Background: Bombings are an increasing threat to the public's health. Descriptive studies of blast injuries have been published, but these injuries have not been studied using analytical epidemiological methods. This study assesses factors associated with fatality risk among individuals exposed to the 1995 Oklahoma City bombing.

Methods: Retrospective case-control analysis using multivariable logistic regression. Odds ratios (OR) of fatality are calculated among occupants of the Alfred P. Murrah Federal Building on April 19, 1995.

Results: Of the 348 occupants exposed, 163 (46.8%) were fatally injured. Fatality risk was greatest in the collapsed region of the building (adjusted OR 176.7, 95% confidence interval [CI] 65.9–474.2). Age ≥40 was also associated with a significantly increased risk of fatality (OR 3.7, 95% CI 1.4–9.8). Among people found in the noncollapsed region of the building, employees' status compared to a visitor's or child's status was protective (OR 0.13, 95% CI 0.01–1.3)

Conclusions: Structural collapse is the most important risk factor for fatality in a building bombing. Progressive collapse may be prevented through more supportive building design. Protection of vulnerable building occupants can be improved by placement of relevant facilities in more structurally reinforced areas. Regular evacuation training of personnel and clear egress routes may also reduce fatality in a building bombing. (Disaster Med Public Health Preparedness. 2007;1:27–33)

During the morning rush hour on Thursday, 07 July 2005, a series of four bombs exploded, affecting London's public transport system.These terrorist attacks killed 52 people and injured >700.A majorincident was declared, and the Royal London Hospital (RLH) was a primary receiving hospital.

A total of 194 patients presented to the RLH.Twenty-seven patients required admission. A total of 11 amputations were performed on eight patients. One patient died intra-operatively.Another patient died on Day 6 due to complications related to a head injury.

Coordination is vital to the implementation of the hospital's Major Incident Plan in such an emergency. Subsequent internal reviews of the response of the RLH on 07 July 2005 highlighted problems with communication and documentation, as well as the need for extra staffing.These areas should be improved for the management of future major incidents.

This Panel Session consisted of five country reports (India, Indonesia, Maldives, Thailand, andNepal) and the common issues identified during the Panel discussions relative to seismic events in the Southeast Asia Region. Important issues identified included the needs for: (1) a legal framework upon which to base preparedness and response; (2) coordination between the many organizations involved; (3) early warning systems within and between countries; (4) command and control; (5) access to resources including logistics; (6) strengthening the health infrastructure; (7) professionalizing the field of disaster medicine and management; (8) management of communications and information; (9) management of dead bodies; and (10) mental health of the survivors and health workers.

Two major domestic terrorist groups have plagued Peru over the past 20 years, the Sendero Luminoso or “Shining Path” (SL) and the Revolutionary Movement Túpac Amaru (MRTA). On 28 August 2003, the Peruvian Truth and Reconciliation Commission reported that an estimated 69,280 persons were killed in the internal conflict in Peru from 1980 to 2000. Most of the victims were farmers (56%), most attacks occurred in rural settings (79%), and the SL was responsible for mostof the deaths (54%). Aggressive anti-terrorism efforts by police and military during this period, often at the expense of basic human rights, also contributed to this large burden of terrorism on Peru. During the 1990s, terrorist attacks in Peru had spread to its urban areas. On 17 December 1996, 22 members of MRTA took over the Japanese ambassador's residence in Lima, holding 72 hostages until the grounds were stormed by Peruvian special forces on 23 April 1997.

Until recently, emergency planning and preparedness for terrorism-related events in Peru were largely underdeveloped. In the last five years, Peru has taken two key steps towards developing a mature emergency response system, with the establishment of the country's first emergency medicine residency training program and the construction of the first dedicated trauma center in Lima.

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.

Indonesia has had its share of natural and manmade disasters. From 1997 to 2002, Indonesia has experienced 90 incidents of terrorist bomb attacks. In 13 (14.4%) of the terrorist attacks, the bombs did not explode. A total of 224 persons have been killed, and 340 persons have been injured. Most of those killed or injured were the result of the bombings in Jakarta and Bali. Besides bombings, there have been riots, especially in Jakarta. The Indonesian Surgeons Association established the 1–1–8 Emergency Ambulance Service Foundation to develop the Prehospital Emergency Medical Services in Indonesia. Despite difficulties, this service has been implemented in 18 cities. The occurrence of disasters, riots, ethnic conflicts, terrorist attacks, and the introduction of the Advanced Trauma Life Support (ATLS) course in 1995, have helped to convince the people and the government that it was important to develop this 1–1–8 Emergency Ambulance Services system, and agreed to accept a Safe Community Program. With the Safe Community Program, Jakarta with its Integrated 1–1–8 Emergency Ambulance Service managed to provide proper emergency medical care to the casualties caused by terrorist bombings, riots, and in the three weeks of floods during which 75% of Jakarta was submerged.

The Republic of China on the island of Taiwan has experienced at least 20 terrorist events since 1979, including 13 aircraft hijackings and five bombings. Factors responsible for the relatively small burden of terrorism on Taiwan in the past include tight military control over political dissent until 1987, a warming relationship with the People's Republic of China in the 1990s, political inclusion of major internal cultural groups, geographic isolation, and a lack of other significant international enemies. Nevertheless, today Taiwan faces a new prospect of terrorism by adversaries of the United States and its allies and by an international paradigm shift in the types of weapons used by terrorists.

National emergency management has been enhanced significantly since the Ji Ji earthquake in 1999, including the assignment of lead government agencies to the planning and preparedness for specific types of terrorist events involving nuclear, biological, and/or chemical releases. Other significant improvements at the operations level, include the establishment of two national disaster medical assistance teams, four urban search and rescue teams, 13 local disaster medical assistance teams, and eight chemical emergency response hospitals. Future challenges include improving the coordination of inter-agency response at the national level and the quantity and quality of local disaster response assets.