The Counter Terrorist Magazine - August/September 2009

L O N E W O L F K I L L E R • TA L L A D E G A R E S C U E • I R A T E C H N O L O G Y

Counter The

Official Journal of the Homeland Security Professional AUGUST/SEPTEMBER 2009

VOLUME 2 • NUMBER 4

THE PEOPLE’S REPUBLIC OF

CHINA VS.ISLAM

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Counter The

AUGUST/SEPTEMBER 2009 VOLUME 2 • NUMBER 4

Official Journal of the Homeland Security Professional

COVER STORY:

26

FEATURES:

CONTENTS

26

6

42

59

The People’s Republic of CHINA VS. ISLAM

by Jennifer L. Hesterman

6

Case Study: THE LONE WOLF KILLER

by John Andrews

Hand: 14 First FBI HOSTAGE RESCUE AT TALLADEGA

by James A.McGee

IRA TECHNOLOGY 42

How Far Has It Spread?

by Andy Oppenheimer

OPERATIONAL USE OF KETAMINE 52

Pain Control and Procedural Sedation

by Shawn Hunter, M.D.

DEPARTMENTS: 4

From the Editor

49

Book Review

59

Innovative Products

60

Training Review

Cover Photo: ©istockphoto.com/antoniodalbore

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Counter The

FROM THE EDITOR:

Protect and Serve

Official Journal of the Homeland Security Professional

VOLUME 2 • NUMBER 4

By Chris Graham

O

n June 8, 2008, Tomohiro Kato stabbed 12 shoppers in Tokyo, Japan.

He killed a total of seven people. Police chased and apprehended him.

On July 2, 2008, Hossam Dawyyat attacked cars on a busy street in Jerusalem, Israel, with a Caterpillar 966 front-end loader. Dawyyat killed three people before being killed by a soldier, a security officer, and police.

On April 3, 2009, Jiverly Wong attacked an immigration center in Binghamton, New York. He shot 17 people, 13 of whom died, before committing suicide.

These incidents, and countless others, bear many commonalities. These attacks illustrate the fact that it is impossible for any policing agency to prevent occurrences of violent crime. Individual citizens are both the first and last line of defense in their own security.

Those of us who have sworn to “support and defend the constitution of the United States” are painfully aware that we rarely have any privileges that civilians do not have regarding the carriage of weapons or the use of force for personal security. Our ability to protect ourselves and our families is no different than that of any citizen.

Our brothers and sisters who “protect and serve” are granted special privileges and responsibilities pertaining to the carriage of weapons and use of force. Even members of policing agencies, however, face the reality that their family members are vulnerable.

Parents, spouses, and adult children can only protect themselves in the same ways that all citizens are permitted to.

Although the above incidents share commonalities, there is a distinct difference as well. American citizens are guaranteed the right to bear arms for defense by the Second Amendment to the U.S. Constitution. No other nation has so clearly codified the citizen’s ability to defend himself or herself. One must therefore wonder, if a single victim in the Binghamton attack had been armed and in possession of the most basic level of fighting proficiency, how many lives might have been saved?

We are fortunate to live in a nation that has historically exercised restraint when it comes to concentrating trust and responsibility in the hands of government agents.

Obviously, this is one of many important issues facing all Americans. It is only fair to make your requirements on this topic known to your elected representatives before the next rapidly approaching election.

It is important that your representatives are aware that this subject is just as critical as freedom of speech itself. Whether you live in the Wild West on the Mexican border, in al-Qaeda’s favored target—New York City—or anywhere in between, uninhibited application of the Second Amendment to the Constitution is as necessary today as it was in 1791.

Semper Fidelis, Chris Graham Editor of The Counter Terrorist

AUGUST/ SEPTEMBER 2009

Editor Chris Graham Director of Operations Sol Bradman Director of Advertizing Carmen Arnaes Director of Production Kelli Richardson Contributing Editors John Andrews Jennifer Hesterman Richard Marquise Chuck Pfarrer Graphic Design Morrison Creative Company Copy Editor Laura Town Office Manager Lily Valdes Publisher: Security Solutions International Suite 204 14300 SW 129th Street Miami, Florida 33186 ISSN 1941-8639 The Counter Terrorist Magazine, The Official Journal of the Homeland Security Professional, is published by Security Solutions International LLC, as a service to the nation’s First Responders and Homeland Security Professionals with the aim of deepening understanding of issues related to Terrorism. No part of the publication can be reproduced without permission from the publisher. The opinions expressed herein are the opinions of the authors represented and not necessarily the opinions of the publisher. Please direct all Editorial correspondence related to the magazine to: Security Solutions International SSI, 14300 SW 129th Street, Suite 204, Miami, Florida. 33186 or info@thecounterterroristmag.com The subscription price for 6 issues is $34.99 and the price of the magazine is $5.99.

(1-866-573-3999) Fax: 1-786-573-2090.

For article reprints, e-prints, posters and plaques please contact: PARS International Corp.

Web: www.magreprints.com/quickquote.asp Email: reprints@parsintl.com Phone: 212-221-9595 • Fax: 212-221-9195 Please visit the magazine web site where you can also contact the editorial staff:

www.thecounterterrroristmag.com © 2009 Security Solutions International

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Case Study:

THE LONE WOLF KILLER

By John Andrews

Counter The

Photo: Scott Morrison

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Historically, the “lone wolf” terrorist has been a rarity in the United States. A “lone wolf” is a person who performs politically inspired terrorist acts without orders from or even connections to any type of organization.1

T

hus, this definition would not include members of ecoterrorist organizations such as the Earth Liberation Front (ELF), because even though the ELF lacks a formal structure, it is nonetheless a loose confederation of people with similar goals and modus operandi. On the other hand, the definition of lone wolf would include individuals like Eric Rudolph and Theodore Kaczynski, because neither of these men were a part of or associated with any organization of any kind.

When discussing lone wolves, it may be valid to distinguish them from individuals who commit terrorist acts because they are mentally disturbed, as was the case with Virginia Tech shooter Seung-Hui Cho. Although the lines may become blurry when politically motivated attackers do exhibit some degree of mental illness, for the purposes of this article, we will assume that lone wolves differ from common “lone nuts” in two ways: First, their violent actions

are politically, religiously, and/or ideologically motivated; and second, they make an effort not to get caught.

In recent years, the advent of the Internet and numerous websites dedicated to explosives, firearms training, survivalist skills, surveillance techniques, and radical ideology has helped facilitate the creation of lone wolf terrorists. However, even with the many resources available on the Internet, the lone wolf may remain a rarity. Terrorists seek a cause that gives them emotional relief, social community, and spiritual comfort.

They are drawn to like-minded people, and once among these people, the intensity of their beliefs spirals upward in an apparent game of oneupmanship with their comrades.2 In other words, the members of the terrorist group feed off one another.

This is not possible with the lone wolf, who operates in a vacuum with no support structure. It takes a certain type of individual to conduct violent activities without any social support. In addition, this individual has to possess the ability to conduct

Next, he bought a guitar case in which to carry the weapon, and he scouted the area near one of the synagogues, locating a stand of bushes from which he could fire from without being seen.

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©istockphoto.com/goose_v1

These actors cannot be infiltrated and will therefore continue the armed struggle long after any related organizations have been neutralized.

a successful attack, including the knowledge required to build a bomb or fire a weapon accurately. Finally, the lone wolf has to have certain street skills or tradecraft that allow him to escape once the act is complete.3 One individual who met of all these criteria was Joseph Paul Franklin.

Although Louis Beam’s 1992 essay “Leaderless Resistance” was written after Franklin committed his horrific crimes, Franklin’s life closely followed Beam’s description of those lone wolves who were participating in the far right’s “revolutionary struggle.” In his essay, Beam described a process involving a front group that eschews any illegal activities but provides direction for lone wolves through the dissemination of information by means of newspapers, leaflets, rallies, marches, and other organs of propaganda. (Remember, when Beam wrote his essay, the Internet was in its infancy, so its potential was unknown to him.) Beam recognized that the government would be alerted to and would investigate any organizations that represented a threat. He also knew that the government would try to infiltrate and neutralize these organizations.

Of course, once an organization is compromised, its leadership as well as its rank and file are identified, and the organization may be destroyed.

Thus, as explained in Beam’s essay, the only way for a radical organization to fight under these conditions is to establish individual operators or small “phantom cells” that conduct the actual struggle. In Beam’s words, “No one need issue an order to anyone.

Those truly committed…will act when they feel the time is ripe, or will take their cue from others who precede them… It becomes the responsibility of the individual to acquire the necessary skills and information as to what is to be done.” As described

by Beam, these truly dedicated individuals will do what is necessary without orders from or connections to any organization. These actors cannot be infiltrated and will therefore continue the armed struggle long after any related organizations have been neutralized.

But was Joseph Paul Franklin in fact among these “truly committed” individuals? At one of Franklin’s trials, New York psychiatrist Dorothy Otnow Lewis testified that Franklin was a paranoid schizophrenic who exhibited

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delusional and confused thinking as a result of the brutal physical abuse he suffered as a child; she also pointed out that he still carried scars on his scalp from the blows that were inflicted on him by his parents.

In response to Lewis’s testimony, Franklin took the stand and testified that although he may have had a few minor neuroses, he was not insane, and he knew exactly what he was doing. This testimony was reminiscent of Franklin’s confession to police after he was arrested for a synagogue shooting in the St. Louis area. During that arrest, Franklin was asked whether he felt any remorse. After a long silence, Franklin responded, “I can’t say that I do. The only thing I’m sorry about is that it’s not legal.” When the detective asked what illegal action he was referring to, Franklin responded, “Killing Jews.”4 Indeed, the synagogue shooting in the fall of 1977 serves as a prime example of Franklin’s detailed planning. In his confession, Franklin explained that he bought his rifle in Dallas through a classified ad, thereby insuring no chance of a Maximum protection. Climate control. Customization. A PROTECH® Blast and Ballistic Resistant paper trail through a firearms dealer.

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He then drove to St. Louis, looked up synagogues in the phone book, A PROTECH BRE is just one of many solutions offered by Safariland, renowned for its commitment to saving lives and protecting assets. For complete information on our guard and filed the serial numbers off the booths, guard towers, defensive fighting positions and custom solutions, contact us today. rifle. Next, he bought a guitar case in which to carry the weapon, and 800-733-3832 protecharmored.com he scouted the area near one of the ©2009 Safariland synagogues, locating a stand of bushes from which he could fire from without Circle 145 on Reader Service Card being seen. Franklin then purchased a bike, put it in his car, and rode the June Mission: June 19 - 27, 2009 individual—a true lone wolf. bike to the Mission: predetermined spot19 in the August August - 29, 2009parking lot, and checked his police scanner to see whether he was being Franklin would later go on to bushes. Once there, he lay in wait for chased. Finally, he exited the area via conduct a killing spree targeting several hours until people exited the 5 Interstate 55.

As these many steps African Americans and biracial synagogue, at which time he fired five illustrate, this was a planned murder couples. This spree began in shots. After that, Franklin rode the carried out by an intelligent, rational Oklahoma City on a Sunday in bike back to his car, pulled out of the

Strategic DefenSe initiative.

