Counter-Terrorism Medicine is a new area of expertise mandated by the increasingly complex and devastating terrorist attacks seen recently around the world. We are facing an emerging healthcare crisis, the first to arise in the 21st century. War is evolving from two armies facing off on a battlefield to asymmetric, multi-modality attacks on civilians in our metropolitan centers, mass gathering sites, and transportation hubs. In a world where high-profile events such as those in Paris, Brussels, Nice, and London occur all too often, and lower-profile attacks on soft civilian targets are a nearly daily occurrence, we must learn to be proactive rather than reactive in the steps we take. It is time we define exactly what the unique mitigation, preparedness, and response measures to asymmetric, multi-modality terrorist attack are, and how public health systems, healthcare facilities, and EMS responders must implement them.
Terrorist attacks often result in a surge of specific ballistic and blast-related wound patterns that put high demand on our healthcare systems. In addition, both responders and healthcare facilities are now being either primarily or secondarily targeted as well, demanding a higher awareness of specific scene safety and target-hardening issues. Combined with the need to prepare for CBRNE possibilities in future terrorist attacks, these new challenges facing our hospital-based and EMS personnel must be addressed through specific Counter-Terrorism Medicine practices.
The recent surge in asymmetric attacks is a healthcare crisis, one that will likely escalate over time. As we inadvertently present “soft” targets through our very open societies, terrorists will continue to attack us in ways designed to maximize casualties. Likewise, responders and hospitals will be increasingly targeted, as they are the frontlines of this crisis. We must fuse the lessons we have learned from accidental and natural disasters into the steps we take to address intentional attacks. In order to be most effective, while also protecting the safety of personnel, Counter-Terrorism Medicine practices must be learned, understood, and implemented.
