1

Preparing and Responding to Mass-Casualty Terrorist Attacks - a

Comparative Analysis of the Response to Five Terrorist Attacks

Targeting Rail Bound Traffic

Veronica Strandberg - Department of Political Science & Research Center for Disaster

Medicine, Umeå University

Paper presented at the 2012

Swedish National Conference on Peace and Conflict Research

Panel: Complex conflicts and crisis governance

14-15 June, Gothenburg

Work in progress! Please do not quote or cite without authors permission

This is a paper at a very early stage! Comments welcome to veronica.strandberg@pol.umu.se

___________________________________________________________________________

ABSTRACT

The threat of terrorism is a worldwide concern, often discussed in the context of global change and complex

threats, risks and crises. This paper’s point of departure is ongoing scholarly discussions on the contemporary

terrorism paradigm, which revolves around ways in which terrorists organize, the potential for an increase in

religiously motivated terrorism, and a presumed shift towards more indiscriminate killing through the use of new

tactics and weapons. Special focus is paid to a particular transportation sector, rail bound traffic. The paper

focuses on this because empirical observation suggests that rail bound traffic is extremely vulnerable and at high

risk for terrorist attacks. This paper sets out to explore high profile attacks targeting train and subways in Tokyo

1995, Madrid 2004, London 2005, Mumbai 2006, Moscow/ St. Petersburg 2009. All these attacks bear the

marks of contemporary terrorism, and they posed tremendous challenges for the crisis management response. To

plan and respond to different crises is highly difficult, and is often described as something, unique, complex and

uncertain. The institutional design of crisis management systems differ between countries depending on context,

history, political traditions and so forth. Several researchers have observed that slowly, national governments are

being aware how critically important an institutionalized crisis management capacity is, not at least since new

forms of crises appear on the horizon. This paper aims to compare different crisis management systems, the

response to the events as well as lessons learned from the major attacks in order to answer the pressing question

of how to design a crisis management system that can prepare, respond, mitigate, recover and learn from a

terrorist attack on the rail bound sector.

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INTRODUCTION

Terrorist groups have repeatedly targeted train and subway systems. The public transport

sector, rail bound traffic included, has become a theater of operations for terrorists, aiming at

causing mass-casualty events (Jenkins 2001). How to plan for and carry out effective crisis

management response (commonly referred to as emergency management) to major terrorist

attacks targeting rail bound traffic is at the center for the analysis in this article. Coordinated

bombings, suicide attacks, explosions in confined spaces, attacks during rush hours in order to

maximize the number of injured and fatalities are some components of terrorist attacks that

often are understood as a contemporary or even a “new” form of terrorism (see for example

Hoffman 2006, Simon & Benjamin 2000). Some terrible, yet, clear examples of how rail

bound traffic has become a perfect target for terrorists, aiming at mass-casualty attacks, are

high impact cases such as the sarin gas attack targeting Tokyo’s subway system in 1995.

Further examples are; coordinated bombings on commuter systems in Madrid 2004 and

Mumbai 2006, and suicide attacks targeting the subway system in London 2005, as well as a

bomb attack targeting a high-speed train, running between Moscow and St. Petersburg in

2009.

This article draws mainly on two bodies of research, the field of terrorism studies and

disaster- and crisis management research. Furthermore, in this article, it is argued that crises

and terrorism in particular, are undertaking some fundamental transformations, implying

changes also in crisis management policy as well as in practical approaches to crises.

Accordingly, the overall aim of this article is to investigate governments´ and main

responding agencies response to these highly complex terrorist attacks on trains and subways,

and by doing so, contributing to our knowledge and best practices when responding to mass-

casualty events targeting a vulnerable transportation sector. The analysis will be carried out

by applying a holistic perspective to crisis management, addressing different levels and time

phases. To concretize; the article will investigate the immediate tactical/operational response

to the five cases of attacks, thereafter the multi-organizational response on a strategic level

will be analyzed, and finally the article will reflect on a system level, addressing possible

explaining mechanisms behind the different response outcomes of the attacks.

McEntire (2002:267) establishes that an increasingly amount of attention is paid to the future

of crisis management; both new theoretical perspectives as well as policy guides are required.

The reason for such an observation is the changing nature of crises and changes in how

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terrorist attacks are being carried out, thus, it is in this context the response to the five case

studies under analysis must be interpreted. The attacks in Tokyo, Madrid, London, Mumbai

and Moscow/St. Petersburg , to a varying degree, bear the marks of a transformed form of

terrorism, they also exemplify the rise of transboundary crises, (Ansell, Boin & Keller:

2010:195). Boin (2009:367) establishes, “the world of crises and disasters is shifting”.

Clearly, the notion of change is of crucial importance here. Several researchers argue that

changes in crises, pose new challenges to national governments and policy makers. As Boin

(2004:165) observes; “slowly – very slowly - national governments are being aware how

critically important an institutionalized crisis management capacity is since new forms of

crisis appear on the horizon.” Hence, as already outlined, such an institutionalized crisis

management capacity will be studied from different levels.

Research reveals that there is a worldwide growing concern within the medical community

regarding the current capacity and preparedness to deal with the victims of manmade mass-

casualty incidents (Turégano-Fuentes 2008:1169). True mass casualty events are from a first

responder’s perspective very challenging situations, by definition, “they involve such large

numbers of victims, or such severe or unique injuries that local medical resources cannot fully

cope with them” (Gutierrez de Ceballos 2004:105). Yet, considering a terrorist event such as a

major terrorist attack on train and subways, additional complexities add to the response.

