Publications by authors named "Derrick Tin"

27 Publications

  • Page 1 of 1

Primary Care as Primary Target: A Review of Terrorist Attacks Against Primary Care Providers and Their Offices.

Prehosp Disaster Med 2022 Aug 1;37(4):451-454. Epub 2022 Jul 1.

Department of Family Medicine, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, The Netherlands.

Background: Violence against primary care providers (PCPs) has increased during the current pandemic. While some of these violent acts are not defined as terrorist events, they are intentional events with an aim to disrupt, kill, or injure. Despite their pivotal role in health care, little is known about the risk for PCPs as targets of terrorism.

Methods: 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 terrorist attacks against PCPs and their offices from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary attack and weapon type, location (country, world region), and number of deaths and injuries were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

Results: There were 29 terrorist attacks against PCPs and their offices from 1970-2019. The majority of attacks occurred during or after 2010. There were 58 fatalities, 52 injured, and 13 hostages. Most documented attacks took place in Pakistan, the United States, and Sri Lanka. Bombings concerned 55% of cases and 21% were hostage-takings.

Conclusion: Although less common than attacks on other health care related targets, terrorist attacks against PCPs have occurred. The majority of attacks occurred during the last decade. Future studies are warranted to further assess the risk of terrorist attacks against PCPs: before, during, and beyond the current pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X22000954DOI Listing
August 2022

An Epidemiological Analysis of Terrorism-Related Attacks in Eastern Europe from 1970 to 2019.

Prehosp Disaster Med 2022 Aug 2;37(4):468-473. Epub 2022 Jun 2.

Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

Introduction: Over the past five decades, Eastern Europe has seen relatively little in terms of terrorist attacks. The recent escalation of the Russo-Ukrainian conflict has, however, placed a new spotlight on the region, and new questions and concerns around war, conflict, insurgency, and terrorism are being posed. The Russian invasion and extensive combat operations, the largest in Europe since World War II, are occurring across Ukraine where there are 15 active nuclear reactors, not including the Chernobyl site, that are vulnerable to attack or sabotage. In addition, Eastern Europe has been heavily affected by COVID-19, exposing broad vulnerabilities in an otherwise fragile health care system. This raises concerns over the ability of Eastern European health care institutions to absorb surge and manage terrorist attacks or acts of violent extremism. This study provides an epidemiological description of all terrorism-related fatalities and injuries in Eastern Europe sustained from 1970 - 2019.

Method: Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database functions for all terrorism events which occurred in Eastern Europe from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of this 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: There were 3,901 terrorism-related events in Eastern Europe between the years 1970 and 2019, inclusive. In total, the attacks resulted in 5,391 deaths and 9,538 persons injured. Explosives were the most commonly used weapon type in 59.2% of all attacks in the region, followed by firearms in 27.6%.

Conclusion: From 1970 through 2019, a total of 3,901 terrorist attacks occurred in Eastern Europe, inflicting 5,391 deaths and 9,538 injuries. Of those, 72.3% occurred in Russia and Ukraine. Terrorist attacks sharply declined since the peak in 2014, but there is an overall uptrend in attacks since the 1970s.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X2200084XDOI Listing
August 2022

Health Care Implications of Terrorist Attacks in South Asia.

Prehosp Disaster Med 2022 Jun 13;37(3):338-342. Epub 2022 Apr 13.

Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

Background: The recent United States (US) troop withdrawal out of Afghanistan under a February 2020 US-Taliban agreement and the rapid concurrent collapse of the Afghan military, followed by the ascendance of the Taliban, has placed an international spotlight around the future of South Asian countries. Security threats, in particular, will likely escalate within the region and beyond, with significant concerns around the resurgence of terrorism and violence in the region. This study aims to provide an epidemiological description of all terrorism-related attacks in South Asia sustained from 1970 - 2019. These data will be useful in the development of education programs in Counter-Terrorism Medicine and provide an insight into potential attacks in the future.

