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:
The Journal of the American Osteopathic Association, December 2005, Vol. 105, 533-534. doi:
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. 
 As the premier scholarly publication of the osteopathic medical profession, JAOA—The Journal of the American Osteopathic Association encourages osteopathic physicians, faculty members and students at osteopathic medical colleges, and others within the healthcare professions to submit comments related to articles published in the JAOA and the mission of the osteopathic medical profession. The JAOA's editors are particularly interested in letters that discuss recently published original research.
 Letters to the editor are considered for publication in JAOA with the understanding that they have not been published elsewhere and that they are not simultaneously under consideration by any other publication.
 All accepted letters to the editor are subject to copyediting. Letter writers may be asked to provide JAOA staff with photocopies of referenced material so that the references themselves and statements cited may be verified.
 Readers are encouraged to prepare letters electronically in Microsoft Word (.doc) or in plain (.txt) or rich text (.rtf) format. The JAOA prefers that letters be e-mailed to Mailed letters should also be sent electronically, in one of the aforementioned electronic formats on an IBM-compatible CD or a 3 ½-inch disk, and addressed to Gilbert E. D'Alonzo, Jr, DO, Editor in Chief, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864.
 Letter writers must include their full professional titles and affiliations, complete preferred mailing addresses, day and evening telephone numbers, fax numbers, and preferred e-mail addresses. Authors are responsible for disclosing financial associations and other conflicts of interest.
 Although the JAOA cannot acknowledge the receipt of letters, a JAOA staff member will notify writers whose letters have been accepted for publication. Mailed submissions and supporting materials will not be returned unless authors provide self-addressed, stamped envelopes with their submissions.
 All osteopathic physicians who have letters published in JAOA receive continuing medical education (CME) credit for their contributions. Writers of original letters receive 5 hours of AOA Category 1-B CME credit. Authors of published articles who respond to letters about their research receive 3 hours of Category 1-B CME credit for their responses.
 Although JAOA welcomes letters to the editor, readers should be aware that these contributions have a lower publication priority than other submissions. As a consequence, letters are published only when space allows.
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.