Factors to consider are for example, unique injury patterns caused by bombings, presence of

secondary devices, rapid removal of injured. One can refer to Shapira, Hammond & Cole

(2009) that interestingly observe that the nature of terrorist events, and the effects on the

victims, has prompted novel approaches to rescue operations, their treatment and coordination

of services. This puzzle is at the center in the first part of this article, mainly focusing on a

tactical/operational level in the immediate response to the terrorist attacks. The research

question posed is: how did the main operational responding agencies respond to the terrorist

attacks in Tokyo, Madrid, London, Mumbai and Moscow/St. Petersburg, what were the main

challenges encountered and how were these addressed? Moreover, this article argues that

additional complexity in the response will be added in cases of terrorist incidents, therefore,

this article also sets out to identify challenges in the response that is particularly related to the

nature of terrorism.

Terrorism perceives often as a complex problem that requires multiagency solutions

(Eyerman & Strom: 2008:106). During the last ten years, an increased attention to multi-

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organizational crisis management has been observed (Eyerman & Strom: 2008:91, Uhr 2009).

Even though multi-organizational collaboration suggests as the recipe for effective crisis

management, it is also associated with inherent difficulties. Coordination stands out as

fundamental for success; yet, lack of such function can lead to failure in crisis management.

With other words, coordination represents a double-edged sword. Here, one can refer to the

concept of institutional complexity, which according to Stern (2003:15), includes both

horizontal and vertical dimensions. The former concerns the fact that multiple agencies at the

same level of government tend to hold that they have a stake in the crisis. The vertical

dimension focuses on the involvement of actors across levels of governments. A crisis begins

a certain location, often at a local level, however, the crisis may be “up scaled” into a national

or even an international level. This complexity of multi-organizational collaboration will be

the focus in the second part of the article, addressing a strategic level of the response work to

the five terrorist events. It relates to the following research question, how was multi-

organizational collaboration carried out in the response to the attacks in Tokyo, Madrid,

London, Mumbai and Moscow/St Petersburg?

The attacks under analysis share some striking features; above all, they follow the dramaturgy

of contemporary, high impact terrorist events, causing complex mass-casualty situations,

including aspects such as coordinated bombings during rush hours, suicide attacks and

secondary explosions. Yet, the crisis management responses to these events have come out

differently. I place these examples of contemporary terrorist attacks in a broader crisis

management context at a system level. While the operational level correlates to an immediate

response, and the strategic level takes on a wider time perspective by also incorporating

aspects such as preplanning, the system level zooms further by reflecting on long standing

processes such as development of overarching frameworks for government’s response, legal

frameworks, multi-agency cultures and security awareness. This last part of the article aims to

answer the question: what are the main explaining mechanisms behind the different response

outcomes in Tokyo, Madrid, London, Mumbai and Moscow/St Petersburg?

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FIVE MAJOR ATTACKS TARGETING RAIL BOUND TRAFFIC

The sarin gas attack targeting Tokyo’s subway system is often mentioned as a defining attack

by its introduction of unconventional weapons into the arena of terrorism (Ganor 2009:16).

On 20 March 1995, the cult, Aum Shinrikyo released sarin gas simultaneously on five subway

trains, on three separate subway lines. The attack resulted in 12 fatalities and a very high

number of injured, more than 5500. From a historical perspective, it became the largest crisis

caused by a nerve gas in peacetime, something that was highly unexpected since Tokyo’s

subway system was regarded as one of the safest in the world (Okumura 1998:613). Aum

Shinrikyo classifies as a religious terrorist organization and is being described as an

“apocalyptic and millenarian cult, controlled by a messianic figure, Ahoko Ashara” (Cameron

1999:277,279).

Since 9/11, the global jihadi terrorism has come to define much of the discussions on

terrorism. Of special concern has been the fact that the jihadi terrorism is believed to represent

a transformation in international terrorism, concerning both scale and motive (Ganor

2009:16). This concern later realized by major transport bombings in Europe. On 11 March

2004, Madrid’s commuter system suffered a large-scale terrorist attack, 10 bombs detonated

within a couple of minutes in four different commuter trains. The attack occurred during rush

hour and killed 191 persons, and injured more than 2000 (Gutierrez de Ceballos 2005:104),

thereby it produced the largest loss of life in a single attack on European soil in modern

history (Turégano-Fuentes 2008:1169). Islamic extremists influenced by Al-Qaida were held

responsible for the bombings, the group Abu Hafs al-Masri Brigades claimed responsibility,

however it is uncertain whether the claim was valid or not (Global Terrorism Database 2012).

One year later, in 2005, in London, another major attack on rail bound traffic took place. In a

short time span, three bombs exploded on underground trains and a fourth bomb detonated on

a double-decker bus. In all, 56 persons were killed and around 700 injured in these suicide

attacks. Several groups claimed responsibility, including Abu Hafs al-Masri Brigades and the

Secret Organization of al-Qaida in Europe (Global Terrorism Database 2012).

At the end of the twentieth century, a change in terms of geography occurred in international

terrorism. Focus from the traditional epicenter of the Middle East shifted to central and South

Asia (Ganor 2009:14). With this development, in combination with the fact that India has one

of the largest railway systems in the world, carrying around 20 million of passengers on a

daily basis (Government of India Ministry of Railways 2012:4), it is not surprising that India

has suffered several major terrorist attacks on their railway system. On 7 December 2006, the

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railway hub Mumbai was struck by a series of bomb explosions. Bombs detonated inside first

class trains at seven different stations, causing the death of 187 civilians, injuring 817. The

bombings were attributed to Lashkar-e Taiba (Rand Cooperation Database 2012).

The fifth case of a major terrorist attack on rail bound traffic, took place in November 2009,

in Russia, when jihadists from the North Causasus Resistance detonated bombs on Nevsky

Express. The explosion caused four carriages of the luxurious high-speed train to derail,

killing at least 26, injuring more than 100 (Daily Mail 2009/11/29). Nevsky Express runs

between Moscow and St. Petersburg, thus, unlike the four attacks already described, this event

did not take place in an urban setting, but in a remote area with deep forest (the New York

Times 2009/11/29). The geographic location posed profound challenges in terms of crisis

management. Worth noting is also that a second, fortunately less powerful, explosion took

place the second day while the response operation still was going on (Daily Mail 2009/11/29).