Methods: 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 Afghanistan, Bangladesh, Bhutan, India, Maldives, Mauritius, Nepal, Pakistan, and Sri Lanka (collectively referred to as South Asia) from January 1, 1970 - December 31, 2019. Primary weapon type, primary target type, country where the incident occurred, and number of deaths and injuries were collated and exported for analysis.

Results: In total, 23.69% of all terrorist attacks from 1970-2019 occurred in the South Asia region, causing 96,092 deaths and 141,333 non-fatal injuries. Of those, 50.1% of attacks in South Asia used explosives, 31.9% used firearms, 9.4% used unknown weapons, 5.9% used incendiary attacks, 2.3% were melee attacks, and <0.5% used chemical, biological, and other weapon types.

Conclusion: Over 88% of the attacks occurred in Afghanistan, Pakistan, and India combined. While there has been a decline in attacks since a peak in 2014, there are concerns of a significant increase in terrorism activity in recent months which could impact an already fragmented health care system. The use of explosives and firearms as attack modalities accounted for 82.0 % of all weapon types used, but the impact of terrorism and conflict expands beyond simple death and casualty tolls.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X22000607DOI Listing
June 2022

Chemical Agent Use in Terrorist Events: A Gathering Storm Requiring Enhanced Civilian Preparedness.

Prehosp Disaster Med 2022 Jun 8;37(3):327-332. Epub 2022 Apr 8.

Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA.

Background: The use of chemical weapons in terrorist attacks, though rare, remains a significant challenge and concern due to their ability to inflict mass casualties. Chemical attacks remain a topic of interest for Disaster Medicine (DM) and Counter-Terrorism Medicine (CTM) specialists and are clearly an area in need of enhanced preparedness. This study aims to provide an epidemiological description of all terrorism-related attacks using chemical agents as a primary weapon, sustained from 1970 - 2019. These data will be useful in the development of education programs in CTM and provide an insight into how best to prepare for potential attacks in the future.

Methods: 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 using chemical weapons as a primary attack method from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. The GTD also details the specific chemical used, when known, in the summary of incidents. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

Results: A total of 292 terrorist attacks involving chemical agents as a primary attack method were recorded from 1970 - 2019, registering 284 deaths and 13,267 injuries. Acid (52) was the most commonly used chemical agent, followed by "unspecified poison" (43), "unknown chemical agents" (29), "unspecified gas" (27), tear gas (27), chlorine gas (24), cyanide (21), mercury (9), pepper spray or mace (9), mustard gas (8), insecticide or 1080 (8), diphenylamine chloroarsine (7), phosphate or phosphorous (3), sodium hydroxide or corrosive liquid (3), sarin (2), "unspecified drugs" (2), VX nerve gas and other nerve gas (2), pesticides (2), cleaning chemicals/paint thinner (2), ammonia (2), anesthesia agent (1), arsenic (1), chlorine and mustard gas mix (1), phenarsazine chloride (1), rat poison (1), unknown irritative gas (1), hydrochloric acid and sodium cyanide mix (1), unknown white powder (1), antiseptic dye (1), and chlorine gas and white phosphorous mix (1).

Conclusion: The use of chemical weapons in warfare, though prohibited by the Chemical Weapons Convention (CWC), remains a rare but concerning terrorist attack methodology. In recent years, there have been more instances where potentially deadly chemicals have been used in civilian settings. Dual use industrial chemicals, in particular, pose a significant concern. Acid was the most commonly used chemical weapon in 52 attacks. Tear gas, chlorine, and cyanide were each used in over 20 attacks. Both DM and CTM specialists advocate for better preparedness and response training for intentional events in civilian settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X22000528DOI Listing
June 2022

Attacks on Educational Institutions.

Prehosp Disaster Med 2022 Jun 7;37(3):333-337. Epub 2022 Apr 7.

Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA.

