FINAL PROGRAMME

The Medical University of Varna

organizes in cooperation with:

the Israeli Institute of Counter-Terrorism (Herzliya),

Hadassah University Hospital (Jerusalem),
Rambam University Hospital (Haifa)
and the Embassy of Israel to Bulgaria

First International Workshop on Anti-Terrorism

(Varna, University Hospital St. Marina, 16-19 June 2014)

SCIENTIFIC, EDUCATIONAL AND QUALIFICATIONAL PROGRAMME

Preamble:

The Workshop is dedicated to the global threats of terrorism world-wide.

Bulgaria suffered a bad experience with the terroristic act in Bourgas airport (26 July 2012), as a
result of which we had 6 casualties and over 35 injured.

A working team comprising with specialists from the Embassy of Israel in Bulgaria, lead by H.E.
The Ambassador, and professors from Varna Medical University, lead by The Rector, assisted the
organization of the measures to overcome the consequences after the terroristic bomb attack,
together with the group of professionals from the Ministry of Internal, Ministry of Health and
the entire Government team sent to Bourgas immediately after the bloody episode, the first
one in the new history of Bulgaria.

This was the time when The Rector of Varna Medical University Prof.Dr. Kr.Ivanov, H.E. The
Israeli Ambassador Mr. Shaul Kamisa-Raz and the Honorary Consul of Israel to Bulgaria
Prof.Dr. Kr.Metodiev, decided to organize a special forum in Varna with the basic idea to
improve the coordination, collaboration and management of anti-terroristic measures
before, during and after an eventual terroristic attack in any of its possible variants.

The intention is to discuss with, to educate and qualify Bulgarian colleagues to disseminate
after the Workshop the know-how and experience of the Israeli leading specialists in this
extremely actual and important discipline: anti-terrorism in any aspects.
Now, almost 2 years after the tragedy in Bourgas, we are ready with the Programme of this
Workshop and we are proud to announce that the speakers list includes the top-level,
internationally recognized, anti-terrorist specialists from Israel: representing the Institute of
Counter-Terrorism in Herzliya, the University Hospitals Hadassah in Jerusalem and Rambam
in Haifa, as well as the Embassy of Israel to Bulgaria and the Medical University of Varna.

Speakers: Boaz Ganor, Eitan Azani, Hany Bahouth, Miklosh Bala, Gila Hyams, Julie
Benbenishty, Mica Shamir, Krassimir Metodiev

Programme in details - days/hours:

16 June 2014:
9.30-10.00 h: opening ceremony, greeting addresses of VIP guests,
introductory short presentations of
The Rector Prof.Dr. Kr.Ivanov
and H.E. The Ambassador Shaul Kamisa-Raz;
moderator: Prof.Dr. Kr.Metodiev (Honorary Consul of Israel to Bulgaria)

Sessions:

16 June 2014:
10.00-12.30 h: first session: The terrorist phenomenon:
Speakers: Boaz Ganor, Eitan Azani (Inst. Counter-Terrorism, Herzliya)
a. The Evolution of modern terrorism
b. Terrorism definition
c. Modern terrorism strategy
d. Terrorism and counter terrorism formula

12.30-14.00 h: lunch break

14.00-16.30 h: second session: Terrorist actors:

Speakers: Boaz Ganor, Eitan Azani (Inst. Counter-Terrorism, Herzliya)
a. The hybrid terrorist organization
b. Hezbollah
c. Al Qaeda and it's affiliates:
i. Al-Qaeda global infrastructure- AQ central;
AQIM; AQAP; ISIS; Al Shabab; AQ Affiliates
ii. Al-Qaeda grand strategy - 7 phases strategy
iii. Al-Qaeda operational strategy and Modus
operandi general models and case studies

16.30-17.00 h: coffee break

17.00-18.00 h: discussions, wrap up first day (Boaz Ganor and Eitan Azani)

17 June 2014:
9.30-11.00 h: third session: Terrorists modus operandi:
Speakers: Boaz Ganor, Eitan Azani (Inst. Counter-Terrorism, Herzliya)
a. General Data- terror attacks
b. The suicide attacks phenomenon

11.00-11.30 h: coffee break

11.30-13.00 h:
c. Non conventional terrorism CBRN (including Al Qaeda and WMD- Motivation;
Religious justification and capabilities)
d. Cyber terror- the use of the internet as: an operational platform; virtual training camp;
source for intelligence; virtual laboratory for IED's and poison

13.00-14.30 h: lunch break

14.30-17.00 h: fourth session: International processes and terrorism:

Speakers: Boaz Ganor, Eitan Azani (Inst. Counter-Terrorism, Herzliya)
a. The revolutions in the middle east (The "Arab spring") and its implications on local and
global terrorism
b. Radical Dawa infrastructure and groups - in the EU - General
c. The threat of terrorism to the health systems the counterfeit medicine case study

