Terrorism-Related Chemical, Biological, Radiation, and Nuclear Attacks: A Historical Global Comparison Influencing the Emergence of Counter-Terrorism Medicine

2021 ◽  
pp. 1-4
Author(s):  
Derrick Tin ◽  
Fredrik Granholm ◽  
Alexander Hart ◽  
Gregory R. Ciottone
Keyword(s):  
Health Care ◽  
Grey Literature ◽  
Low Frequency ◽  
Disaster Medicine ◽  
Terrorist Attacks ◽  
Fecal Matter ◽  
Counter Terrorism ◽  
Global Comparison ◽  
State Terrorism ◽  
Fatal Injuries

Abstract Background: Terrorist attacks are growing in complexity, increasing concerns around the use of chemical, biological, radiation, and nuclear (CBRN) agents. This has led to increasing interest in Counter-Terrorism Medicine (CTM) as a Disaster Medicine (DM) sub-specialty. This study aims to provide the epidemiology of CBRN use in terrorism, to detail specific agents used, and to develop training programs for responders. Methods: The open-source Global Terrorism Database (GTD) was searched for all CBRN attacks from January 1, 1970 through December 31, 2018. Attacks were included if they fulfilled the terrorism-related criteria as set by the GTD’s Codebook. Ambiguous events or those meeting only partial criteria were excluded. The database does not include acts of state terrorism. Results: There were 390 total CBRN incidents, causing 930 total fatal injuries (FI) and 14,167 total non-fatal injuries (NFI). A total of 347 chemical attacks (88.9% of total) caused 921 FI (99.0%) and 13,361 NFI (94.3%). Thirty-one biological attacks (8.0%) caused nine FI (1.0%) and 806 NFI (5.7%). Twelve radiation attacks (3.1%) caused zero FI and zero NFI. There were no nuclear attacks. The use of CBRN accounted for less than 0.3% of all terrorist attacks and is a high-risk, low-frequency attack methodology. The Taliban was implicated in 40 of the 347 chemical events, utilizing a mixture of agents including unconfirmed chemical gases (grey literature suggests white phosphorous and chlorine), contaminating water sources with pesticides, and the use of corrosive acid. The Sarin gas attack in Tokyo contributed to 5,500 NFI. Biological attacks accounted for 8.0% of CBRN attacks. Anthrax was used or suspected in 20 of the 31 events, followed by salmonella (5), ricin (3), fecal matter (1), botulinum toxin (1), and HIV (1). Radiation attacks accounted for 3.1% of CBRN attacks. Monazite was used in 10 of the 12 events, followed by iodine 131 (1) and undetermined irradiated plates (1). Conclusion: Currently, CBRN are low-frequency, high-impact attack modalities and remain a concern given the rising rate of terrorist events. Counter-Terrorism Medicine is a developing DM sub-specialty focusing on the mitigation of health care risks from such events. First responders and health care workers should be aware of historic use of CBRN weapons regionally and globally, and should train and prepare to respond appropriately.

Terrorist Attacks in Western Europe: A Counter-Terrorism Medicine Analysis

2022 ◽  
pp. 1-6
Author(s):  
Derrick Tin ◽  
Dennis G. Barten ◽  
Harald De Cauwer ◽  
Luc JM Mortelmans ◽  
Gregory R. Ciottone
Keyword(s):  
French Revolution ◽  
Western Europe ◽  
Disaster Medicine ◽  
Database Search ◽  
Terrorist Attacks ◽  
Modern Concept ◽  
Mass Casualties ◽  
Global Trends ◽  
Counter Terrorism ◽  
Reign Of Terror

Abstract Background: The modern concept of terrorism has its roots in the “old continent” of Western Europe, more specifically in France, during the “Reign of Terror” period of the French Revolution. At the time, this form of state terror had a positive connotation: it was a legitimate means of defending the young state. While no single accepted definition of terrorism exists today, it is universally considered an attack on both state and society. The health care impacts of terrorist attacks often extend disproportionally beyond the casualty toll, but the potential for such events to induce mass casualties remains a concern to Disaster Medicine and Counter-Terrorism Medicine (CTM) specialists. Method: Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all events which occurred in Western Europe from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary weapon type, country where the incident occurred, and number of deaths and injured were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. Results: A total of 15,306 events were recorded in Western Europe out of a total of 201,183 events world-wide between the years 1970 and 2019 inclusive. This resulted in a total of 5,548 deaths and 17,187 injuries. Explosives were used as a primary weapon/attack modality in 8,103 attacks, followed by incendiary attacks in 3,050 events and firearm use in 2,955 events. The use of chemical, biological, radiation, and nuclear (CBRN) weapons was rare and only accounted for 47 events. Conclusion: From 1970 through 2019, 9.11% of all terrorist attacks occurred in Western Europe. Compared to global trends of attack methodologies in the same study period, the use of explosives as a primary attack modality in Western Europe was similar (52.94% in Western Europe versus 48.78% Global). Firearm use was comparatively low (19.31% versus 26.77%) and the use of CBRN as an attack modality was rare (0.30% versus 0.20%). The United Kingdom, Spain, and France accounted for over 65% of all terrorist attacks and over 75% of terrorism-related deaths in Western Europe.