Background: Educational institutions around the world have long been targets of terrorist attacks. Schools, colleges, and universities often lack security measures against intentional threats and may be viewed as relatively easy, soft targets with high potential for mass casualties. The long-term psychosocial impact on children, youth, and survivors of terrorist attacks are significant and recovery remains a challenge. Deliberate attacks on students and children, in particular, can also often gain mass-media attention, provoke significant community unrest, and place a spotlight on the local government's inability to protect the vulnerable. This study is an epidemiological examination of all terrorism-related events targeting educational institutions from 1970-2019.

Method: Data collection was performed using a retrospective search through the Global Terrorism Database (GTD). The database was searched using the internal search functions for all events that occurred from January 1, 1970 - December 31, 2019. "Educational institutions" as a primary target type was selected for the purpose of this study and events were further sub-classified by country and attack type. All classifications were pre-determined by the GTD.

Results: The GTD listed 4,520 attacks against educational institutions, recording 3,732 deaths and 9,920 wounded. This accounted for 2.7% of all terrorist attacks (total 168,003 attacks against all target types). There has been a downtrend in attacks since the 2014 peak when 344 attacks were recorded that year. Pakistan recorded the most attacks with 969 events, followed by Afghanistan (369), India (311), and Iraq (279). The most common attack types included bombing/explosions (2290), facility/infrastructure attacks (636), armed assaults (628), hostage takings (kidnappings [415]), assassinations (357), unarmed assaults (72), unknown (67), hostage takings (barricade incidents [46]), and hijackings (9).Eight hundred seventy-three of the 4,520 attacks were recorded against teachers, professors, and instructors and 486 attacks were recorded against "other personnel" such as security and non-teaching staff.

Conclusion: Terrorist attacks on educational institutions are rare but significant target types. In total, 41.2% of attacks on educational institutions occurred in South Asia, followed by 18.9% in the Middle East and North Africa. Western Europe and North America accounted for 3.9% and 3.6%, respectively. Educational institutions around the world should evaluate their risks and put in place appropriate hardening measures as well as preparedness and recovery plans to intentional threats.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X22000590DOI Listing
June 2022

Transport Terrorism: A Counter-Terrorism Medicine Analysis.

Prehosp Disaster Med 2022 Mar 11:1-6. Epub 2022 Mar 11.

Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

Background: Many capital cities around the world have been subjected to terrorist attacks on their transport systems with devastating consequences. Large crowds in small enclosed spaces, disruption to people movement, and the psychosocial and financial repercussions of attacks are some of the many soft target vulnerabilities of mass-transit systems.This study is an epidemiological examination of all terrorism-related events targeting air, sea, and ground transport modalities sustained from 1970-2019, comparing the rates of fatal injuries (FI) and non-fatal injuries (NFI).

Method: The Global Terrorism Database (GTD) was downloaded and searched using the internal database search functions for all events that occurred from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. "Transportation," "Airport and Aircraft," and "Maritime" as primary target types were selected for the purpose of this study, and events were further sub-classified by region, weapon type used, and by suicide attack (SA). "Airport personnel" were excluded. All classifications and sub-classifications were pre-determined by the GTD.

Results: There were 8,729 transportation-related (air, sea, and ground) attacks documented during the study period with 19,020 fatalities and 45,218 NFI. This accounted for 5.2% of all terrorist attacks (168,003 total events), 5.6% of all FI (total 339,435), and 9.1% of all NFI (total 496,225). The mean FI was 2.2 per event and the mean NFI was 5.2 per attack.South Asia (28.4%), Middle East and North Africa (18.2%), and South America (14.9%) accounted for 61.5% of all transport related attacks. Attacks on subways inflicted a disproportionately high 51.5 NFI per attack. Suicide attacks recorded the highest ratios for both FI (13.71 per attack) and NFI (139.00 per attack).