No one was hurt in the second explosion but it illustrates an articulated fear that terrorists use

secondary attacks in order to increase destruction and fear.

I argue that these five cases are defining attacks in several ways that need further exploration

– from a comparative perspective. Four defining characteristics assign to contemporary

terrorism. Today’s terrorists are assumed to act increasingly transnationally and in loosely

organized networks, they are inspired by religion, they seek weapons capable of attacking as

many people as possible, and finally, terrorist are increasingly indiscriminate in who they kill

(see for example Laqueur 2003, Hoffman 2006 and for critique of the paradigm Duyvesteyn

2004, Tucker 2001). When sarin gas was released in Tokyo’s subway, it signaled a defining

moment, renewing the attention to religious motivated terrorism, and in particular with regard

to the risk of groups using weapons of mass destruction. The rise of mass casualty bombings

also makes a defining aspect in the development of contemporary terrorism – which the

attacks Madrid, London, Mumbai and Moscow/St. Petersburg later illustrated. The key to

each of this new developments, according to Quillen (2002: 279-280) lay in the ability and

desire to kill large number of people. It is without doubt a challenge to respond to these

events. A comparative case study approach allows for informative comparisons, contributing

to our understanding of the practical and strategic response. Far from every national

government, crisis management systems, or individual first responders, have had exposure to

major terrorist events. Moreover, as Smith (2009) emphasizes, the emergence of new “low

probability-high consequences events”, sometimes referred to as “black swans” (Taleb 2007)

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calls for new techniques and analytical frameworks for dealing with these particular complex

events. This article aims to contribute in such a direction.

This article mainly builds on previous research, some attacks, such as Tokyo, Madrid and

London are well addressed in research, while the events in Mumbai and Moscow/St

Petersburg are more sparsely researched. For the purpose of this article, interviews were

conducted with representatives from different responding agencies to the attacks in Madrid,

London and Moscow/St Petersburg, these are complementary to previous research. When

available, official documents, such as national governments official reports or evaluations of

the response have been used. Lastly, a main source for information on the terrorist attacks has

been various terrorist incidence databases.

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It should be underlined that literature on crisis management (as well as on terrorism), is rather

under theorized. One pressing question that engages scholars within this field is the issue of a

potential general theory of crisis management. The key concern revolves around how general

such a theory can be. Crises differ widely but there might be some general patterns or

structures that underlie crises and can be generally applicable to prediction, treatment and

prevention (Mitroff, Pauchant, Shrivastava 2006:48). When analyzing the response at

different levels and from different time perspectives, one touches immediately on the question

of effective or successful crisis management. Clearly, it relates to a second question of how

we can measure crisis management response. Researchers (see for example Mitroff &

Pearson 1993, Quarantelli 1997), within the crisis management field have suggested criteria

for measuring response. However, Pearson and Clair (1998) underline the difficulty in

differentiating effective from ineffective crisis management. Also within the disaster medicine

field, often considered a descriptive discipline, researchers argue that there are clear

challenges in comparing outcomes from different types of incidents. Ruter, Örtenwall &

Wiktström (2004:52), exemplify such difficulties well by pointing at an often-recurring

conclusion: “shortcomings in communication”. Such a general conclusion must be specified,

for example, was it a technical problem or a coordination problem? Clearly, there are

challenges associated with analyzing outcomes of a response, regarding both the process as

well as the result. Yet in order to answer the questions posed in this article, one need to relate

to these challenges, the empirical part takes on a structure, using a large number of points of

comparisons. These points, or components in the response, are all recurring in the literature as

key ingredients in crisis management. Informative are performance indicators regarding

medical management (see for example Ruter, Örtenwall & Wiktström : 2004 on development

of 20 measurable indicators), both on a tactical on site - and a strategic level. It is important to

note that the most frequently described problems in major incidents often ascribe to

management at a strategic level (Ruter, Örtenwall & Wiktström 2004:53). Performance

indicators at the strategic level, as the communication example illustrated, can be harder to

measure than indicators at a tactical level, at which the time before the first victim is

evacuated serves as one example of a measurable indicator.

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CRISIS MANAGEMENT AT A TACTICAL/OPERATIONAL LEVEL

When a large-scale crisis hits a society, such as a terrorist attack, the immediate crisis

management response is of outmost importance. An effective crisis management depends on

first responders. According to Boin (2007), these key actors must feel capable to “operate in

the dark” taking on challenging tasks, preplanned rescue work as well as seize initiatives

along the way as known command structures may collapse. Allocation of materials,

equipment, and accurate information are challenges. Moreover, first responders need to have

the capacity to assess when crisis management plans need to be activated, and when rendered

useless. All these elements are crucial in order for providing the best response available to the

victims. Following part addresses this first response, taking both the out-of hospital as well as

the in-hospital response into consideration.

TOKYO MADRID LONDON MUMBAI MOSCOW/ST

PETERSBURG

OUT-OF HOSPITAL RESPONSE

Fatalities 12 191

56 187 27

Injured 5500 1800

700 871 132

Time of attack 07.48-08.00 07.39- 07.42 08.50 (trains)

09.47 (bus)

18.24 – 18.35 21.35

Number of

attack sites

5 4 4 7 1

Initial confusion

over the cause of

the attack

Yes – during the

first hour, calls came

from all 15 affected stations, at the time

TMACC did not

realized it was one cause. (Okumura

1998)

No indication of

competing views, it

was quickly confirmed that

there were four

sites caused by terrorism. (Gomez

2007)

Yes - Initially, an

electrical power surge

was reported, also a train derailment was

reported (Lockey 2005)

Yes – confusion over

cause remained, villagers

reported a loud slap, indicating an explosion

(Reuters 2009) also

speculations over an electrical fault.

Ambulances 131 (Okumura 1998)

291 (Ceb 2004) 200 vehicles, 400 staff (eyerman 6 strom 2008)

Except ambulances going to S.t Petersburg,

there were 40-50

ambulances at a collection point in

Novgorod.

