Imagine if you will, having lunch at a local bistro with your best friend. Suddenly, you find yourself thrown flat among shards of glass, wood, and twisted metal. Your ears ring, vision blurs, and you can barely breathe. You realize there’s been an explosion of sorts, and you’re lucky to be alive.

Your friend is not so lucky. They lie a few feet away, a viscous gash running through their neck all the way to the spine. He or she spasms, choking, and gagging even as they bleed out. You are watching your friend die.

Just as the awful realization hits, your sphere of awareness begins to expand. Others are in similar disarray. Some are like you, others badly hurt, and some like your friend are clearly terminal if not dead already.

Soon enough a car veers toward the building’s remains, screeches to a halt, and its occupants rush inside. They claim to be off duty EMT personnel. One of them shuffles toward you, yells “yellow”, and orders you to wait outside. They then give your friend a cursory glance and declare “black”, moving on without another look. It doesn’t take any medical or emergency training to know your friend, your still living friend, has just been given up for dead.

Could you stand by, coolly detached, knowing this was done for the greater good? Now imagine thousands of other mental taxing disaster scenarios that may be thrust upon an unprepared John Q., ask a similar question, and picture the result. During a functional chemical weapon exercise performed in Cincinnati, the human disaster factor is summarized perfectly in this caption.

FitzGerald, D. J., Sztajnkrycer, M. D., & Crocco, T. J. (2003). Chemical weapon functional exercise–Cincinnati: observations and lessons learned from a “typical medium-sized. citys response to simulated terrorism utilizing weapons of mass destruction. Emmitsburg, MD: National Emergency Training Center. Page 209, image caption:

For decontamination and triage to be effective and efficient, early control of victims is essential. In a real event would the responding units be as effective at rapidly organizing the crowd of hysterical “victims” into an orderly decontamination line?

Conclusions were speculative at best, but researchers speculated in a real emergency the the herding cats principal would be likely to hinder response efforts.

FitzGerald, D. J., Sztajnkrycer, M. D., & Crocco, T. J. (2003). Chemical weapon functional exercise–Cincinnati: observations and lessons learned from a “typical medium-sized. citys response to simulated terrorism utilizing weapons of mass destruction. Emmitsburg, MD: National Emergency Training Center. Page 209:

Lessons learned. Anticipate initial difficulty in establishing scene priorities. In this scenario, the engine company that responded first was met by a stream of screaming victims, which distracted the company from initial scene evaluation. The four firefighters were pressed to gain rapid control of the situation, activate the incident command system, and begin gross decontamination. It remains unclear whether a small cadre of firefighters could gain control so efficiently in the setting of an actual terrorist event. It also remains unclear whether
such crowd control would be possible in the setting of 5,500 victims, as in the Tokyo incident. However, it is likely that the majority of people in a large event
would disperse prior to arrival of first responders, and that those remaining would comprise individuals too sickened to escape.

In short, to expect an organized triage of victims in any sizable incident is something of a pipe dream. Response personnel (and victims themselves) must prepare to not only handle the disaster itself, but to deal with the inevitable, mercurial human nature thereafter.