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October 1979. On that day, Jesse and Marian Taylor, a mixed-race couple, stopped at a supermarket on the way home from their children’s hulahoop contest. As he returned to the parking lot with a bag of groceries, Jesse was killed when he was hit by three shots. Then, as his common-law wife Marian rushed to his side, she was fatally shot with a single round from a high-caliber rifle 75 yards away.

The assassin (later determined to be Joseph Paul Franklin) escaped, and there was no apparent reason for the attack. This pattern of cold-blooded killings was repeated in Indiana, Ohio, Pennsylvania, Georgia, Tennessee, and Utah. The shootings were deadly accurate and always conducted from some distance with a high-powered rifle or shotgun.5 Louis Beam was therefore right about one thing: It is extremely difficult for law enforcement to stop the terrorist activities of a lone wolf like Joseph Paul Franklin. In fact, Franklin carried out a series of as many as 20 murders, bank robberies, and arsons beginning in 1977 and ending three years later in the fall of 1980. His crimes also included the attempted assassinations of highprofile targets Vernon Jordan and Larry Flynt. Local, state, and federal law enforcement put in thousands of investigative hours prior to Franklin’s apprehension. (This pattern was repeated in the cases of both Ted Kaczynski and Eric Rudolph.)

Franklin’s crime spree finally came to an end at a skid row blood bank in Lakeland, Florida, where the sharpshooter whose eyesight was too poor to be eligible for the draft was arrested without incident.6 Of course, not all lone wolves are white supremacists. Consider

the example of jihadist lone wolf Derrick Shareef. In 2006, Shareef, a 22-year-old Muslim convert, decided he wanted to commit “violent jihad” against Americans. He prepared a martyrdom video in case he didn’t survive his attempt to do so, and he even went through a purification process that included shaving off his body hair. Shareef belonged to no organized group, nor did he receive funding from any outside source. He appeared to be self-recruited and selftrained. His plan was to place grenades in garbage cans at the CherryVale shopping mall in Rockford, Illinois, on the Friday before Christmas.

Shareef picked this date in order to maximize causalities. The only flaw in his plan was that he approached an FBI source in an attempt to trade a set of stereo speakers for four grenades and a handgun, which led to his arrest before he could launch his attack.7 Yet another jihadist lone wolf is Hesham Mohamed Hadayet, also known as Hesham Mohamed Ali. Hadayet was born in Egypt and entered the United States in 1992; ten years later, on July 4, 2002, he pulled a gun and opened fire at the El Al Israel Airlines ticket counter at LAX, killing two people and wounding several others before an airline security guard shot him. When authorities later went to Hadayet’s apartment, they found a note on the door saying, “Read the Koran.” It should be noted that U.S. authorities did not consider Hadayet’s attack an act of terrorism, but rather an isolated incident by a mentally deranged individual.8 This raises an important question: How many other politically inspired terrorist incidents conducted by lone wolves have been written off as isolated incidents?

NOTES: Burton, Fred, and Stewart, Scott, “The Lone Wolf Disconnect,” Stratfor Global Intelligence, January 30, 2008, http://www.stratfor.com/weekly/ lone_wolf_disconnect (accessed May 6, 2009).

2 Andrews, John, “The Sociology of Jihad,” The Counter Terrorist, July/ August 2008.

3 Burton and Scott, “The Lone Wolf Disconnect.”

4 Malcolm Gladwell, “Damaged,” New York Times, February 24, 1997.

5 Ibid.

5 Gaines, James, “On the Trail of a Murderous Sniper Suspect: The Tangled Life of Joseph Paul Franklin,” People, November 24, 1980.

6 Ibid.

7 Porteus, Liza, “Feds Arrest Man They Say Planned to Detonate Grenades in Illinois Shopping Mall,” www.foxnews.com, December 9, 2006.

8 Weiss, Kenneth, “Gunman Kills Two at LAX,” Los Angeles Times, July 5, 2002.

1

ABOUT THE AUTHOR: Mr. Andrews served as a Special Agent of the Federal Bureau of Investigation for twenty-three years.

He worked the Vernon Jordan shooting in Indiana as a first office agent, and he conducted international terrorist investigations for nine years. Mr. Andrews currently serves as an adjunct professor at Florida State University, and he has also been a guest lecturer at Troy University. He conducts police training throughout the United States for Benchmark Professional Seminars and Unitech.

•

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First Hand:

FBI HOSTAGE RESCUE

AT TALLADEGA

By James A. McGee

Counter The

All photos courtesy of James A. McGee

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The inmate uprising in August 1991 at the Federal Correctional Institution (FCI) Talladega was not the first of its kind. Similar events had already occurred in 1987 at FCI Oakdale and at the United States Penitentiary (USP) in Atlanta. All three incidents were instigated by Cuban inmates who had entered the United States during the 1980 Mariel boatlift.

M

any of these refugees

had been released from

Cuba’s prisons, and once

they arrived in the United States, they continued their lives of crime. Ultimately, these men were arrested, convicted, and sentenced in U.S. courts for crimes committed in America. Then, upon their entry into the U.S. penal system, a dilemma developed.

These Cubans had not been granted U.S. citizenship so, according to the Immigration and Naturalization Service (INS), they could not be released back into American society after finishing their terms of incarceration. Instead, they were subject to deportation to Cuba. However, Cuba didn’t want these men back, so they remained in a state of custodial limbo.

During each of the three uprisings, the Cubans demanded that INS proceedings be changed to deal more favorably with their immigration status. The Oakdale and Atlanta uprisings were ultimately resolved through negotiations and INS concessions. Talladega presented a different challenge. That’s because in 1991, the United States and Cuba came to an agreement: 32 of the 121 Cuban inmates being housed at FCI Talladega

were to be sent home. Upon hearing of this development, the inmates, who anticipated that Castro would not welcome them with open arms, rioted and took eleven hostages in order to fight deportation. The hostages were Federal Bureau of Prison (BOP) and Immigration and Naturalization Service (INS) employees working inside FCI Talladega.

The Cubans later released two of the hostages as a result of negotiations.

The BOP issued a written press release characterizing the Cuban inmates as “the most violent and incorrigible inmates ever held in the Bureau of Prisons.” One

This point is perhaps best illustrated through an example from Abu Ghraib. At the now-famous prison also known as “Abu G,” the smuggling of contraband, especially drugs, by both prisoners and Iraqi correction officers was rampant.

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Forced Entry at the Alpha Unit.

They had collected each hostage’s identification card and placed it into a pillowcase. If food was not delivered, they would select a name from the pillowcase and that hostage would be stabbed to death.

of the Cuban inmate leaders seemed to provide evidence for this conclusion when he stated, “We’re willing to kill everyone to not go to Cuba. The thing here is limited to three words, freedom or death.” Then, during the evening of August 29, 1991, the Cuban inmates agreed to a sick call, or an opportunity to see medical personnel. During that sick call, the Cubans demanded more food and issued a caveat. They had collected each hostage’s identification card and placed it into a pillowcase. If food was not delivered, they would select a name from the pillowcase and that hostage would be stabbed to death. This type of lottery system would be the mechanism for choosing all hostages that would be killed. Based on the violent nature of the uprising and subsequent hostage taking, coupled with the political demands expressed by the Cuban inmates, acting United States Attorney General William Barr categorized the incident as an act of terrorism. Later that evening, as conditions deteriorated inside FCI Talladega, FBI Director William Sessions decided that a deliberate assault was

required in order to save the hostages’ lives.

The operations order (OPORD) revealed that there were potentially two hostage hot spots within our area of responsibility once we made entry into the crisis site. The first hot spot was immediately inside and to the right of our initial breach point. The second was through the front lobby, in a room that could only be accessed from inside the cellblock. The hostages were believed to be in either of the hot spots, or possibly split and detained in both locations.

If everything worked as planned, the Hostage Rescue Team (HRT) would enter the Alpha Unit cellblock through three breach points subsequent to the detonation of explosive breaching charges at each location. Upon entry, we would confront the 121 Cuban inmates while executing our objective: Locating and rescuing the nine remaining hostages.

Prior to our rescue attempt, there was significant concern regarding what weapons the Cubans might possess.

We knew they had seized batons and pepper spray from the BOP guards

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taken hostage, and that they had crafted handmade knives and shanks.

The inmates also had access to various cleaning and medical supplies. Any flammable liquids within these supplies could be fashioned into Molotov cocktails, which could then be thrown at the assault teams to ignite a fire.

Containers of detergent could also be poured on the tile floors to create a slippery surface, and bleach or other caustic chemicals could be thrown in the eyes of the assault teams. Similarly, surgical tubing could be fashioned into slingshots, which could launch halfinch hex nuts at a deadly velocity. Other possible booby traps could include trip wires or lightbulbs filled with flammable liquid to create an explosion when the wall switch was turned on. I also knew the inmates could manufacture crude firearms in the form of “zip guns.”

Hotel Team headed toward our Suburban assault vehicle in silence. I slid into the driver’s seat as the team leader got in on the passenger side. Three operators climbed into the backseat.

The rest of Hotel Team stepped onto the running boards and took hold of the handgrips welded to the body of the Suburban. The Hotel Team Suburban was positioned at the head of the line of vehicles that, on the command to move from phase line yellow to phase line green, would slowly taxi across the lawn past the BOP perimeter and stage in front of the Alpha Unit. Tension was high. Everyone was mentally rehearsing his individual responsibilities. The initial movement inside the crisis site was predetermined and had been practiced during assault rehearsals. We all sat and waited for the command to move. This was a defining moment for all HRT operators, past, present, and future.

The president of the United States, the attorney general, and the director of the

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FBI believed that we could successfully rescue the hostages. I reflected on my training. I knew I was ready.

The command was given, and we moved to phase line green with compromise authority. The breachers moved forward and began the task of securing the breaching charges to each of the three entry points, but they immediately confronted a problem. The early morning dew had left condensation on the exterior of the doors, and, as a result, the charges were not adhering properly. Fortunately, Hotel Team’s entry point was inside an alcove that had protected the doors from condensation.

I positioned myself as the point man, first in the line of march when we entered the crisis site. I attempted to blade my 5’11”, 210-pound frame behind the blast shield, which would provide protection from the overpressure from the charge.

Directly across from my position, I could

see Echo Team moving into position.

They would follow us through the breach point. Big Jack was Echo Team’s breacher.

He was carrying an enormous amount of gear that included a circular saw and a torch. As point man for Hotel Team, my total body weight was about 275 pounds with all of my assault gear. Big Jack tipped the scales at around 370 pounds with all his gear and equipment.

Suddenly I noticed two Cuban inmates looking out the elongated window directly adjacent to where I was hunkered down. The sensitive listening devices our techs had secreted inside the cellblock picked up their conversation.

“They’re here!” one said.

“Who’s here?” the other asked.

They both peered out the window with a look of disbelief and panic. I knew if the two inmates warned the other Cubans, the hostages could be killed.

The assault would commence at any

I knew if the two inmates warned the other Cubans, the hostages could be killed. moment, so it was too late to announce a compromise. I raised a clenched fist to the two Cubans, signaling them to hold their position inside the room where they were. If they stayed inside the room, they would be annihilated when the explosive charge detonated. My thought was, “Two less inmates to worry about.”