Firefighters Fire department

responsible for 182 emergency medical

teams and 1,650

emergency medical technicians

(Okumura 1998)

200 (Ceb 2004) 250 (eyerman & strom

2008)

Volunteers 500 (Ceb 2004) Played an important

role (LRRR:3)

1000 volunteers

turned up at the

main hospital

Not in an organized way

due to the location,

nearby villagers

performed the initial reponse

Prehospital

triage

Triage was done by

emergency medical services (under

responsibility of the

fire department) however a large

number victims

went to hospitals

No form of triage

system using for example color

markings was used

(Bolling 2007)

Yes, Edgware Road and

Tavistock by ambulance service and

medically trained

bystanders, Aldgate and King´s Cross by

London HEMS staff

No triage system

in place

Villagers became first

responders, had to sort out the dead from the

living (the New York

Times (2009-09-28) No systematic approach

seemed to be in place in

the later rescue

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themselves (Okumura 1998)

work(interview)

Over triage 68% (at (

GMUGH)(frykberg 2005)

63%

(Aylwin 2006)

8% (at King

Edward VII Memorial

Hospital (lancet)

Field hospitals Emergency rescue

quarters were established at the

sites, no

decontamination of victims on site

(Okumura 1998)

Within 30 min at

the four incident sites

(Gomez 2007)

Lightly injured persons

were taken to hospitals by bus, stopped when

the bus bomb took

place (fors 2006)

No A mobile hospital was

set up close to the scene

Immediately

dead at scene

177 (9%) (Fuentes 2008)

53 (7%) (Aylwin 2006)

Critical

mortality rate

19,5 %

(Fuentes 2008)

15%

(Aylwin 2006)

“Immediate

fatalities + non

critical injuries”

82.5% as mild cases , 16.7 moderately

0,78, 5 patients –

severely

YES YES YES YES

Waited for

cbrne experts to

arrive

No No No (fors 35) No No

Articulated

strategy to avoid

overstretching of

resources

No, instead all aviable resources

were sent to the first

incident site

Yes (Fors 2006) No

Evacuation of

commuters

The underground was

evacuated in 44 min.

This was the second evacuation of the entire

network in living

memory, previous was in 1991.

250 000 persons were evacuated

Total time for

evacuation of all

casualties

In 2.39 hours

(Gomez 2007)

Within 3 hours

(home office 2006)

IN-HOSPITAL TREATMENT

Number of

persons taken to

hospital

688 transport

4000 by foot

775

(Fuentes 2008)

350

(Lockey 2005)

90

(BBC) 50 to hospitals in St.

Petersburg (Jones 2009)

Critically ill

persons

transported to

hospital

165 (Bolling2007) 20 (Aylwin 2006)

54 (at the main hospital)

Deshpande

Main receiving

hospital

St. Luke Hospital

Gregorio Maranon University General

Hospital

Royal London Hospital + 6 (Fors 2006)

King Edward VII

Memorial

Hospital

Uneven

distribution of

casualties

Yes- two closets, received by far

most of the victims,

almost 82% of reported cases

(Fuentes

2008:1170).

The maximum number of

casualties brought

to King Edward VII Memorial

Hospital (lancet)

Surge 150/ 500 patients in the first hour (the

major receiving hospital)

50 patients within the first 45

minutes (Despande)

Time incident –

first arrival of

priority patient

to hospital

48 min (first victim

transported by

ambulance) (Okumura

1996:130)

23 min until the

first critically

injured patient was transported

(Gomez)

75 min

(Moon 2007)

30 min

(Moon 2007)

2 hours to get to the

scene (BBC)

In-hospital-

deaths

14 (Fuentes 2008)

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Critical

mortality rate

19,5 % (Fuentes 2008)

15% (Aylwin 2006)

Most common

injuries

encountered

Symptoms

encountered after chemical exposure;

eye symptoms,

headache, throat pain, dyspnea,

nausea, dizziness

and nose pain (Pangi 2002)

Tympanic

perforation, chest injuries, shrapnel

wounds, fractures,

first-degree or second-degree

burns (Ceb 2004)

Head injury, chest

trauma, fractures, tympanic

membrane

perforations, tinnitus, giddiness

(Despande)

Fractures, bleedings,

pshycological trauma.

Figure 1 The figure shows different points of comparison at a tactical/operational level between the five case

studies.

“The golden hour” describes as ubiquitous in the trauma care literature, indicating the broad

ranging support for the idea that trauma patients have better outcomes if they can receive

definitive care within 60 minutes of the occurrence of their injuries. The concept of the golden

hour has been guiding for much of current trauma systems, clearly stating the urgency in the

situation (Lerner 2001: 758). Accordingly, analysis of a tactical/operational level of crisis

management focuses on the immediate response, including the “golden hour” as well as

subsequent hours. Boin and ´t Hart (2010:360) reflect on recurring challenges encountered in

the response to major crises, these challenges are also informative when analyzing the five

cases in this article. Diagnosing and deciding are two useful concepts, meaning the difficulty

in forming a picture of the nature and extent of the threat or damage. Moreover, from a

strategic perspective, terrorism is primarily seen as a strategy of surprise (Crenshaw 1987),

timing, location and nature of an attack is impossible to anticipate. It is clear that all cases of

attacks on rail bound traffic had surprising elements, and the first responders did not know

what to expect. Four of the five case studies were multi-site attacks, and the nature of such an

event has been articulated as particular challenging. Tokyo faced the scene of five subway

trains affected by sarin gas, Madrid and London had to handle four explosion sites, and

Mumbai was struck at seven locations. To further exemplify complicating aspects; in London,

where casualties emerged from stations and different ends of tunnels, separate incident scenes

emerged. Four explosions in London turned into the declaration of eight separate scenes, all

requiring full emergency response (Lockey 2005). So each site was a serious incident in its

own, in addition came their unprecedented cumulative effect, creating a great portion of

confusion and speculation on the risk of further attacks (London Regional Resilience Report

2005).