Counter-Terrorism Medicine: Creating a Medical Initiative Mandated by Escalating Asymmetric Attacks

2020 ◽  
Vol 35 (6) ◽  
pp. 595-598 ◽  
Author(s):  
Michael Court ◽  
Brydie Edwards ◽  
Fadi Issa ◽  
Amalia Voskanyan ◽  
Gregory Ciottone
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Disaster Medicine ◽  
The Body ◽  
Health Care Planning ◽  
Counter Terrorism ◽  
Definition Of ◽  
Discrete Part ◽  
Heath Care ◽  
Political Health

AbstractIntroduction:Since 2001, a burgeoning interest by health care professionals in the growing asymmetrical terrorist threat and its impact on health care preparation and response has seen significantly increased academic output around this nebulous subject. Despite this, there has failed to be a consolidation of this sub-specialty.Discussion:This editorial argues for the consolidation of the body of experience gathered since 2001 into an initiative called Counter-Terrorism Medicine (CTM). It proposes that previously discrete sub-specialty areas can be consolidated, with improvements in collective understanding, and can build on previous work to provide a non-political health care focused definition of terrorist events, based on the triad of Violence, Intent, and Heath Care Impact. It notes the importance this defining triad has in health care planning and response considerations. Finally, it defines the parameters of CTM within the larger specialty of Disaster Medicine (DM).Conclusion:There is a growing body of academic work on the health care implications of terrorism. The time is right to coalesce these into an initiative referred to as CTM and to consider this as a discrete part of DM.

scholarly journals Opioid Attack and the Implications for Counter-Terrorism Medicine

2021 ◽  
pp. 1-3
Author(s):  
Derrick Tin ◽  
Zachary Kallenborn ◽  
Alexander Hart ◽  
Attila J. Hertelendy ◽  
Gregory R. Ciottone
Keyword(s):  
The United States ◽  
Disaster Medicine ◽  
Terrorist Attacks ◽  
Chemical Weapons ◽  
Terrorist Organizations ◽  
Counter Terrorism ◽  
Chemical Weapons Convention ◽  
Response Measures ◽  
Potential Use

Abstract While the opioid epidemic engulfing the United States and the globe is well-documented, the potential use of powerful fentanyl derivatives as a weapon of terror is increasingly a concern. Carfentanyl, a powerful and deadly fentanyl derivative, is seeing a surge in popularity as an illegal street drug, and there is increasing congressional interest surrounding the classification of opioid derivatives under the Chemical Weapons Convention (CWC) given their potential to cause harm. The combination of the potency of opioid derivatives along with the ease of accessibility poses a potential risk of the use of these deadly agents as chemical weapons, particularly by terrorist organizations. Disaster Medicine specialists in recent years have established a sub-specialty in Counter-Terrorism Medicine (CTM) to address and research the unique terrorism-related issues relating to mitigation, preparedness, and response measures to asymmetric, multi-modality terrorist attacks.

A Decade of Terrorism in the United States and the Emergence of Counter-Terrorism Medicine

2021 ◽  
pp. 1-5
Author(s):  
Derrick Tin ◽  
Alexander Hart ◽  
Gregory R. Ciottone
Keyword(s):  
United States ◽  
Grey Literature ◽  
The United States ◽  
Counter Terrorism ◽  
The Past ◽  
The Us ◽  
Global Terrorism ◽  
National Newspaper ◽  
Global Terrorism Database ◽  
Fatal Injuries

