Characteristics of Prehospital Response to Terrorism: A systematic literature review

Background:  Terrorism is increasingly the aetiology of mass casualty incidents.  Improved prehospital response capability targeted to the unique characteristics of high threat incidents is an area of urgent focus.  Gaps in current knowledge coupled with inconsistent reporting and difficulties in accessing data create difficult conditions for capability enhancement. Methods: A systematic literature review was conducted to describe the characteristics of prehospital response to terrorism from 2011 -2017.  Papers were included if they described a prehospital response to a terrorist incident, were in English or translatable to English and full text was available. Results:  6115 records were located in the initial search of grey and published literature, with 71 retrieved for full text after screening of title and abstract.  23 papers were included in the final analysis, describing 6 separate terrorist attacks.  The majority of literature was published by physicians, all were from Western countries with advanced Emergency Medical Services(EMS) and a standard reporting template was not identified.  The level of evidence was low to very low.  Themes of tactical triage, coordinated activation and response, use of damage control resuscitation and tactical casualty care were common throughout the papers. Conclusions:  The paucity of high level evidence and systematic reporting of lessons learned in the prehospital terrorism response field requires a renewed push for access to data and the establishment of reporting systems that are inclusive of all responders. Keywords:  Terrorism, Pre-hospital, Response, Tactical Emergency Casualty Care, Tactical Combat Casualty Care