Another challenging task is efficient mobilizing and organizing (Boin and ´t Harts 2010), it is

well known that a mass-casualty event often taxes crisis management systems, hospitals,

infrastructure, and exceeds available resources to the extent that optimum trauma care is in

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danger (Aylwin 2006:2219). Here one can establish differences among the cases, London,

Madrid and Tokyo report to have delivered all available resources almost immediately to the

sites (yet, resources were minimized to extent possible, in order to not overstretch capacity in

case of further attacks). In the case of the bombing of Nevsky express, the situation was

precarious due to its location, around 400 km north-west of Moscow. Rescue operations were

initiated minutes after received information of the attack, yet it took the first responding

agencies nearly three hours to reach the site. Meanwhile nearby villagers came to perform

triage – one of the initial steps in a response, in this case the villagers had to sort the dead

from the living (Barry: 2009). Use of triage differ among the cases, in Mumbai, there was no

systematic triage system. In the case of Madrid and Tokyo, no triage system by color making

was used, even though, as in the case of Madrid, equipment for such a systematic approach

was available. In Tokyo, fire fighters mainly carried out triage, however a majority of the

victims went to hospitals themselves. London appears to have used triage in the most

systematic manner.

On- site challenges such as facing large number of casualties, effective triage and rapid

mobilization belong to established procedures. However, during the response to the attacks

several complicating aspects need attention, several of them relate to scene safety. CBRNE

terrorism is often talked about as a worst-case scenario, and preplanning for such situations

are part of most crisis preparedness plans (Fors 2006). Yet, Okumura (1998:623) concludes

that one of the most serious problems in Tokyo 1995, was the lack of chemical disaster

planning, which was later reflected in a high degree of secondary exposure of the hospital

staff to the chemical substance. Almost 10% of all emergency medical technicians showed

acute symptoms, mainly eye symptoms and headache, and it was suspected that they were

exposed in ambulances to the vaporized sarin from the victims. The rescue work is considered

to have been affected since the medical personnel had to receive medical treatment (Okumura

1998:615). Another risk that relates to terrorist events is secondary devices at the incident

scene; Madrid is illustrative in this regard. Ten bombs detonated at four sites, however four

bombs never exploded. In addition, the police collected bags from the sites, without knowing

about its content, one bag with an unexploded bomb was taken and discovered at a police

station (Bolling 2007:256). Secondary devices also affected the response, hospital tents were

established in a near vicinity of the site, and had to be moved when first responders realized

the risk of further explosions (Bolling 2007:253). Secondary devices was also present in

Mumbai, the police safely defused one bomb. Scene safety also relates to secondary bombs,

13

planned to explode near the first bomb site, targeting bystanders or first responders. In the

case of the bombings of the high-speed train between Moscow and St. Petersburg, a smaller

device went of the second day, hurting one of the investigators (BBC 2009/12/02).

Fortunately, this time the second bomb resulted in minor damage, yet it sheds light of the

problem. Security procedures when approaching incident scenes is an area that needs further

attention (Leppäniemi 2009. 30). London is the case where such procedures appear to have

been developed, yet, some complicating aspects were reported. For example, police officers at

some sites were working very strictly to the rules, and hindered thereby other agencies from

gaining access (London Regional Resilience Report 2005:11). A last point relating to scene

safety is the fact that the uncertain security situation calls for rapid scene clearance, (emphasis

on scoop and go) yet that also imply an increased surge in the receiving hospitals.

Turning to the in-hospital response, one needs to pay close attention to that different types of

attacks cause different injury patterns. Bombings are the most frequent used tactic in terrorist

attacks; bombings were also used in four of the five case studies. It is well established in the

literature that bomb attacks result in injuries that are caused by a combination of mechanisms,

such as blast (from changes in atmospheric pressure), penetrating injuries (caused by

shrapnel), blunt (consequence of body displacement caused by expanded gases), and burns.

Head, chest, abdominal, traumatic amputation and blast lung injuries are frequent observed

among critically injured (Frykberg 2004:20). What complicates this picture further, is the fact

that most care providers are not familiar with these types of blast injuries (Turégano -Fuentes

2008:1169 ). One can also add a dimension that relates directly to the modus operandi of

terrorists, suicide bomb attacks (SBA). According to Turégano-Fuentes (2008:1173)

characteristic for SBA injuries are a combination of blunt injuries, multiple penetrating

injuries with extensive soft tissue damage, and burns. This injury pattern was reported from

London 2005, the only case of suicide attack among the five attacks.1

1 Further analysis of the in-hospital treatment will be conducted.

14

CRISIS MANAGEMENT AT A STRATEGIC LEVEL

As stated, the immediate response to a major crisis is extremely important, how individual

first responders, or teams, perform their tasks can make tremendous difference for the victims.

However, an effective crisis management do not only depends on individual rescue workers.

If a major crisis takes place, formal organizations need to coordinate their objectives,

resources must be shared and activities need to be synchronized (Uhr 2009). These

coordination aspects relate to a strategic level, accordingly, in the following part, key aspects

fundamental for carrying an effective coordination of the response operations will be analyzed

for each of the five attacks.2

TOKYO MADRID LONDON MUMBAI MOSCOW

Preparedness

capacity –

training and

education

Prior to the

attack, there

were no

integrated drills

including all of

the concerned

organisations

(okumura

1998:616)

The responding

agencies had been

trained well, often

in integrated drills

Regular interagency

trainings, a major

exercise on London

underground took

place just before the

attacks

No organized

crisis

management

response system

until 1996, now

the biggest

hospital has

regularly

trainings

Previous

experience of

major high

profile

cases/terrorism

Mostly natural

disasters such as

earthquakes and

floods, limited

experience of

man-made

disasters, a

smaller sarin gas

attack in 1994

(Okumura 1998)

