective crisis management do not only depends on individual rescue workers.
If a major crisis takes place, formal organizations need to coordinate their objectives,
resources must be shared and activities need to be synchronized (Uhr 2009). These
coordination aspects relate to a strategic level, accordingly, in the following part, key aspects
fundamental for carrying an effective coordination of the response operations will be analyzed
for each of the five attacks.2
TOKYO MADRID LONDON MUMBAI MOSCOW
Preparedness
capacity –
training and
education
Prior to the
attack, there
were no
integrated drills
including all of
the concerned
organisations
(okumura
1998:616)
The responding
agencies had been
trained well, often
in integrated drills
Regular interagency
trainings, a major
exercise on London
underground took
place just before the
attacks
No organized
crisis
management
response system
until 1996, now
the biggest
hospital has
regularly
trainings
Previous
experience of
major high
profile
cases/terrorism
Mostly natural
disasters such as
earthquakes and
floods, limited
experience of
man-made
disasters, a
smaller sarin gas
attack in 1994
(Okumura 1998)
Long history
dealing with
attacks carried out
by ETA, but no
experience of such
a large-scale
attack
Yes, Great Britian
has suffered several
attacks, mostly
related to the
Northern Ireland
conflict, London
also have a
relatively extensive
experience of
handling train
incidents (Fors
2006)
Mumbai
bombings 1993
– coordinated
bombings
targeting rail
bound traffic
Moscow theatre
crisis 2002,
Beslan school
seizure crisis
2004,
(Porfiriev 2005)
Key document for
coordination/legal
instruments
Tokyo regional
disaster plan (intended to
provide initial
medical rescue
and backup
support)
*PLATERCAM
The Territorial
Plan of Civil
Protection of the
Community of
Madrid
* the Health
Regulating Law
of the
Community of
Madrid
(Gomez 2007)
*LESLP London
Major Incidents
Procedures Manual
*2004 Civil
Contingencies Act
Eyerman & strom
2008)
Multi-agency
approach to crisis
management
No, actors
carried out their
roles without
central
coordination.
Yes Yes No
2 Another aspect that I will address is the importance of the response that takes place outside formal
organizations and preplanned structures, research shows that ad-hoc behavior and innovative and flexible solutions are key in a better understanding of crisis management (Uhr 2009). In large- scale attacks such as the five case studies there are reasons to believe that “informal crisis management” also played an important role.
15
Declaration of
“major
incident”/upscaling
of command and
control
Main hospital disaster plan was
activated 85 min
after the attack (okumura
In 96 min PLATERCAM
classified the
situation as the maximum level –
level 3, a national
command organization (Gomez
2007)
33 min “A London-wide major incident”
Various actors
declared major incidents at the sites at
different times, the
first, Aldgate station 09.05 by London Fire
Brigade
The Institutional Disaster
Management
Program (DMP) was activated 5-10
after the first
victims entered the main hospital
(Deshpande)
Within 10 minutes after the first
information, “extra
resources” were called for.
Crisis of manpower Yes, The emergency
medical system
and medical transportation
were overtaxed: (Pangi 436
The attack occurred at time for shift
change at several
responding agencies, No shortage of
personnel reported.
(Bolling 2007)
No “The events of 7 July did not exceed the
capacity of the
responding agencies to contain anddeal with
the situation” (LRRF
2006)
No When the rescue teams arrived at the
site, the was no
need for more manpower.
First press
conference was
given
In 2h 35 min – indicating that
sarin intoxication
was suspected (okumura 2008)
Shutting down of
train system
Yes, within 25
minutes, seen as a
lesson learned from Madrid (Fors 2006)
Train system
resumed operation
05.00 the day after
(Fors 2006)
10.00 the day after
(the Hindu 2006)
Communication –
calls
22 000 incoming calls in the first 16
hours (Bolling)
42 000 calls to Metropolitan Police
Casualty Bureau
(Lockey 2005)
Main area of
concern
Telecomunications Telecommunications
(LRRR:6)
Anticipation of
psychological care
Was not part of disaster planning at
the biggest hospital
Yes, assistance arriwed at the
remote place
during the first hours
Identification of
dead
155 of 191 bodies
were identified
within 24 hours (Bollin)
Ad-hoc leadership
Flexible solutions
Figure 2 The figure shows different points of comparison at a strategic level between the five case studies.
Research findings point clearly in the direction that a single organization cannot tackle major
crises, instead interagency and networked forms of management and organization is
emphasized. Boin and ´t Hart (2010:365) argue “the crisis response of a society is to a very
considerable extent determined by the breadth and depth of interorganisational relations in its
crisis management systems. Response to the major attacks on rail bound traffic required the
collaboration of a wide range of institutions and organizations, how well collaboration was
institutionalized, differ between the case studies.
