Are You Prepared For Suicide Bombers?

Most terrorism experts agree, it is no longer a question of "if," it is now a question of "when" - when will suicide belt-bombers bring their brand of terrorism to the United States?

We have all seen the horrific scenes from Israel after suicide bombers entered crowded restaurants or buses and detonated themselves, usually killing or injuring scores of innocent civilians. Former Israeli Prime Minister Benjamin Netanyahu has already warned the U.S. Congress that suicide bombers may next target the United States. Homeland Security Secretary Tom Ridge has indicated more than once that there is an "enduring vulnerability" to attack by suicide bombers on American soil.

In 1997, two men from Brooklyn, NY - one Palestinian and one Lebanese - were arrested as they finalized a belt-bomb plot against the New York City subway system. In the 1980s, suicide bombers were used in Lebanon, Kuwait and Sri Lanka. In the 1990s, this form of terrorism spread to Israel, India, Panama, Algeria, Pakistan, Argentina, Croatia, Turkey, Tanzania and Kenya, and it has been used against our troops in Iraq.

The goal of the suicide bombers is to sacrifice their lives with the intent to destroy targets to advance their political objectives. The suicide bombers are psychologically and physically trained to die while destroying their enemy targets.

According to propaganda from various groups that use suicide belt-bombers, those who sacrifice their lives love death. In the eternal life, Hamas, Fatah and Al Qaeda videotapes reveal, "there will be rivers of honey and 72 virgins as reward for being 'martyred' in the glorious fight against the despised enemies of God." Usually, the families of those who martyr themselves are taken care of financially.

Jane's lists 10 groups capable of using suicide terrorism. While most on the list would not want to turn public opinion in the United States against their cause by using suicide bombers in America, the Osama bin Laden network of Al Qaeda is on the list. Al Qaeda members have certainly demonstrated their willingness to sacrifice themselves against American targets. Other experts feel that the radical elements of the Palestinian organizations that use suicide belt-bombers would have no problem using belt-bombs in America, since they feel America supports Israel, and this may be the only way to move America away from its support of Israel.

The ingredients are all in place. America's porous border with Canada certainly is an inviting method for suicide belt-bombers to enter the United States. The making of the belt-bomb is relatively inexpensive - costing only about $150 - and most of the materials can be bought locally.

Many experts feel that as America hardens specific targets against hijackings, car bombs and other terror tactics, terrorists have moved toward suicide belt-bombings, which are difficult to defend against. Al Qaeda has used trucks, ships and airplanes against American targets. Concrete barriers may stop truck bombers and tougher security at airports may prevent further hijackings, but it is difficult to stop a human bomb. The human bomber is cheap, explosives are easily concealed beneath clothing until detonated at a carefully chosen moment, and the result is highly lethal and attracts wide media coverage.

So where would we expect to see suicide belt-bombers in America? Many point to shopping malls, restaurants, night clubs, sporting events and VIPs who might be mingling with a crowd. If suicide belt-bombers choose to use their terror weapon in shopping malls, you can almost predict what would happen to the economy as Americans stop shopping in malls. Unfortunately, suicide belt-bombs are not only a weapon, but they are a weapon with a message - that you are not safe anywhere.

Don't rule out the use of ambulances. Palestinians have used ambulances in the past several years to travel throughout the cities of the Gaza Strip. On July 1, 2002, terrorists traveled in ambulances in the city of Nablus. On June 20, 2002, ambulances from the Sheikh Zaid Hospital in Ramallah transported wanted terrorists to and from the hospital and to various other places inside the city while it was under curfew. On March 27, 2002, a terrorist used a Palestinian Red Crescent ambulance to transport explosive belts. Children disguised as patients were also found in the ambulance. The explosive belt was found under the stretcher that the "sick child" was lying on. The belt contained 10 kilos of explosives, nails and shrapnel.

On a 2002 trip to Israel, U.S. Secretary of State Colin Powell's motorcade was targeted by suicide bombers. A Red Crescent ambulance transporting a dead Palestinian policeman was searched and found to contain explosives and suicide belt-bombs. The two Palestinians in the ambulance admitted under questioning that they had planned to drive the ambulance onto the Jerusalem-Tel Aviv expressway, the route taken later by the Powell motorcade. One of the men was to stay in the vehicle while the other strapped on the bomb and hid in roadside bushes. The ambulance was rigged to explode as Powell's car drove by. The second bomber was then supposed to leap into the milling crowd of officials and security men and blow himself up.

There are issues that fire and EMS personnel should consider when dealing with suicide bombers. First is security of the site after the incident. A common tactic is to detonate a second device to injure rescue personnel and others. There have even been reported cases of three and four bombers, each one waiting for another group of rescue personnel to arrive. Perimeters should be established and only uniformed personnel should be allowed within the perimeter.

From the response side of the equation, since a suicide belt-bomber will produce multiple casualties, your incident command system should be utilized. A belt-bombing is not only a terrorist event, it is a crime scene. Therefore, efforts should be made to preserve evidence, including clothing and other personal articles.

When dealing with patients from a belt-bomb blast, expect shrapnel injuries. To harm a victim, a projectile must exchange its energy with the human tissue. Most shrapnel from bombs have low velocity. Compensation from low velocity occurs when hundreds of fragments hit the body.

During your assessment, consider the victim of an explosive detonation will likely have shrapnel injuries. Treat airway problems as a high priority. Some fragment wounds may be small and unnoticeable. Therefore, do a head-to-toe secondary survey. Treatment of shrapnel wounds is dictated by the type of injury.

Unfortunately, what we have been immune from for many years will regrettably reach our shores one day. Only with knowledge, preparation and planning can we minimize the effects.

Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief of Special Operations for Jefferson County, MO. He retired in 2001 as the chief paramedic for the St. Louis Fire Department after serving the City of St. Louis for 25 years. He is also vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC). He is a frequent speaker at EMS and fire conferences nationally and internationally, and is on the faculty of three colleges. Ludwig has a master's degree in management and business and a bachelor's degree in business administration, and is a licensed paramedic. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 636-789-5660 or via