Long history

dealing with

attacks carried out

by ETA, but no

experience of such

a large-scale

attack

Yes, Great Britian

has suffered several

attacks, mostly

related to the

Northern Ireland

conflict, London

also have a

relatively extensive

experience of

handling train

incidents (Fors

2006)

Mumbai

bombings 1993

– coordinated

bombings

targeting rail

bound traffic

Moscow theatre

crisis 2002,

Beslan school

seizure crisis

2004,

(Porfiriev 2005)

Key document for

coordination/legal

instruments

Tokyo regional

disaster plan (intended to

provide initial

medical rescue

and backup

support)

*PLATERCAM

The Territorial

Plan of Civil

Protection of the

Community of

Madrid

* the Health

Regulating Law

of the

Community of

Madrid

(Gomez 2007)

*LESLP London

Major Incidents

Procedures Manual

*2004 Civil

Contingencies Act

Eyerman & strom

2008)

Multi-agency

approach to crisis

management

No, actors

carried out their

roles without

central

coordination.

Yes Yes No

2 Another aspect that I will address is the importance of the response that takes place outside formal

organizations and preplanned structures, research shows that ad-hoc behavior and innovative and flexible solutions are key in a better understanding of crisis management (Uhr 2009). In large- scale attacks such as the five case studies there are reasons to believe that “informal crisis management” also played an important role.

15

Declaration of

“major

incident”/upscaling

of command and

control

Main hospital disaster plan was

activated 85 min

after the attack (okumura

In 96 min PLATERCAM

classified the

situation as the maximum level –

level 3, a national

command organization (Gomez

2007)

33 min “A London-wide major incident”

Various actors

declared major incidents at the sites at

different times, the

first, Aldgate station 09.05 by London Fire

Brigade

The Institutional Disaster

Management

Program (DMP) was activated 5-10

after the first

victims entered the main hospital

(Deshpande)

Within 10 minutes after the first

information, “extra

resources” were called for.

Crisis of manpower Yes, The emergency

medical system

and medical transportation

were overtaxed: (Pangi 436

The attack occurred at time for shift

change at several

responding agencies, No shortage of

personnel reported.

(Bolling 2007)

No “The events of 7 July did not exceed the

capacity of the

responding agencies to contain anddeal with

the situation” (LRRF

2006)

No When the rescue teams arrived at the

site, the was no

need for more manpower.

First press

conference was

given

In 2h 35 min – indicating that

sarin intoxication

was suspected (okumura 2008)

Shutting down of

train system

Yes, within 25

minutes, seen as a

lesson learned from Madrid (Fors 2006)

Train system

resumed operation

05.00 the day after

(Fors 2006)

10.00 the day after

(the Hindu 2006)

Communication –

calls

22 000 incoming calls in the first 16

hours (Bolling)

42 000 calls to Metropolitan Police

Casualty Bureau

(Lockey 2005)

Main area of

concern

Telecomunications Telecommunications

(LRRR:6)

Anticipation of

psychological care

Was not part of disaster planning at

the biggest hospital

Yes, assistance arriwed at the

remote place

during the first hours

Identification of

dead

155 of 191 bodies

were identified

within 24 hours (Bollin)

Ad-hoc leadership

Flexible solutions

Figure 2 The figure shows different points of comparison at a strategic level between the five case studies.

Research findings point clearly in the direction that a single organization cannot tackle major

crises, instead interagency and networked forms of management and organization is

emphasized. Boin and ´t Hart (2010:365) argue “the crisis response of a society is to a very

considerable extent determined by the breadth and depth of interorganisational relations in its

crisis management systems. Response to the major attacks on rail bound traffic required the

collaboration of a wide range of institutions and organizations, how well collaboration was

institutionalized, differ between the case studies.

Achieving effective collaboration calls for preplanned structures and familiarity with roles

and responsibilities, a step in such a direction is recurring trainings and drills. By coincidence,

several of the attacks took place close in time to larger crisis management drills. For example,

16

in the hospital receiving most victims in Mumbai, there was a disaster management plan drill

only a month prior to the attacks (Moon, Bogle & Minas 2007:640). Likewise, in London a

larger emergency exercise on the London underground took place just a couple of weeks

before the attack (Lockey 2005). In the case of Tokyo, drills are reported to have been carried

out regularly, however drills and plans were mainly aimed for fires and earthquakes

(Okumura 1998:618). Also in Russia and in Madrid, it is common with recurring exercises.

In the case of Japan, the Tokyo metropolitan government is responsible for regional disaster

planning and its management. The Tokyo regional disaster plan establishes that Tokyo

Metropolitan Fire Department (TMFD) has the responsibility in providing first aid to victims

and selecting the hospitals to which victims will be transported to. The metropolitan police

have primary jurisdiction over law enforcement. In addition, the Japanese Self Defense Forces

are a resource, often mentioned is their knowledge in chemical disasters (Okumura 1998: 613-

614). When reviewing the literature on the subway attack it becomes clear that inter-agency

coordination was surrounded with challenges. Okumura (1998:616) identifies three main

problems encountered. Firstly; limited out-of-hospital care, secondly; lack of cooperation and

communication among different actors, and thirdly; general lack of preparedness for a

chemical disaster. Pangi (2002:428) uses “compartmentalized bureaucracy” to describe that

Japanese agencies usually work separate from each other, and this lack of cross-agency

cooperation hinders effective response systems. To exemplify, there were no contingency

plans in order detailing how to respond to an attack caused by chemical substances. The only

actor with such planning was the military (Pangi 2002:428). However, the Self Defense

Forces cannot act without the consent of the prime minister. Yet, they are allowed to carry out

rescue work in a crisis situation, but it requires a request from the local government. In this

specific context of a chemical attack, in the early stage, the resources were not deployed

optimally. In all, respective actor appears to have carried out their response without a central

coordination.

