Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-05-04T12:18:32.633Z Has data issue: false hasContentIssue false

Hospitals: Soft Target for Terrorism?

Published online by Cambridge University Press:  08 December 2016

Harald De Cauwer*
Affiliation:
Department of Neurology, Dimpna Regional Hospital, Geel, Belgium
Francis Somville
Affiliation:
Department of Emergency Medicine and Traumatology, Dimpna Regional Hospital, Geel, Belgium Department of Health Psychology, University of Leiden, Leiden, The Netherlands
Marc Sabbe
Affiliation:
Department of Emergency Medicine, University Hospitals, Leuven, Belgium Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium
Luc J. Mortelmans
Affiliation:
Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
*
Correspondence: Harald De Cauwer, MD AZ St Dimpna, Department of Neurology JB Stessenstraat 2 2440 Geel, Belgium E-mail: dr.harald.decauwer@azstdimpna.be

Abstract

In recent years, the world has been rocked repeatedly by terrorist attacks. Arguably, the most remarkable were: the series of four coordinated suicide plane attacks on September 11, 2001 on buildings in New York, Virginia, and Pennsylvania, USA; and the recent series of two coordinated attacks in Brussels (Belgium), on March 22, 2016, involving two bombings at the departure hall of Brussels International Airport and a bombing at Maalbeek Metro Station located near the European Commission headquarters in the center of Brussels.

This statement paper deals with different aspects of hospital policy and disaster response planning that interface with terrorism. Research shows that the availability of necessary equipment and facilities (eg, personal protective clothing, decontamination rooms, antidotes, and anti-viral drugs) in hospitals clearly is insufficient. Emergency teams are insufficiently prepared: adequate and repetitive training remain necessary.

Unfortunately, there are many examples of health care workers and physicians or hospitals being targeted in both political or religious conflicts and wars. Many health workers were kidnapped and/or killed by insurgents of various ideology. Attacks on hospitals also could cause long-term effects: hospital units could be unavailable for a long time and replacing staff could take several months, further compounding hospital operations. Both physical and psychological (eg, posttraumatic stress disorder [PTSD]) after-effects of a terrorist attack can be detrimental to health care services. On the other hand, physicians and other hospital employees have shown to be involved in terrorism. As data show that some offenders had a previous history with the location of the terror incident, the possibility of hospitals or other health care services being targeted by insiders is discussed.

The purpose of this report was to consider how past terrorist incidents can inform current hospital preparedness and disaster response planning.

De CauwerH, SomvilleF, SabbeM, MortelmansLJ. Hospitals: Soft Target for Terrorism?Prehosp Disaster Med. 2017;32(1):94–100.

