South Korea has experienced >30 suspected terrorism-related events since 1958, including attacks against South Korean citizens in foreign countries. The most common types of terrorism used have included bombings, shootings, hijackings, and kidnappings. Prior to 1990, North Korea was responsible for almost all terrorism-related events inside of South Korea, including multiple assassination attempts on its presidents, regular kidnappings of South Korean fisherman, and several high-profile bombings. Since 1990, most of the terrorist attacks against South Korean citizens have occurred abroad and have been related to the emerging worldwide pattern of terrorism by international terrorist organizations or deranged individuals.

The 1988 Seoul Olympic Games provided a major stimulus for South Korea to develop a national emergency response system for terrorism-related events based on the participation of multiple ministries. The 11 September 2001 World Trade Center and Pentagon attacks and the 2001 United States of America (US) anthrax letter attacks prompted South Korea to organize a new national system of emergency response for terrorism-related events. The system is based on five divisions for the response to specific types of terrorist events, involving conventional terrorism, bioterrorism, chemical terrorism, radiological terrorism, and cyber-terrorism. No terrorism-related events occurred during the 2002 World Cup and Asian Games held in South Korea. The emergency management of terrorism-related events in South Korea is adapting to the changing risk of terrorism in the new century.

A terrorism movement has been active in Spain during the last 20 years, with a painful number of victims. Civil Defense is in charge of the coordination of all the structures that are implicated in a terrorist incident. There are three typical patterns of attacks: (1) individual attacks; (2) group attacks; and (3) mass attacks. The individual attacks are done with guns, usually 9 mm, fired from a short distance; victims die from serious intracranial damage. Collective attacks are done using explosives under vehicles, tramp bombs, or “bomb vehicles;” victims are of different severity with wounds, burns, and blast injuries. With mass attacks with “bomb vehicles” in buildings or crowded public places, the numbers of victims are elevated and produce brutal social consequences.

Emergency Medical Services integrated in to “Civil Defense” try to minimize the damage by initializing treatment on-scene and with the rapid provision of definitive care. During the last year, post-traumatic stress disorder treatment groups have been providing care to the victims and personnel. Chemical or biological weapons have not been used, although this is a great concern to the authorities.

Over the past two decades, terrorism has exacted an enormous toll on the Republic of Turkey, a secular democracy with a 99.8% Muslim population. From 1984 to 2000, an estimated 30,000 to 35,000 Turkish citizens were killed by a nearly continuous stream of terrorism-related events. During this period, the Partiya Karekeren Kurdistan (PKK), a Kurdish separatist group (re-named KADEK in 2002), was responsible for the vast majority of terrorism-related events (and casualties), which disproportionately affected the eastern and southeastern regions of Turkey, in which the PKK has focused its activities. Most terrorist attacks over the past two decades have been bombings or shootings that produced <10 casualties per event. From 1984 to 2003, 15 terrorist attacks produced ≥30 casualties (eight shootings, five bombings, and two arsons). The maximum number of casualties produced by any of these events was 93 in the Hotel Madimak arson attack by the Tu r kish Islamic Movement in 1993.

This pattern suggests that terrorist attacks in Turkey rarely required more than local systems of emergency medical response, except in rural areas where Emergency Medical Services (EMS) are routinely provided by regional military resources. The last decade has seen the development of several key systems of local emergency response in Turkey, including the establishment of the medical specialty of Emergency Medicine, the establishment of training programs for EMS providers, the spread of a generic, Turkish hospital emergency plan based on the Hospital Emergency Incident Command System, and the spread of advanced training in trauma care modeled after Advanced Trauma Life Support.