A special thank you to my mentor, Kenneth Grey (retired Centers for Disease Control and Prevention [CDC] branch chief and developer of the CDC’s first emergency operations unit and center).
The threat of terrorism is a high-priority national security and law enforcement concern in the United States. Modern policy on combating terrorism against the United States has been evolving over the past 30 years. A series of Presidential Decision Directives (PDDs), along with implementing guidance, executive orders, interagency agreements, and legislation, now provide the basis for counterterrorism programs and activities in more than 40 federal agencies, bureaus, and offices. Unfortunately, public policy and societal reactions regarding disasters do not always translate into effective outcomes of “lessons learned.”
Terrorism itself has been an age-old threat to the public health and security of many populations throughout the world. Since the 1980s, terrorist attacks against the United States have led to legislative, regulatory, organizational, and programmatic actions associated with comprehensive and ambitious expectations. Further study is needed before we can conclude the extent to which these major changes will have a lasting and significant effect upon the practice of disaster medicine as a health science.
Nevertheless, two major accomplishments have been realized since the terrorist attacks of 2001: (1) National capacity of emergency management appears to have been increased and (2) awareness and possibly even commitment to the issue of emergency preparedness appears to be greater. This chapter will identify recent terrorist events that have had a significant effect upon U.S. society and public policy.
U.S. domestic emergency management policy has evolved over the past 70 years. Since the 1990s, terrorist events have taken an increasingly important role in shaping larger response strategies related to U.S. emergency management policy, the implementation of the incident management system, and the development of comprehensive disaster mitigation strategies. One must first understand the fundamentals of these three major historical developments to appreciate fully the lessons learned and residual pitfalls.
The Development of Current U.S. Emergency Management Policy
Modern emergency management policy in the United States began with the “Unlimited National Emergency” (Proclamation 2487 of May 27, 1941), immediately prior to World War II. Over three decades later, out of concern for a catastrophic earthquake predicted to occur in the central United States, the Earthquake Hazards Reduction Act of 1977 mandated the development of a Federal Response Plan for a Catastrophic Earthquake. In July 1979 Executive Order 12148 delegated authority to the Federal Emergency Management Agency (FEMA) to establish federal policies and to coordinate civil defense, as well as civil emergency planning, management, mitigation, and assistance functions, of executive agencies. Then, FEMA was also assigned the lead responsibility for response to consequences of terrorism. The Robert T. Stafford Disaster Relief Act, P.L. 100-707 was enacted in 1986 to formalize a coordinated federal policy that included development of a Federal Response Plan. In 1990 FEMA issued the Federal Response Plan to establish a process for coordinated delivery of federal disaster assistance. Acting upon lessons learned during the Hurricane Andrew response in 1992, Congress adopted a formal “all-hazards approach” to emergency management in the National Defense Authorization Act of 1994, PL 103-160.
In June 1995 President Clinton issued PDD-39, the central blueprint for the U.S. counterterrorism strategy. PDD-39 elaborated a strategy for combating terrorism consisting of three main elements: (1) reducing vulnerabilities and preventing and deterring terrorist acts before they occur; (2) responding to terrorist acts that occur, including managing crises and apprehending and punishing terrorist perpetrators; and (3) managing the consequences of terrorist attacks. All three elements of the strategy apply to terrorism involving weapons of mass destruction (WMD). Emergency managers will recognize these elements as phases of the risk-reduction cycle, including disaster prevention, mitigation, and response.
The Defense against WMD Act of 1996, P.L. 104-201 (also known as the Nunn-Lugar-Domenici Act), September 23, 1996, drew upon the convergence of federal assets at the Atlanta 1996 Olympic Science and Technology Center , and directed this momentum to set in place a long-term effort to prepare domestic response for terrorist threats.
The Development of Incident Management Systems
The Incident Command System (ICS) was conceptualized more than 30 years ago, in response to a devastating wildfire in California. The Congress mandated that the U.S. Forest Service design a system that would improve the ability of wildland fire-protection agencies to coordinate interagency action effectively and to allocate suppression resources in dynamic situations. This system became known as the Firefighting Resources of California Organized for Potential Emergencies (FIRESCOPE) ICS. Although FIRESCOPE ICS was originally developed to assist in the response to wildland fires, it was quickly recognized as a system that could help public safety responders provide effective and coordinated incident management for a wide range of situations, including floods, hazardous materials accidents, earthquakes, and aircraft crashes. In 1982 all FIRESCOPE ICS documentation was revised and adopted as the National Interagency Incident Management System (NIIMS). In Homeland Security Presidential Directive 5 (HSPD-5), President Bush called on the Secretary of Homeland Security to develop a national incident management system (NIMS) to provide “a consistent nationwide approach for federal, state, tribal, and local governments to work together to prepare for, prevent, respond to, and recover from domestic incidents,” regardless of cause, size, or complexity.