My obligation was to save nine hostages, and if two Cuban inmates acting as lookouts posed an imminent threat to the hostages, they needed to be neutralized.

I could not shoot them with complete accuracy through the thick glass of the jail window, so if the explosive charge

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eliminated the threat, then so much the better.

Within seconds, there was radio traffic.

The HRT Commander reaffirmed the assault teams’ positions at Phase Line Green. Then came the command, “Stand by; I have control. Five…four…three… two…one…execute.” At the count of one, the Hotel Team breacher fired the shooter in his hand. When the primer inside the shooter fired, it ignited the shock tube, which safely separated the breacher and the rest of the line of march from the explosive charge. On the breacher’s first attempt, however, several seconds passed and the charge failed to detonate. Our position was certainly compromised by now, and the hostages were in imminent danger of being killed.

Fortunately, the style of shooter used had a backup primer. The breacher thus recocked the shooter, yelled, “Fire in the hole! Fire in the hole!” and fired again.

As I moved through the entry corridor, I focused on my predesignated route.

Visibility was less than one foot due to smoke and suspended dust. I probed ahead with my MP5 submachine gun.

I relied upon the team rehearsals, my knowledge of the facility floor plan, and my training to navigate forward in the dust. I moved into the hallway adjacent to the lobby. There in front of me, prone on the floor, were the two inmates I’d seen through the window. The blast wave had caught up with them as they tried to run away and had knocked them to the floor. I gave the command, “No se mueva! Don’t move or you’ll be shot!”

The inmates lay still on their stomachs with arms and legs spread. Big Jack moved past my position and into an adjacent hallway. There he encountered the Cuban inmate ringleader, who was lying on the floor in the fetal position. He had soiled his pants, and when he looked

up at Big Jack he muttered, “What haaaappeeeened?”

The FCI Talladega mission was the first dynamic hostage rescue conducted by the FBI Hostage Rescue Team. The book Phase Line Green: The FCI Talladega Hostage Rescue memorializes the brave actions of those who fight every day to preserve America’s freedom and is testimony to the HRTs motto, “Servare Vitas—To Save Lives.

•

ABOUT THE AUTHOR: Mr. McGee has served as an FBI field agent, a member of the Hostage Rescue Team, and a Supervisory Special Agent in the Domestic Terrorism/Counterterrorism Planning Section. He currently teaches at the University of Southern Mississippi and at Tulane University. He is the author of Phase Line Green: The FCI Talladega Hostage Rescue.

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THE PEOPLE’S REPUBLIC OF

CHINA

Despite its role as a major player in the global market, the People’s Republic of China (PRC) remains a secretive and closed society. With state control of the media, a government firewall on the Internet, and little tolerance for dissent or protest among the country’s 1.3 billion citizens, President Hu Jintao continues to enforce the hard-line policies of his predecessors.

Counter The

Camels at the Great Wall, Xinjiang Province, China. Photo:©istockphoto.com/alantobey

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F

By Jennifer L. Hesterman

A VS. ISLAM A

fter the tragic events of 9/11,

the United States sought

to secure China’s

assistance in the fight against al-Qaeda and other radical Islamist groups. In fact, though neither widely publicized nor acknowledged by their government, as many as 18 Chinese citizens lost their lives in the September 11 attacks. Initially, PRC leadership expressed support, and they voted with many other members of the United Nations on September 12, 2001, in favor of a joint resolution to prevent and eradicate acts of terrorism around the world.

However, in the intervening years, there have been few substantive counterterrorism discussions between the U.S. and Chinese governments.

Therefore, hopes that the issue of counterterrorism could segue into more in-depth security-related dialogue and cooperation have not been realized.

The 2008 Olympic Games forced China to publicly deal with myriad domestic challenges, including a deeply hidden conflict with the country’s Muslim populace. Prior

to the August 8 opening ceremony, the Chinese government warned repeatedly of a domestic terror threat emanating from the Xinjiang region, fueled by Muslim extremists. The international press widely reported on associated crackdowns against Muslims within the country, and China claimed it had successfully disrupted several terrorist plots against the Games. For many people, this was the first glimpse of the internal struggle among the Chinese government, China’s sizeable Muslim populace, and radical Islamist terror groups. A closer look reveals that the situation on the ground is quite complex, and it cannot be separated from the region’s history.

THE HISTORY OF MUSLIMS IN CHINA Arab influence in China can be traced back to the pre-Muslim sixth century. During this time, the silk trade brought merchants into the country’s many seaports, as well as along a 4,000-mile road connecting China to the Roman Empire. Then, with the advent of the Muslim faith in the early seventh

Muslim woman, Kashgar, Xinjiang Province.

Photo:©istockphoto.com/alantobey

Over the next 800 years, the Muslims’ position in China began to deteriorate, and the group eventually became an oppressed populace that often revolted.

Background photo: Emin minaret mosque in Turpan, Xinjiang Province, China. Photo: ©istockphoto.com/sarikkath The Counter Terrorist ~ August/September 2009 27

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Khunjerab Pass on the Sino-Pakistan border. ©istockphoto.com/sarikkath

The region has been an area of instability for almost 2,000 years, ever since China won a bloody conflict to acquire it from Mongolia.

century, merchants and missionaries introduced their religion into China through trading activities. Throughout this era, the relationship between the Muslims and the Chinese was friendly.

In fact, several times in its history, China used the Muslim populace to assist in military endeavors.

Notably, in 755, over 4,000 Muslim Turks assisted the Chinese emperor in striking down an uprising by one of his military commanders.

This operation was successful, and

afterward, many Muslim fighters remained and settled into the reclaimed city (modern day Xi’an), married Chinese women, and raised families. Their descendents were some of the first Hui people in China, a minority Muslim group that now numbers over 10 million.

As China’s economy flourished during the Song dynasty (960–1279), Islam made its largest inroads into the country, with adherents building mosques and establishing independent communities and governing bodies.

In fact, the easternmost mosque constructed during this period, Masjid al-Ashab, was built in 1009 in the port city of Guangzhou, and it still stands today.

Eventually, the Mongol invasion of China led to the overthrow of the Song dynasty, and many Muslims regard the resulting period as the “golden age” of Islam in China. For one, the Mongol Yuan dynasty (1260– 1382), founded by Kublai Khan, gave Muslims special status and positions in the government. Furthermore, Muslim soldiers from Central Asia who helped Khan conquer China were sent to repopulate the south of the country, which had been vacated during the fighting. It was also during the Mongol period that the Uighur Turks of northwestern China and large stretches of the Xinjiang region converted to Islam. Today, more than 8 million Uighur Muslims still reside in Xinjiang, which they consider their homeland.

Over the next 800 years, the Muslims’ position in China began to deteriorate, and the group eventually became an oppressed populace that often revolted. These rebellions were brutally addressed; for instance, between 1648 and 1878, more than

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“If our collective voice is impeded from speaking or shut down, the way is paved for radical Islam to move ahead.”

Daniel Pipes, director of the Middle East Forum

SHOULD WE LET ISLAMISTS SILENCE PUBLIC DISCOURSE ABOUT ISLAM? Islamists—the followers of radical Islam—have launched a legal jihad by filing predatory lawsuits designed to silence discourse about Islam, radical Islam, Shari‘a, terrorism, and related topics.

Writers and activists, famous and obscure, have been repeatedly targeted in the United States and throughout the West by “hate speech” and defamation laws, and we are witnessing the revival of blasphemy codes. The ultimate goal is to smooth the way for Islamists to impose Islamic law across the world.

The Legal Project of the Middle East Forum came into existence precisely to protect the right to engage in free speech on this important issue. It provides financial and legal resources to those victimized by this form of “lawfare,” and takes offensive legal action as needed. The Legal Project also provides expert analyses in the form of articles, memoranda, and amicus briefs, and serves as an information clearinghouse on these topics.

To learn more, please visit www.legal-project.org.

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The Counter Terrorist ~ August/September 2009 29 PromoTing AmericAn inTeresTs 6/16/09 1:52 PM

12 million Hui and Uighur Muslims were killed in 10 unsuccessful uprisings against the Qing dynasty.

The most notable uprising was the Panthay Rebellion (1855–1873), which resulted in the outright massacre of over 1 million Muslims by the Chinese government.

Following the advent of

Communism in China, the twentieth century found Muslims practicing discreetly in the face of the government’s atheistic doctrine.

China’s Cultural Revolution in the late 1960s resulted in further oppression of Muslims, as well as the destruction of many mosques in the country. However, following the death of leader Mao Zedong, Muslims

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were again given a limited amount of religious freedom, and mosques and religious schools were reopened.

Many Muslims subsequently became outspoken activists against the government, including a key leader of the 1989 democracy movement that culminated in the Tiananmen Square incident: a Uighur Muslim from Xinjiang named Wu’er Kaixi.

Xinjiang (meaning “new frontier”) is a vast region of deserts and mountain ranges in northwest China, accounting for one-sixth of the country’s territory. The region has been an area of instability for almost 2,000 years, ever since China won a bloody conflict to acquire it from Mongolia. In the 1940s, during a period of civil war, the region successfully broke away from China and formed its own country, East Turkestan, but the Muslim governing body was deposed just nine years later by Communist China. At that point, the territory was renamed the Xinjiang Uyghur Autonomous Region (XUAR), a name still used today.

The majority ethnic group in the XUAR is the Uighur Muslims (45%), followed closely by the Han Chinese (41%). Interestingly, the Han Chinese constituted just 4% of Xinjiang’s population in 1940, but this percentage quickly and substantially increased through forced repopulation efforts by the Chinese government.

After 40 years of uneasy truce, the Xinjiang region was deeply affected by the collapse of the Soviet Union in the 1980s. Citizens witnessed firsthand the establishment of the breakaway republics of Kazakhstan and Kyrgyzstan, both border countries.

A separatist Uighur uprising ensued,

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creating present-day tensions between the Chinese government and residents of region. In a remarkable 2002 Time article about the region entitled “One Nation Divided,” Matthew Forney examined Beijing’s still-present fear that Xinjiang will become its “Chechnya,” which has compelled the Chinese government to maintain an ironclad grip on the region.

The Xinjiang region also borders Pakistan and Afghanistan, with several rural, unpatrolled passages between these countries. The ability for free movement along these borders is worrisome to U.S. officials because the region is also home to the East Turkestan Islamic Movement (ETIM), a State Department–designated foreign terrorist organization.

ETIM: DANGEROUS AND UNPREDICTABLE ETIM is a militant Uighur organization that advocates creation of the independent Islamic state of East Turkestan in the Xinjiang region. The founder and leader of the organization, Hassan Makhsum, was shot and killed by the Pakistani Army on October 2, 2003, during raids on al-Qaeda-associated compounds

in western Pakistan. ETIM was blamed for several car bomb attacks in Xinjiang in the 1990s, as well as the death of a Chinese diplomat in May 2002. That same year, two ETIM members were deported to China from Kyrgyzstan for plotting to attack the U.S. embassy in Kyrgyzstan along with other U.S. interests abroad, but the group has neither admitted to nor denied the accusations.