17.00-17.30 h: coffee break

17.30-18.30 h: discussions, wrap up second day (Boaz Ganor and Eitan Azani)

18 June 2014:
9.30-11.00 h: fifth session: Medical aspects of Anti-Terrorism Part I:
Speakers: Hany Bahouth, Miklosh Bala, Gila Hyams, Julie Benbenishty, Mica Shamir
(University Hospitals: Hadassah-Jerusalem and Rambam-Haifa)
a. Opening remarks
b. Mass casualty Definition and general guidelines
c. Mass casualty - terror related events in Israel and the Israeli Trauma system
d. Videos and demonstrations

11.00-11.30 h: coffee break

11.30-13.00 h:
e. MCE Pre-hospital Aspect
f. Mass casualty trauma life support
g. Hospital Triage MCE management
13.00-14.00 h: lunch break

14.00-15.30 h:
h. Preparing the ER for a MCE
i. Nursing system management of MCE
j. Hospital setup during MCE: first 8 hours

15.30-16.00 h: coffee break

16.00-17.30 h:
k. Mega- Mass Casualty event
l. Lessons learned the Hard Way: War and Terror; Attacks and Debriefing
17.30-18.30 h: discussions, wrap up third day (Hany Bahouth, Miklosh Bala, Gila Hyams,
Julie Benbenishty, Mica Shamir)

19 June 2014:
9.30-11.00 h: sixth session: Medical aspects of Anti-Terrorism Part II:
Speakers: Hany Bahouth, Miklosh Bala, Gila Hyams, Julie Benbenishty, Mica Shamir,
Krassimir Metodiev (University Hospitals: Hadassah-Jerusalem and Rambam-Haifa; Medical
University-Varna)
a. Non-conventional Disasters - Chemical, biological, and radiological disaster
b. Risk infections and bioterrorism: overview, current situation
c. Blast injuries: Evaluation, management and intensive care treatment

11.00-11.30 h: coffee break

11.30-13.00 h:
d. Ethical challenges and dilemmas
e. Emotional and stress related consequence Patients, staff, adolescence PTSD

13.00-14.00 h: lunch break

14.00-16.00 h:
f. Interactive drill
g. Debriefing and conclusions
e. Training instructions, demonstrations and practical aspects

16.00-16.30 h: coffee break

16.30-18.00 h: discussions, wrap up fourth day, wrap up the entire Workshop (Hany
Bahouth, Miklosh Bala, Gila Hyams, Julie Benbenishty, Mica Shamir, Krassimir Metodiev)

18.00-18.30 h: closing ceremony, final conclusive words and distribution of Certificate for
attendance and qualification (Rector Prof.Dr. Kr.Ivanov, Ambassador Shaul Kamisa-Raz)
Venue of the Workshop:
Main Auditorium Prof. V.Ivanov, University Hospital St. Marina, Varna

Contributions: TBA

Contact person, information, feed-back:

Prof.Dr. Kr.Metodiev, Honorary Consul of Israel to Bulgaria,
9002 Varna, 55 M.Drinov str., Medical University, Rectorate Building
e-mail: kr.metod@yahoo.com and kr.metod@gmail.com
Tel/fax: +359-52-634107 and 677114, Mobile: +359-888-712407 and +359-878-694803

Additional information and educational solutions for next qualification workshops on anti-
terrorism in Bulgaria:

Professional Practice Gaps to be addressed

(the reasons for the selected topics)

The gap in organizational skills needed from your hospital staff in order to prepare your
organization for a mass casualty disaster. This Workshop will provide suggestions of our
work lists, and the personnel needed who provide the knowledge and skills for our level 1
trauma center, based on our experience.
The utilization of your own resources to meet the needs during mass casualty event- your
trauma team, your ER, OR and administration staff in order to close the gap between
resources and casualty needs.

Developing working relations with municipality, public health, police, fire and the local
media in order to better facilitate needs during mass causality incidents in your home town,
based on our experience and working relationships and how we have benefitted.

We will discuss the basic principles of how to treat blast, crush and penetrating injuries in a
mass casualty situation where you might possibly have 20-50 injured in your hospital at the
same time. This includes care in ER, OR ICU and Rehabilitation, based on our long term
experience handling multiple mass casualty urban incidents.

We will discuss the complexities and sensitivities of combining and collaborating with
forensic medicine teams as well as security, police and army at the same time you are
treating your severe multiple casualties. This includes the added factor of the wounded and
the staff from multi-cultural backgrounds, as any urban area contains.

How to keep your staff resilient and prevent secondary PTSD or burnout.
The participants in this Workshop will share our practice tools which we use the build
resilience and compassion in our clinical areas based on our experience and outcomes.

What is waiting in the future?