The attack in Madrid caused enormous devastation and the response involved a large number

of actors. Spain has a history of dealing with terrorism, mainly from separatist groups such as

ETA. However, the scale and the nature of the attack with different incident sites outreached

previous experience. When reviewing research it becomes clear that preplanned coordination

instruments became important during the response. PLATERCAM serves as the legal

instrument that activates in relation to catastrophe situations. It serves as a framework for the

17

coordination between participating public administrative bodies; moreover, it outlines

mechanisms for mobilization of human resources and materials needed for response. A

second central instrument is the Health Regulating Law of the Community of Madrid,

establishing that the Health Community is responsible for directing the services, including

developing emergency plans and coordinate medical resources in cases of crises. (Gomez

2007:248). The scale of the attack led to activation of both regional and national command

organizations. A quick up scaling of coordination was made, the highest level of

PLATERCAM, level 3, was activated in around 35 minutes after the attack (Gomez

2007:250), - something that previously had never happened (Bolling 2007). The treatment of

all victims is overall regarded as successful, at all four scenes (Gomez 2007). Yet some

coordination challenges were encountered. For example, two organizations; Summa and

Samur, are responsible for prehospital treatment. In the response, both organizations felt that

they led the rescue work at the sites. After the response, it also became clear that distribution

of casualties to the different hospitals had been rather uneven (Bolling 253-254). One of the

main lessons learned, except improvements in telecommunications, is the need to establish a

top of command at each of the sites, hence improving the ability to respond in different areas

at different times (Gomez 2007). However, according to Ceballos (2004:106) lack of previous

experience of such a large-scale crisis, its multi-site nature included, was counterbalanced by

the commitment of the agencies involved and spontaneous leadership in different areas.

The response to the attacks in London stands out as the case with the most organized multi-

agency coordination. Eyerman and Strom (2008:90,100) points at a long history of responding

to both natural and manmade crises, and a articulated multi-agency approach to crisis

management has existed for more than 60 years. A large number of responding actors,

including various volunteer groups were activated on July 7. The foundation of London’s

multi-agency coordination is a system with three levels of response; gold (strategic), silver

(tactical), and bronze (operational). The different levels relate to different functions and

responsibilities, which are outlined in a Major Incidents Procedures Manual (LESLP).

According to Eyerman and Strom (2008), also echoed in the London Regional Resilience

Forums “multi-agency debrief” (2006), several successful elements of the response can be

identified. In one way or another, these successful elements are dependent on an effective

coordination. Rapid recognition and declaration of a major incident, agreed-upon command

and control systems, limited confusion over roles and responsibilities, effective handling of

casualties and coordinated media messages, are considered to have been key aspects in the

18

response. One can once again refer to the nature of a multi-site attack, implying several

incident sites (sometimes more than number of attack sites). London reports to have

integrated lessons learned from the response in New York, where the arriving forces initially

rushed in with too many resources (Fors 2006:22). Even though the response operation in

London is regarded as a “coordination regime” (Eyerman and Strom 2008), there is always

room for improvements. At a strategic level it can be illustrated by some confusions between

the U.K. government and the London response community. The first has a Cabinet Office

Briefing Room (COBR) that enables the prime minister and key government officials to

obtain critical information and communicate with main responding agencies. The London

response community, on their side, relies on the Gold Coordinating Group to direct strategic

operations (Eyerman and Strom 2008: 97). The official evaluation of the response concluded

the need for greater clarity between the two main actors (LRRF 2006:6). However, the

response was summarized, “while the response had by no means been perfect, the overall

multi-agency emergency response to the 7 July bombings had been very successful (LRRR:

3).

According to Supe (2008), India has experienced an increased frequency of civil disasters,

Mumbai itself has suffered from simultaneously terrorist bombings in 1993 and also extensive

floodings. These events together with other crises have contributed to the development of a

more comprehensive system for crisis management. It should be underlined that prior to 1996,

there was no organized system for deliver emergency medical care to victims of different

crises. The Disaster Management Cell of the Municipal Corporation of Greater Mumbai plays

a key role in the city’s crisis management, and sets out to handle by an integrated response.

The pre-hospital care in Mumbai is the responsibility of the Mumbai Fire Brigade,

traditionally limited to transportation of victims, in recent years trained paramedics have been

integrated to the response. On July 11, no prehospital triage was performed, leading to a

bigger surge at the hospitals, this surge was also increased by the fact that the Mumbai train

network is above ground and thereby shortens the transportation time to hospitals (Moon,

Bogle & Minas 2007). In the cases of Madrid and London, it was clear that inter-agency

collaboration revolved around distribution of casualties and sense making of the attack. In

Mumbai the public transportation system constituted an important actor, transporting the

casualties rapidly to the hospitals. Worth noting is that the time from the incident to the first

priority patient reaching hospital in Mumbai was only 30 minutes, compared to 75 minutes in

London. Major crises often attract large crowds of bystanders, sometimes hindering rapid

19

transport. Large voluntarily resources can also be helpful, yet on the day of the attacks, there

was confusion on how to handle, and possible deploy, these resources. A weakness mentioned

regarding the main hospital´s disaster management was that the roles and function of this

sudden additional manpower was not defined in the preplanning structures (Moon, Bogle &

Minas 2007:639-640).

The response to the bombings of the Nevsky Express running between St. Petersburg and

Moscow stands out among the five case studies, it is in particular informative when it comes

to challenges due to its remote location. The explosion took place on the border of Tver and

Novgorod regions (Gazeta 20120512). Consequently, main responding actors came from

these two regions, there were also response teams from S.t Petersburg and Moscow. Villagers

performed the immediate response at site. The nearest village is located around 5km from the

incident site, so even this immediate response was difficult. Responding agencies from St.

Petersburg reports prompt actions, the incident took place 21.35, ten minutes later information

of the attack reached the responding agencies, a minute later a first team left for the site. It

took another ten minutes before a decision was made to call for extra resources. A crisis

center was later also established in Moscow. It took the first team, from Novgorod, around

three hours to arrive. The subsequent hours, more teams arrived and carried out their work

under the lead of the Novgorod team, accordingly the operational team at a local level took

lead in strategy and decided upon the distribution of victims to hospitals in Novgorod, St.