More recently, the Chinese government fingered ETIM in January 2008, when it arrested a group of individuals who were supposedly manufacturing explosives to attack hotels and government buildings in Beijing. Then, in April of that year, the government said it had arrested 35 people for plotting to kidnap athletes, journalists, and other visitors to the Olympic Games. The members of this group reportedly possessed 22 pounds of explosives, eight sticks of dynamite, and “jihadist” literature.

ETIM LINKS TO AL-QAEDA In January 2002, the PRC released a report containing evidence that Hassan Makhsum had met with Osama bin Laden in 1999 and

received promises of money, and also that Bin Laden had sent “scores of terrorists” into China. Later, in its 2009 report on terrorism, the U.S. State Department reported that ETIM is indeed linked to al-Qaeda and the international mujahideen movement, with ETIM having received training and financial assistance from alQaeda. According to the State Department, ETIM militants also fought alongside al-Qaeda and Taliban forces in Afghanistan during Operation Enduring Freedom (OEF).

In fact, 22 ethnic Uighurs were captured by U.S. forces during OEF operations and subsequently held and questioned at the U.S. military base in Guantanamo Bay, Cuba; many have since been released or relocated.

Today, ETIM continues to expand its operations beyond the XUAR. According to Pakistani officials, the Chinese government believes ETIM recently established military headquarters in the tribal areas of eastern Pakistan. Moreover, China’s public security minister met with Pakistani officials in February 2009 to specifically discuss ETIM. During the meeting, he claimed that ETIM Continued on page 34

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Chinese authorities blame separatist groups for more than 200 “terrorist attacks” since 1990, resulting in 162 deaths and more than 440 injuries.

is planning an attack on the Chinese mainland during the upcoming October celebration of the sixtieth anniversary of the Communist revolution.

The Jihad Battlefront Expands: Enter the Turkestan Islamic Party Beyond ETIM, the Turkestan Islamic Party (TIP) presents yet another challenge for China. TIP appears to be a splinter group of ETIM, and it may also be an umbrella group for members of defunct terror groups including the Islamic Movement of Uzbekistan (IMU). TIP is located primarily in Waziristan and other areas of northwest Pakistan, and although it has existed for several years, it has recently appeared to be gaining both structure and momentum.

TIP is clearly a radical Islamist organization with a global mindset.

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In April 2008, the group posted its manifesto online: We are a group that promotes jihad for the sake of Allah...

Members, [united in] monotheism, devoutness, piety, and jihad for the sake of Allah, aim to liberate Muslim East Turkestan from the apostate Communist Chinese occupation... and impose shari’a [law] in [this region]. By cooperating with the Muslim mujahideen throughout the Islamic world, [we aim to] restore the Islamic Caliphate and impose shari’a throughout the world.

TIP’s activity increased in the months leading up to the Olympic Games. In April 2008, the group issued a video depicting its execution of three Chinese men. A few weeks later, the group took credit for a bus explosion in Shanghai that killed three and wounded many others. In July

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2008, another video acknowledged the group’s role in the execution of simultaneous bombing attacks on three buses in Kunming.

Around the time of these incidents, China’s official news agency, Xinhua, reported the capture of 82 suspected terrorists who were allegedly plotting to sabotage the Olympics. The report stated that police in Urumqi (the capital of the XUAR) had killed five knife-wielding Muslims and detained 10 others who allegedly wanted to launch a “holy war.” The Urumqi police chief also said that 41 illegal places of worship in Xinjiang were closed in 2008 because they were determined to be training grounds for “holy war.”

Finally, four days before the Olympic Games’ opening ceremony in August 2008, the TIP used tanks and grenades to kill 16 police officers

Mosque in Xinjiang. ©istockphoto.com/xxapril The Counter Terrorist ~ August/September 2009 35

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in the Xinjiang city of Kashi. Then, the group’s last act before the Games was to issue a violent, propaganda-laden video with direct threats to the Olympics, none of which were carried out.

Currently, the Chinese government is attempting to restrict foreign support for insurgent groups such as ETIM and TIP, and it has increased its number of deployed security personnel in response to perceived terrorist activities in Xinjiang. Indeed, it is hard to argue with the facts: China does face an extremist threat.

Chinese authorities blame separatist groups for more than 200 “terrorist attacks” since 1990, resulting in 162 deaths and more than 440 injuries.

However, China’s brutality and methods of engagement with the Muslim community as a whole, in the name of combating the terrorist threat, are topics of great scrutiny and

W.S.

debate.

2007, the House of Representatives passed House Resolution 497, which states the following: The authorities of the People’s Republic of China have manipulated the strategic objectives of the international war on terror to increase their cultural and religious oppression of the Muslim population residing in the Xinjiang Uyghur Autonomous Region.

Also, in the State Department’s 2008 edition of Country Reports on Human Rights Practices, China received failing marks for its handling of the Uighur Muslims in Xinjiang. Rather than improving its treatment of this group prior to the Olympics, as it promised to the international committee when selected as host, China actually increased its cultural and religious repression of the Uighurs.

Other human rights abuses within China include extrajudicial killings,

HUMAN RIGHTS WATCH Exiled Uighurs say there is no real terrorist risk emanating from their region, and they accuse the PRC of exaggerating or fabricating this threat as an excuse to crack down on all forms of dissent. Whereas the Chinese government claims that the Uighurs are guilty of violent crimes and “terrorism,” the Uighurs themselves say that they have been wrongly subjected to executions, torture, detentions, harassment, religious persecution, and racial profiling as a result of trumped-up accusations.

Indeed, various human rights groups are now concerned that the PRC is using the post-9/11 environment to justify brutal crackdowns, and the U.S. Congress appears to agree. Thus, in September

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torture and coerced confessions of prisoners, and forced labor. From 2007 to 2008, arrests of individuals accused of committing one or more of the PRC’s stated “three evils”—terrorism, separatism, and extremism—doubled. The State Department’s view on these arrests is noteworthy :

It was sometimes difficult to determine whether raids, detentions, and judicial punishments directed at individuals or organizations suspected of promoting the “three forces” were instead actually used to target those peacefully seeking to express their political or religious views. The government continued to

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repress Uighurs expressing peaceful political dissent and independent Muslim religious leaders, often citing counterterrorism as the reason for taking action.

In a country in which the press is controlled by the government, it is impossible to tell whether violent activities in China are politically motivated acts of terrorism or simply criminal attacks. What is known, however, is this: Approximately 500,000 prisoners sit in punitive detention without having been charged, and a full 70% of those charged with crimes in China go to trial without legal representation.

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Today, the United States and China continue to have limited cooperation in the counterterrorism realm. After the events of 9/11, the Chinese government reluctantly permitted the U.S. embassy in that country to add an FBI attaché to its staff, making this person the lone U.S. law enforcement agent on the ground. China has also reluctantly shared intelligence information with the U.S.; for instance, before the Olympics, the Chinese government reported the threat of an airline hijacking, although when pressed, it produced no evidence. Nonetheless, through this event, U.S. agencies involved in the mitigation of threats to the Olympic Games received rare insight into China’s security concerns, capabilities, and allocation of assets, which could have—but did not—lead to further collaboration.

Some scholars believe that an atheistic, closed society such as China should be better able than a democracy to deal with terrorist threats. After all, it seems cherished liberties make democracies vulnerable.

However, it seems that the Chinese

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government’s ironclad grip on its citizens and society does not seem to prevent would-be Islamist terrorists from attacking in the name of jihad.

•

ABOUT THE AUTHOR Ms. Hesterman is a retired Air Force colonel. She is currently a senior analyst for the MASY Group, a global intelligence and risk management firm, as well as a professor at American Military University. Her book Transnational Crime and the Criminal-Terrorist Nexus was published in 2005.

SOURCES: http://www.cfr.org/ publication/9856/ http://www. saudiaramcoworld.com/issue/199106/ the.far.east.htm http://www.jamestown. org/terrorism/news/article. php?articleid=23505Muslim Chinese: Ethnic Nationalism in the People’s Republic. Dru C. Gladney, Harvard University. 1996 (p. 295)http:// www.time.com/time/magazine/ article/0,9171,218371,00.html http://www.state.gov/s/ct/rls/ crt/2005/65275.htm http://inhomelandsecurity. com/2008/07/olympic_games_just_ weeks_away.html http://www.time.com/time/ magazine/article/0,9171,218371,00. html http://www.state.gov/documents/ organization/31947.pdf http://www.fas.org/sgp/crs/terror/ RL33001.pdf http://www.time.com/time/ world/article/0,8599,1890205,00. html?iid=tsmodule http://memri.org/bin/articles.cgi?Pag e=archives&Area=sd&ID=SP194708 http://www.theaustralian.news.com. au/story/0,25197,23999325-12377,00. html

http://www.liveleak.com/ view?i=13a_1218125381&p=1 http://www.cdi.org/terrorism/etim.cfm http://www.theaustralian.news.com.au/ story/0,25197,23999325-12377,00.html http://fpc.state.gov/documents/ organization/110764.pdf http://www.fas.org/sgp/crs/terror/ RL33001.pdf

http://www.govtrack.us/congress/ billtext.xpd?bill=hr110-497 http://www.state.gov/g/drl/rls/ hrrpt/2008/eap/119037.htm http://www.amnestyusa.org/china/ page.do?id=1011134 http://www.state.gov/g/drl/rls/ hrrpt/2008/eap/119037.htm

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IRA

How Far Has It Spread?

TECHNOLOGY

By Andy Oppenheimer

One fine September day in 1984, a young Irishman walked into the palatial reception area of the Grand Hotel in Brighton, on the south coast of England, and checked in as Roy Walsh. This was not his real name.

Counter The

Šistockphoto.com/clathrop

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T

he man went up to his

room, removed the bath panel,

and hid an explosive device

of his own creation after setting its pioneering timer to run down three weeks later. Then, at 2.45 a.m. on October 12, after those three weeks had elapsed, Patrick Magee’s bomb exploded with devastating effect. It was intended to assassinate the entire British Cabinet, who had gathered at the Grand Hotel for the Conservative Party’s annual conference.

Although Magee’s assassination attempt failed, the Grand Hotel explosion did claim five lives and produce many injuries. This is not surprising, given that the front of the hotel was completely blown out; in fact, pieces of the building were hurled by the gelignite explosion out into the sea.

The most significant aspect of this attack, however, was the bomb itself, which was the first known device to use a video recorder as a long-delay timer. Had this bomb exploded during the day, and at the height of the 1984 Conservative conference, far more people would have been killed.

The Brighton incident is just one example of the Irish Republican Army’s pioneering ingenuity in the development of improvised explosive devices (IEDs). Between 1970 and 2005, the IRA detonated a staggering 19,000 IEDs in the United Kingdom.

That’s one every 17 hours—which makes this effort the biggest terrorist bombing campaign in history, as well as one that featured unparalleled

advancements in technology, tactics, and methods.

