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To quickly operate a temporary hospital using disaster medical containers in the event of a large-scale disaster, dozens of large trailers must be quickly brought to the disaster site. This study aims to establish a logistic system for transporting and installing containers using drones and GIS.
Method:
By linking drones and GIS, a theoretical model was created to quickly determine routes and installation sites for large trailers transporting medical containers from candidate routes simulated in advance by taking into account hazard maps and road conditions.
Results:
Using this system, it is possible to
(1) Establish whether the roads planned to be passed through are passable.
By narrowing down candidate routes through preliminary simulations that overlay hazard maps and roads that are passable for large trailers, it is possible to narrow down the routes that need to be confirmed. Immediately after a disaster, a drone can be used to confirm road damage, flooding, landslides, etc., and map them on the GIS to determine the extent to which they are passable.
(2) Identify locations that take into account demand and safety.
Locations that are close to the disaster area, safe, and in demand for medical care can be determined and identified based on the population mesh and the damage situation.
Conclusion:
GIS and drones have a high affinity and are used in various ways. However, there is still no linkage between GIS and drones adapted to medical care and logistics at disaster sites in Japan. This system is indispensable to comprehensively determine the safety and demand of roads and installation sites.
The authors developed an evaluation tool to measure changes in exercise participants' awareness of disaster risk and their disaster preparedness behaviors. To create the tool, a mechanism was modeled to visualize the process of changing people's crisis awareness and behavior and questions were developed for each of the twelve factors and two outcomes within the mechanism. In this study, we conducted a disaster exercise in the pharmacy department of Hospital A, one of the disaster base hospitals, and measured the effectiveness of the exercise using the tool.
Method:
In the disaster exercise, participants were asked to perform dispensing tasks on five dummy prescriptions using actual medicines, based on the assumption that the dispensing support system was out of order due to a major earthquake. Participants were paired up and dispensed as much as possible within a time limit of 30 minutes. Pre- and post-education sessions were conducted before and after the exercise. Respondents were asked to score each question on a 5-point scale at three time points: before the pre-education, immediately after the disaster exercise, and after post-education.
Results:
59 people, including 16 participants, responded to the questionnaire using the evaluation tool. The analysis of the evaluation results revealed that the disaster exercise increased the participants' crisis awareness. Furthermore, participants improved their scores on the questions on feelings of anxiety about the current situation, assumptions about the impact, sense of ownership, and fear of not acting, but no change was observed among non-participants. However, there was no significant difference in scores between the two groups regarding whether they had taken action for disaster preparedness in the period following the exercise.
Conclusion:
The exercise raised the participants' crisis awareness, but did not encourage them to change their behavior. Future research should consider ways to encourage staff members to take action to prepare for disasters.
Global Emergency Care Skills (GECS) is a charity which delivers medical training to health care professionals in low and middle income countries. Teaching airway management both didactically and through simulation training is a key component of the GECS Emergencies and Trauma Course. In 2022, a team of doctors delivered an intensive, five-day teaching course with a strong emphasis on airway management and airway emergencies at St. Joseph’s Nyabondo Mission Hospital in rural Kenya. This course was delivered to a group of doctors, nurses and clinical officers. At the conclusion of this course we collected qualitative feedback from course participants. The aim of this study was to assess airway knowledge and skills acquisition, as well as real-world application and potential for ongoing teaching of acquired airway skills.
Method:
A questionnaire was distributed to course participants to ascertain their experience of didactic airway teaching, airway skills stations, and airway simulation. Each question offered a binary response. To continue to enhance course content, we invited participants to submit qualitative feedback at the end of the questionnaire.
Results:
Questionnaires were returned by 19 of a total 24 participants. 53% were registered nurses, 21% were clinical officers, 5% were medical officers and 21% did not respond to this question. Median post graduate clinical experience was four years (2.75-5.25). 37% indicated that they had not heard of simulation training for medical education before undertaking this course. 58% had no previous airway training although 63% had prior exposure to clinical situations which required emergency airway management. 100% reported feeling more confident in their airway skills and potential for training colleagues following this course.
Conclusion:
The results indicate that participants gained knowledge, skills, and confidence when approaching airway emergencies. Furthermore, results showed increased perceived competence by participants at providing airway training to colleagues.
