By Dan Foster
Special Contributor to In Homeland Security

Terrorism is a tactic that has survived for thousands of years and seeks to cause fear, panic, and economic damage to a given population in order to exert control or influence political, social, or religious practices through unusual levels of brutality. As technology advances, so too do the tools available to terror organizations and those inspired by them.

Though there have been many examples of high and low technology use by groups such as ISIS over the last couple years, the primary tools of any nefarious organization remains shootings, bombings, and cyber attacks. Some Americans wish to deny reality and believe that the world is a safe place to live where everybody can coexist peacefully.

RELATED: March Terror Threat Snapshot: 147 Homegrown Terror Cases Since 9/11

This is patently untrue as long as there are extremists of any ideology. Though global terrorism has been increasing over the recent history, properly understanding and preparing for its effects will minimize negative impacts.

Mass Shootings

One of the most common terror attacks is mass shootings since this requires little skill or resources to carry out while inflicting significant physical and psychological damage to those attacked. This style of indiscriminate killing is a form of atrocity, and as noted by Dave Grossman in his recent book On Killing: The Psychological Cost of Learning to Kill in War and Society, this close range and personal delivery of death, when properly used, can be incredibly effective at achieving the psychological effect of destroying the will of the attacked.

Though the physical wounds from gunshots are addressed with competency almost everywhere in America, the psychological damage may be largely ignored. Persons who were not present at the attack site may develop adverse psychological reactions, thus emergency managers and planners should ensure sufficient assets are available to support the community as a whole versus only those directly affected. Prior to committing to a preparation/response plan, additional methods of attack and their effects must be considered.

Improvised Explosive Devices

Bombings, or the use of improvised explosive devices (IEDs), pose a different means of physical injury that many locales may not be prepared for. In addition to the physical injuries, these devices sow psychological discord because of the heinous sights caused by an IED detonation. Unlike gunshot wounds, many first response personnel are never exposed to blast and fragmentation injuries and may not have the training or confidence to effectively treat the victims.

The most sensitive portion of the human body to blast overpressure is the ears, followed by those organ systems that contain gases such as the lungs. According to the Centers for Disease Control, tympanic membrane compromise is one of the earliest signs of blast injury. As a safety measure, anybody exhibiting symptoms of ear injury or compromised equilibrium should be medically evaluated as lung injuries are the most common forms of fatality for those who survived the initial overpressure event.

When treating physical casualties after an IED detonation, first responders should be aware that the leading causes of preventable death are arterial bleeding and tension pneumothorax. Both of these conditions can be treated with relative ease in field conditions. Though the physical injuries after a blast may prove challenging to address without proper training for a catastrophic event, planning must also include how to minimize the psychological ramifications of the horror witnessed.

Loosely characterized, there will be direct and indirect psychological victimization after a terror attack such as a bombing. Direst victimization applies to those who were present at the attack site and witnessed the event, perhaps narrowly escaping. Acute Stress Disorder (ASD) may become manifest with Post-Traumatic Stress Disorder (PTSD) being diagnosed if symptoms persist beyond a four-week span. Though ASD and PTSD are related, they each stem from differing root causes.

The most common form of indirect victimization takes place via the media. As images of horror are repeatedly broadcast into millions of homes in exquisite detail, the psychological warfare of the terrorist is being amplified across the nation. Emergency managers in all locations must plan for psychological challenges should another large scale attack take place in America.

Cyber Attacks

As technology continues to advance, the threat of cyber attack lingers. Terror organizations such as ISIS have proven they are adept with technology but for now this means of attack is primarily the tool of nation states. Most likely from a terror group is physical destruction of key information assets; however, the possibility of hardware or software vulnerability exists. Physical casualties would be a secondary order of effect as goals of economic collapse and psychological trauma via attack against the financial network or critical infrastructure would be immediately advanced.

Though difficult to quantify, the best practice is to prevent an attack from occurring. Regardless of prevention efforts, preparation by training for the physical and psychological injuries consistent with terror attacks must be undertaken. Development of standard operating procedures (SOP) and exercises to test the SOPs must occur along with coordination between adjacent locales and state assets. Vulnerability assessments must be conducted and actions taken to close identified gaps. The fusion cell model works well and should minimally include local, county, and state police, fire and medical responders and supervisors, civilian community leaders, bomb technicians, and any specialized assets such as industrial hygienists should the threat assessment yield a potential for chemical, biological, radiological, or nuclear (CBRN) attack.

Psychological preparation should account for the fact that these casualties are likely to significantly outnumber the physical variety and place sufficient assets where the need is greatest. Based on terror management theory, the most vulnerable populations are likely to include those who are likeliest to feel as though they contribute least to the advancement of society and those who already lack anxiety control or are not accepted within larger society.

Measures that ensure these vulnerable populations gain a sense of contribution to and acceptance within society is likely to minimize or prevent a number of psychological casualties, thereby freeing resources to address other challenges. Oftentimes, seemingly menial tasks and accomplishments can be highly meaningful to both the community and the individual(s) completing these tasks. Emergency planners and managers owe it to their communities to understand the most likely threats, develop proactive and reactive measures to mitigate them, and test these measures regularly.

About the Author: Dan is a former U.S. Marine Corps Explosive Ordnance Disposal (EOD) technician with emergency response experience both in the U.S. and overseas. He is currently an instructor under contract from the Department of Defense teaching counter IED and anti-terrorism principles to actively serving military personnel.