Terrorism, et al.

This issue and the next issue of Prehospital and Disaster Medicine deal with the prevalence of and issues associated with terrorism from an international perspective. The papers included were collected and edited by Dr. Jeffrey Arnold, who has invested limitless hours in his desire to clarify the issues associated with terrorism. He has worked with each of the authors to provide the clearest possible reports. As a beginning to an ongoing program, he has accumulated reports from 17 countries. These Special Reports provide a remarkable summary of the scope of terrorism worldwide. He puts the entire issue into perspective in his editorial, "The International Burden of Terrorism" In addition, he has promoted the development of consensus for a medical/public health definition of terrorism (pages 47-52). In achieving these landmarks, he continues to provide important leadership in the discipline of Disaster and Emergency Medicine. Several additional points may help in establishing the language and issues associated with terrorism. First, the terms terrorism, terror, and terrorist as used elsewhere by many have been interchanged inappropriately. Terrorism is an action, terror is the effect intended by acts of terrorism, and a terrorist is the actor. The intent of terrorism is to create change by the creation of fear in a target population in an effort to force economic, political, and/or social change. Since terrorism often is associated with fanaticism for a cause, similar definitions pertain. By definition, a. fanatic is a person filled with excessive and often misguided enthusiasm for something. In the context of terrorism, fanatics are angry persons looking for revenge for some action or rule that they consider inappropriate. The motivation is to create damage and not to create change. The Oklahoma City bombing was an act of fanaticism and not terrorism. Fanaticism is the action—an attempt or attempts to achieve the cause, and a fanatic is the actor attempting to achieve the cause. The net effect of a terrorist act or an act done by a fanatic is damage, which is generally both physical and emotional. Thus, the medical impact of both terrorism and fanaticism is the same. The medical/public health definition of terrorism developed by Dr. Arnold and his colleagues is essential to the development of our science. As you peruse the country reports, it will become apparent that so far, from a medical/public health perspective, terrorist acts have created multi-casualty incidents, at least from the perspective of physical injuries. Generally, the responses have not required outside medical assistance. Whether such acts have created a sufficient degree of terror and disorganization in the populations affected either directly or indirectly, in order to be labeled as a disaster is not clear. But, what will occur when the production of multi-casualty incidents do not produce the political/economic changes sought by the terrorists? Will the terrorists then resort to creation of larger events that will result in sufficient levels of damage to cause disasters, such as could occur by employing weapons of mass destruction (WMD)? In such circumstances, the objectives of the terrorists would remain the same—creation of fear in the target population^) and others. But, now outside assistance would be needed to respond to such events and the human toll would escalate.