Overcrowding in the Emergency Room (ER) is a worldwide phenomenon affecting healthcare professionals' ability to apply life-saving interventions to critically wounded and sick patients. Implementing a routine triage system allows the early recognition and treatment of critical conditions such as polytrauma, difficulty in breathing, shock, and altered mental status. Furthermore, a triage system allows the prioritization of patients and the delivery of timely care. We describe the improvements in patient care for the critically ill through the implementation of a triage system in Hospital Escuela (HE), a 1306-bed, academic, tertiary care hospital in Honduras
Method:
Demographic data was recovered through paper triage forms from January 2020 until December 2021. From January 2022 to June 2022, the data was primarily recovered from digital triage forms. The data was consolidated, analyzed, and interpreted using Microsoft Excel.
Results:
During the thirty-month period, there were 161,848 triage consults, with 2.7% being critically wounded and sick patients, classified “red” according to the triage system. Most cases were triaged as yellow (53%), followed by green (23.6%), and then orange (15.8%). Some triage forms (5%) did not assign classifications. One-third (33.4%) of consults were diverted from the ER to the Triage and Urgent Care Room (SATU for the acronym in Spanish). Trauma-related cases accounted for 26.2% of the consults with 3.6% of the overall being weapon wounded.
Conclusion:
Implementing a triage system in HE enhanced the recognition and treatment of critically wounded and sick patients. This system has improved patient flow and the use of clinical space in the ER by diverting low-acuity patients to the SATU. Multi-disciplinary collaboration among healthcare professionals has also improved and the need to create a centralized Resuscitation Room was recognized.
Disasters can quickly overwhelm a healthcare system’s capacity and exacerbate existing gaps in access to specialty care. The Region 1 RDHRS has developed a disaster telehealth system. This presentation will highlight how a proof of concept developed into a prototype system, and how it is becoming operational. We will elaborate on the barriers of implementing a telehealth system to provide access to acute consultation with disaster-relevant specialists, and the steps the Region 1 RDHRS is taking to develop solutions.
Method:
An RDHRS is a tiered system across states and regions created to deliver a more coherent and comprehensive response to health security threats. A key RDHRS capability is providing disaster telehealth services to target gaps in healthcare coverage, allowing providers to access disaster-relevant clinical expertise in the immediate aftermath of a catastrophic no-notice event.
The Region 1 RDHRS disaster telehealth system can rapidly mobilize a national pool of volunteer specialists to support overwhelmed local providers at the point of care. This system is flexible to support a range of disasters and easy to navigate without prior training. The system is device-agnostic and functions on existing telecommunication systems without requiring new hardware/software installation.
Results:
Operationalizing a telehealth system to deliver acute episodic unscheduled care across state lines is fraught with challenges. We collaborated with various subject matter experts to develop solutions that allow for rapid volunteer verification, training, and mobilization. Despite advances driven by COVID-19, barriers related to license portability, liability protection, and credentialing of volunteer specialists across state lines remain complex. We are developing disaster waivers and template documents that can be rapidly implemented via executive action at state and regional levels.
Conclusion:
The Region 1 RDHRS team is collaborating with the other pilot sites within the RDHRS program to develop a unified national disaster telehealth response based on this model.
Journalists work in dangerous places. In recent years, the risk of illness and injury while reporting has increased, whether in the setting of conflict, protest, extreme weather, or environmental disaster. Journalists are targeted more than ever before. Working safely in remote and dangerous settings, especially without the protection of a large organization, requires a wide range of skills related to safety and security. For several years, the Dart Center for Journalism and Trauma at Columbia University has offered brief, intensive courses focused on personal safety, self defense, cyber-security and medical skills for freelance journalists working in dangerous settings.
Method:
We re-conceptualized the medical first responder portion of the Dart Center's "Reporting from Crisis Zones" course to emphasize basic skills related to acute injury and illness, from trauma resuscitation (e.g, hemorrhage control) to environmental exposure and medical illness. We identified the most common medical concerns that these learners might encounter and incorporated feedback from prior courses to develop a one-day curriculum meant to address the most pressing needs of incidental first responders with minimal medical training, and whose primary mission is not providing medical care to others.
