The Nature of Terror Medicine

Introduction: Clinicians play a pivotal role in responding to victims of terror, yet we know little about the typology and the type of trauma inflicted. In the past, organization-sponsored terrorism was perceived as the major threat; however, since 2021, more than 50 per cent of ASIO’s priority caseload is domestic extremism, paralleled by a global surge of 320 per cent from 2016 to 2021. Government sources indicate that the most likely form of terrorism in Australasia will involve attacks by lone actors or a small group using simple attack methodologies and rudimentary weapons targeting crowded places. Methods: This report will provide context and deepen understanding of the terrorism threat posed by all sources, focusing on lone actors (using the Christchurch Mosque massacre as a case study). It will examine methods, targets, and the health implications for emergency physicians to enhance prevention, preparedness, response, and recovery from terrorist events using datasets such as the Global Terrorist Database (GTD), Counterterrorism agency analysis, and a comprehensive literature review. Results: A terrorist act committed by a lone actor represents a distinctive form of political violence targeting individuals/groups perceived as “others” or “outsiders,” posing a threat to the perpetrator’s sense of nationalism, veiled within an anti-government and anti-democratic context. Targets are mainly religious (31%), private citizens (29%), Government 14% The most common weapons used are incendiary devices or firearms (73%). Chemical use is 1%. Terror attacks result in greater trauma than that of non-terrorism related trauma, affect more body regions, and cause patients to stay twice as long in the hospital. Victims have a higher ISS and require more surgical interventions. Conclusion: A perfect storm is emerging globally: climate change, disinformation, conspiracy theories, and inequality. Clinicians have a role in expanding knowledge, advocacy, understanding, response coordination, and expertise in recovery.