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Background: Analysts have warned on multiple occasions that hospitals are potential soft targets for terrorist attacks. Such attacks will have far-reaching consequences, including decreased accessibility, possible casualties, and fear among people. The extent, incidence, and characteristics of terrorist attacks against hospitals are unknown. Therefore, the objective of this study was to identify and to characterize terrorist attacks against hospitals reported to the Global Terrorism Database (GTD) over a 50-year period., Methods: The GTD was used to search for all terrorist attacks against hospitals from 1970-2019. Analyses were performed on temporal factors, location, attack and weapon type, and number of casualties or hostages. Chi-square tests were performed to evaluate trends over time and differences in attack types per world region., Results: In total, 454 terrorist attacks against hospitals were identified in 61 different countries. Of these, 78 attacks targeted a specific person within the hospital, about one-half (52.6%) involved medical personnel. There was an increasing trend in yearly number of attacks from 2008 onwards, with a peak in 2014 (n = 41) and 2015 (n = 41). With 179 incidents, the "Middle East & North Africa" was the most heavily hit region of the world, followed by "South Asia" with 125 attacks. Bombings and explosions were the most common attack type (n = 270), followed by 77 armed assaults. Overall, there were 2,746 people injured and 1,631 fatalities. In three incidents, hospitals were identified as secondary targets (deliberate follow-up attack on a hospital after a primary incident elsewhere)., Conclusion: This analysis of the GTD identified 454 terrorist attacks against hospitals over a 50-year period. It demonstrates that the threat is real, especially in recent years and in world regions where terrorism is prevalent. The findings of this study may help to create or further improve contingency plans for a scenario wherein the hospital becomes a target of terrorism.

In this study, we examine how the two facets of the fear of terrorism—the affective and behavioural fears—shift over time. To this end, we use a unique longitudinal data set of a representative sample of 755 Dutch respondents, recruited from the Longitudinal Internet Studies for the Social Sciences panel, in the time period between November 2017 and May 2020. We find that the reported affective fear of terrorism is significantly lower during the COVID‐19 crisis in 2020 than it was in 2017. Yet a divergent trend for behavioural fear of terrorism occurred. In spite of decreased affective fear of terrorism threats, respondents in 2020 reported increased protective and avoidance behaviours, similar to behaviours promoted to stop the spread of COVID‐19. [ABSTRACT FROM AUTHOR]

Introduction: Terrorists increasingly aim at so-called soft targets, such as hospitals. However, little is known about terrorist attacks against Emergency Medical Services (EMS). Objective: This study aims to review all documented terrorist attacks against EMS that occurred world-wide from 1970-2019 using the Global Terrorism Database (GTD). Methods: Reports of terrorist attacks against EMS were extracted from the GTD from 1970-2019. Data collection included temporal factors, attack and weapon type, number of casualties, and if it was a primary or secondary attack (secondary attack: deliberate attack against the first responders of an initial terrorist attack). Reports were excluded if EMS were not a target or if it was unclear whether they were a target. Chi-square tests were performed to evaluate trends over time. Results: There were 184 terrorist attacks against EMS, resulting in 748 deaths and 1,239 people injured. Terrorist attacks against EMS significantly increased over the past two decades. The "Middle East & North Africa" was the most frequently affected region with 81 attacks (44.0%) followed by "South Asia" with 41 attacks (22.3%). Bombings and explosions were the most common attack type (85 incidents; 46.2%) followed by armed assaults (68 incidents; 35.3%). Combined prehospital and hospital attacks were first reported in 2005 and occurred seven times. The first secondary attack against EMS dates from 1997, after which an increase was observed from 10 to 39 incidents in the periods 2000-2009 and 2010-2019, respectively. Conclusions: This analysis of the GTD, which identified 184 terrorist attacks against EMS over a 50-year period, demonstrates that terrorist attacks against EMS have significantly increased during the years and that secondary attacks are an emerging risk. Bombings and explosions are the most common attack type. Terrorist attacks against EMS are most prevalent in countries with high level of internal conflicts, however, they have also occurred in western countries. These incidents may hold valuable information to prevent future attacks. [ABSTRACT FROM AUTHOR]

Introduction: Emergency departments (EDs) are reasonably well prepared for external disasters, such as natural disasters, mass casualty incidents, and terrorist attacks. However, crises and disasters that emerge and unfold within hospitals appear to be more common than external events. EDs are often affected. Internal hospital crises and disasters (IHCDs) have the potential to endanger patients, staff, and visitors, and to undermine the integrity of the facility as a steward of public health and safety. Furthermore, ED patient safety and logistics may be seriously hampered. Methods: Case series of 3 disasters within EDs. Narrative overview of the current IHCD-related literature retrieved from searches of PubMed databases, hand searches, and authoritative texts. Discussion: The causes of IHCDs are multifaceted and an internal disaster is often the result of a cascade of events. They may or may not be associated with a community-wide event. Examples include fires, floods, power outages, structural damage, information and communication technology (ICT) failures, and cyberattacks. EDs are particularly at-risk. While acute-onset disasters have immediate consequences for acute care services, epidemics and pandemics are threats that can have long-term sequelae. Conclusions: Hospitals and their EDs are at-risk for crises and their potential escalation to hospital disasters. Emerging risks due to climate-related emergencies, infectious disease outbreaks, terrorism, and cyberattacks pose particular threats. If a hospital is not prepared for IHCDs, it undermines the capacity of administration and staff to safeguard the safety of patients. Therefore, hospitals and their EDs must check and where necessary enhance their preparedness for these contingencies. [ABSTRACT FROM AUTHOR]

Crises and disasters feature high on political and public agendas around the world. Practitioners wrestle with the challenge to provide protection while maintaining legitimacy. They pine for insights that lie at the heart of public administration: designing effective institutions and preserving transparency; enabling and empowering citizens without undermining a coordinated response; balancing long-term risks against short-term needs; bridging the divide between theory and practice, and between the public and private sectors. But in the debates about designing institutions that protect against transboundary threats and critical infrastructure failures, the public administration community is strangely absent. It has parked itself on the sideline, concerning itself with the routine processes of governance. In this article, we argue that the time has come for public administration scholars to incorporate crisis and disaster management into the main research agendas of the field. [ABSTRACT FROM AUTHOR]

In the face of modern crises, the European Union (EU) has increased its efforts to build common crisis management capacity across the continent. As the EU seeks to both coordinate national crisis and disaster authorities and build its own supranational capacities, it is worth asking whether the EU is capable of designing an effective European homeland security apparatus that will fit member state expectations as well as its unique supranational character. In this article, we apply a bureaucratic politics perspective to explore and assess how the EU's governance structures and policymaking processes constrain and facilitate its efforts to build transnational crisis management capacity. We discuss how institutional and policymaking characteristics may affect the EU's ongoing effort to enhance security and safety for the inhabitants of European states. [ABSTRACT FROM AUTHOR]

The spate of terrorist attacks in New York, London and Madrid has raised some significant issues for the public management of critical infrastructures. In many countries, privatizations in the 1980s and 1990s have transferred key elements of the critical infrastructure to private companies. Because these infrastructures are of major significance to our societies and economies, they must be protected against prolonged periods of breakdown. The ‘new’ terrorism has the potential to do just that. The management of this new threat is a complex task, which invariably will be undertaken by both public and private actors. They must deal with the core challenges of the prevention of attacks, effective communication of information across organizational boundaries and the ‘ownership’ of crisis decision-making. This article considers these issues within the context of the broader research areas of public management and crisis management. [ABSTRACT FROM AUTHOR]