Conclusion: Transport modalities are vulnerable terrorist soft targets. The repercussions of attacks on public transport modalities represent a significant and unique psychosocial and economical risk to the affected communities. Suicide attacks on subways represent a unique and significantly higher casualty risk than other transport modalities. Risk mitigation strategies should be regularly revisited by Counter-Terrorism Medicine (CTM) specialists.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X22000371DOI Listing
March 2022

Terrorist Attacks in the Middle East: A Counter-Terrorism Medicine Analysis.

Prehosp Disaster Med 2022 Mar 3:1-5. Epub 2022 Mar 3.

Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Associate Professor, Harvard Medical School, Cambridge, MassachusettsUSA.

Background: The Middle East and North Africa (MENA) region has been, like many parts of the world, a hotbed for terrorist activities. Terrorist attacks can affect both demand for and provision of health care services and often places a unique burden on first responders, hospitals, and health systems. This study aims to provide an epidemiological description of all terrorism-related attacks in the Middle East sustained from 1970-2019.

Methods: 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 Iraq, Yemen, Turkey, Egypt, Syria, West Bank and Gaza Strip, Israel, Lebanon, Iran, Saudi Arabia, Bahrain, Jordan, Kuwait, United Arab Emirates, North Yemen, Qatar, and South Yemen from January 1, 1970 - December 31, 2019. Primary weapon type, primary target type, country where the incident occurred, and number of deaths and injuries were collated and the results analyzed.

Results: A total of 41,837 attacks occurred in the Middle East from 1970-2019 accounting for 24.9% of all terrorist attacks around the world. A total of 100,446 deaths were recorded with 187,447 non-fatal injuries. Fifty-six percent of all attacks in the region occurred in Iraq (23,426), 9.4% in Yemen (3,929), and 8.2% in Turkey (3,428). "Private Citizens and Properties" were targeted in 37.6% (15,735) of attacks, 15.4% (6,423) targeted "Police," 9.6% targeted "Businesses" (4,012), and 9.6% targeted "Governments" (4,001). Explosives were used in 68.4% of attacks (28,607), followed by firearms in 20.4% of attacks (8,525).

Conclusion: Despite a decline in terrorist attacks from a peak in 2014, terrorist events remain an important cause of death and injuries around the world, particularly in the Middle East where 24.9% of historic attacks took place. While MENA countries are often clustered together by economic and academic organizations based on geographical, political, and cultural similarities, there are significant differences in terrorist events between countries within the region. This is likely a reflection of the complexities of the intricate interplay between politics, culture, security, and intelligence services unique to each country.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X22000358DOI Listing
March 2022

Bioterrorism: An analysis of biological agents used in terrorist events.

Am J Emerg Med 2022 Apr 6;54:117-121. Epub 2022 Feb 6.

Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, USA.

Background: The Covid19 pandemic has reignited debates and discussions around healthcare systems' biosecurity vulnerabilities and cast a spotlight on the potential weaponization of biological agents. Terrorist and violent extremist groups have already attempted to incite the intentional spread of Covid19 and to use it as an improvised form of a biological weapon. This study aims to provide an epidemiological description of all terrorism-related attacks using biological agents sustained between 1970 and 2019.

Methods: 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 using biological weapons between January 1, 1970 - December 31, 2019.

Results: 33 terrorist attacks involving biological agents were recorded between 1970 and 2019, registering 9 deaths and 806 injuries. 21 events occurred in the United States, 3 in Kenya, 2 each in both the United Kingdom and Pakistan and a single event in Japan, Columbia, Israel, Russia and Tunisia.

Conclusion: The reported use of biological agents as a terrorist weapon is extremely rare and accounts for 0.02% of all historic terrorist attacks. Despite its apparent rarity, however, bioterrorism has the ability to inflict mass injuries unmatched by conventional weapons. Anthrax has been the most commonly used in previous bioterrorism events with the vast majority of reported attacks occurring in the United States by a single suspected perpetrator. Counter-Terrorism Medicine (CTM) and Disaster Medicine (DM) specialists need to be proactive in delivering ongoing educational sessions on biological events to first responder communities, and anticipate emerging novel biotechnology threats.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2022.01.056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8818129PMC
April 2022

A Counter-Terrorism Medicine Analysis of Drone Attacks.