IRA INNOVATIONS, TARGETS, AND TACTICS Many of the IRA’s IED-related innovations—including timing and power units (TPUs), long-delay timers, remote detonation (via command wire and radio-controlled devices), homemade detonators, lighttriggered initiation, and electronic triggers, to name but a few—came about as a result of the organization’s strategy and tactics. These included precise and careful targeting without intention to kill the maximum number of civilians, other than those deemed to be involved with the continued British rule of Northern Ireland.

The use of long-delay timers meant that the IRA could target locations and troops more accurately, prevent its own operatives from being blown up, and also prevent civilians from being killed at the height of the workday. Prior to the perfection of these timers, the IRA was on a learning curve for much of the 1970s, as many of its bomb deployments killed civilians and IRA operatives in addition to their intended targets.

Moreover, throughout this period, whenever coded warnings failed or a device killed civilians who got in the way of an attack, the IRA was forced to change tactics, methods, and materials so that it didn’t lose support from its own community. At the

same time, other inventions emerged to take out explosive ordnance disposal (EOD) squads and aid in direct assassination, most notably the mercury tilt switch, which was taken out of central heating systems and used to boobytrap under-vehicle IEDs so that they would detonate with even the slightest movement.

TECHNOLOGY TRANSFER: FOLLOWING THE TRAILS Now that the Provisional IRA is no longer active, the primary concern for public safety and counter terror officials has shifted to determining when, how, and where IRA technologies, tactics, and methods were transferred during the organization’s 30-year

©istockphoto.com/spanky1

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campaign. Tracing which groups may have benefited from the IRA’s expertise either directly or indirectly (as is the case with many terrorist organizations today) is extremely difficult, and proof of direct acquisition is limited.

The process by which terrorists obtain knowledge and skills is relevant here. Traditionally, criminals and terrorists have been known to engage in deal making (i.e., “you do this for me, and I’ll help you”) when it suits them.

Sometimes, the willingness to deal arises when groups view themselves as ideological “brothers in struggle.”

Otherwise, materials, technology, and expertise get passed along by accident or by the very nature of information sharing and gathering, particularly these days, with the Internet and instant mass communications. Unlike current groups, the IRA did not have ready access to information via the Internet—including the passwordprotected jihadist Internet—and other open sources. Thus, it took the IRA generations of armed struggle to achieve its eventual level of expertise.

Information was passed between operatives within the Irish Republican community, as well as through stolen

manuals and help and expertise from abroad.

Of course, there is also accidental overlap of terrorist methods, such as when one group “discovers” a means of IED making that is actually a repeat of something previously used by another group. For instance, the IRA pioneered mobile phone IED initiation, but it ultimately decided against using this technique because it was deemed unreliable. In 2004, however, the terrorists who attacked the Madrid transit system found this method an excellent fit for their plans, and they used it to deliberately target and kill hundreds of civilians.

PREVIOUS DIRECT TRANSFER: ETA AND THE PLO In the 1970s, the IRA established associations with several of the many terrorist groups operating in Europe and beyond. In doing so, the organization hoped to broaden its area of operations so that it could more readily target British bases and other interests outside the United Kingdom. For example, links were established with the Basque ETA

separatist group in Spain, which had a similar nationalist-based aim, and both groups ultimately benefited from the association. Another group, the Breton Freedom Front, is said to have suggested to the IRA that they approach Libya’s Colonel Muammar Qadhafi, as he had stated his intention to assist groups that were conducting insurgencies against old imperial powers.1 The result was several shipments to the IRA of arms and explosives from Libya.

Back in Spain, ETA targeted British vacationers using car bombs and similar IEDs, along with kidnappings and targeting of security personnel. The group had an on-off strategy similar to that of the IRA, and it too exhibited selectivity in its attacks, especially assassinations. There was also continued two-way traffic between ETA and the IRA; in fact, as late as 2002, ETA supplied the IRA with fresh stocks of plastic explosives (in this case, C-4) in return for bomb-making technology. 2 This enabled the IRA to hand over some of its out-of-date Semtex explosives as part of the decommissioning process required by the 1998 peace agreement without losing its bombing capabilities. 3

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In addition to ETA, the IRA also supported the Palestine Liberation Organization (PLO) for many years, with encouragement by the Soviet Union as part of that nation’s bid to undermine Western interests. For example, in August 1979, a bomb attack in Brussels that injured four members of a British military band and 12 others was carried out by the IRA in conjunction with the PLO, according to German intelligence reports to the British. As with ETA, the relationship between the IRA and the PLO involved two-way traffic; for instance, Israeli intelligence knew that the IRA was receiving arms from Al-Fatah in exchange for sharing bomb-making techniques with Black September (AlFatah’s armed wing) at a training camp near Beirut and at a Syrian-controlled camp in the Beqaa Valley. 4 The IRA also taught this group how to pack milk churns with homemade napalm; in fact, the British Army dismantled several IRA napalm milk churn bombs in the 1970s. 5

FOLLOWING BY EXAMPLE The IRA’s ammonium nitrate car bombs, especially those used in its city of London attacks in the early 1990s, were meant to create maximum damage to property and the British economy. Al-Qaeda and associated groups also began using the same type of bomb, the so-called “nuclear weapon of guerrilla warfare,” around that time, following the IRA’s example—except that these groups wanted to kill as many, not as few, civilians as possible, and that is still their goal today. Therefore, these groups do not need elaborate timers to try to ensure that their IEDs go off with minimal casualties, unless they want to attain

more precise targeting.

In addition, many bomb deployment practices used by the Taliban and other terrorists and insurgents are similar to IRA methods, although these groups acquired much of their information about these techniques via indirect, rather than direct, transfer. Nonetheless, some devices come straight out of the IRA textbook, such as electronically controlled pressuremat booby-trap devices, disguised IEDs, and command wire detonation. These methods were pioneered and regularly deployed by the IRA in rural and urban areas to ambush British troop convoys, without risk of the bomber or the bomb being seen.

Booby traps were also set to lure bomb disposal operatives into danger.

The hallmarks of IRA bombing practices have also emerged in Iraq.

For example, an attack that killed eight British soldiers in Basra in 2005 used technology developed from photographic flash units, which was employed by the IRA some 15 years earlier. According to British intelligence, this and other techniques had, in some instances, reached the Middle East through the IRA’s earlier cooperation with Palestinian groups, rather than through collusion with Iran. 6 For example, in 2002, Royal Engineers bomb disposal officer Paul Collinson, working with the Red Cross in the Jenin refugee camp in the West Bank, reported that more than 200 Palestinian pipe bombs were “exact replicas of ones I found in Northern Ireland. The size of bomb, the way they put the nail in, the way of igniting it with a lightbulb filament, where they drilled the holes through, the use of a command wire and the means of initiating the bomb; these are all the same. They have all the hallmarks of originating

The hallmarks of IRA bombing practices have also emerged in Iraq. from Ireland. When you put two and two together, then it seems that they could well have been trained by the IRA.” 7 Although there is no proof of direct links or weapons and expertise handover from the IRA to modern Islamic groups, or of any IRA intention to link with such groups, the IRA’s methods somehow eventually led to the death of troops and civilians in the Middle East.

DISSIDENT GROUPS: A RESURGENT THREAT Today, the two main dissident Republican groups, the Real IRA and Continuity IRA, continue to present serious security risks. The recent killings committed by each group in Northern Ireland followed a series of attacks on police officers and attempts at bomb deployment. Unsubstantiated reports appeared in March 2008 that the Real IRA could have links with alQaeda, and that the two groups were sharing expertise. Also, when the Real IRA broke away from the Provisionals in 1997, it purloined weapons and explosives from that group. Indeed, the Real IRA’s bomb-making expertise was evident in the Omagh atrocity in August 1997, which killed 29 people, and it was more recently demonstrated in an intercepted car bomb found in Castlewellan, a village in Northern

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Ireland, in January 2009.

In March 2008, British intelligence service MI5 set up a dedicated team to monitor suspected al-Qaeda activists and supporters on both sides of the Irish border, after Irish police arrested three suspected Islamist terrorists in a flat in Tralee, County Kerry, where bomb-making materials were found.

“Sleeper cells” in Northern Ireland with suspected links to other cells in Britain were said by security forces to “operate a very tight structure, just like the IRA.” Another cell believed to be operating in the Mid-Ulster area planted roots around Portadown, Lurgan, and Craigavon. 8 Also of interest are alleged links with al-Qaeda in Ulster of Kafeel Ahmed, the British terrorist who drove a car loaded with gas cylinders into the terminal at Glasgow Airport in June 2007 and died of burns as a result.

Ahmed is believed to have arrived in Northern Ireland in 2001 and enrolled at Queen’s University Belfast to study aeronautical engineering, graduating in 2003 and staying on as a paid researcher. 9 It was reported in The Guardian newspaper in July 2003 that an expert bomb-maker who was once a member of the Provisional IRA in Newry, but switched his allegiance in 1999 to the Real IRA, had been sent to the Occupied Territories to sell his expertise to groups like Islamic Jihad. Both Northern Irish and Irish police said they have known of his activities for more than 10 years. Israeli intelligence indicated that he had linked up with rejectionist Palestinian groups in a sequence of contacts resembling “the ‘real IRA’s Colombia.’” 10 According to Reva Bhalla, Director of Analysis at Texas-based global intelligence company Stratfor, “The IRA of the 1970s utilized the same supply

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links for arms and drugs as al-Qaeda does in present day. But there is a huge gap between the time periods when both groups operated in North Africa and Latin America, which makes it nearly impossible that al-Qaeda and IRA interests overlapped in any meaningful sense.” But Bhalla does concede the possibility that “al-Qaeda and al-Qaeda–affiliated groups took tactical lessons from IRA training manuals that have been circulating since the 1970s.” 11

FARC: DIRECT TRANSFER Of any terrorist group that is currently active, the Revolutionary Armed Forces of Colombia (FARC) has been a prime beneficiary of IRA technology and training. Interestingly, ETA may have provided the link between the IRA and FARC, having been in touch with the Colombian underground since its 1966 conference in Havana, Cuba. Evidence indicates that the Provisional IRA was paid for its services to FARC in Colombia, and that the group ran a training program there ran between 1997 and the summer of 2001. 12 With no more than three to five Provisional IRA members operating in Colombia at any one time, in total, about 30 IRA members worked inside FARC-controlled areas as part of the training program. About $2 million was paid per training period, and there were between 10 and 14 such periods, which meant that FARC gave the Provisional IRA a total amount of more than $20 million.

In August 2001, three IRA members—Niall Connolly, Martin McCauley, and James Monaghan, the Provisional IRA’s chief mortar designer and later director of engineering—were arrested in Colombia in a demilitarized zone. The Colombians claimed IRA influence went even further—on to

Iran and Cuba. In addition, the chief of the Colombian Army, General Jorge Mora, found that FARC had given the IRA drugs, money, and weapons in exchange for training, which included instruction in mortar design and manufacture, armor-piercing methods, and explosives manufacture.

The IRA-designed mortars were increasingly used throughout 2001, and in 2002, they were employed in several attacks with devastating effects.

For example, 115 people were killed in a FARC attack on the rural town of Bellavista; this attack involved mortars identical to the IRA’s Mark 18 device.

This apparatus consists of two gas cylinders welded together that carry a payload of homemade explosives.