This talk will assess the future threats waiting to happen to the entire world.
Non-conventional Disasters. The participant will be able to distinguish what the possible
threats are, and be able to assess patients for non conventional injuries.

At the end of this Workshop you will participate in an interactive drill, which will incorporate
all you have learned in this Workshop, you will be able to practically use the new
competencies learned.

Upon return from this Workshop, you will then be in an expert position to return to your
organization and prepare for the next mass casualty incident.
It is not a question of "if" but "when".

Learning Objectives

1. Overview of mass casualty events (MCE) - Upon completion of this talk the participant
should be able to determine the overall and general epidemiology of all factors relevant in a
mass casualty event.
2. MCE peacetime preparation - This talk will elaborate on all resources needed to prepare
the participants organization for a mass casualty incident. We will analyze together the gaps
in equipment, personnel, and surge capacity in order to return to their hospitals to update.
3. Pre-hospital MCE management - this talk focuses on the clinical aspects of pre-hospital
care as well as developing communications with pre-hospital teams in order to achieve
optimal patient outcomes. The participants will be able to discuss their own management
system and together we will determine strategies.
4. Medical management of MCE - Our aim is to share with you all medical and nursing
management strategies that are used in controlling a mass casualty incident- Keep in mind
that a MCE happens to the entire organization- it is not just the ER's problem!
5. Non-conventional Disasters - Who knows what is waiting for us in the future? Anticipated
radiological, nuclear, chemical and biological scenarios will be described. Best possible
treatment plans will be explained.
6. Blast injuries the objective of this talk is for the participant to be able to assess each
patient's multi-system injuries and adapt tools for best managing the patient long term care.
Actual Case scenarios will be discussed and analyzed
7. Emotional and stress related consequence - We will discuss how to keep our teams
resilient, what measures should we take and how to keep our experienced staff at the
bedside. We will share with the participants our experiences and lessons learned as well as
results from 2 longitudinal research studies investigating medical teams in Israel.
8. Interactive drill - This drill will incorporate all the participant have learned from this
workshop. Each one will role play a position during an incident which we will de-brief
afterwards. This is the most effective way to asses ones learning experience.
Upon completion of this Workshop, participants should be able to perform in any capacity
before, during and after a local disaster involving multi-casualties.

2. KEY CLINICAL APPLICATIONS

Take home messages that are intended to improve practice and can be easily adopted:
Emotional Consequences to Disaster and mass casualties

Create effective working patterns and guidelines

CHECK LISTS:
Peace time preparation from national to local to hospital to departmental level

Future threats

References

Key Clinical Application #1: Emotional Consequences to Disaster and mass casulties

Reference 1: Treating Survivors in the Acute Aftermath of Traumatic Events

Excerpted with permission, from a chapter written by Arieh Y. Shalev, M.D.,
to appear in R. Yehuda (Ed.), Treating Trauma Survivors with PTSD: Bridging the Gap
Between Intervention Research and Practice. Washington, DC: American Psychiatric Press

Reference 2: Posttrauamtic Stress Disorder among hospital surgical physicians exposed to

victims of terror: a prospective controlled questionnaire survey. Weiniger, Shalev, Ofek,
Freedman,Weissman, Einav J Clin Psychiatry 2006-67;890-896

Key Clinical Application #2: Create effective working patterns and guidelines CHECK LISTS
Peace time preparation from National to local to Hospital to departmental level

Reference 1:
Evacuating Trauma Victims: To the Nearest or the Appropriate Hospital? Shapira , IMAJ
2006;8:129130

Reference 2:
Hospital Management of a Bio-terror Event Shapira, Shemer, Oren IMAJ 2002; 4:493494

Reference 3:
Patterns of Injury in Hospitalized Terrorist
Victims Peleg, Aharonson,-Daniel, Michael, Shapira, and the Israeli Trauma Group
American Journal of Emergency 21, ( 4) 2003

Reference 4
A Multicasualty Event: Out-of-hospital and In-hospital Organizational Aspects
Avitzour; Libergal; Assaf; Adler; et al Academic Emergency Medicine; 2004; 11, 10; 1102

Key Clinical Application #3: Future threats

Reference 1: Facing the New Threats of Terrorism: Radiologists Perspectives Based on

Experience in Israel Sosna, Sella, Shaham, Shapira, Rivkind, Bloom, Libson, Radiology 2005;
237:2836
Reference 2: The Logic of Suicide Terrorism; B.Hoffman Volume 291, No. 5.The Atlantic
Monthly, 2003 www.rand.org

Reference 3: Terror Politics and Medicine: The Role of Leadership

SHAPIRA, MOR-YOSEF Studies in Conflict & Terrorism, 27:6571, 2004

Reference 4: Risk infections and possibilities for biomedical terrorism; Philip Elzer,
Krassimir Metodiev, IOS Press, NATO Science Series, 2004