Achieving effective collaboration calls for preplanned structures and familiarity with roles
and responsibilities, a step in such a direction is recurring trainings and drills. By coincidence,
several of the attacks took place close in time to larger crisis management drills. For example,
16
in the hospital receiving most victims in Mumbai, there was a disaster management plan drill
only a month prior to the attacks (Moon, Bogle & Minas 2007:640). Likewise, in London a
larger emergency exercise on the London underground took place just a couple of weeks
before the attack (Lockey 2005). In the case of Tokyo, drills are reported to have been carried
out regularly, however drills and plans were mainly aimed for fires and earthquakes
(Okumura 1998:618). Also in Russia and in Madrid, it is common with recurring exercises.
In the case of Japan, the Tokyo metropolitan government is responsible for regional disaster
planning and its management. The Tokyo regional disaster plan establishes that Tokyo
Metropolitan Fire Department (TMFD) has the responsibility in providing first aid to victims
and selecting the hospitals to which victims will be transported to. The metropolitan police
have primary jurisdiction over law enforcement. In addition, the Japanese Self Defense Forces
are a resource, often mentioned is their knowledge in chemical disasters (Okumura 1998: 613-
614). When reviewing the literature on the subway attack it becomes clear that inter-agency
coordination was surrounded with challenges. Okumura (1998:616) identifies three main
problems encountered. Firstly; limited out-of-hospital care, secondly; lack of cooperation and
communication among different actors, and thirdly; general lack of preparedness for a
chemical disaster. Pangi (2002:428) uses “compartmentalized bureaucracy” to describe that
Japanese agencies usually work separate from each other, and this lack of cross-agency
cooperation hinders effective response systems. To exemplify, there were no contingency
plans in order detailing how to respond to an attack caused by chemical substances. The only
actor with such planning was the military (Pangi 2002:428). However, the Self Defense
Forces cannot act without the consent of the prime minister. Yet, they are allowed to carry out
rescue work in a crisis situation, but it requires a request from the local government. In this
specific context of a chemical attack, in the early stage, the resources were not deployed
optimally. In all, respective actor appears to have carried out their response without a central
coordination.
The attack in Madrid caused enormous devastation and the response involved a large number
of actors. Spain has a history of dealing with terrorism, mainly from separatist groups such as
ETA. However, the scale and the nature of the attack with different incident sites outreached
previous experience. When reviewing research it becomes clear that preplanned coordination
instruments became important during the response. PLATERCAM serves as the legal
instrument that activates in relation to catastrophe situations. It serves as a framework for the
17
coordination between participating public administrative bodies; moreover, it outlines
mechanisms for mobilization of human resources and materials needed for response. A
second central instrument is the Health Regulating Law of the Community of Madrid,
establishing that the Health Community is responsible for directing the services, including
developing emergency plans and coordinate medical resources in cases of crises. (Gomez
2007:248). The scale of the attack led to activation of both regional and national command
organizations. A quick up scaling of coordination was made, the highest level of
PLATERCAM, level 3, was activated in around 35 minutes after the attack (Gomez
2007:250), - something that previously had never happened (Bolling 2007). The treatment of
all victims is overall regarded as successful, at all four scenes (Gomez 2007). Yet some
coordination challenges were encountered. For example, two organizations; Summa and
Samur, are responsible for prehospital treatment. In the response, both organizations felt that
they led the rescue work at the sites. After the response, it also became clear that distribution
of casualties to the different hospitals had been rather uneven (Bolling 253-254). One of the
main lessons learned, except improvements in telecommunications, is the need to establish a
top of command at each of the sites, hence improving the ability to respond in different areas
at different times (Gomez 2007). However, according to Ceballos (2004:106) lack of previous
experience of such a large-scale crisis, its multi-site nature included, was counterbalanced by
the commitment of the agencies involved and spontaneous leadership in different areas.
The response to the attacks in London stands out as the case with the most organized multi-
agency coordination. Eyerman and Strom (2008:90,100) points at a long history of responding
to both natural and manmade crises, and a articulated multi-agency approach to crisis
management has existed for more than 60 years. A large number of responding actors,
including various volunteer groups were activated on July 7. The foundation of London’s
multi-agency coordination is a system with three levels of response; gold (strategic), silver
(tactical), and bronze (operational). The different levels relate to different functions and
responsibilities, which are outlined in a Major Incidents Procedures Manual (LESLP).
