/
/

Bomb attack in Finnish shopping centre in 2002 – KAMEDO-report 87

The Kamedo-reports are published by the Swedish Disaster Medicine Study Organisation (Kamedo), at the National Board of Health and Welfare. Observers study the medical, psychological, organisational and social aspects of disasters. The results, with a focus on experiences gained, are presented in the reports.

This report is entirely in Swedish. Only summary in English.

Summary

The time is 7.36 pm on Friday, 11 October 2002. There are between one and two thousand people in the Myyrmanni shopping centre in the town of Vantaa, just north of Helsinki. The shops are soon going to close. Suddenly, a bomb explodes immediately beside a crowd of people watching a clown perform his act. The audience includes many children.
The bomb was later proven to be homemade and was set off by a male student aged 19. Five people including the perpetrator died immediately and an area of 400 sq m was devastated. Two more people died later and more than 160 people, including many children, needed medical attention.
Units from the rescue, police and medical services were quickly directed to the site. At an early stage, the rescue service made the assessment that there were sufficient rescue personnel on site and that all that was required were more ambulances to transport casualties to hospital.
The doctor from the air ambulance helicopter led the medical care work within the affected area under the command of the Rescue Manager. No assembly point was set up. It was possible within one hour to transport the 32 most seriously injured by ambulance to various hospitals in the region. In addition, a spontaneous evacuation took place via private cars and taxis.

Domestic experience

Ministry of the Interior’s commission of enquiry
The first rescue units went in to help victims in the same way as in the case of a normal accident. The Finnish Ministry of the Interior’s subsequent commission of enquiry indicated that the incident had more in common with a terrorist attack, which is something that Finnish rescue teams were not used to handling. The enquiry team was of the opinion that it would have been justified to include this in the assessments of the risk of another attack and that rescue workers who are faced with an accident site ought also to be made aware of this.
The Ministry of the Interior’s enquiry also indicated that the region did not carry out sufficient exercises and have enough experience of handling major accidents, particularly on the medical side. Major accidents are unusual and a drill is normally held once a year – this was considered insufficient by the enquiry team.

Experiences of those involved

No special markings was used either for medical or rescue management personnel. However, these weaknesses in the organisation had been known for at least ten years. The air ambulance helicopter’s doctors also had difficulties in knowing the levels of competence of the various ambulance paramedics during the operation.
Tölö hospital has the task of coordinating the hospitals in the capital city’s region in conjunction with special incidents. There was deficient contact between the healthcare management team at the incident site and Tölö hospital. The ambulance paramedics were also working according to normal procedures. These two circumstances led to the paediatric clinic at Mejlan hospital becoming overloaded. At the same time, unutilised resources were available at Tölö hospital. The communications problems were partly technical; for example, the mobile telephone network was overloaded.
Deficiencies in collaborative procedures between the police and medical staff created problems in providing information to relatives. Telephone numbers were incorrectly issued, which meant that the local emergency centre in Vantaa, as well as the emergency incident centre that was established, were burdened with calls that did not belong there.
During the first 24 hours, one person at Tölö hospital was responsible for all information from the healthcare services to the media. The media is assessed as having behaved correctly and there were no reports of any attempts to breach confidentiality.
In most places, coordination worked faultlessly between the various authorities and rescue units involved. Once the intensive phase was over, however, an old controversy recurred between the City of Helsinki and the air ambulance helicopter organisation regarding the medical management issues.
The emergency centre had the task of trying to help people suffering from psychological problems in the wake of the explosion. There were too few telephone lines and too few people available to carry out this work.
The emergency centre was also given the task of administering the support fund set up by the Vantaa town administration board to support the people affected. The town administration board’s decision to set up the fund seemed like a good idea at the outset. However the rigid regulations, which the Emergency Centre had to adhere to, meant that it took some time before sums of money were paid out. This weakened the credibility and good reputation that the Emergency Centre had acquired by its handling of the bomb attack.

Observer’s experiences

• After a non-accidental bomb explosion, it is difficult for rescue workers and healthcare workers to wait for a full assessment of whether any more explosions are likely to occur. That would take too much time and it might be impossible to save some badly injured individuals.
• For an individual fire-fighter or healthcare worker there is usually no choice about whether to carry out the work because of the danger to his or her own life. There would be much too strong a sense of being weak and cowardly. In addition, these professional groups are confronted with people in need in such a way that taking action is usually inescapable. Any decisions about waiting or abstaining from carrying out a rescue ought therefore always to come from someone with management responsibility.
• It is important that various categories of personnel should be wearing clearly marked armbands or waistcoats. This makes the distribution of responsibility and tasks much easier during operations at the incident site or assembly locations.
• When the number of casualties is limited, transporting the casualties straight to hospital is usually accomplished so quickly that it is not necessary to set up any intermediate station or assembly location.
• When an air ambulance helicopter with a doctor onboard is available in a suburban or rural environment, it is usually first to arrive on scene at the incident location once the alarm has been issued. For that reason and because of the high level of medical skill onboard, this resource ought clearly to be included in any emergency plans. At the same time, other options should also be available, such as doctors and nurses in emergency vehicles.
• Managing an emergency operation does not just require basic emergency medical training but also, above all, specialist training in managing personnel. Holding a high-level post, such as qualification as a specialist consultant, is not a sufficient qualification for managing an emergency rescue operation.
• It can be difficult to leave behind habitual procedures and to change over to emergency procedures when no clear order has been issued concerning this. It is important therefore to issue an emergency alarm to ensure that everyone involved knows which rules apply.
• Procedures for collaboration between the rescue service, police and medical care personnel, or for collaboration within each organisation, ought to be well prepared in advance of a major emergency operation. It is important that the collaboration should work just as well during the intensive phase as well as in the aftermath. This may have an important political symbolic value in the eyes of the general public.
• An emergency operation frequently does not develop exactly in the way that has been planned and trained for. Different teams are quickly formed to resolve the problem on an ad hoc basis. It is important then that the division of responsibility is made clear, that the emergency plan is adhered to in the most practicable manner, but that improvisation must also be permitted.
• Once the emergency alarm has been issued at a hospital, as a rule, people present themselves so that sufficient personnel are rapidly in place. Volunteers are seldom required and are therefore often an encumbrance.
• In emergency communications, it is important that different means of communication are available: mobile phones, telephone lines via the fixed telephone network but also alternative networks, such as the armed forces telephone networks and radio. This lessens the risk of all communications links going down. It is also important that these means of communications are used regularly in everyday duties or that there are regular exercises using them.
• Information to the receiving hospital should primarily contain details about the number of casualties and, of those, how many have serious injuries.. Details about the particular injuries are less important since full clinical examinations must always be carried out at the hospital.
• It is easy for the loading at receiving hospitals to become imbalanced when the transportation of casualties from the incident site is being carried out rapidly and without any central coordination. This uneven loading can be corrected, however, by temporarily moving personnel from one hospital to another.
• Hospitals that receive casualties ought to have the capacity to provide primary care for all types of injuries – regardless of the age of the casualty. The care is often the same, but medical equipment suitable to the age of a child should be available.
• It is important, in the longer perspective, to assure psychological and social care in emergency situations, e.g. via groups such as the local authority’s management team for Psychological and Social Support and Care.
• Today, bomb explosions are a common cause of large numbers of people being killed and injured. Diagnosis and treatment of injuries caused by pressure waves and the treatment of high-energy blast injuries ought to be taken up once again in trauma training courses, i.e. training in how to treat serious injuries.

Read the full Summary

Contact

Susannah Sigurdsson
+46 (0)75 247 30 00