ANALYSIS: Is Obama Ready for a Bomb on the Train?

In an analysis provided to ABC News, three American scholars advise the Obama administration on how to anticipate and respond to likely terror threats against the U.S.

The last things President Obama will want to confront in his first year in office are the bodies of dead Americans and complaints of ineffective government response following a terrorist attack within the United States. His predecessors both faced terrorism in their first year in office: President Clinton on February 26, 1993 at the World Trade Center and President Bush at the same location and at the Pentagon on September 11, 2001. President Obama may well face a comparable attack.

Since the establishment of the Department of Homeland Security in 2002, there has not been a successful attack by a foreign terrorist on U.S. soil. How much of this is the result of good work and how much is just luck? It is impossible to know. However, Al-Qaeda remains very active and Osama bin Laden is likely plotting his next attack. His deputy, Ayman al-Zawahiri, commenting recently on our election, calls upon jihadists to continue the war relentlessly.

In the wake of 9/11, the anthrax incidents that followed, and concerns of huge caches of non-conventional weapons in Saddam Hussein's Iraq, the United States began a concerted effort to prepare for the possibility of a non-conventional attack on American soil. Billions have been invested and federal, state, and local officials have trained to respond to the consequences of a mass casualty nuclear, biological, or chemical (NBC) attack. Important and necessary accomplishments have been made on this score.

However, a recent Washington meeting co-sponsored by the Centers for Disease Control and Prevention and Harvard's National Preparedness Leadership Initiative, raised the possibility that while we have placed extraordinary attention on these horrendous perils, it may well be a much more ordinary danger that we face next.

The meeting brought together homeland security, public health, and hospital officials from Boston, New York, Washington, Chicago, San Francisco, and Los Angeles, U.S. cities with subways and mass transit systems that are "soft targets." They met with their counterparts from Madrid, London, Tel Aviv, Islamabad, New Delhi, and Mumbai, cities hit by mass casualty conventional attacks that left thousands dead and with preparedness and response systems that learned a great deal from the experience.

'Pay Heed to the Lessons Learned Abroad'

Those who attended the meeting were reminded that despite the impressive complexities of the 9/11 attacks, jihadist organizations prefer relatively easy and accessible soft targets, actions that shatter the population's trust in their government. Might we see in the U.S. the sort of terrorism that was experienced elsewhere? While no one can know for sure, it is wise to us to pay heed to the lessons learned abroad.

Our international colleagues reported being initially surprised by the inadequacies of their response systems when they were first hit.

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.

What Should President Obama Take From These Lessons?

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.

Fourth, while official plans outline a well orchestrated series of compliant actions on the part of the population and responders, the immediate aftermath of such a tragedy is pandemonium. People do not wait for ambulances to get to the hospital. The "walking wounded" victims get there on their own, creating a first wave of moderately injured victims. Those who are severely injured and cannot walk, the "horizontal victims," take longer to get onto stretchers, into the ambulance, and to the hospital. By the time this wave of critically injured patients arrives at the hospital, much capacity has already been consumed. One lesson from abroad: distribute less severely victims to more distant hospitals that are less likely to be overrun by the injured.

The Time to Prepare is Now

Fifth, educate clinicians in this country about the unique patterns of injury that occur in bomb blast victims. Doctors and nurses in Madrid were learning these lessons in the midst of their response to the train bombings, delaying care when there was no time to waste.

Six: think resilience. The intent of these bombings is to bring people down, to destroy our confidence, to foster fear, and to shatter our economy. We know the period after a new President assumes office is one of greater vulnerability. We must all be vigilant. If you find a suspicious package or observe suspicious behavior, report it to authorities. This is a time to be safe, not sorry. Be prepared to get back on your feet if we are hit. It will be difficult. However, returning to normal living is the most defiant of acts following a terrorist bombing.

9/11 was a wake-up call and we have been fortunate that, to date, there has not been a repetition. However, time dulls our memories and complacency sets in with its own dangers. Now is the time for our homeland security, our preparedness, and our response officials to turn their attention to what is a more likely set of threats. While we have little experience here, there is much we can gain from that of our friends abroad, and in the name of humanity, they are generous in their willingness to share what they learned.

The election of Barack Obama has kindled a new sense of hope and optimism that is sweeping our country, despite the deep troubles that face us. It is that very sense of leadership, hope, and optimism that Al-Qaeda and other terrorist organizations would want to shatter. The time to prepare for what are clear vulnerabilities is not after they happen, but rather before. And that time is now.

Leonard Marcus, Isaac Ashkenazi, and Barry Dorn are faculty of the National Preparedness Leadership Initiative, a joint program of the Harvard School of Public Health and Harvard's Kennedy School of Government.

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