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Terrorist Attacks Against Health Care Facilities, Health Care Workers, and First Responders: A Scoping Review

Published online by Cambridge University Press:  26 August 2025

Mitch Lommen ,
Dennis G. Barten Open the ORCID record for Dennis G. Barten [Opens in a new window] ,
Kyra Heuvelings ,
Harald G. De Cauwer Open the ORCID record for Harald G. De Cauwer [Opens in a new window] ,
Frits van Osch ,
Derrick Tin  and
Gregory Ciottone
Mitch Lommen
Affiliation:
Department of Emergency Medicine, VieCuri Medical Centre, Venlo, the Netherlands
Dennis G. Barten*
Affiliation:
Department of Emergency Medicine, VieCuri Medical Centre, Venlo, the Netherlands
Kyra Heuvelings
Affiliation:
Department of Emergency Medicine, VieCuri Medical Centre, Venlo, the Netherlands
Harald G. De Cauwer
Affiliation:
Department of Neurology, Dimpna Regional Hospital, Geel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
Frits van Osch
Affiliation:
Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands Department of Epidemiology, NUTRIM School for Nutrition and Metabolism, Maastricht University, Maastricht, the Netherlands
Derrick Tin
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA
Gregory Ciottone
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA Harvard Medical School, Beth Israel Deaconess Medical CenterBoston, MassachusettsUSA
*
Correspondence: Dennis Barten, MD VieCuri Medical Center Department of Emergency Medicine Venlo, the Netherlands Email: dbarten@viecuri.nl
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Abstract

Introduction:

Since 2001, the world has encountered an increase in terrorist attacks on civilian targets, during which conventional as well as unconventional modalities are being used. Terrorist attacks put immediate strains on health care systems, whilst they may also directly threaten the safety of first responders, health care workers, and health care facilities.

Study Objective:

This scoping review aimed to systematically map the existing research on terrorist attacks targeting health care facilities, health care workers, and first responders, and to identify opportunities to improve future research and health care response to terrorist attacks.

Methods:

A scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. A systematic search for relevant literature was conducted through electronic databases including PubMed, Cochrane, and Embase. Inclusion and exclusion criteria were applied to check eligibility. Extracted data from the articles included the title, first author, year of publication, journal, study design, number of attacks, number of injured, number of fatalities, target type, and weapon modalities. Furthermore, methodological quality assessment was performed.

Results:

The initial search within three major databases yielded 4,656 articles, including 2,777, 1,843, and 36 articles from PubMed, Embase, and Cochrane Library, respectively. Finally, 11 studies were included, which were all database reviews.

Conclusions:

This scoping review included 11 studies focusing on terrorist attacks against health care facilities, health care workers, and first responders. Nearly all studies were exclusively based on the Global Terrorism Database (GTD). An increase of attacks on health care-related targets was consistently reported by all studies in this review, but there were significant discrepancies in reported outcomes. In order to improve counter-terrorism preparedness and the future protection of health care workers, counter-terrorism medicine (CTM) research may benefit from a more standardized and transparent approach to document and analyze terrorist attacks, as well as the inclusion of additional databases other than the GTD.

Keywords

counter-terrorism medicinehealth careprehospital carescoping reviewterrorismviolence

Information

Type
Structured Review
Information
Prehospital and Disaster Medicine , Volume 40 , Issue 4 , August 2025 , pp. 224 - 231
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

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Footnotes

Editor’s Note: Editor-in-Chief (EIC) Dr. Jeffrey Franc declares a minor conflict of interest (COI) in reviewing this manuscript. In instances where the EIC has a minor COI, the manuscript follows the standard review process but requires additional approval from an Editorial Board member before acceptance. Final approval for publication of this manuscript was given by Editorial Board member Dr. Bruria Adini.

Note: Authors M Lommen and DG Barten contributed equally.

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