According to Eyerman and Strom (2008), also echoed in the London Regional Resilience
Forums “multi-agency debrief” (2006), several successful elements of the response can be
identified. In one way or another, these successful elements are dependent on an effective
coordination. Rapid recognition and declaration of a major incident, agreed-upon command
and control systems, limited confusion over roles and responsibilities, effective handling of
casualties and coordinated media messages, are considered to have been key aspects in the
18
response. One can once again refer to the nature of a multi-site attack, implying several
incident sites (sometimes more than number of attack sites). London reports to have
integrated lessons learned from the response in New York, where the arriving forces initially
rushed in with too many resources (Fors 2006:22). Even though the response operation in
London is regarded as a “coordination regime” (Eyerman and Strom 2008), there is always
room for improvements. At a strategic level it can be illustrated by some confusions between
the U.K. government and the London response community. The first has a Cabinet Office
Briefing Room (COBR) that enables the prime minister and key government officials to
obtain critical information and communicate with main responding agencies. The London
response community, on their side, relies on the Gold Coordinating Group to direct strategic
operations (Eyerman and Strom 2008: 97). The official evaluation of the response concluded
the need for greater clarity between the two main actors (LRRF 2006:6). However, the
response was summarized, “while the response had by no means been perfect, the overall
multi-agency emergency response to the 7 July bombings had been very successful (LRRR:
3).
According to Supe (2008), India has experienced an increased frequency of civil disasters,
Mumbai itself has suffered from simultaneously terrorist bombings in 1993 and also extensive
floodings. These events together with other crises have contributed to the development of a
more comprehensive system for crisis management. It should be underlined that prior to 1996,
there was no organized system for deliver emergency medical care to victims of different
crises. The Disaster Management Cell of the Municipal Corporation of Greater Mumbai plays
a key role in the city’s crisis management, and sets out to handle by an integrated response.
The pre-hospital care in Mumbai is the responsibility of the Mumbai Fire Brigade,
traditionally limited to transportation of victims, in recent years trained paramedics have been
integrated to the response. On July 11, no prehospital triage was performed, leading to a
bigger surge at the hospitals, this surge was also increased by the fact that the Mumbai train
network is above ground and thereby shortens the transportation time to hospitals (Moon,
Bogle & Minas 2007). In the cases of Madrid and London, it was clear that inter-agency
collaboration revolved around distribution of casualties and sense making of the attack. In
Mumbai the public transportation system constituted an important actor, transporting the
casualties rapidly to the hospitals. Worth noting is that the time from the incident to the first
priority patient reaching hospital in Mumbai was only 30 minutes, compared to 75 minutes in
London. Major crises often attract large crowds of bystanders, sometimes hindering rapid
19
transport. Large voluntarily resources can also be helpful, yet on the day of the attacks, there
was confusion on how to handle, and possible deploy, these resources. A weakness mentioned
regarding the main hospital´s disaster management was that the roles and function of this
sudden additional manpower was not defined in the preplanning structures (Moon, Bogle &
Minas 2007:639-640).
The response to the bombings of the Nevsky Express running between St. Petersburg and
Moscow stands out among the five case studies, it is in particular informative when it comes
to challenges due to its remote location. The explosion took place on the border of Tver and
Novgorod regions (Gazeta 20120512). Consequently, main responding actors came from
these two regions, there were also response teams from S.t Petersburg and Moscow. Villagers
performed the immediate response at site. The nearest village is located around 5km from the
incident site, so even this immediate response was difficult. Responding agencies from St.
Petersburg reports prompt actions, the incident took place 21.35, ten minutes later information
of the attack reached the responding agencies, a minute later a first team left for the site. It
took another ten minutes before a decision was made to call for extra resources. A crisis
center was later also established in Moscow. It took the first team, from Novgorod, around
three hours to arrive. The subsequent hours, more teams arrived and carried out their work
under the lead of the Novgorod team, accordingly the operational team at a local level took
lead in strategy and decided upon the distribution of victims to hospitals in Novgorod, St.
Petersburg and Moscow, the most critical wounded were transported by helicopter.
Psychological assistance arrived already at the site at 03.00. According to the responding
agencies, (interview St. Petersburg) they regarded the response successful, yet room for
improvements relates to inter-agency cooperation at a strategic level. “A few more minutes
would have been needed in order to better coordinate between the different levels of
authorities”.
20
CRISIS MANAGEMENT AT A SYSTEM LEVEL
In this last part, mechanisms that are fundamental for crisis management at a system
level are yet to be analyzed. The institutional design of crisis management systems differ
between countries depending on context, history, political traditions and so forth. This part of
the article revolves around differences and possible similarities in the five cases
institutionalized crisis management capacity. In order to take on a holistic approach when
analyzing crisis management response, all elements of a crisis management system need
attention. As Uhr (2009:29) establishes, a crisis management system consists of several
elements, including individuals, groups of individuals, formal organizations, laws and
regulations, knowledge, culture, communication devises, even vehicles and stretchers are
included, as well as dynamical relations between the different entities (Uhr 2009:20). In other
words, there is a high degree of complexity embedded in crisis management, and differences
and similarities that emerge from the analysis can be synthesized into different national
approaches to crisis management response.