In addition, in May 2001, multiplelaunch mortars, also originally devised by the IRA, were used to attack the presidential palace in Bogotá during the inauguration of President Uribe, resulting in the deaths of 21 people.

Most FARC methods are also IRA methods; these include car bombs, trip-wire booby traps, booby-trapped mines, disguised bombs, and, most significantly, anti-jamming devices.

Several technologies are also in service with various national armed forces today, such as fuel-air explosives (FAE).

In fact, the CIA acquired designs for a fuel-air device from the three IRA operatives arrested in Colombia, who claimed that the IRA was developing a FAE device for FARC. These devices make a very big bang, so they would show up on satellite surveillance.

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disbanded. The dissident groups, however, do not accept the 1998 Good Friday Agreement and continue to resort to violence to achieve their aims.

Although their campaign is seen as futile, officials are nonetheless greatly concerned with how far these groups will apply their fanaticism in forging links with other terrorists.

Many observers would opine that examining the IRA’s transfer of weapons and expertise elsewhere is tantamount to shutting the stable door after the horse has bolted. And what evidence exists, which in many instances is incomplete or unproven, illustrates how complex it is to track multifaceted and covert links and exchanges between groups. What is increasingly clear, however, is that the current jihadist network is expanding, the expertise is there, and patterns of attack are being replicated. It is there-

fore our challenge to ascertain fully how far and wide this expertise and these technologies have spread.

ABOUT THE AUTHOR Mr. Oppenheimer is Editor of World Security Report and author of IRA The Bombs and the Bullets: A History of Deadly Ingenuity (Irish Academic Press). A UK-based CBRNE consultant specialising in counter-IED, he was Editor of Jane’s Nuclear, Biological and Chemical Defence and NBC International from 2006 to 2008.

Families Acting for Innocent Relatives (FAIR), “FAIR Petition Against the Libyan Government,” May 26, 2005, http://www. victims.org.uk/petition.html.

2 Wilkinson, “British Unit in Spain to Track ETA and IRA,” Daily Telegraph, July 31, 2002.

3 Bamber, D., and Oliver, T., “Basque Bombers Top Up IRA’s Terror Arsenal,” Daily 1

FIRSTHAND AC COUNTS AND FROM FRONTL INE PERSONNE ANALYSES L AND ExPERT IN THE wAR AG S AINS T TERROR Based on

edite

ophir falk and hed by nry Morgenstern

Understandin

g and Confro nting the threat

Confronting the threat

U.s. and policymakers, first israeli experiences and detailed interv responders, and threat of suicide students of home iews with frontline personnel, terro Suicide Terror enab land security to understand and for future attacks. r. it analyzes recent suicide attac deal with the grow les ks as well as our following the expe current vulnerabili Moreover, they learn ing rt authors’ advic ties and likely e, readers how to prepare for and losses in the and implement an effec learn possible measures to preve scenarios event of an attac nt an attack. tive and quick respo k. nse to minimize following an overv casualties iew and historical review of suicide terror, the book cover • Global jihad s: • Israel’s confron tation with suicide te rrorism • America’s expe rience with suicide b ombings • Internationalizat ion of suicide terroris m • High-risk scena rios and future trends • Methods for co nfronting suicide terror • Medical manag ement of suicide terro rism Using eye-witnes s accounts, the text recreates the studies help reade look and feel of rs actua these very dangerousget into the minds of suicide terro rists in order to unde l terrorism incidents. Detailed threats. case rstand how to best This book is a defin prevent and confr itive study of suicide ont experts who have terror, synthesizing t dealt with it firsth he experience of wel devastating threa and. anyone respo l-known Israeli and A t should read this nsible for understanding, preve meric book and consider nting, and confrontin an its recom mend OPHIR FALK, LLB, ations with all serio g this usness. institute for Coun MBA, is a Partner at the Naveh, K ter terrorism, wher of experience in e he has published antor Even-Har law firm and a Rese vario numerous articles carried out risk asses us security capacities and serve in the field. Mr. falk arch Fellow at the d as a consultant sments for olympic has over a decade for the venues and critic 2004 olympic game HENRY MORGEN al national infras s, where he STERN is the Presi tructure. than 500 federal, dent of security state solutions internation first responders to Is , and local agencies to effectively al, a company that of suicide terror. He rael to study Homeland Security. Mr. confront the threat of terror and regul has trained more has o arly Morg takes ffere enste groups of d exp rn is a wid radio stations, and ert commentary on t Web broadcasts. error-related issu ely published author on the subje es for NBC, ABC ct , CBS, Fox, numerous

SUICIDE TERROR Understanding and

SUICIDE TERROR

falk Morgenstern

Ophir Falk and Henr y Morgenstern have serious about winn compiled a book that should be read ing the war on terro better understan r. By painstakingly by anyone who is d the nature of analyzing the empi our enemies and rical data, they they offer important why they employ help us insights on how these barbaric tacti terrorism can be In so doing, they cs. Most crucially, effectively confr have performed onte an d and ultimately invaluable servi crucial battle. ce for all those defeated. who are committed to winning this —Benjamin Neta nyahu, former Prime Minister of Israe l

Telegraph, June 30, 2002.

4 Etengoff, A., “Analyst Doubts Link Between Al Qaeda and Real IRA,” The News, March 17, 2009, http://www.instantnews.net/ analyst-doubts-link-between-al-qaeda-andreal-ira.aspx.

5 Clarke, L., and Johnston, K., Martin McGuinness: From Guns to Government (Edinburgh: Mainstream Publishing, 2006), 130.

6 Harkin, G., et al., “Revealed: IRA Bombs Killed Eight British Soldiers in Iraq,” The Independent, October 16, 2005.

7 “Bamber, D., “IRA ‘is Teaching Palestinians How to Blow Up Israeli Soldiers’ in West Bank,” Daily Telegraph, April 28, 2002.

8 McDonald, H., “MI5 Targets Ireland’s alQaeda Cells,” The Observer, March 2, 2008.

9 Ibid.

10 McDonald, H., “Manhunt for Real IRA’s Bomb Expert on West Bank,” The Guardian, July 13, 2003.

11 Etengoff, “Analyst Doubts Link Between al-Qaeda and Real IRA.” 12 Personal communication with former Irish Army and police EOD operative.

www.SuicideTerror.com • 866-573-3999 48 The Counter Terrorist ~ August/September 2009

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BOOK REVIEW

Suicide Terror:

Reviewed by: Solomon Bradman

Understanding and Confronting the Threat Authors: Ophir Falk and Henry Morgenstern “Ophir Falk and Henry Morgenstern have compiled a book that should be read by anyone who is serious about winning the war on terror. By painstakingly analyzing the empirical data, they help us better understand the nature of our enemies and why they employ these barbaric tactics.

Most crucially, they offer important insights on how terrorism can be effectively confronted and ultimately defeated. In so doing, they have performed an invaluable service for all those who are committed to winning this crucial battle.”

—Benjamin Netanyahu, Prime Minister of Israel

I

n an era in which America finds itself ever further from 9/11; in a time in which the Secretary of Homeland Security speaks about “overseas contingency operations,” claiming that the words “war on terror” are politically mired; in a mindset in which mentioning the word “terrorism” itself is considered politically incorrect and we must instead speak about “manmade incidents” for fear of offending our adversaries, this 2009 book on the subject of suicide terror, aimed at homeland security professionals and students, may seem out of place.

However, even as we change language in a clearly Orwellian attempt to make evil go away, suicide terror has a habit of raising its ugly head. When John Wiley & Sons approached SSI president Henry Morgenstern with the idea of having him write a book on the subject, Morgenstern contacted people he knew that had first-hand experience with the subject in order to create the best study possible.

Morgenstern was able to recruit Ophir Falk, a research fellow at the International Institute for Counter-Terrorism (ICT) in Israel and a veteran of counter terror

units, who worked diligently with him to supervise and edit a cast of writers that includes a former Israeli intelligence officer; an Israeli professor of medicine who has been credited with the most experience in dealing with these attacks; a 30-year veteran of U.S. law enforcement who recently retired as a chief of police; a U.S. professor and expert on bioterrorism; and several researchers from the ICT in Herzliya, Israel. The

result is the very first book to compile the collective international experience with suicide terror, from Israel to Iraq to the United States, including the many uses of this tactic all over the world.

The preface, written by Henry Morgenstern (who also wrote the global jihad chapter) sets the tone for the entire book by depicting the critical terror incident at Beit Lid, Israel—an incident that led the then–prime minister of Israel to say that suicide terror was a strategic threat to the existence of the state of Israel—as part of a complete international terrorist infrastructure.

Indeed, suicide terror is the culmination of an international Islamic movement that goes from initial fund-raising to religious incitement and edicts and then stretches its tentacles into the world legal system and communications media like the Internet, and it is present in every country. Suicide terror is the weapon system of choice for jihadists (as well as some recently demised groups such as the Tamil Tigers) to accomplish a clear political and religious goal: salvation of the Earth by subjecting it to the rule of Islam. The reason suicide terror is so frequently used is not just because the terrorists are limited to asymmetrical capabilities; it is also meant to send a message that terrifies the local population and causes their will to disintegrate. As described in the overview chapter, the conclusion is obvious: Suicide terror is used because it works. For instance, it worked when it helped precipitate the U.S. withdrawal from Lebanon after Hezbollah’s 1983 bombing of the U.S. embassy and Marine barracks, and it arguably continued to work until 2001.

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After that, a price was paid by terrorists for their use of this weapon to kill 3,000 Americans.

The book makes it clear that the act of suicide terror is justified by jihadists in clearly defined religious edicts and in the meaning of the word “jihad” itself. Throughout the book, there are plenty of case studies (not to mention scenarios that all would do well to learn) that demonstrate without a doubt that the international environment—which stretches from characters like Professor Sami Al-Arian in Tampa and the Council on American-Islamic Relations right down to the suicide terrorists of 9/11, and which includes a legal wing of the jihad movement that would subvert our laws and freedoms—is being manipulated by jihadists in an attempt to create a world subject to Islamic law. The jihadists also use a wide variety of other motivational factors to enable and develop the goal of terrorizing populations and encouraging

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compliance with the idea of a world ruled by Islam. Whether a land struggle in Chechnya or a struggle between Israel and the Palestinians, the authors conclude that these are excuses for a much bigger cause.

The chapter on the Israeli experience is probably the most in-depth and bestresearched chapter of any available on the subject of Israel’s bitter experience with suicide terror attacks. Through indepth interviews with the key players in Israel (and unprecedented accounts of the policies of killing terrorists that Israel has pursued), students and professionals will learn exactly how events have unfolded in Israel and just what methods have worked to stop this horrible weapon from weakening that country. Today, with barely any change in effort by terrorists, the Israelis have been able to stop 99% of the attacks against them. The book’s emphasis on the superb Israeli intelligence effort, and also its great details on the way this effort was conducted, give a picture that very few will ever have seen before.