Abstract Background: The United States (US) is ranked 22nd on the Global Terrorism Index (2019), a scoring system of terrorist activities. While the global number of deaths from terrorism over the past five years is down, the number of countries affected by terrorism is growing and the health care repercussions remain significant. Counter-Terrorism Medicine (CTM) is rapidly emerging as a necessary sub-specialty, and this study aims to provide the epidemiological context over the past decade supporting this need by detailing the unique injury types responders are likely to encounter and setting the stage for the development of training programs utilizing these data. Methods: The Global Terrorism Database (GTD) was searched for all attacks in the US from 2008-2018. Attacks met inclusion criteria if they fulfilled the three terrorism-related criteria as set by the GTD. Ambiguous events were excluded when there was uncertainty as to whether the incident met all of the criteria for inclusion in the GTD. The grey literature was reviewed, and each event was cross-matched with reputable international and national newspaper sources online to confirm or add details regarding weapon type used and, whenever available, details of victim and perpetrator fatalities and injuries. Results: In total, 304 events were recorded during the period of study. Of the 304 events, 117 (38.5%) used incendiary-only weapons, 80 (26.3%) used firearms as their sole weapon, 55 (18.1%) used explosives, bombs, or dynamite (E/B/D), 23 (7.6%) were melee-only, six (2.0%) used vehicles-only, four (1.3%) were chemicals-only, two (0.7%) used sabotage equipment, two (0.7%) were listed as “others,” and one (0.3%) used biological weapon. There was no recorded nuclear or radiological weapon use. In addition, 14 (4.6%) events used a mix of weapons. Conclusions: In the decade from 2008 through 2018, terrorist attacks on US soil used weapons with well-understood injury-causing modalities. A total of 217 fatal injuries (FI) and 660 non-fatal injuries (NFI) were sustained as a result of these events during that period. Incendiary weapons were the most commonly chosen methodology, followed by firearms and E/B/D attacks. Firearm events contributed to a disproportionality high fatality count while E/B/D events contributed to a disproportionally high NFI count.

scholarly journals Understanding Adaptive Bioterrorism Methods: Counter Terrorism Medicine implications of Bongkrekic Acid Poisoning

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Derrick Tin ◽  
Attila J. Hertelendy ◽  
Fadi Issa ◽  
Gregory R. Ciottone
Keyword(s):  
Disaster Medicine ◽  
Terrorist Attacks ◽  
Counter Terrorism ◽  
Reduce Risk ◽  
Bongkrekic Acid ◽  
Terrorist Events

Terrorist attacks fall under a unique category within the disaster medicine (DM) spectrum. Unlike accidental man-made disasters where there is an inherent pre-disaster objective to reduce risk and mitigate potential hazards, terrorist events have the aim of intentionally inflicting maximum casualties and disrupting the day to day functioning of society.

scholarly journals On the Issue of Special Exercises in the Counterterrorism System Involving Specialists of Health Care Management Bodies, Medical Formations and Organizations

2021 ◽  
pp. 11-16
Author(s):  
I.G. Titov ◽  
Keyword(s):  
Health Care ◽  
Military Training ◽  
Disaster Medicine ◽  
Healthcare Management ◽  
Expert Assessment ◽  
Counter Terrorism ◽  
Organizational Issues ◽  
Medicine Service ◽  
The Subject ◽  
Terrorist Acts

The objectives of the study are to analyze the experience of exercises conducted in the counter-terrorism system by specialists of the regional Disaster Medicine Service, to identify key organizational issues of preparation and implementation of exercises; to develop proposals for their improvement in the subject of elimination of medical and sanitary consequences of terrorist acts committed with the use of conventional means of destruction. Materials and research methods. Sources of information and materials studied: normative and methodological documents regulating the procedures of organizing and conducting military training in the field of healthcare; materials of trainings performed by specialists from regional EMC on the subject of organizing the liquidation of medical and sanitary consequences of terrorist acts; data from expert evaluation maps on the subject of the study; scientific papers and publications on technologies of training and exercises involving specialists from healthcare management bodies, medical units and organizations. The following scientific methods were used in the research: content analysis method, expert assessment method, statistical method, logical and informational modeling, and analytical method. Results of research and their analysis. The results of the study of basic organizational issues of preparing and conducting special exercises (command-staff exercise, staff training, tactical and special exercises) conducted in the regions with the participation of specialists of public health authorities, medical formations and organizations within the framework of counter-terrorism are presented. Sound proposals were made to improve the technology of preparing and conducting special exercises and communicating their results to medical specialists. The results of the study showed that almost all the experts (98.0%) were in full agreement with the need, in order to maintain and increase the preparedness of health care authorities, medical organizations, including emergency medical care and the Disaster Medicine Service, to conduct regional trainings on the subject of medical support of the population during terrorist acts. And only 2.0% of the experts had difficulty in formulating a specific conclusion on this issue.

scholarly journals 50 Years of Mass-Fatality Terrorist Attacks: A Retrospective Study of Target Demographics, Modalities, and Injury Patterns to Better Inform Future Counter-Terrorism Medicine Preparedness and Response

