Letters to the Editor  |   December 2005
Ripple Effects of Terrorism
Author Affiliations
  • Tyler Cymet, DO
    Section Head, Family Medicine, Sinai Hospital of Baltimore; Assistant Professor of Internal Medicine, Johns Hopkins School of Medicine Baltimore, Maryland
Article Information
Disaster Medicine
Letters to the Editor   |   December 2005
Ripple Effects of Terrorism
The Journal of the American Osteopathic Association, December 2005, Vol. 105, 533-534. doi:10.7556/jaoa.2005.105.12.533
The Journal of the American Osteopathic Association, December 2005, Vol. 105, 533-534. doi:10.7556/jaoa.2005.105.12.533
To the Editor:  
The recent article by Gail Dudley, DO, and Robin B. McFee, DO, MPH, in the September 2004 issue of JAOA—The Journal of the American Osteopathic Association (Preparedness for biological terrorism in the United States: Project BioShield and beyond. 2004;105:417–424) examines preparedness plans addressing the physical injuries and infections resulting from acts of biological terrorism. We must remember, however, that in response to an act of terrorism in the United States, the osteopathic medical profession will also have to provide attention to the psychological health of those people who are affected. Terrorist attacks have a wider effect than just physical symptoms. 
The mantra of the terrorist is “kill 1, scare 10,000.” Experience has shown that acts of terrorism and other disasters are low-likelihood, high-impact events for the people affected—both in terms of their daily living and the effect on their psyches.1,2 
We minimize the effects of terrorism when we focus on only the relatively low number of direct victims of any given attack. The full effects of a terrorist attack can be compared to ripples in water that has been disturbed. The ripples expand outward and have an effect in areas greater than just the one spot where the water was disturbed. The reason terrorism can be such an effective technique is that it produces a large number of indirect victims, many of whom are psychologically impacted to the point of changing their ways of thinking or behaving. 
To successfully combat terrorism, preparedness plans must take into account all of the people who are potentially affected by an attack—not just the direct victims. 
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Hogan DE, Burstein JL, eds. Disaster Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins;2002 : 3-16.
Murdock S, Cymet TC. Treating the victims of a disaster: physical and psychological effects. Compr Ther. In press.