This book is a must-read for the serious practitioner because, although we have changed the names of the enemy and his actions, the enemy is not quite finished with us, as events everywhere demonstrate, whether in Pakistan, Mumbai, or New York City. The jihadists are still fighting a war, whether or not we want to call it such. Indeed, ongoing terrorist actions may inspire local U.S. homegrown groups to copycat Middle Eastern terrorists. This, and the close to 50 incidents that have been either thwarted or classified as non-terrorist actions in the United States, should give us all pause. As the authors make clear, a little preparation for this terribly effective weapon will go a long way in preventing it. In short, this book brings together the world’s best experience with the subject and makes it clear that an ounce of prevention is worth a pound of cure when it comes to suicide terror.

•

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KETAMINE: Pain Control and Procedural Sedation

Photo: istockphoto.com/shaunl

By Shawn Hunter, M.D. All emergency medicine professionals, including special forces and tactical medics, physician assistants, and physicians, must know how to perform procedures such as reducing fractures, intubating patients, treating burns, and controlling violent patients. Of course, those clinicians who work in austere environments face the additional challenges of limited equipment, limited medications, and limited manpower.

Counter The

Šistockphoto.com/egdigital

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P

rofessional medical kits

usually contain medications for both pain control (i.e., analgesics) and sedation. Unfortunately, most of these medications have undesired side effects, such as respiratory depression or hypotension (low blood pressure). Ketamine, however, avoids many of these side effects. Furthermore, the drug works quickly, can be given by multiple routes, preserves airway reflexes, and maintains blood pressure.

Because of these features, ketamine is used to provide sedation and analgesia for patients undergoing painful procedures. It is also an ideal induction agent for rapid sequence intubation (RSI), especially in asthmatic individuals. In addition, multiple studies have shown that ketamine is safe and effective, even with children.1 Another important characteristic of this drug is its widespread availability. Indeed, ketamine is used in the developing world for both minor and major medical procedures, and it is listed as a “Core Medicine” in the World Health Organization’s “Essential Drugs List.”2 Given its efficacy, safety profile, long shelf life, worldwide familiarity, low cost, and ease of use, ketamine is well-suited for emergency medicine procedures in less-than-ideal environments. Before administering this drug, however, it’s important to more fully understand its pharmacology, typical uses, indications, dosing guidelines, and related warnings, as described in the following sections.

HISTORY OF KETAMINE IN MEDICAL PRACTICE Researchers first discovered ketamine (Ketalar), a derivative of PCP, in 1962. In fact, ketamine was designed to serve as an alternative anesthetic to PCP, and it was first approved for official use in the United States in 1970.3 Ketamine has been widely used in the developing world for decades.4 Within the past 10 years, it has become an extensively used agent in U.S. emergency departments for procedural sedation.

PHARMACOLOGY The chemical name for ketamine is 2-(o-chlorophenyl)-2-(methylamino) cyclohexanone (hydrochloride): (C11H13ClNO)_HCl.5 (See illustration on previous page).

Ketamine has a half-life of 2 to 3 hours. It is metabolized in the liver and excreted by the kidneys. Ketamine does not need to be refrigerated, but it should be discarded if it shows particulate matter.6 Ketamine blocks the action of glutamate at the NMDA receptor, which in turn affects brain structures including the amygdala, hippocampus, and prefrontal cortex. Unlike narcotics or benzodiazepines, which depress the reticular activating system, ketamine interrupts pathways between the thalamocortical and limbic systems, resulting in dissociation.7 Here, dissociation is defined as “a trancelike state characterized by profound analgesia,

retention of protective airway reflexes, spontaneous respirations, and cardiopulmonary stability.” While in this state, patients show nystagmus (i.e., their eyes move back and forth), occasional moaning, and little movement.8 More importantly, when dissociated, patients do not feel pain, are sedated, and will generally not remember the procedure.

INDICATIONS Ketamine can be used for a number of purposes, including procedural sedation, pain control, and endotracheal intubation, among others.

Given its efficacy, safety profile, long shelf life, worldwide familiarity, low cost, and ease of use, ketamine is wellsuited for emergency medicine procedures in less-than-ideal environments.

Ketamine Chemical Structure.

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PROCEDURAL SEDATION Ketamine may be used for sedation during painful procedures, such as fracture reduction, repair of complex facial lacerations, or lumbar puncture– especially in children. Also, in the developing world, ketamine is used to provide sedation for procedures such as emergency amputations, caesarian sections, and appendectomy.9 STATUS ASTHMATICUS Low-dose ketamine is a useful drug for severely asthmatic patients. When administered to asthmatic individuals, it helps maintain airway reflexes and relax bronchial smooth muscles.10 RAPID SEQUENCE INTUBATION (RSI) Ketamine is the preferred induction agent when intubating patients with asthma. Because the drug preserves blood pressure, it should also be considered for patients in hypovolemic, hemorrhagic, or septic shock who require RSI.11 When using ketamine during RSI, note that the drug does not provide significant muscle relaxation; therefore, administration of paralytics such as succinylcholine or rocuronium is necessary.12 VIOLENT PATIENT CONTROL Violent patients can harm themselves and others and are at risk for excited delirium. Administration of ketamine is one way to rapidly control violent or combative trauma patients and prevent these consequences from occurring.13 SEVERE PAIN: CRUSH INJURIES, SEVERE LACERATIONS, AND/OR FRACTURES Ketamine quickly and safely controls severe pain when narcotics are unsafe, not available, or not working.

Administration should be considered when transporting non-intubated patients that are in severe pain and

agitated.14 PHARMACOLOGIC INTERVIEW Finally, an infrequently used intervention is the pharmacologic interview. Little, if any, data are available on using ketamine for this purpose.

However, given the nature of the dissociation produced by this drug, ketamine is probably not a useful agent for this purpose.15 USES • Fracture reductions • Severe pain control (analgesia) • Rapid sequence intubation • Major surgical operations • Severe asthma • Dental procedures • Burn dressing changes • Lumbar punctures in small children • Complex laceration repairs in small children • Catheterization • Combative patient control DOSING AND ROUTE Ketamine can be given by intravenous (IV), intramuscular (IM), oral, nasal, or rectal routes.

In adults and pediatric patients, an initial dose of 1.5 to 2 mg/kg delivered IV will cause dissociation within 2 to 3 minutes, and this state will last between 5 and 10 minutes. In comparison, when a dose of 2 to 5 mg/kg is delivered IM, dissociation will begin in 5 to 10 minutes and last from 20 to 30 minutes.16 Of course, repeated doses may be necessary for longer procedures.

DOSING SUMMARY17 Adult sedation and analgesia: • 0.25 to 2 mg/kg IV • 2 to 5 mg/kg IM Pediatric sedation and analgesia: • 0.5 to 1 mg/kg IV • 2 to 4 mg/kg IM

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May be repeated as necessary SAFETY AND PREPARATION Ketamine should only be used by clinicians who are specially trained in its use, able to maintain patient respirations, and able to definitively control an airway.

Multiple studies demonstrate ketamine’s safety—even in pediatric populations and prehospital settings.19 For those who must provide procedural sedation in a less-than-ideal setting with limited monitoring equipment, ketamine provides a margin of safety unmatched by other agents.

FASTING STATUS Procedural sedation protocols in the operating room (OR) and emergency department (ED) often recommend at least 2 to 6 hours of fasting (NPO) prior to administering procedural sedation to prevent aspiration of stomach contents. However, more recent studies call these recommendations into question.20 More importantly, using ketamine in combat, emergency, or tactical settings may require a shorter fasting interval, if such an interval is even possible. Indeed, this is a common situation in both ED and field settings when facing a life- or limb-threatening situation.

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PRETREATMENT In the past, most clinicians pretreated pediatric patients with atropine prior to administration of ketamine to prevent excess oral secretions. However, recent studies show that this may not be necessary, and this practice is falling out of favor.21 PATIENT MONITORING In the ED setting, procedural sedation protocols recommend monitoring that includes all of the actions listed in below.

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Monitoring in the ED Setting22 • Frequent vital signs • Continuous cardiac monitoring • Continuous pulse oximetry (SaO2) • Continuous capnography (End tidal CO2) The gear required for this sort of monitoring may be lacking in a field or tactical environment; in such situations, you may have no monitoring equipment except for your eyes, ears, and stethoscope. In these less-thanideal scenarios, ketamine provides a margin of safety unmatched by other agents. Of course, as the clinician, you are ultimately responsible for balancing the benefits of ketamine versus its potential risks.

CONTRAINDICATIONS Despite its generally high safety margin, use of ketamine should be avoided with certain patients. Some contraindications of ketamine include the conditions discussed in the following sections.

CARDIOVASCULAR CONDITIONS Ketamine increases a person’s heart rate, blood pressure, and cardiac output. Therefore, if possible, ketamine should be avoided in patients with uncontrolled hypertension, aortic dissection, aneurysm, or cardiac disease.23 OCULAR INJURIES Ketamine can increase intraocular pressure. Thus, avoid administering ketamine if a patient has a penetrating or blunt globe injury or glaucoma.24 (See photo next page) TRAUMATIC BRAIN INJURY (TBI) Ketamine can also temporarily raise a person’s intracranial pressure. Consequently, specialists suggest avoiding ketamine in patients with TBI.25

The chart above summarizes a decision algorithm for using ketamine.18 PSYCHIATRIC ILLNESS It is thought that patients with psychiatric disorders may be more prone to emergence reactions than members of the general population following ketamine administration. However, some experts suggest that ketamine is, in fact, acceptable for sedating “uncooperative mentally disabled” adults.26 SIDE EFFECTS Side effects do occasionally occur with use of ketamine. Some of the more commonly seen side effects are discussed in the following sections.

NAUSEA AND VOMITING Nausea and vomiting are not uncommon after ketamine. They generally occur during the recovery phase and are self-limited.27 EMERGENCE REACTION With ketamine, the emergence reaction is characterized by hallucina-

tions, confusion, fear, and out-of-body experiences. It usually happens as the patient is exiting the dissociative stage.

Although rare in children, this reaction is reported in 0 to 30% of U.S. adults. Thankfully, emergence can be prevented by giving pre-procedure suggestion, creating a quiet scenario, and/or giving benzodiazepenes.28 RESPIRATORY DEPRESSION AND APNEA Fortunately, both respiratory depression and apnea are uncommon with ketamine. When either occurs, it is usually associated with rapid IV (bolus) administration. For this reason, IV ketamine should be given slowly, over a period of 60 seconds.29 LEGAL ISSUES A few legal notes about ketamine should also be mentioned, particularly with regard to its use and regulation

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both in the United States and overseas.

REGULATION The United States Drug Enforcement Administration (DEA) classified ketamine as Class III drug in 1993.31 In the U.S., its use is basically restricted to licensed physicians. In Canada, the drug is listed as a Class I substance, whereas in the United Kingdom, it is scheduled as Class C substance.30 OVERSEAS USE In some developing nations, nonphysicians such as physician assistants, special forces medics, and tactical medics employed with private security companies are allowed to use and/or purchase ketamine. If you are among these individuals, as always, follow your scope of practice and protocols.

In addition be sure to find out in advance how you should clear customs if you plan on traveling with ketamine. Even if the country in which you will be working allows you to possess this medication, your country of departure (e.g., the United States) may not.

