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Terrorist Attacks Against Emergency Medical Services: Secondary Attacks are an Emerging Risk

Published online by Cambridge University Press:  02 February 2022

Cindy T.J. Schmeitz Open the ORCID record for Cindy T.J. Schmeitz [Opens in a new window] ,
Dennis G. Barten Open the ORCID record for Dennis G. Barten [Opens in a new window] ,
Kevin W.Y. van Barneveld Open the ORCID record for Kevin W.Y. van Barneveld [Opens in a new window] ,
Harald De Cauwer Open the ORCID record for Harald De Cauwer [Opens in a new window] ,
Luc Mortelmans ,
Frits van Osch ,
Jaap Wijnands ,
Edward C. Tan  and
Arjen Boin
Cindy T.J. Schmeitz
Affiliation:
Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands Department of Intensive Care Medicine, VieCuri Medical Center, Venlo, The Netherlands
Dennis G. Barten*
Affiliation:
Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
Kevin W.Y. van Barneveld
Affiliation:
Department of Emergency Medicine, VieCuri Medical Center, Venlo, The Netherlands
Harald De Cauwer
Affiliation:
Department of Neurology, Dimpna Regional Hospital, Geel, Belgium
Luc Mortelmans
Affiliation:
Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
Frits van Osch
Affiliation:
Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
Jaap Wijnands
Affiliation:
North Limburg Safety Region, The Netherlands
Edward C. Tan
Affiliation:
Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
Arjen Boin
Affiliation:
Department of Political Science, Leiden University, Leiden, The Netherlands
*
Correspondence: D.G. Barten, MD Department of Emergency Medicine VieCuri Medical Center P.O. Box 1926, 5900 BX Venlo The Netherlands E-mail: dbarten@viecuri.nl
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Abstract

Introduction:

Terrorists increasingly aim at so-called soft targets, such as hospitals. However, little is known about terrorist attacks against Emergency Medical Services (EMS).

Objective:

This study aims to review all documented terrorist attacks against EMS that occurred world-wide from 1970-2019 using the Global Terrorism Database (GTD).

Methods:

Reports of terrorist attacks against EMS were extracted from the GTD from 1970-2019. Data collection included temporal factors, attack and weapon type, number of casualties, and if it was a primary or secondary attack (secondary attack: deliberate attack against the first responders of an initial terrorist attack). Reports were excluded if EMS were not a target or if it was unclear whether they were a target. Chi-square tests were performed to evaluate trends over time.

Results:

There were 184 terrorist attacks against EMS, resulting in 748 deaths and 1,239 people injured. Terrorist attacks against EMS significantly increased over the past two decades. The “Middle East & North Africa” was the most frequently affected region with 81 attacks (44.0%) followed by “South Asia” with 41 attacks (22.3%). Bombings and explosions were the most common attack type (85 incidents; 46.2%) followed by armed assaults (68 incidents; 35.3%). Combined prehospital and hospital attacks were first reported in 2005 and occurred seven times. The first secondary attack against EMS dates from 1997, after which an increase was observed from 10 to 39 incidents in the periods 2000-2009 and 2010-2019, respectively.

Conclusions:

This analysis of the GTD, which identified 184 terrorist attacks against EMS over a 50-year period, demonstrates that terrorist attacks against EMS have significantly increased during the years and that secondary attacks are an emerging risk. Bombings and explosions are the most common attack type. Terrorist attacks against EMS are most prevalent in countries with high level of internal conflicts, however, they have also occurred in western countries. These incidents may hold valuable information to prevent future attacks.

Keywords

ambulancecounter-terrorism medicineEmergency Medical Services (EMS)secondary attackterrorismterrorist attack
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 2 , April 2022 , pp. 185 - 191
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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Footnotes

Note: CTJ Schmeitz and DG Barten contributed equally to the manuscript.

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