Results:
The resulting 8-10 hour curriculum focuses on hemorrhage control, basic airway and respiratory maneuvers and wound care, with additional focus on medical illness, indications for evacuation, and communication and prevention techniques. The re-structured curriculum was first offered in Spring 2022. Feedback from learners was positive.
Conclusion:
Basic first responder skills are critical for journalists working in dangerous settings, who represent a unique population of learners with specific needs and objectives. Next steps include developing a better understanding of the medical and traumatic problems truly encountered by this population in the field, assessing the long-term educational impact of the course, and developing ongoing opportunities to reinforce learning via online resources, refresher sessions, and guideline development.
The docimology or "science of examinations" is a scientific discipline devoted to the study of the examination in all its dimensions. The main objective is the development of standards guaranteeing valid, reliable and objective tests. It was adopted within a Medical School in 2007.
Our aim was to analyze results of docimological survey results of written acute medicine examinations through a global approach, by discipline and by item.
Method:
This was a retrospective study analyzing the notes of acute medicine examinations (January and May sessions) of Second Cycle Medical Studies 3). We have calculated docimological parameters allowing three levels of assessment: global, by discipline, and items analysis.
Results:
We analyzed 407 scripts, 99 questions and 6,919 pieces of data. The overall success rate was 97.6%. Highest success rates were found in Medical resuscitation (87%). The lowest rate was found in emergency medicine (53%). The difficulty index for the January session was 0.53 and 0.61 for the May session. For the January session: 24% of questions were easy, 14% of questions were difficult and 61% were of acceptable difficulty. For the May session: 40% of questions were easy, 6% of questions were difficult and 54% were of acceptable difficulty. The discrimination index was 0.27 for the January session and 0.24 for the May session. Discrimination was very good in 18% of items and good in 25%. Useless and bad discrimination items were about 35% for both sessions. Average Cronbach’s Alpha was 0.84, showing good internal-consistency.
Conclusion:
Overall, acute medical examinations have joined docimological recommendations and had an acceptable internal consistency and a good level of difficulty and discrimination. However, some weaknesses had been revealed specially for the discipline with low weighting. A reflection on the integration of questions would make up for these weaknesses. This would ensure better assessment and training.
The use of chemical, biological, radiation, and nuclear (CBRN) weapons is not new, and though rare, it is an issue of concern around the world due to their ability to cause large-scale mass-casualty events and their potential threat to global stability. The purpose of this study is to explore the use of CBRN weapons by non-state actors through analysis of the Violent Non-State Actor (VNSA) CBRN Event database, and aims to better inform health care systems of the potential risks and consequences of such events.
Methods:
Data collection was performed using a retrospective database search through the VNSA CBRN Event database.
Results:
A total of 565 events were recorded. Five hundred and five (505) events (89.4%) involved single agents while 60 events (10.6%) involved multiple agents. Fatalities numbered 965 for chemical agents, 19 for biological agents, and none for radiological and nuclear events. Injuries numbered 7,540 for chemical agents, 59 for biological agents, 50 for radiological events, and none for nuclear attacks. Fatality and injury per attack was 2.22 and 17.37, respectively, for chemical event agents and 0.15 and 0.48, respectively, for biological event agents.
Conclusion:
Violent Non-State Actors were responsible for 565 unique events around the world involving the use of CBRN weapons from 1990-2020. The United States (118), Russia (49), and Iraq (43) accounted for the top three countries where these events occurred. While CBRN events remain relatively rare, technological advances have the potential to facilitate the use of such weapons as part of a hybrid warfare strategy with significant repercussions for civilian health and health care systems.
This study aims to determine and compare the effectiveness of Drop, Cover, and Hold On versus Fetal Position in the Triangle of Life regarding reducing casualties during earthquakes and establishing a consensus among medical search and rescue experts.
Methods:
In this study, the data collected from ten experienced medical search and rescue professionals were analyzed using a three-stage Delphi technique to compare Drop, Cover, and Hold On versus Fetal Position in the Triangle of Life.
