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In the decade following the September 11, 2001, terrorist attacks, Americans have become more accustomed to the threat of terrorist attacks by weapons of mass destruction (WMD). Training for response to such events is now common for first responders and medical personnel. This chapter will present practical approaches to terrorist attacks involving WMD and explosives, an overview of specific types of explosives, and strategies for dealing with blast and burn injuries in the prehospital setting.


  • Define terrorism, domestic and international.

  • Discuss specific threats to emergency responders to terrorist events.

  • Discuss principles and strategies relating to the approach to a possible terrorist attack.

  • Define the term weapon of mass destruction, and list examples.

  • Discuss specific issues related to emergency response to various types of WMD events.

  • Describe explosives and incendiaries and give examples.

  • Discuss specific medical conditions associated to exposure to explosives and incineraries.

  • Discuss signs of the possible presence of explosives on a scene (eg, pipe lengths, blasting caps, detonator cord, etc).


Terrorism is any violent act directed against people or property, which is intended to cause damage and/or death, instill fear, and disrupt normal activity among civilians while drawing attention to or furthering a specific nongovernmental group or cause.

Domestic terrorism in the United States refers to activities undertaken in the territorial jurisdiction of the United States which appear to be intended to intimidate or coerce a population or influence governmental policy by mass destruction, assassination, or kidnapping 1 [18 USC 2331(5)].

International terrorism refers to terrorist activities that would violate American criminal laws or the laws of any state and which occur outside the territorial jurisdiction of the United States or transcend national boundaries in terms of the means by which they are accomplished, the population they are meant to affect, or the locale in which the events occur or where the perpetrators seek asylum. 2

Uses of chemical, biological, radiation, nuclear, and explosive (CBRNE) resources have been well described as possible terrorist scenarios. Explosives have long been weapons of choice for international attacks due to their relative ease of use, low cost, and high impact. In the Middle East, improvised explosive devices (IEDs) and suicide bombings occur with relative frequency. Although there have been fewer explosive attacks in the United States, notable examples from the past two decades include the use of stationary IEDs in the 1993 World Trade Center attack and the Centennial Park bombing during the 1996 Olympic Games in Atlanta, Georgia. Vehicle-borne improvised explosive devices (VBIED) were used in 1995 at the Oklahoma City Murrah Building bombing and the September 11, 2001, attacks on the World Trade Center and the Pentagon. There was also an unsuccessful VBIED attempt in Times Square in 2010. Internationally, explosives were second only to firearms as the most common method of attacks ...

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