A National Model for Tactical Emergency Medical Support in Finland

Abstract

Introduction: In the past five decades, the region of Latin America and the Caribbean (LAC) has been subject to several types of terrorist attacks, with most committed by local terrorist organizations. However, there have also been attacks by international terrorist groups. Internationally, terrorist attacks are increasing in both frequency and complexity. Significant concerns exist regarding the use of Chemical Warfare Agents (CWAs) in civilian settings. Asphyxiants (e.g. cyanide), opioids (e.g. fentanyl), and nerve agents (e.g. sarin) represent some of the most lethal CWAs. To date, there is very little published data on their use in the LAC region despite the fact that the recent attacks in Syria have sparked international interest in the use and regulation of CWAs. Aim: To improve civilian health service preparedness in response to CWAs attacks by describing the types of agents historically used within the LAC region. Methods: Information was extracted and analyzed from the open-source Global Terrorist Database hosted by the University of Maryland, regarding CWA-LAC from January 1, 1970, to December 31, 2017. Results: During the forty-seven year period reviewed, there were 29,846 terrorist attacks in the LAC region, with 63.6% occurring in the southern region. Twenty-nine CWA attacks were reported, with the most common agents being tear gas (37%) and cyanide (29.6%). The most frequent targets were religious figures/institutions (22.2%), law enforcement (18.5%), and government agencies/personnel (18.5%). Discussion: Cyanide is one of the most prevalent agents used for chemical weapons attacks in the LAC region. Preparedness should be enhanced for CWA terrorist attacks, especially those involving cyanide, given its life-threatening nature, prevalence, and the existence of reversal agents. First responders, physicians , and nurses should be aware of this potential hazard and be trained to respond appropriately. Additionally, regional stockpiles of antidotes should be considered by governmental bodies within the LAC region.