Prehosp Disaster Med 2022 Jan 31:1-5. Epub 2022 Jan 31.

BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA.

Background: The rapid popularization of unmanned aerial vehicles (UAVs; also referred to as drones), in both the recreational and industrial sectors, has paved the way for rapid developments in drone capabilities. Although the threat of UAVs used by terrorists has been recognized by specialists in both Counter-Terrorism and Counter-Terrorism Medicine (CTM), there are limited data on the extent and characteristics of drone use by terrorist organizations.

Methods: 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 terrorist attacks using UAVs from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary weapon type, number and type of UAVs used, related attacks, location (country, world region), and number of deaths and injuries were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

Results: There were 76 terrorist attacks using UAVs. The first attack occurred in 2016, and the number of attacks per year varied considerably (range: 4-36). Forty-seven of the 76 attacks (70%) were successful. Twenty-seven individually listed events (36%) were related and part of nine coordinated, multi-part incidents. A total of 50 deaths and 132 injuries were recorded, which equated to 1.09 deaths (range: 0-6) and 2.89 injuries (range: 0-20) per successful attack. The mean number of UAVs used in an attack was 1.28 (range: 1-5) and multiple UAVs were used in 22% of attacks.

Conclusion: The use of UAVs to carry out terrorist attacks is on the rise. Seventy-six terrorist attacks using this novel method were recorded since 2016, killing 50 and injuring 132 people. While the use of UAV-related explosives appears less lethal than traditional explosive attacks, advancing technologies and swarming capabilities, increasing ability to carry larger payloads, and the possibility of UAVs to disperse chemical, biological, radiological, and nuclear (CBRN) weapons will likely increase UAV lethality in the future, requiring CTM specialists be more proactive.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X22000139DOI Listing
January 2022

A Counter-Terrorism Medicine Analysis of Drone Attacks.

Prehosp Disaster Med 2022 Jan 31:1-5. Epub 2022 Jan 31.

BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MassachusettsUSA.

Background: The rapid popularization of unmanned aerial vehicles (UAVs; also referred to as drones), in both the recreational and industrial sectors, has paved the way for rapid developments in drone capabilities. Although the threat of UAVs used by terrorists has been recognized by specialists in both Counter-Terrorism and Counter-Terrorism Medicine (CTM), there are limited data on the extent and characteristics of drone use by terrorist organizations.

Methods: 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 terrorist attacks using UAVs from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary weapon type, number and type of UAVs used, related attacks, location (country, world region), and number of deaths and injuries were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

Results: There were 76 terrorist attacks using UAVs. The first attack occurred in 2016, and the number of attacks per year varied considerably (range: 4-36). Forty-seven of the 76 attacks (70%) were successful. Twenty-seven individually listed events (36%) were related and part of nine coordinated, multi-part incidents. A total of 50 deaths and 132 injuries were recorded, which equated to 1.09 deaths (range: 0-6) and 2.89 injuries (range: 0-20) per successful attack. The mean number of UAVs used in an attack was 1.28 (range: 1-5) and multiple UAVs were used in 22% of attacks.

Conclusion: The use of UAVs to carry out terrorist attacks is on the rise. Seventy-six terrorist attacks using this novel method were recorded since 2016, killing 50 and injuring 132 people. While the use of UAV-related explosives appears less lethal than traditional explosive attacks, advancing technologies and swarming capabilities, increasing ability to carry larger payloads, and the possibility of UAVs to disperse chemical, biological, radiological, and nuclear (CBRN) weapons will likely increase UAV lethality in the future, requiring CTM specialists be more proactive.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X22000139DOI Listing
January 2022

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

Prehosp Disaster Med 2022 Feb 7;37(1):19-24. Epub 2022 Jan 7.

Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21001370DOI Listing
February 2022

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

Prehosp Disaster Med 2022 Feb 7;37(1):19-24. Epub 2022 Jan 7.

Director, BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21001370DOI Listing
February 2022

Opioid Attack and the Implications for Counter-Terrorism Medicine.

Prehosp Disaster Med 2021 Dec 11;36(6):661-663. Epub 2021 Oct 11.

Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Cambridge, MassachusettsUSA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21001059DOI Listing
December 2021

Chemical Warfare Agents in Terrorist Attacks: An Interregional Comparison, Tactical Response Implications, and the Emergence of Counterterrorism Medicine.

J Spec Oper Med 2021 ;21(3):51-54

Background: Terrorist attacks are growing in frequency, increasing concerns about chemical warfare agents (CWAs). Asphyxiants (e.g., cyanide), opioids (e.g., carfentanyl), and nerve agents (e.g., ricin) represent some of the most lethal CWAs. Our aim was to define the epidemiology of CWA use in terrorism and detail specific agents used to allow for the development of training programs for responders.

Methods: The open-source Global Terrorism Database (GTD) was searched for all chemical attacks from January 1, 1970, to December 31, 2018. Attacks were included when they fulfilled the terrorism-related criteria as set forth in the internal Codebook of the GTD. Events meeting only partial criteria were excluded.

Results: A total of 347 terrorism-related chemical events occurred, with 921 fatalities and 13,361 nonfatal injuries (NFIs) recorded during the study period. South Asia accounted for nearly 30% (101 of 347) of CWA attacks, with 73 of 101 occurring in Afghanistan. The Taliban was implicated in 40 of 101 events utilizing a mixture of agents, including unknown chemical gases (likely representing trials of a number of different chemicals), contamination of water sources with pesticides, and the use of corrosive acid. The largest death toll from a single event (200 fatalities) was attributed to a cult-related mass murder in the Kasese District of Uganda in March 2000. East Asia sustained the highest NFI toll of 7,007 as a result of chemical attacks; 5,500 were attributed to the Tokyo subway sarin gas attack of 1995 by Aum Shinrikyo.

Conclusion: The use of CWAs remains a concern given the rising rate of terrorist events. First responders and healthcare workers should be aware of potential chemical hazards that have been used regionally and globally and should train and prepare to respond appropriately.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.55460/UU8Q-EDYQDOI Listing
September 2021

Half-a-Century of Terrorist Attacks: Weapons Selection, Casualty Outcomes, and Implications for Counter-Terrorism Medicine.

Prehosp Disaster Med 2021 Oct 16;36(5):526-530. Epub 2021 Aug 16.

Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

Background: High profile terrorist attacks in major capital cities have seemingly become a regular occurrence and the resultant mass-casualty events continue to challenge health care systems. Counter-Terrorism Medicine (CTM) addresses unique terrorism-related issues relating to the mitigation, preparedness, and response measures to asymmetric, multi-modality terrorist attacks. This study is an epidemiological examination of all terrorism-related events sustained from 1970-2019, analyzing historical weapon types used and the resulting fatal injuries (FI) and non-fatal injuries (NFI) sustained.

Methods: The Global Terrorism Database (GTD) was searched for all attacks from 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. Available counts of FI and NFI in each incident were then sorted and aggregated by weapon type to enable mean and standard deviation calculations.

Results: In total, 168,003 events were recorded from the years 1970-2019. Explosives, bombs, and/or dynamite (E/B/D) were the most commonly used weapon type and accounted for 48.78% of all terrorism events, followed by the use of firearms in 26.77% of events. A total of 339,435 FI and 496,225 NFI resulted from all terrorism events that occurred during the study period. Combined, E/B/D and firearms accounted for 75.55% of all events, 67.1% of all FI, and 79.3% of all NFI. Each individual terrorism event inflicted a mean FI rate of 2.14 FI per event (SD = 10.2) and a mean NFI rate of 3.22 NFI per event (SD = 45.19).