Results:
At the end of the first round of Delphi, all of the experts mentioned the following factors: age, position, and surface area of the injured person. A victim’s time under rubble and the experience of search and rescue teams are two prominent factors related to search and rescue. After the earthquake simulation in the second round, mannequin damage rates were examined by opening rubble pavement and tunnels. Following the second round of ratings, a third round of questionnaires was administered. As part of this questionnaire, participants were asked to give a score from one to ten based on their level of agreement. Whether they agreed or disagreed with Fetal Position in the Triangle of Life and Drop, Cover, and Hold On using a ten-point Likert scale, and the agreement rates were measured and compared. Experts completed a comparison of the two positions in the third round.
Conclusion:
According to this expert consensus, the Fetal Position in the Triangle of Life has the following advantages over Drop, Cover, and Hold On: reduced surface area, less crush injuries, protection of a larger body part from injury, better protection from hypothermia, and better maintenance of basal metabolism.
Disaster Medicine (DM) requires skills, knowledge, and prior experience that are rarely put to test by health care providers. Pediatric DM presents unique challenges in terms of both knowledge and practice.
Methods:
An anonymous survey consisting of demographic and five-point Likert scale questions was administered to physicians, nurses, and other medical personnel from Israel’s major medical emergency teams who were deployed to respond to the refugee crisis in Ukraine. This included teams from the Hadassah and Tel Aviv Sourasky Medical Centers and the Israel Ministry of Health.
Results:
Of the 171 members of the medical teams deployed on the Ukraine border, a total of 105 responses were obtained (61.4%) from 61 physicians, 50 nurses, and 12 other health care providers. The teams were composed of pediatricians (31.6%), internal medicine physicians (21.6%), Emergency Medicine and intensive care physicians (18.0%), and 31.0% other specialties.
For 60% of the participants, this was their first deployment, and 78% had received no training in DM. Members rated the need for DM training at 4/5 (IQR 3-5). Forty-nine (49) members (46.6%) were not briefed on situational awareness and 97 members (89.5%) were not trained in the recognition of acute stress reactions. The responders also rated their concerns about providing medical aid to children at 2/5 (IQR 1-3). A medical clown was part of the teams 42.8% of the time; the presence of clowns was rated at a median of 4/5 (IQR 4-5). The team members underscored the need for more targeted training in DM at 5/5 (IQR 3-5).
Conclusion:
The findings highlight the need for the formulation of a disaster education model that includes pediatric DM.
In the last ten years, Japan has experienced several large-scale earthquakes with devastating social and health impacts. Earthquakes directly and indirectly cause a variety of health problems. Further investigation is required to increase preparedness and preventive efforts. In response to the Hokkaido Eastern Iburi Earthquake on September 6, 2018, 32 Emergency Medical Teams (EMTs) employed the Japanese version of Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED) as a national standard daily reporting template, gathering data on the number and type of health problems treated.
Study Objective:
The purpose of the study is to conduct a descriptive epidemiology study using the J-SPEED data to better understand the health problems during the earthquake disaster.
Methods:
Reported items in J-SPEED (Ver 1.0) form were analyzed by age, gender, and time to better understand the health issues that have arisen from the earthquake.
Results:
Most consultations (721; 97.6%) occurred between Day 1 and Day 13 of the 32-day EMT response. During the response period, disaster stress-related symptoms were the most common health event (15.2%), followed by wounds (14.5%) and skin diseases (7.0%).
Conclusion:
The most often reported health event during the response period was stress-associated illnesses related to disasters, followed by wounds and skin conditions. The health consequences of natural disasters depend on diverse local environment and population. As a result, this initial study was hard to generalize; however, it is expected that data accumulated using the J-SPEED system in the future will strengthen and extend the conclusions.
Disaster Medicine (DM) is defined by Koenig and Shultz as the “disciplines and organizations involved with governmental public health, public and private medical delivery including Emergency Medical Services (EMS), and governmental emergency management.” The Accreditation Council for Graduate Medical Education (ACGME) sets curriculum requirements and standards for Emergency Medicine (EM) residencies and EMS fellowships, which include a limited portion of the DM curriculum topics recommended by the Society of Academic Emergency Medicine (SAEM). The ACGME does not currently approve DM fellowships, as DM is not recognized as a subspecialty by the American Board of Medical Specialties (ABMS). This lack of nationally standardized guidelines for DM training leads to variability in disaster-related knowledge and skills, even among physicians trained by ACGME-accredited programs.