Hospital pharmacists and the DEA are good resources for information about ketamine regulation: U.S. Drug Enforcement Administration Office of Diversion Control/International Drug Unit (800) 882-9539 http://www.deadiversion.usdoj.gov/ index.html

cially trained and qualified clinicians only.

3. Typical dosing for light dissociation is 0.25 mg/kg IV/IM; for deep dissociation is 1 to 2 mg/kg IV or 2 to 4 mg IM; and for RSI is 2 to 4 mg/kg IV.

•

ABOUT THE AUTHOR Dr. Hunter (pseudonym) is a boardcertified emergency physician with experience working in Latin America, Asia, and the Middle East. He provides consulting and educational services for private and government clients, medical professionals, and private security companies. He also instructs tactical and medical courses with Crisis Response International.

DISCLAIMER

This article is presented solely for general educational purposes. The topics discussed should be given/performed by qualified medi-

TAKE HOME POINTS 1. Ketamine is an almost ideal medication for procedural sedation, pain control, or airway control in field, overseas, or operational environments.

2. Ketamine should be given by spe-

A 38-Year-Old Male with Metallic Foreign Body in Left Eye. (photo from author)

cal professionals only.

This article is not meant to replace formal medical training, experience, or continuing medical education. It does not intend to provide advice regarding medical diagnosis or treatment for any specific case.

Readers are recommended to follow their medical direction protocols and work within their established scope of practice.

The author and this magazine tried to present this information as clearly as possible.

Nonetheless, the accuracy of this work cannot be guaranteed. Neither the author nor the magazine assume any responsibility or liability for your use of the information in this article.

Look up doses, routes, indications, and contraindications for yourself.

ENDNOTES

1 Green, S., “Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation in Children,” Annals of Emergency Medicine 44, no. 5 (2004): 460–471; Green, S., et al., “Intramuscular Ketamine for Pediatric Sedation in the Emergency Department: Safety Profile in 1,022 Cases,” Annals of Emergency Medicine 31, no. 6 (1998): 688–697; Newton, A., and Fitton, L., “Intravenous Ketamine for Adult Procedural Sedation in the Emergency Department: A Prospective Cohort Study,” Emergency Medicine Journal 25, no. 8 (2008): 498–501.

2 World Health Organization, Model List: Essential Medicines, 14th ed. (Geneva: Author, 2005).

3 Center for Substance Abuse Research, “Ketamine,” http://www.cesar.umd.edu/ cesar/drugs/ketamine.asp (accessed March 30, 2009).

4 Guldner, G., et al., “Ketamine for Procedural Sedation and Analgesia by Nonanesthesiologists in the Field: A Review for Military Health Care Providers,” Military Medicine 171, no. 6 (2006): 484–490; VanRooyen, M., et al., eds., Emergent Field Medicine (New York: McGraw-Hill, 2002).

5 Bedford Laboratories, ketamine package insert, http://www.bedfordlabs.com/products/ inserts/ketamine_pi.pdf (accessed March 22, 2009).

6 Ibid.; Roberts, J., and Hedges, J., eds., Clinical Procedures in Emergency Medicine, 2nd ed. (Philadelphia: Saunders, 1991)

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Green, “Clinical Practice Guideline”; Guldner et al., “Ketamine for Procedural Sedation.”

8 Green, “Clinical Practice Guideline.”

9 VanRooyen et al., Emergent Field Medicine; Wedmore, I., et al., “Pain Management in the Wilderness and Operational Setting,” Emergency Medicine Clinics of North America 23, no. 2 (2005): 585–601; Bing, J., and Fu-jin, L., “Preliminary Trial of Ketamine Anesthesia in War Casualties,” Chinese Medical Journal 95, no. 7 (1982): 491–493.10.

10 Roberts and Hedges, Clinical Procedures in Emergency Medicine; Marx, J., et al., eds., Rosen’s Emergency Medicine, 6th ed.

(Philadelphia: Elsevier, 2006).

11 Ibid.; L’Hommedieu, C., and Arens, J., “The Use of Ketamine for the Emergency Intubation of Patients with Status Asthmaticus,” Annals of Emergency Medicine 16, no. 5 (1987): 568–571.

12 Roberts and Hedges, Clinical Procedures in Emergency Medicine.

13 Melamed, E., et al., “The Combative Multitrauma Patient: A Protocol for Prehospital Management,” European Journal of Emergency Medicine 14, no. 5 (2007): 7

265–268.

14 Wedmore et al., “Pain Management in the Wilderness”; Melamed et al., “The Combative Multitrauma Patient.”

15 Roberts and Hedges, Clinical Procedures in Emergency Medicine.

16 Green, “Clinical Practice Guideline”; Guldner et al., “Ketamine for Procedural Sedation.”

17 Green, “Clinical Practice Guideline”; Guldner et al., “Ketamine for Procedural Sedation”; Wedmore et al., “Pain Management in the Wilderness”; Marx et al., Rosen’s Emergency Medicine.

18 Green, “Clinical Practice Guideline.”

19 Ibid.; Green et al., “Intramuscular Ketamine”; Newton and Fitton, “Intravenous Ketamine for Adult Procedural Sedation”; Bredmose, P., et al., “Pre-Hospital Use of Ketamine for Analgesia and Procedural Sedation,” Emergency Medicine Journal 26 (2009): 62–64.

20 Green, S., et al., “Fasting and Emergency Department Procedural Sedation and Analgesia: A Consensus-Based Clinical Practice Advisory,” Annals of Emergency Medicine 49, no. 4 (2007): 454–461.

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Brown, L., et al., “Adjunctive Atropine Is Unnecessary During Ketamine Sedation in Children,” Academic Emergency Medicine 15, no. 4 (2008): 314–318.

22 Green, “Clinical Practice Guideline”; Marx et al., Rosen’s Emergency Medicine.

23 Ibid.

24 Marx et al., Rosen’s Emergency.

25 Green, “Clinical Practice Guideline”; Marx et al., Rosen’s Emergency Medicine.

26 Green, “Clinical Practice Guideline.”

27 Ibid.

28 Ibid.; Guldner et al., “Ketamine for Procedural Sedation.”

29 Green, “Clinical Practice Guideline.”

30 United States Drug Enforcement Administration, “Drug Scheduling: Ketamine,” http://www.usdoj.gov/dea/pubs/ scheduling.html (accessed March 27, 2009); National Association of Pharmacy Regulatory Authorities, “Canada Drug Scheduling,” http://www.napra.ca/pages/schedules/search. aspx (accessed March 27, 2009).

31 United Kingdom Home Office, “Controlled Drugs List,” http://www. homeoffice.gov.uk/document/cdlist.pdf (accessed March 27, 2009).

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TRAINING REVIEW

By Shannon Arledge

T

Photo: Courtesy Shannon Arledge

EMS Weapons of Mass Destruction Course

he Center for Domestic

Preparedness (CDP) features

a three-day EMS course that addresses the effects of chemical and biological agents—including radiation and explosives injuries. This Weapons of Mass Destruction (WMD) EMS course is one of several health care–related classes designed to prepare the response community for accidental or man-made emergency events.

According to EMS course manager John Skinner, the diverse group of response providers who participate in the course includes not only emergency medical technicians and paramedics, but also emergency room nurses, medical emergency planners, and law enforcement officers.

“Any time a medical responder—or any responder with medical skills—initiates contact with a potential casualty in the field, they place themselves at the mercy of a terrorist or an accidental hazardous environment,” said Skinner. “The fact that hazardous situations can be harmful if responded to improperly, making responders the victims, is important.

This EMS training provides the nation’s responders with the skills required to protect themselves while they perform their important life-saving mission for the public.”

“This wasn’t simple EMS training,” said Michael Montgomery, an EMTdispatcher from Oklahoma City, after finishing the course. “It is not what you expect. When you walk away

Emergency responders at all levels may experience tragic events involving mass casualties at some point in their career. Emergency medical services (EMS) workers are often on the front lines with other response personnel, and understanding the potential threats they all face could determine a successful outcome to the emergency response.

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I�������� ��� P��������� S��������� from this course, it is going to make at The Center for Rural Development you a better medic. You’re going to I�������� ��� P��������� S��������� approach emergency situations with a at The Center for Rural Development new perspective and a better ability to identify hazards. I also have a better understanding of what other emergency departments—such as firefighters— Courses for Public Safety Practitioners experience, and I can be a better asset Courses include: during an emergency.”  Law Enforcement Professionals The WMD EMS course has been Available Now! offered by the CDP for the past four  Fire Service Professionals years, and each class can accommodate 40 Coming Soon! responders. Upon successful completion  Emergency Management Professionals of this course, an individual may be Coming Soon! eligible for 2.4 continuing education units (CEU).

According to Mike Aguilar, CDP Enroll in a course today.

No fees! No cost! training specialist, responders are more DISCLAIMER: This project was supported by Cooperative Agreement Number 2006-GD-T6-K001 administered by the U.S. Department of Homeland Security/FEMA, Training and Exercises Integration frequently finding themselves at the Secretariat. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the U.S. Department of Homeland Security. center of dangerous events, as compared For more information please visit to a few years ago when medical www.preventivestrategies.net or www.ruraltraining.org personnel typically received victims Circle 123 on Reader Service Card IPS-RDPC-DHS Ad 4.75 x 4.875.indd 1 4/13/2009 4:33:01 PM outside crime scenes or accidents.

“In the past, our emergency health care response providers may not have known patients were potentially contaminated with life-threatening toxic material,” commented Aguilar. “And if they did know of the danger, they were unsure of the proper response procedures required to protect the patient, themselves, and their colleagues. The CDP EMS training instills the proper use of triage techniques, decontamination, and treatment and stabilization of victims while emphasizing response force safety.”

In doing so, the EMS course places students in an unusual environment.

However, according to Skinner, health care responders across America may someday be forced to face catastrophic, stressful events. Thus, responders who participate in the CDP’s EMS training will gain new appreciation and be better

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prepared for the variety of hazardous and dangerous situations they might someday encounter.

“This course isn’t designed to refresh blood pressure procedures,” said Skinner.

“It starts participants thinking out of the box in reference to treatment of mass casualties in a contaminated environment.”

“The hands-on experience makes a difference,” stated Stephanie Maze, a paramedic from Asheville, NC. “Even the seasoned paramedic will benefit, and the WMD focus makes the training more relevant.”

Another goal of the EMS course is increased awareness. Medical response personnel should always approach a disaster scene with an index of suspicion and be able to identify potential hazards without becoming victims—and they should also seek to prevent the loss of other responders’ lives, Skinner added.

Most CDP courses last three days and, on occasion, a fourth day is added to the EMS course that includes training at the Chemical, Ordnance, Biological, and Radiological Training Facility (COBRATF). There, students have an opportunity to reinforce the triage and decontamination procedures they learned during the course while in a genuine toxic nerve agent environment. Upon completion of the COBRATF training, participants have gained confidence in their protective gear—and, more importantly, in their own ability to respond to a contaminated scene.

•

ABOUT THE AUTHOR

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Shannon Arledge is a public affairs specialist for FEMA’s Center for Domestic Preparedness (http://cdp.dhs.gov). CDP training (to include transport, lodging and meals) for state, local, and tribal responders is funded by FEMA.

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