Type
Special Reports
Copyright
© World Association for Disaster and Emergency Medicine 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. University of Maryland. Global Terrorism Database. https://www.start.umd.edu/gtd/. Accessed June 2, 2016.Google Scholar
2. CBC News. Attacks in Moscow: 1996-2011. http://www.cbc.ca/news/world/attacks-in-moscow-1996-2011-1.1008425. Accessed June 2, 2016.Google Scholar
3. Editors of Encyclopedia Britannica. 2002 Bali Bombings. http://www.britannica.com/event/2002-Bali-Bombings. Accessed June 2, 2016.Google Scholar
4. Reuters. Terrorist attacks have more than quadrupled since 2001, with top targets Iraq, Pakistan, and Afghanistan: survey. http://www.nydailynews.com/news/world/terrorist-attacks-quadrupled-2001-article-1.1212991. Accessed June 2, 2016.Google Scholar
5. Topham, G, Weaver, M, Luhn, A. Egypt plane crash: Russia says jet was bombed in terror attack. http://www.theguardian.com/world/2015/nov/17/egypt-plane-crash-bomb-jet-russia-security-service. Accessed June 2, 2016.Google Scholar
6. Heylen, K, Huyghebaert, P. Who are the victims of the attacks in Brussel? http://deredactie.be/cm/vrtnieuws/binnenland/1.2611567. Accessed June 2, 2016.Google Scholar
7. FOD Volksgezondheid, veiligheid van de voedselketen en leefmilieu. Voorbereiding op de uitbraak van een grieppandemie – continuiteit van de diensten. Accessed June 2, 2016.Google Scholar
8. Mounier-Jack, S, Jas, R, Coker, R. Progress and shortcomings in European national strategic plans for pandemic influenza. Bull World Health Organ. 2007;85(12):923-929.Google Scholar
9. Wetter, DC, Daniell, WE, Treser, CD. Hospital preparedness for victims of chemical or biological terrorism. Am J Public Health. 2001;91(5):710-716.Google ScholarPubMed
10. De Cauwer, H, Mortelmans, L, d’Orio, V. Belgische ziekenhuizen onvoldoende voorbereid op pandemie. Hospitals.be. 2009;2:19-24.Google Scholar
11. Loutfy, MR, Wallington, T, Rutledge, T. Hospital preparedness and SARS. Emerg Infect Dis. 2004;10(5):771-776.Google Scholar
12. Rosenfeld, JV, Fitzgerald, M, Kossmann, T, et al. Is the Australian hospital system adequately prepared for terrorism? Med J Aust. 2005;183(11-12):567-570.CrossRefGoogle Scholar
13. Okumura, T, Takasu, N, Ishimatsu, S. Report of 640 victims of the Tokyo subway Sarin attack. Ann Emerg Med. 1996;28(2):129-135.Google Scholar
14. Ehrenstein, BP, Hanses, F, Salzberger, B. Influenza pandemic and professional duty: family or patients first? A survey of hospital employees. BMC Public Health. 2006;6:31.Google Scholar
15. Irvin, CB, Cindrich, L, Patterson, W, Southall, A. Survey of health care personnel response during a potential avian influenza pandemic: will they come to work? Prehosp Disaster Med. 2008;23(4):328-335.CrossRefGoogle ScholarPubMed
16. Mortelmans, L, De Cauwer, H, Van Dyck, E, Monballyu, P, Van Giel, R, Van Turnhout, E. Are Belgian senior medical students ready to deliver basic medical care in case of a H5N1 pandemic? Prehosp Disaster Med. 2009;24(5):438-442.Google Scholar
17. O’Boyle, C, Robertson, C, Secor-Turner, M. Nurses’ beliefs about public health emergencies: fear of abandonment. Am J Infect Control. 2006;34:351-357.CrossRefGoogle ScholarPubMed
18. US Department of Homeland Security. Critical Infrastructure Sectors. http://www.dhs.gov/critical-infrastructure-sectors. Accessed January 27, 2016.Google Scholar
19. Rogers, MC. The liability risk of hospitals as a target of terrorism. http://www.ehcca.com/presentations/emsummit2/4_02.pdf. Accessed January 27, 2016.Google Scholar
20. AHC media. Special Alert: JCAHO Impostors - Impostors could be targeting hospitals to gain information for terrorist attacks. http://www.ahcmedia.com/articles/88090-special-alert-jcaho-impostors-impostors-could-be-targeting-hospitals-to-gain-information-for-terrorist-attacks. Accessed January 27, 2016.Google Scholar
21. Khan, Z. Pakistan’s doctors protest at killing of 13 colleagues this year. BMJ. 2002;324(7341):805.Google Scholar
22. Bhutta, ZA. What must be done about the killings of Pakistani health care workers? BMJ. 2013;346:f280.CrossRefGoogle Scholar
23. Steele, J. The Iraqi brain drain. http://www.theguardian.com/world/2006/mar/24/ iraq.jonathansteele. Accessed June 2, 2016.Google Scholar
24. Arie, S. Injured Syrian protestors are removed from beds as forces target hospitals. BMJ. 2011;343:d5996.Google Scholar