Study Objective:
The objective of this study is to analyze the DM components covered in EM residency and EMS fellowship in the United States and compare those to SAEM DM fellowship curriculum guidelines.
Methods:
The DM curriculum components of EM residencies and EMS fellowships were evaluated, using the SAEM DM curriculum as a control. Overlapping topics, as well as gaps between the programs, were analyzed using descriptive statistics.
Results:
Of the DM curriculum components developed by SAEM, EMS fellowship covered 15 of 19 (79%) major curriculum components and 38 of 99 (38%) subtopics, while EM residency covered seven of 19 major curriculum components (37%) and 16 of 99 (16%) subtopics. Together, EM residency and EMS fellowship cover 16 of 19 (84%) major curriculum components and 40 of 99 (40%) subtopics.
Conclusion:
While EMS fellowship covers a large portion of the DM major curriculum components recommended by SAEM, there are several important DM subtopics that are not covered either in EM residency or EMS fellowship. Furthermore, there is no standardization for the depth and manner that DM topics are addressed in either curriculum. Time constraints in EM residency and EMS fellowship may also prevent extensive review of important DM topics. Disaster Medicine covers a distinct body of knowledge, represented in the curriculum subtopics, that are not covered in either EM residency or EMS fellowship. The development of an ACGME-accredited DM fellowship and recognition of DM as a distinct subspecialty could allow for more effective DM graduate medical education.
Ethiopian policy and strategy aim to make health care systems capable of dealing with emergencies. However, Ethiopian health care still lacks a comprehensive “all-hazard” approach and a disaster preparedness program. Thus, this study aimed to assess the level of disaster preparedness in selected public hospitals for mass-casualty incidents (MCIs) in Amhara Regional State, Northwest Ethiopia.
Methods:
A descriptive cross-sectional study was conducted at general and comprehensive specialized hospitals (CSHs) in Amhara Regional State, Ethiopia using a World Health Organization (WHO) hospital emergency response checklist that included a domain on mass-casualty management (MCM) adapted from a literature review.
Results:
Seventeen (17) hospitals were evaluated (response rate: 81%). Five (29.4%) were teaching hospitals (tertiary health care) and 12 (70.5%) were non-teaching (secondary health care) hospitals. With an average mean of 97.3 (SD = 33.68; range 31-160), most hospitals under WHO required an Acceptable level of preparedness. Two were at an Unacceptable (0-67) level of preparedness, 12 (70.5%) hospitals were at an Insufficient (68-134) state, while the other three had an Acceptable (135-192) level of preparedness.
Conclusion:
The preparedness level of hospitals is Insufficient for potential MCIs in this region and needs prior attention in implementing existing strategic guidelines to develop and activate hospital disaster plans if and when needed.
The aim of this review was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians.
Report and Methods:
PubMed, Embase, CINAHL, and SCOPUS were searched from January 1, 2006 through March 15, 2022 for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven (11) observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing (survey-weight adjusted odds ratio [OR] 4.20; 95% confidence interval [CI], 1.02 to 17.27) and less frequent hand hygiene after glove use (survey-weight adjusted OR 10.51; 95% CI, 2.54 to 43.45) were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity (unadjusted risk ratio [RR] 4.2; 95% CI, 1.03 to 17.22). Workers were more likely to be vaccinated against influenza if their employer offered the vaccine (unadjusted OR 3.3; 95% CI, 1.3 to 8.3). Active, targeted education modules for H1N1 influenza were effective at increasing vaccination rates and the success of on-site vaccine clinics.
Conclusions:
Evidence from the United States exists on the effectiveness of IPC practices in EMS clinicians, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. More research is needed on the effectiveness of PPE and vaccine acceptance.
Terrorist attacks against hospitals and health care providers have disproportionally increased during the last decades. A significant proportion of these attacks targeted abortion clinics and abortion providers. In the light of the overturning of Roe v. Wade in 2022, an increase of anti-abortion terrorist attacks is anticipated. Therefore, it becomes imperative to gain further insight into the risk and characteristics of past terrorist attacks. This study aimed to review terrorist attacks against health care targets providing abortion services from 1970 through 2020.