Conclusions: Although terrorism is complex and does not solely rely on death tolls as a measure of success, this analysis shows a historic mean FI rate of 2.14 and NFI rate of 3.22 per event over the past 50 years. Proven weapons such as E/B/D and firearms combine to account for over 75% of weapon types used in all events. Use of weapons of mass destruction (WMDs) such as chemical, biological, radiation, and nuclear (CBRN) weapons has been rare (0.2%), yet has extreme high potential to inflict mass casualties with mean NFI rates of 49.62 and 28.75 for chemical and biological weapons, respectively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21000868DOI Listing
October 2021

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.

Prehosp Disaster Med 2021 Oct 9;36(5):531-535. Epub 2021 Aug 9.

Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21000819DOI Listing
October 2021

Rise of the Unmanned Aerial Vehicles: An Imminent Public Health Threat Mandating Counter-Terrorism Medicine Preparedness for Potential Mass-Casualty Attacks.

Prehosp Disaster Med 2021 Oct 2;36(5):636-638. Epub 2021 Aug 2.

Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

The mass proliferation and increasing affordability of unmanned aerial vehicles (UAVs) in recent years has given rise to weaponized UAV use by terrorists, leading to mounting and credible concerns this attack methodology will be the next terrorism modus operandi. Counter-Terrorism Medicine (CTM) specialists need to consider how UAVs alter or create new mass-casualty scenarios that can further exploit existing medical preparedness vulnerabilities. With an opportunity to be proactive in disaster prevention, mitigation, and preparedness, it is imperative this gathering storm be acknowledged and stakeholders explore how best to prepare for, respond to, and mitigate the consequences of UAV incidents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21000765DOI Listing
October 2021

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

Prehosp Disaster Med 2021 Aug 30;36(4):399-402. Epub 2021 Jun 30.

Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21000625DOI Listing
August 2021

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

Prehosp Disaster Med 2021 Aug 17;36(4):380-384. Epub 2021 Jun 17.

Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21000558DOI Listing
August 2021

Terrorism in China and the Emerging Needs for Counter- Terrorism Medicine Following a Decade of Deaths and Injuries.

Prehosp Disaster Med 2021 Jun 26;36(3):270-275. Epub 2021 Feb 26.

Beth Israel Deaconess Medical Center (BIDMC) Disaster Medicine Fellowship; Department of Emergency Medicine, BIDMC; Harvard Medical School, Boston, MassachusettsUSA.

Background: China is ranked 42nd on the Global Terrorism Index (2019), a scoring system of terrorist activities. While China has a relatively low terrorism risk, events globally have wide-ranging repercussions for future attacks, putting first responders and emergency health workers at risk. This study aims to provide the epidemiological context for the past decade detailing the unique injury types responders are likely to encounter and to develop training programs utilizing these data.

Methods: The Global Terrorism Database (GTD) was searched for all attacks in China between the years 2008-2018. Attacks met inclusion criteria if they fulfilled the terrorism-related criteria as set by the GTD's Codebook. Ambiguous events, as defined by the GTD's Codebook, were excluded. English language grey literature was searched to ensure no events meeting these criteria were missed. A focused search of online English language newspaper articles was also performed for any terrorist events between 2008-2018.

Results: One-hundred and eight terrorist events occurred in the study time period. Of the 108 incidents, forty-seven (43.5%) involved Explosives/Bombs/Dynamite (E/B/D) only, with an average fatality count of 2.9 and injury count of 7.5 per event. Twenty-seven (25.0%) used bladed or blunt weapons in melees with an average fatality count of 9.7 and an injury count of 8.8 per event. Five (4.6%) involved incendiary weapons with an average fatality count of 2.4 and an injury count of 7.2 per event. Two used only chemical weapons (1.8%) with no recorded deaths and an injury count of 27.0 per event. Two events had unknown weapon types (1.8%) with one recorded death and no injury count. One event used a firearm (0.9%) and led to one death and no injuries. One event used a vehicle (0.9%), which also led to one death and no recorded injuries. Twenty-three attacks used a mix of weapons (21.2%) with an average fatality count of 17.1 and an injury count of 12.0 per event.