25. Gardham, D. Islamic State creates jihadi health service. BMJ. 2015;350:h3487.Google Scholar
26. Johnson, O. Colombian doctors are killed as their neutrality is ignored. BMJ. 2002;325(7367):732.CrossRefGoogle ScholarPubMed
27. National Abortion Federation. Violence and disruption statistics: incidents of violence & disruption against abortion providers. http://5aa1b2xfmfh2e2mk03kk8rsx.wpengine. netdna-cdn.com/wp-content/uploads/Stats_Table_2014.pdf. Accessed May 15, 2016.Google Scholar
28. Catala I. Paris Terror Attacks: How the “White Plan” Medical Emergency Plan Was Implemented. http://www.medscape.com/viewarticle/854652. Accessed January 27, 2016.Google Scholar
29. Alves, DW, Bissell, RAJ. Ambulance snatching: how vulnerable are we? Emerg Med. 2003;25(2):211-214.Google Scholar
30. Simon, HK, Khan, NS, Delgado, CA. Weapons detection at two urban hospitals. Pediatr Emerg Care. 2003;19:248-251.CrossRefGoogle ScholarPubMed
31. Kansagra, SM, Rao, SR, Sullivan, AF, et al. A survey of workplace violence across 65 US emergency departments. Acad Emerg Med. 2008;15(12):1268-1274.CrossRefGoogle ScholarPubMed
32. Hancock, C, Johnson, C. Thinking the unthinkable: the NHS and terrorist action. Health Care Risk Report. 2006;12(5):16-18.Google Scholar
33. Ganor, B, Halperin, Wemli M,. Terrorist attacks against hospitals case studies. http://www.ict.org.il/Article/77/Terrorist-Attacks-against-Hospitals-Case-Studies. Accessed January 27, 2016.Google Scholar
34. Centers for Disease Control and Prevention (CDC). Injuries and illnesses among New York City Fire Department rescue workers after responding to the World Trade Center attacks. MMWR. 2002;11(Spec No:1-5):51.Google Scholar
35. Worland, J. California Governor Declares State of Emergency in San Bernardino. http://time.com/4156030/state-of-emergency-san-bernardino. Accessed January 27, 2016.Google Scholar
36. Neria, Y, DiGrande, L, Adams, BG. Posttraumatic stress disorder following the September 11, 2001 terrorist attacks. A review of the literature among highly exposed populations. Am Psychol. 2011;66(6):429-446.Google Scholar
37. Berninger, A, Webber, MP, Niles, JK, et al. Longitudinal study of probable posttraumatic stress disorder in firefighters exposed to the World Trade Center disaster. Am J Ind Med. 2010;53:1177-1185.CrossRefGoogle Scholar
38. Grieger, TA, Waldrep, DA, Lovasz, MM, Ursano, RJ. Follow-up of Pentagon employees two years after the terrorist attack of Sept. 11, 2001. Psychr Serv. 2005;56:1374-1378.Google Scholar
39. Jordan, NN, Hoge, CW, Tobler, SK, Wells, J, Dydek, GJ, Egerton, WE. Mental health impact of 9/11 Pentagon attack: validation of a rapid assessment tool. Am J Prev Med. 2004;26:284-293.Google Scholar
40. Misra, M, Greenberg, N, Hutchinson, C, Brain, A, Glozier, N. Psychological impact upon London Ambulance Service of the 2005 bombings. Occup Med. 2009;59(6):428-433.Google Scholar
41. Niles, JK, Webber, MP, Gustave, J, et al. The impact of the World Trade Center attack on FDNY fire fighter retirement, disabilities, and pension benefits. Am J Ind Med. 2011;54(9):672-680.Google Scholar
42. Associated Press. A months-long cyber-attack against the UCLA hospital system could jeopardize 4.5 million people’s information. http://uk.businessinsider.com/cyber-attack-against-the-ucla-hospital-system-could-jeopardize-45-million-peoples-information-2015-7?r=US&IR=T. Accessed January 27, 2016.Google Scholar
43. Crosby, C. Maine General Health in Augusta reports cyberattack. http://www.centralmaine.com/2015/12/08/mainegeneral-health-in-augusta-reports-cyber-attack. Accessed January 27, 2016.Google Scholar
44. Rocheleau, M. Anonymous reportedly behind cyber-attacks against children’s hospital web site in response to Justina Pelletier custody case. http://www.boston.com/business/technology/2014/04/24/anonymous-reportedly-behind-cyber-attacks-against-children-hospital-website-response-justina-pelletier-custody-case/jMK3iPaZZvl4mVaz5sbQ3I/ story.html. Accessed January 27, 2016.Google Scholar
45. Lichtenfels, R. US Department of Homeland Security’s National Cybersecurity and Communications Integration Center. https://www.isaca.org/chapters2/New-York-Metropolitan/membership/Documents/2012-04-30%20Spring%20Conference-Meeting/2%20Lichtenfels%20DHS%20NCCIC%202.pdf. Accessed January 27, 2016.Google Scholar