2021 ◽  
pp. 1-5
Author(s):  
Derrick Tin ◽  
Attila J. Hertelendy ◽  
Alexander Hart ◽  
Gregory R. Ciottone
Keyword(s):  
Target Selection ◽  
Disaster Medicine ◽  
Study Data ◽  
Counter Terrorism ◽  
Unknown Number ◽  
Private Citizens ◽  
Near Future ◽  
Global Terrorism Database ◽  
Mass Fatality ◽  
Fatal Injuries

Abstract Background: Terrorism-related deaths have fallen year after year since peaking in 2014, and whilst the coronavirus disease 2019 (COVID-19) pandemic has disrupted terrorist organizations capacity to conduct attacks and limited their potential targets, counter-terrorism experts believe this is a short-term phenomenon with serious concerns of an escalation of violence and events in the near future. This study aims to provide an epidemiological analysis of all terrorism-related mass-fatality events (>100 fatalities) sustained between 1970-2019, including historical attack strategies, modalities used, and target selection, to better inform health care responders on the injury types they are likely to encounter. Methods: The Global Terrorism Database (GTD) was searched for all attacks between the years 1970-2019. Attacks met inclusion criteria if they fulfilled the three terrorism-related criteria as set by the GTD codebook. Ambiguous events were excluded. State-sponsored terrorist events do not meet the codebook’s definition, and as such, are excluded from the study. Data analysis and subsequent discussions were focused on events causing 100+ fatal injuries (FI). Results: In total, 168,003 events were recorded between the years 1970-2019. Of these, 85,225 (50.73%) events recorded no FI; 67,356 (40.10%) events recorded 1-10 FI; 5,791 (3.45%) events recorded 11-50 FI; 405 (0.24%) events recorded 51-100 FI; 149 (0.09%) events recorded over 100 FI; and 9,077 (5.40%) events recorded unknown number of FI. Also, 96,905 events recorded no non-fatal injuries (NFI); 47,425 events recorded 1-10 NFI; 8,313 events recorded 11-50 NFI; 867 events recorded 51-100 NFI; 360 events recorded over 100 NFI; and 14,130 events recorded unknown number of NFI. Private citizens and property were the primary targets in 67 of the 149 high-FI events (100+ FI). Of the 149 events recording 100+ FI, 46 (30.87%) were attributed to bombings/explosions as the primary attack modality, 43 (28.86%) were armed assaults, 23 (15.44%) hostage incidents, two (1.34%) were facility/infrastructure attacks (incendiary), one (0.67%) was an unarmed assault, seven (4.70%) had unknown modalities, and 27 (18.12%) were mixed modality attacks. Conclusions: The most common attack modality causing 100+ FI was the use of bombs and explosions (30.87%), followed by armed assaults (28.86%). Private citizens and properties (44.97%) were most commonly targeted, followed by government (6.04%), businesses (5.37%), police (4.70%), and airports and aircrafts (4.70%). These data will be useful for the development of training programs in Counter-Terrorism Medicine (CTM), a rapidly emerging Disaster Medicine sub-specialty.

Deterrence and Democracy

2018 ◽  
Author(s):  
Richard A. Falkenrath
Keyword(s):  
War On Terror ◽  
Terrorist Attacks ◽  
Global War On Terror ◽  
Counter Terrorism ◽  
Liberal Democratic ◽  
The Us ◽  
Democratic Societies ◽  
Global War ◽  
Taking Action ◽  
The Given

This chapter examines strategy and deterrence and traces the shift from deterrence by ‘punishment’ to deterrence by ‘denial’ in Washington’s conduct of the Global War on Terror. The former rested on an assumption that the consequences of an action would serve as deterrents. The latter may carry messages of possible consequences, but these are delivered by taking action that removes the capabilities available to opponents – in the given context, the Islamist terrorists challenging the US. Both approaches rest on credibility, but are more complex in the realm of counter-terrorism, where the US authorities have no obvious ‘return to sender’ address and threats to punish have questionable credibility. In this context, denial offers a more realistic way of preventing terrorist attacks. Yet, the advanced means available to the US are deeply ethically problematic in liberal democratic societies. However, there would likely be even bigger questions if governments failed to act.

scholarly journals P070: Mixed effectiveness of emergency department diversion strategies: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102
Author(s):  
S.W. Kirkland ◽  
A. Soleimani ◽  
B.H. Rowe ◽  
A.S. Newton
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Services ◽  
Grey Literature ◽  
Study Data ◽  
Care Utilization ◽  
Alternative Source ◽  
Increased Risk ◽  
The Impact

Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.

scholarly journals State Terrorism and Counter-terrorism

Terrorism ◽  
2004 ◽  
pp. 113-127 ◽  
Author(s):  
Igor Primoratz
Keyword(s):  
Counter Terrorism ◽  
State Terrorism
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