In Israel, responders literally fought for control at the sites where 39 Scud missiles hit the crowded Tel Aviv area in 1991 during the first Persian Gulf War. The country rallied, establishing the Home Front Command, clearly delineating roles and responsibilities among responding organizations, and preparing their population to be on alert, ready, and responsive should a threat or emergency occur. That system set the international standard in responding to terrorist attacks during the 2001-2006 intifada.
London had already experienced frequent terrorism at the hands of the Irish Republic Army, but our 9/11 changed their stance. When suicide terrorists hit the transit system on July 7, 2005, their response system - with its clear demarcations of Gold/Strategy, Silver/Tactics, and Bronze/Field Operations - clearly laid out roles and accountability, enabling them to quickly activate a massive response without conflict over jurisdictions or authority to act. However, they were shocked by the devastation caused by the high explosive charges within their tightly packed subway tubes, and instituted procedures to more efficiently evacuate casualties in the future. Their goal: a resilient London.
Madrid on March 11, 2004 was jolted by a series of four near simultaneous train bombs that hit at the height of the morning rush hour. More than one thousand were injured and 192 were killed. Victims overwhelmed not only the hospital system but also the EMS system. It was simply luck that the hospital where most of the victims went was the largest and best-equipped in Madrid and, because the blast occurred during the change of shifts at that hospital, extra personnel were on hand to help treat the wounded.
Colleagues from Pakistan and India described the panic and resulting chaos that reverberated in hospitals following suicide attacks. They reported on measures taken to restrict hospital hallways to those needing care and limiting the access of anxious relatives and eager politicians who descended on the hospitals and impeded efficient medical care.
What should President Obama and other leaders take from these lessons? First, the Al-Qaeda pattern is the multiple, thematic, and near simultaneous set of attacks. There were four train bombings in London and Madrid, two U.S. embassies hit in Africa, and four planes hijacked on 9/11. When we learn of an attack, our first instinct should be vigilance. What is the pattern? What could happen next?
Second, assume conventional weapons are involved unless intelligence or evidence dictates otherwise. If officials are overly afraid of NBC, fire, police, and rescue workers may freeze along a perimeter waiting for an "all clear" from hazardous threat detection units while victims lie injured at the scene.
Third, the real "first responders" are not fire, police, and EMS professionals. They are the second wave of help. It is the crowd of fellow passengers who jump into action, on the scene, and who are able to assist and support victims in those critical first moments following injury. President Obama must ask himself how he can galvanize the populace so that they know what to do if they are present and physically able to help.