46. FDA. Cybersecurity. http://www.fda.gov/MedicalDevices/DigitalHealth/ucm373213.htm. Accessed January 27, 2016.Google Scholar
47. American Hospital Association. Cybersecurity and Hospitals. http://www.aha.org/content/13/ahaprimer-cyberandhosp.pdf. Accessed 27 January 2016.Google Scholar
48. US Federal Bureau of Investigation (FBI). US Attorney’s Office. Former security guard who hacked into hospital’s computer system sentenced to 110 months in federal prison. https://www.fbi.gov/dallas/press-releases/2011/dl031811.htm. Accessed January 27, 2016.Google Scholar
49. Colaianni, A. A long shadow: Nazi doctors, moral vulnerability, and contemporary medical culture. J Med Ethics. 2012;38(7):435-438.CrossRefGoogle ScholarPubMed
50. Sibley, R. When healers become killers: the doctor as terrorist. CMAJ. 2007;177(6):688.Google Scholar
51. Demaria, AN. Radicalized physicians. J Am Coll Cardiol. 2010;55(7):698-699.Google Scholar
52. Burleigh, M. What makes a doctor become a terrorist? http://www.dailymail.co.uk/ debate/article-2194466/What-makes-doctor-terrorist.html#ixzz3rja3jblb. Accessed January 27, 2016.Google Scholar
53. The Guardian. Sudan medical students may have joined Isis, says university. http://www.theguardian.com/world/2015/jun/29/sudan-medical-students-may-have-joined-isis-says-university. Accessed January 27, 2016.Google Scholar
54. Cook, F. Preacher who radicalized Charlie Hebdo killers is now a NURSING INTERN ‘on duty’ in A&E unit at victims’ hospital. http://www.dailymail.co.uk/news/article-2905278/Preacher-radicalised-Charlie-Hebdo-killers-nursing-intern-duty-E-unit-victims-hospital.html. Accessed January 27, 2016.Google Scholar
55. Al-Alawi, I, Schwartz, S. Radical Muslim doctors and what they mean for the NHS. BMJ. 2008;336(7648):834.Google Scholar
56. Amin, S. Radical Muslim doctors: pure speculation is dangerous. BMJ. 2008;336(7650):906.Google Scholar
57. Sherif, J. Radical Muslim doctors: sweeping misrepresentation will fuel fear and prejudice. BMJ. 2008;336(7650):906.Google Scholar
58. Mawas, A. UK doctors who go to Syria just want to alleviate suffering. BMJ. 2015;351:h4024.Google Scholar
59. Gardham, D. Islamic State creates jihadi health service. BMJ. 2015;350:h3487.CrossRefGoogle ScholarPubMed
60. Godlee, F. Editor’s reply to Lodhi, Mawas, Waqar, ElSayed and colleagues, Obeidalla, and Hamad. BMJ. 2015;351:h4177.CrossRefGoogle ScholarPubMed
61. Dyer, C. British doctor appears in recruitment video for Taliban. BMJ. 2014;349:g6903.Google Scholar
62. Dyer, C. Doctor convicted of terrorism related offences in US is struck off by GMC. BMJ. 2012;344:e1300.Google Scholar
63. Carta, MG, Moro, MF, Bass, J. War traumas in the Mediterranean area. Int J Soc Psychiatry. 2015;61(1):33-38.Google Scholar
64. Gill, P, Horgan, J, Deckert, P. Bombing alone: tracing the motivations and antecedent behaviors of lone-actor terrorists. J Forensic Sci. 2014;59(2):425-435.Google Scholar
65. Bhui, K, Warfa, N, Jones, E. Is violent radicalization associated with poverty, migration, poor self-reported health, and common mental disorders? PLoS One. 2014;9(3):e90718.Google Scholar
66. King, M, Taylor, D. The radicalization of homegrown Jihadists: a review of theoretical models and social psychological evidence. Terrorism and Political Violence. 2011;23(4):602-622.Google Scholar
67. Post, JM. Terrorism and right-wing extremism: the changing face of terrorism and political violence in the 21st century: the virtual community of hatred. Int J Group Psychother. 2015;65(2):242-271.Google Scholar
68. FBI. Workplace violence. Issues in response. Critical Incident Response Group National Center for the Analysis of Violent Crime. FBI Academy; Quantico, Virginia. https://www.fbi.gov/stats-services/publications/workplace-violence. Accessed June 5, 2016.Google Scholar
69. Hirsch, M, Carli, P, Nizard, R, et al. The medical response to multisite terrorist attacks in Paris. Lancet. 2015;386(10012):2535-2538.Google Scholar
70. Mortelmans, LJ, Van Boxstael, S, De Cauwer, HG, Sabbe, MB; Belgian Society of Emergency and Disaster Medicine (BeSEDiM) study. Preparedness of Belgian civil hospitals for chemical, biological, radiation, and nuclear incidents: are we there yet? Eur J Emerg Med. 2014;21(4):296-300.Google Scholar