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.

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.

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.

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.

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.

Modern conflicts are characterized by wide-spread use of conventional explosive ordnance (EO), improvised explosive devices (IEDs), and other air-launched explosives. In contrast to advances in military medicine and high-income civilian trauma systems since the United States-led wars in Afghanistan and Iraq, the mortality rate among civilian EO casualties has not decreased in decades. Although humanitarian mine action (HMA) stakeholders have extensive presence and medical capabilities in EO-affected settings, coordination between HMA and health actors has not been leveraged systematically.

Data from a prior systematic review of emergency care interventions feasible within the context of HMA activities and low-resource health care systems were used to model mortality reduction among EO victims. Interventions were categorized using the World Health Organization (WHO) Emergency Care System Framework sites of “scene,” “transport,” and “facility.” The cumulative impact of the interventions on EO-related mortality was estimated using pooled effect estimates and simulation modeling.

The meta-analysis included 16 reports from 13 countries, representing 127,505 injured persons. Pooled effect estimates across subcategories of emergency care interventions were 0.42 for layperson transportation (95%CI, 0.24-0.74), 0.79 for prehospital notification systems (95%CI, 0.51-1.19), 0.52 for prehospital trauma care training courses (95%CI, 0.46-0.59), 0.67 for facility-based trauma care training courses (95%CI, 0.48-0.92), and 0.66 for facility-based trauma team organization and activation protocols (95%CI, 0.45-0.97). A 68% reduction in mortality (95%UI, 57%-79%) was observed when implementing the full set of interventions in a region with no prior implemented interventions.

Enhanced coordination between HMA and health actors to implement a structured set of emergency care interventions holds potential to significantly reduce preventable death among civilian EO casualties.

Many factors influence the likelihood of bystander cardiopulmonary resuscitation (BCPR) after out-of-hospital cardiac arrest (OHCA), but gender disparities in prehospital care remain under-examined, particularly in relation to the bystander’s connection to the patient.

The objective of this study was to evaluate the association between gender and the likelihood of receiving BCPR in OHCA. The primary outcome of the study was to examine differences in BCPR rates among men and women who experienced OHCA. The secondary outcome was to investigate whether bystanders were more likely to provide CPR based on their relationship to the victim, comparing “true” layperson CPR to CPR administered by family members or friends and how these rates differed between men and women.

This retrospective prehospital chart review included all encounters from a single urban Emergency Medical Services (EMS) agency with a cardiac arrest prior to EMS arrival from January 1, 2017 through June 30, 2022 (n = 701). For each encounter, the presence or absence of BCPR was recorded, along with the relation of the bystander to the patient. “True” BCPR was defined as CPR performed by a layperson unknown to the patient. Patients were excluded if they exhibited signs of obvious death, were physically inaccessible to bystanders, had CPR initiated by trained facility staff or police, had a do not resuscitate (DNR) order present on EMS arrival, received CPR but were not in cardiac arrest, or were younger than 18 years old (n = 174). Odds ratios (OR) with 95% confidence intervals (CI) were used to evaluate data, with statistical significance defined at P < .05.

The study examined 701 cardiac arrest encounters: 250 female (35.7%) and 451 male (64.3%). Overall, men (n = 123; 27.3%) were more likely to receive BCPR than women (n = 48; 19.2%); OR = 1.58; 95%CI, 1.08-2.30; P = .02. Among those who received BCPR, women were significantly more likely to have received it from someone they knew (83.3% versus 65.9%; OR = 2.59; 95%CI, 1.11-6.04; P = .03) while men were more likely to receive “true” layperson BCPR.

This study identifies significant gender disparities in prehospital BCPR and highlights an association between the bystander’s relationship to the patient and the likelihood of intervention.