TOKYO MADRID LONDON MUMBAI MOSCOW
Well defined
leadership
Centralized crisis
management
system
Decentralized
crisis management
system
Ad hoc solutions Networked
governance
Resilience
Figure 2 The figure shows different points of comparison at a strategic level between the five case studies.
It is important to underline that crisis management is inherently political – a particular way of
handling adversity (Boin 2004:174). Governments have a fundamental responsibility in
providing security for their citizens, and throughout history, their competence in governing
crises, preventing as well as responding to emergencies, have been tested. The examination of
governments’ competence dealing with complex crises is considered more significant today
due to the fact that modern governments appear to become better equipped technologically,
yet, they must rely on legitimacy in order to govern (Farazmand 2007: 149,154). One can also
observe a trend towards a professionalization of disaster planners and crisis managers
21
(Quarantelli, Lagadec, Boin 2006:20), which main task is to formulate institutional
procedures as well as cultural climates which can develop capacities to cope with
extraordinary threats (McConnel and Drennman 2006:59). In other words, governments have
a fundamental responsibility to provide security for its citizens, and an institutional capacity
to do so is crucial; however, how this institutional capacity is developed and organized differ
between countries. This relates to an often raised question, do crisis management really
matters? (good management as well as mismanagement), and as this article will illustrate, yes
it does.
If crisis management is to make a positive difference, Rosentahl (2003:134-135) stresses the
importance of us understanding the relevance of recent crisis management maxims. First, it is
without question that leadership plays a crucial role in the immediate crisis response.
However, in large-scale crises, there will be many stakeholders as well as several actors that
are claiming their role in the decision-making processes, in other words, an institutional
complexity exists. This complexity indicates that a well-defined leadership is not sufficient as
the only point of analysis. Therefore, Rosenthal also underlines the importance of those
responsible for crisis management to take on a prepared, prompt and decisive response action,
the first minutes and hours of a crisis is decisive for success or failure. For the purpose of this
article, these actors have been interpreted as mainly first responders. Thirdly, Rosenthal adds
the concept of inconceivability as one could interpret as version or an additional maxim of
crisis management. With reference to Dror, Lagadec, Pofiriev & Quarantelli’s (2001) work on
the emergence of new crises, inconceivability is understood as a key aspect in the struggle to
carry out effective crisis management.
Ansell, Boin and Keller (2010) emphasize that transboundary crises pose significant
management as well as analytical challenges. Regarding the management side, coordination
and communication of actions across organizations, professions and political jurisdictions are
underlined as key challenges. Analytical difficulties revolve mainly around a lack of
understanding of what organizational factors that will produce reliable performance across a
network of actors. The literature is informative in how to foster reliable performance in single
organizations, however, the dynamics when organizations are uncertain about who their
partners in crisis might be, is less known (Ansell, Boin and Keller 2010:195). Clearly,
collaboration appears to be a key, but also a main challenge in crisis management, and
different levels face different challenges (see for example Boin & ´t Hart 2010).
22
As noted, the role of government in disasters and crisis situations is regarded as complex,
debates tend to focus on centralized versus decentralized approaches including networked
governance (Cheong 2011: 1073). Traditionally, disaster and crisis management has been
concentrated to a centralized, national level, invoking a crisis’s urgency and uncertainty (´t
Hart 1993). This traditional centralized approach corresponds to concepts such as command
and control, and explains as an approach in which; “orders and instructions are explicit, often
to the point of detailing not only what is to be done but also how, when, and with what
means” (Uhr 2009:22,59). In other words, the vertical dimension is of importance. However,
the centralized approach has come into question; some scholars argue that centralized
command and control structures cannot fully cope with intersectional and cross-jurisdictional
coordination challenges. Instead, more decentralized, networked collaboration is regarded as
needed, stressing its shared authority, collaboration and negotiation (Cheong 2011: 1074).
The importance of collaboration has already been reflected upon, however, one can take the
decentralization model further, as Uhr (2009:23) shows, there is a substantial room for “ad-
hoc behavior in crises, a behavior that do not necessarily corresponds to written, preplanned
structures, but rather to the concept of trust (Uhr 2009:23).
Uhr (2009:20) refers to national crises and international disasters such as hurricane Katrina
and the tsunami in 2004, and concludes that various managerial problems appear to be
common to both of them and possibly to be universal. Moreover, Malone and Crowston
(1990) establish that different functions of steering and controlling crises pose different
challenges, and some of these challenges has already been mentioned, they also argue that,
“when analyzing coordination, the collective behavior of the actors must be evaluated in
terms of how well it achieves some overall goal”, thus indicating a holistic approach to crisis
management.
23
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