Methods:
Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database functions for all terrorist attacks against abortion health care providers from January 1, 1970 - December 31, 2020. Temporal factors, location, attack and weapon type, and number of casualties or hostages were analyzed using descriptive statistics.
Results:
In total, 262 terrorist attacks were identified in five different countries. The majority (96.6%) occurred in the United States, with the highest counts during the last 20 years of the 20th century. Facility and infrastructure attacks were the most common attack types, followed by bombings and explosions. The attacks resulted in 34 injuries and nine fatalities. Kidnapping took place in three incidents. Of all successful attacks, 96.9% resulted in property damage.
Conclusion:
Abortion-related health care facilities and providers have repeatedly been the target of terrorists over the past decades. Nearly all of these attacks took place in the United States, with the highest counts during the last 20 years of the 20th century.
Foreign body airway obstruction (FBAO) is a life-threatening emergency, and the prognosis of patients with FBAO is greatly affected by the prehospital process. There are only a few large-scale studies analyzing prehospital process databases of the fire department.
Study Objective:
The aim of this study was to investigate whether characteristics of patients with FBAO were associated with prehospital factors and outcomes.
Methods:
In this retrospective observational study, patients transferred to the hospital by the Tokyo, Japan Fire Department for FBAO from 2017 through 2019 were included. The association between neurologically favorable survival among the characteristics of patients with FBAO and prehospital factors affecting the outcomes was evaluated.
Results:
Of the 2,429,175 patients, 3,807 (0.2%) patients had FBAO. The highest number of FBAO cases was 99 (2.6%), which occurred on January 1 (New Year’s Day), followed by 40 cases (1.1%) on January 2, and 28 cases (0.7%) on January 3. The number of patients who experienced out-of-hospital cardiac arrest (OHCA) caused by FBAO was 1,644 (43.2%). Comparing the OHCA and non-OHCA groups, there were significant differences in age, sex, time spent at the site, and distance between the site and hospital. Cardiac arrest was significantly lower in infants after FBAO (P < .001). In total, 98.2% of patients who did not have return of spontaneous circulation (ROSC) before hospital arrival died within 30 days, a significantly higher mortality rate than that in patients who had ROSC (98.2% versus 65.8%; P < .001).
Conclusions:
Among patients who did not have ROSC following FBAO upon arrival at the hospital, 98.2% died within 30 days. Thus, it is important to remove foreign bodies promptly and provide sufficient ventilation to the patient at the scene to increase the potential for ROSC. Further, more precautions should be exercised to prevent FBAO at the beginning of the year.
Sports venues foster community and support local economies. Due to their capacity to host hundreds to thousands of spectators, sports venues are vulnerable to becoming targets of terrorism. Types of venues targeted, regional trends, and methods of attack employed world-wide have not been well-described.
Methods:
A search of the Global Terrorism Database (GTD) was conducted from 1970 through the end of 2019. Pre-coded variables for target type “business” and target subtype “entertainment/cultural/stadium/casino” were used to identify attacks involving venues where sports events might be viewed by spectators as part of an audience. Sports venues were specifically identified using the search terms “sport,” “stadium,” ”arena,” and “ring,” as well as mention of any specific sport. Two authors then manually reviewed each entry for specific information to confirm appropriateness for inclusion, selecting preferentially for attacks against venues where watching a sports event was the primary focus for the majority of the attendees. Descriptive statistics were performed using R (3.6.1).
Results:
Seventy-four (74) terrorist attacks targeting sports venues were identified from January 1, 1970 through December 31, 2019. Thirty-three (33) attacks, or 44.6% of attacks, involved soccer stadiums or soccer venues, while 33.8% of attacks (25 attacks) involved unspecified sports venues. A bombing or explosion was the most frequent method of attack employed, comprising 87.8% of attacks. The highest number of attacks occurred in the Middle East & North Africa. In total, 213 persons died and 699 more were wounded in attacks against sports venues.
Conclusion:
Although terrorist attacks against sports venues are uncommon, they carry the risk of mass casualties, especially when explosives are used. A greater understanding of the threat posed by terrorist attacks against sports venues can aid emergency preparedness planning and future medical responses.