Petersburg and Moscow, the most critical wounded were transported by helicopter.

Psychological assistance arrived already at the site at 03.00. According to the responding

agencies, (interview St. Petersburg) they regarded the response successful, yet room for

improvements relates to inter-agency cooperation at a strategic level. “A few more minutes

would have been needed in order to better coordinate between the different levels of

authorities”.

20

CRISIS MANAGEMENT AT A SYSTEM LEVEL

In this last part, mechanisms that are fundamental for crisis management at a system

level are yet to be analyzed. The institutional design of crisis management systems differ

between countries depending on context, history, political traditions and so forth. This part of

the article revolves around differences and possible similarities in the five cases

institutionalized crisis management capacity. In order to take on a holistic approach when

analyzing crisis management response, all elements of a crisis management system need

attention. As Uhr (2009:29) establishes, a crisis management system consists of several

elements, including individuals, groups of individuals, formal organizations, laws and

regulations, knowledge, culture, communication devises, even vehicles and stretchers are

included, as well as dynamical relations between the different entities (Uhr 2009:20). In other

words, there is a high degree of complexity embedded in crisis management, and differences

and similarities that emerge from the analysis can be synthesized into different national

approaches to crisis management response.

TOKYO MADRID LONDON MUMBAI MOSCOW

Well defined

leadership

Centralized crisis

management

system

Decentralized

crisis management

system

Ad hoc solutions Networked

governance

Resilience

Figure 2 The figure shows different points of comparison at a strategic level between the five case studies.

It is important to underline that crisis management is inherently political – a particular way of

handling adversity (Boin 2004:174). Governments have a fundamental responsibility in

providing security for their citizens, and throughout history, their competence in governing

crises, preventing as well as responding to emergencies, have been tested. The examination of

governments’ competence dealing with complex crises is considered more significant today

due to the fact that modern governments appear to become better equipped technologically,

yet, they must rely on legitimacy in order to govern (Farazmand 2007: 149,154). One can also

observe a trend towards a professionalization of disaster planners and crisis managers

21

(Quarantelli, Lagadec, Boin 2006:20), which main task is to formulate institutional

procedures as well as cultural climates which can develop capacities to cope with

extraordinary threats (McConnel and Drennman 2006:59). In other words, governments have

a fundamental responsibility to provide security for its citizens, and an institutional capacity

to do so is crucial; however, how this institutional capacity is developed and organized differ

between countries. This relates to an often raised question, do crisis management really

matters? (good management as well as mismanagement), and as this article will illustrate, yes

it does.

If crisis management is to make a positive difference, Rosentahl (2003:134-135) stresses the

importance of us understanding the relevance of recent crisis management maxims. First, it is

without question that leadership plays a crucial role in the immediate crisis response.

However, in large-scale crises, there will be many stakeholders as well as several actors that

are claiming their role in the decision-making processes, in other words, an institutional

complexity exists. This complexity indicates that a well-defined leadership is not sufficient as

the only point of analysis. Therefore, Rosenthal also underlines the importance of those

responsible for crisis management to take on a prepared, prompt and decisive response action,

the first minutes and hours of a crisis is decisive for success or failure. For the purpose of this

article, these actors have been interpreted as mainly first responders. Thirdly, Rosenthal adds

the concept of inconceivability as one could interpret as version or an additional maxim of

crisis management. With reference to Dror, Lagadec, Pofiriev & Quarantelli’s (2001) work on

the emergence of new crises, inconceivability is understood as a key aspect in the struggle to

carry out effective crisis management.

Ansell, Boin and Keller (2010) emphasize that transboundary crises pose significant

management as well as analytical challenges. Regarding the management side, coordination

and communication of actions across organizations, professions and political jurisdictions are

underlined as key challenges. Analytical difficulties revolve mainly around a lack of

understanding of what organizational factors that will produce reliable performance across a

network of actors. The literature is informative in how to foster reliable performance in single

organizations, however, the dynamics when organizations are uncertain about who their

partners in crisis might be, is less known (Ansell, Boin and Keller 2010:195). Clearly,

collaboration appears to be a key, but also a main challenge in crisis management, and

different levels face different challenges (see for example Boin & ´t Hart 2010).

22

As noted, the role of government in disasters and crisis situations is regarded as complex,

debates tend to focus on centralized versus decentralized approaches including networked

governance (Cheong 2011: 1073). Traditionally, disaster and crisis management has been

concentrated to a centralized, national level, invoking a crisis’s urgency and uncertainty (´t

Hart 1993). This traditional centralized approach corresponds to concepts such as command

and control, and explains as an approach in which; “orders and instructions are explicit, often

to the point of detailing not only what is to be done but also how, when, and with what

means” (Uhr 2009:22,59). In other words, the vertical dimension is of importance. However,

the centralized approach has come into question; some scholars argue that centralized

command and control structures cannot fully cope with intersectional and cross-jurisdictional

coordination challenges. Instead, more decentralized, networked collaboration is regarded as

needed, stressing its shared authority, collaboration and negotiation (Cheong 2011: 1074).

The importance of collaboration has already been reflected upon, however, one can take the

decentralization model further, as Uhr (2009:23) shows, there is a substantial room for “ad-

hoc behavior in crises, a behavior that do not necessarily corresponds to written, preplanned

structures, but rather to the concept of trust (Uhr 2009:23).

Uhr (2009:20) refers to national crises and international disasters such as hurricane Katrina

and the tsunami in 2004, and concludes that various managerial problems appear to be

common to both of them and possibly to be universal. Moreover, Malone and Crowston

(1990) establish that different functions of steering and controlling crises pose different

challenges, and some of these challenges has already been mentioned, they also argue that,

“when analyzing coordination, the collective behavior of the actors must be evaluated in

terms of how well it achieves some overall goal”, thus indicating a holistic approach to crisis

management.

23

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