Hostname: page-component-5b777bbd6c-7mr9c Total loading time: 0 Render date: 2025-06-25T22:14:32.596Z Has data issue: false hasContentIssue false
  • English
  • Français

Terrorists Use of Ambulances for Terror Attacks: A Review

Part of: Prehospital and Disaster Medicine Counterterrorism Collection

Published online by Cambridge University Press:  28 October 2020

Gregory N. Jasani Open the ORCID record for Gregory N. Jasani [Opens in a new window] ,
Reem Alfalasi ,
Garrett A. Cavaliere ,
Gregory R. Ciottone  and
Benjamin J. Lawner
Gregory N. Jasani*
Affiliation:
Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MarylandUSA
Reem Alfalasi
Affiliation:
Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MarylandUSA
Garrett A. Cavaliere
Affiliation:
Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MarylandUSA
Gregory R. Ciottone
Affiliation:
Division of Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA
Benjamin J. Lawner
Affiliation:
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MarylandUSA Maryland ExpressCare Critical Care Transport Program, Baltimore, MarylandUSA
*
Correspondence: Gregory Jasani, MD 110 S Paca St 6th floor, Ste 200 Baltimore, Maryland21201USA E-mail: gjasani@som.umaryland.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Using an ambulance as an attack modality offers many advantages to a terrorist organization. Ambulances can carry more explosives than most vehicles and can often bypass security. Yet, studies examining how terrorist organizations have incorporated ambulances into their attacks are lacking.

Study Objective:

This article seeks to identify and analyze known instances in which an ambulance has been used in a terrorist attack.

Methods:

The Global Terrorism Database (GTD) was searched for terrorist events that involved the use of an ambulance from the years 1970-2018. Variables of event time, location, and loss of life were analyzed.

Results:

Twenty instances where an ambulance had been used in a terrorist attack were identified from the GTD. Fifteen of the attacks occurred in the Middle East, while the remaining five occurred in Southeast Asia. All attacks except one had occurred after 2001, and 13 had occurred within the past decade. Most attacks (12/20) resulted in up to three people killed, while six attacks had 10-20 casualties. The deadliest attack occurred in Kabul, Afghanistan in 2018 and caused over 100 casualties. One event did not have casualty information in the GTD. In all cases, ambulances were used as vehicle-borne improvised explosive devices (VBIED) by terrorist organizations.

Conclusion:

This study shows that terrorists are increasingly acquiring and utilizing ambulances in their attacks, often with deadly consequences. Security and public health experts must be aware of this hazard and work to deny terrorists access to these vehicles.

Keywords

ambulancecar bombterrorismterrorist attacks
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 1 , February 2021 , pp. 14 - 17
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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.)

Article purchase

Temporarily unavailable

References

Young, R. Defining terrorism: the evolution of terrorism as a legal concept in international law and its influence on definitions in domestic legislation. Boston College International and Comparative Law Review. 2006;29(1):23-106. http://search.ebscohost.com.proxy-hs.researchport.umd.edu/login.aspx?direct=true&db=edshol&AN=edshol.hein.journals.bcic29.7&site=eds-live. Accessed May 12, 2020.Google Scholar
US Department of Homeland Security. Planning Considerations: Complex Coordinated Terrorist Attacks July 2018. https://www.fema.gov/media-library-data/1532550673102-c4846f270150682decbda99b37524ca6/Planning_Considerations-Complex_Coordinated_Terrorist_Attacks.pdf. Accessed May 9, 2020.Google Scholar
US Department of Homeland Security. Incident Site Security: Secondary Attacks. https://www.hsdl.org/?view&did=765478. Accessed May 10, 2020.Google Scholar
Thompson, J, Rehn, M, Lossius, HM, Lockey, D. Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature. Crit Car. 2014;18(5):521.CrossRefGoogle ScholarPubMed
San Diego Law Enforcement Coordination Center. Altered Vehicle Resembling Ambulance Used to Conceal Improvised Explosive Device in Kabul, Afghanistan. https://info.publicintelligence.net/SDLECC-AmbulanceVBIED.pdf. Published 2018.Accessed May 10, 2020.Google Scholar
D’Agata. Experts warn terrorists could use ambulances in future deadly attacks. CBS News. January 29, 2018. https://www.cbsnews.com/news/kabul-attack-terrorists-could-use-ambulances-in-future-deadly-attacks/. Accessed May 8, 2020.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefGoogle ScholarPubMed
National Consortium for the Study of Terrorism and Response to Terrorism (START), University of Maryland. The Global Terrorism Database (GTD) [Data file]. 2019 https://www.start.umd.edu/gtd. Accessed May 8, 2020.Google Scholar
Overton, M. “Trojan ambulances:” an emerging threat. J Paramedic Practice. 2013;5(11):632-636 CrossRefGoogle Scholar
Ludwig, G. Ambulances as Bombs-Now a reality. Firehouse. August 1, 2008. https://www.firehouse.com/safety-health/article/10501307/ambulances-as-bombs-now-a-reality. Accessed May 8, 2020.Google Scholar
Israel Ministry of Foreign Affairs. Use of ambulances and medical vehicles by Palestinian terrorist organizations-14-Feb-2002. https://mfa.gov.il/MFA/PressRoom/2002/Pages/Use%20of%20ambulances%20and%20medical%20vehicles%20by%20Palestin.aspx. Accessed June 1, 2020.Google Scholar
Alves, DW, Bissell, RA. Ambulance snatching: how vulnerable are we? J Emerg Med. 2003;25(2):211-214.CrossRefGoogle Scholar
Daesh uses ambulances to kill 21 people in Iraq. Middle East Monitor News. https://www.middleeastmonitor.com/20161106-daesh-uses-ambulances-to-kill-21-people-in-iraq/. Accessed May 10, 2020.Google Scholar
Ambulances. Metronic, INC. http://metronixinc.com/site/ambulances.html. Accessed May 8, 2020.Google Scholar