The Development of Disaster Risk-Reduction Strategies
U.S. policy related to terrorism has also developed within a global context of strategies trending over the past two decades toward a more comprehensive approach to disaster risk management that also includes disaster risk-reduction efforts, such as prevention, protection, and mitigation. In 1994, the States Members of the United Nations, having met at the World Conference on Natural Disaster Reduction, in the city of Yokohama, Japan, in partnership with nongovernmental organizations and with the participation of international organizations, the scientific community, business, industry, and the media, affirmed, “Disaster prevention, mitigation, and preparedness are better than disaster response in achieving the goals and objectives of the Decade. Disaster response alone is not sufficient, as it yields only temporary results at a very high cost ” [emphasis added]. We have followed this limited approach for too long. This has been further demonstrated by the recent focus on response to complex emergencies, which, although compelling, should not divert from pursuing a comprehensive approach. Prevention contributes to lasting improvement in safety and is essential to integrated disaster management ” [emphasis added]. Although focused on natural disasters, this declaration represented an early recognition of the importance of a more comprehensive approach to managing disasters that also includes pre-event activities of prevention, mitigation, and preparedness.
One decade later, The World Conference on Disaster Reduction was held from January 18 to 22, 2005, in Kobe, Hyogo, Japan, and it adopted the present Framework for Action 2005-2015. The conference provided a unique opportunity to promote a strategic and systematic approach to reducing vulnerabilities and risks to hazards. It underscored the need for, and identified ways of, building the resilience of nations and communities to disasters. The resultant Hyogo declaration concluded, “ an integrated, multi-hazard approach to disaster risk reduction should be factored into policies, planning and programming (emphasis added) related to sustainable development, relief, rehabilitation, and recovery.”
In 2011 the Obama administration released Presidential Policy Directive 8 (PPD-8) that includes “a series of integrated national planning frameworks, covering prevention, protection, mitigation, response, and recovery.” The National Prevention Framework describes what the whole community—from community members to senior leaders in government—should do upon the discovery of intelligence or information regarding an imminent threat to the homeland in order to thwart an initial or follow-on terrorist attack.
Recent Terrorist Events That Have Influenced U.S. Policy
The development of new disaster policy is dependent upon a society’s perception of risk. Public perception of risk is known to be higher immediately after the occurrence of a major disaster. Terrorist attacks have a particularly powerful effect on the human psyche and subsequently often result in rapid, sometimes drastic, public policy changes. During such times, there is a notable window of opportunity for change in disaster reduction policy. Table 63-1 is a listing of select major terrorist events that have occurred over the past three decades and their corresponding influence on resultant U.S. policy.
|Date||Event||Description||Changes in U.S. Policy|
|1983||Bombing of Lebanon Marine Barracks|
|1984||Bahgwan Rajneesh Salmonella Release|
|1985||Rome and Vienna Airport Attacks|
|1988||Bombing of Pan Am Flight 103|
|1993||World Trade Center (WTC) Bombing|
|1994-1995||Aum Shinrikyo sarin attacks|
|1995||Bombing of the Murrah Federal Building in Oklahoma City|
|1995||Chechnyan Threat of Using a Radiological Dispersion Device (RDD)|
|1996||Khobar Towers Bombing|
|1996||Crash of TWA Flight|
|1996||Bombing of Atlanta Olympic Games|
|1998||U.S. Embassy Bombings in Kenya and Tanzania|
|2000||Attack of the U.S.S. Cole|
|2001||WTC and Pentagon Attacks|
|2001||Anthrax Letter Attacks|
|2001||Airliner Shoe Bomb Attempt|
|2002||LAX Airport Shooting|
|2002-2004||Bombings and Attacks in Russia, Indonesia, the Philippines, Kenya, Saudi Arabia, Afghanistan, and Iraq|
|2004||Attack on the U.S. Consulate in Jeddah, Saudi Arabia|
|2004||Madrid Train Bombings|
|2005||London Subway Bombings|
|2009||Shootings at Fort Hood|
|2009||Underwear Bomb Attempt|
|2010||Times Square Bomb Attempt|
|2010||Parcel Bomb Attempt on Cargo Planes|
|2010||Attempted Bombing of a Christmas-Related Mass Gathering|
|2011||U.S. Embassy Attack in Benghazi, Libya|
|2013||Nairobi, Kenya, Shopping Mall Attack|
|2013||Boston Marathon Bombing|