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.
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.