Terrorism is not a new occurrence. Enemy combatants as far back as the 6th century BC attempted to poison, infect, or otherwise conquer enemies.  Historical texts mention use of plague infested fleas in blankets and the deliberate contamination of drinking water via sabotage of wells.  World War I marked Germany’s use of mustard gas followed years later with development and experimentation of the initial modern nerve agents of today.

Traditionally, explosive devices have been the weapon of choice utilized by terrorists due to ease of acquisition, familiarity and portability of these devices. Approximately 80% of terrorism incidents have involved explosives.  With the widespread dissemination of advanced weapons technology, the ability to cause mass casualties and fatalities has increased.  As a result, healthcare providers must be prepared to meet the unique medical requirements posed by the physical and psychological consequences of these weapons of mass destruction.

Recent domestic events have included school shootings in the United States, threats and executed bombings of abortion clinics, federal buildings and the Atlanta Olympics. The importance of EMS and a organized medical response to terrorism was demonstrated on 9/11/2001 with the mass casualties of the attacks on the World Trade Center, Pentagon and interrupted high jacking of aircraft in Pennsylvania. The October 2001 anthrax incidents and hoaxes involving powder and package reports and concerns strained and taxed many EMS and public safety agencies. Yet more recently, the March 2004 and the July 2005 bombings of mass transit/public transportation venues have created an environment of need for knowledge and planning in the care for mass casualties.

While some of the large scale terrorist incidents have occurred in metropolitan areas, the rural, suburban and wilderness areas have also experienced the effects of terrorism. EMS providers medical personnel in these areas will need adequate preplanning and knowledge for a safe, coordinated and unified response to a mass casualty incident involving terrorism.


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