Conclusions: One-hundred and eight terrorist attacks were recorded between 2008-2018 on Chinese soil using well-understood modalities. This resulted in a total of 809 recorded fatalities with 956 non-fatal injuries. The most commonly chosen methodology was E/B/D, followed by melees and the use of bladed weapons. Three events individually recorded a combined casualty toll of over 100 people.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21000170DOI Listing
June 2021

Terrorism in Australia: A Decade of Escalating Deaths and Injuries Supporting the Need for Counter-Terrorism Medicine.

Prehosp Disaster Med 2021 Jun 23;36(3):265-269. Epub 2021 Feb 23.

Director, BIDMC Disaster Medicine Fellowship; Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor, Harvard Medical School, Boston, MassachusettsUSA.

Background: Australia is ranked 71st on the Global Terrorism Index (GTI; 2019), a scoring system of terrorist activities. While it has a relatively low terrorist risk, events globally have wide-ranging repercussions putting first responders and emergency health workers at risk. Counter-Terrorism Medicine (CTM) is rapidly emerging as a sub-specialty needed to address these threats on the front line. This study aims to provide the epidemiological context for the past decade, detailing the unique injury types responders are likely to encounter, and to develop training programs utilizing these data.

Methods: The Global Terrorism Database (GTD) was searched for all attacks in Australia from the years 2009-2019. Attacks met inclusion criteria if they fulfilled the following 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 as a GTD terrorist incident. 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: Thirty-seven terrorist events occurred in the study time period. Of the thirty-seven incidents, twenty-six (70.2%) involved incendiary weapons, five (13.5%) involved firearms, four (10.8%) involved melee (bladed weapon/knife) attacks, two (5.4%) were explosive/bombing/dynamite attacks, and one (2.7%) was a mixed attack using both incendiary and melee weapons. All except one firearms-related incident (four out of five) resulted in either a fatality or injury or both. Every melee incident resulted in either a fatality or injury or both.

Conclusions: In the decade from 2009 to 2019, terrorist attacks on Australian soil have been manageable, small-scale incidents with well-understood modalities. Eleven fatalities and fourteen injuries were sustained as a result of terrorist events during that period. Incendiary weapons were the most commonly chosen methodology, followed by firearms, bladed weapons, and explosive/bombings/dynamite attacks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X21000157DOI Listing
June 2021

Disaster medicine training: The case for virtual reality.

Am J Emerg Med 2021 10 5;48:370-371. Epub 2021 Feb 5.

Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2021.01.085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501088PMC
October 2021

Rethinking disaster vulnerabilities.

Am J Emerg Med 2021 07 6;45:660-661. Epub 2020 Nov 6.

Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2020.10.073DOI Listing
July 2021

The Case for an Australian Disaster Reserve Force.

Am J Emerg Med 2021 08 27;46:698-699. Epub 2020 Oct 27.

Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2020.10.041DOI Listing
August 2021

Hardening hospital defences as a counter-terrorism medicine measure.

Am J Emerg Med 2021 07 30;45:667-668. Epub 2020 Oct 30.

Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2020.10.051DOI Listing
July 2021

What we learned from the 2019-2020 Australian Bushfire disaster: Making counter-terrorism medicine a strategic preparedness priority.

Am J Emerg Med 2021 08 29;46:742-743. Epub 2020 Sep 29.

Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2020.09.069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524436PMC
August 2021

Dog bite wounds in a child.

Authors:
Derrick Tin

Hong Kong Med J 2007 Jun;13(3):247-8

Great Ormond Street Children's Hospital London, United Kingdom.

View Article and Find Full Text PDF

Download full-text PDF

Source
June 2007
-->