Terrorist Attacks Escalate in Frequency and Fatalities Preceding Highly Lethal Attacks

Highly lethal terrorist attacks, which we define as those killing 21 or more people, account for 50% of the total number of people killed in all terrorist attacks combined, yet comprise only 3.5% of terrorist attacks. Given the disproportionate influence of these incidents, uncovering systematic patterns in attacks that precede and anticipate these highly lethal attacks may be of value for understanding attacks that exact a heavy toll on life. Here we examined whether the activity of terrorist groups escalates–both in the number of people killed per attack and in the frequency of attacks–leading up to highly lethal attacks. Analyses of terrorist attacks drawn from a state-of-the-art international terrorism database (The Global Terrorism Database) showed evidence for both types of escalation leading up to highly lethal attacks, though complexities to the patterns emerged as well. These patterns of escalation do not emerge among terrorist groups that never commit a highly lethal attack.     

Planning for exercises of chemical, biological, radiological, and nuclear (CBRN) forensic capabilities

A forensic capability to help identify perpetrators and exclude innocent people should be an integral part of a strategy against terrorist attacks. Exercises have been conducted to increase our preparedness and response capabilities to chemical, biological, radiological, and nuclear (CBRN) terrorist attacks. However, incorporating forensic components into these exercises has been deficient. CBRN investigations rely on forensic results, so the need to integrate a forensic component and forensics experts into comprehensive exercises is paramount. This article provides guidance for planning and executing exercises at local, state, federal, and international levels that test the effectiveness of forensic capabilities for CBRN threats. The guidelines presented here apply both to situations where forensics is only a component of a more general exercise and where forensics is the primary focus of the exercise.     

What does the public want to know in the event of a terrorist attack using plague?

We used formative research to assess the information needs and information-seeking strategies with general public audience segments in response to a hypothetical attack using plague, and we pretested informational materials about plague. Twelve focus groups were conducted across the country, with 129 individuals being purposively sampled by ethnicity and place of residence. Across groups, participants wanted to understand: the nature of the threat of plague, how to protect themselves from transmission, how to detect exposure and symptoms, how to treat infection, and progress in apprehending perpetrators. Participants reported that they would seek information from both the news media and local authorities. Based on the findings and the challenges posed by a terrorist attack using plague, the authors recommend that message materials answer key questions, provide clear action steps, be clear and easily understood, include sources for credibility, and reflect full government disclosure. A dissemination plan is required to ensure that critical information will be available when people need it and where they look.     

Public perceptions and risk communications for botulism

Formative research findings from 10 focus group interviews on botulism are described. Data were collected from a diverse sample of people throughout the United States in 2003, as part of a collaborative multisite initiative sponsored by the Centers for Disease Control and Prevention to improve communications materials on bioterrorism agents. Focus group guides included questions on knowledge, action, emotions, and information seeking in response to a series of scenarios on a hypothetical terrorist attack using botulinum toxin. Data were collected, transcribed, coded, and analyzed using content domains based on risk and health communications theories. Initial participant responses to scenarios were emotional, changing into immediate health and survival concerns conceptualized as information specific to the agent and event. Knowledge about botulism was low, and participants wanted clear, concise, and actionable messages. Broadcast media, the internet, and community-based sources were cited as sources of information. Findings have implications for botulism preparedness messages and for general public risk communications.     

Terrorism threats and preparedness in Canada: the perspective of the Canadian public

Although Canada has not experienced a major terrorist attack, an increased global pending threat has put preparedness at the top of the Canadian government's agenda. Given its strong multicultural community and close proximity to the recently targeted United States, the Canadian experience is unique. However, minimal research exists on the public's reactions to terrorism threats and related preparedness strategies. In order for response initiatives to be optimally effective, it is important that the public's opinions regarding terrorism and preparedness be considered. This qualitative study examined perceptions of terrorism threats among Canadians living in Central and Eastern Canada (N = 75) in the fall of 2004. Conceptualizations of terrorism threat, psychosocial impacts, and sense of preparedness were explored in a series of qualitative interviews. Findings revealed that the majority of Canadians did not feel overly threatened by terrorist attacks, due in part to a perception of terrorist threats as related to global sociopolitical events and a positive Canadian identity. In addition, while most respondents did not feel they were individually affected by the threat of terrorism, there was some concern regarding larger societal impacts, such as increased paranoia, discrimination, and threats to civil liberties. Participants' views on preparedness focused largely on the utility of emergency preparedness strategies and the factors that could mitigate or inhibit preparedness at the individual and institutional levels, with a specific focus on education. Finally, the significant relevance of these findings in shaping terrorism preparedness, both in Canada and generally, is discussed.     

A randomized controlled effectiveness trial of cognitive behavior therapy for post-traumatic stress disorder in terrorist-affected people in Thailand

Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), there is no evidence of its success with PTSD patients still under direct threat of terrorist attacks. This study reports the first randomized controlled trial of CBT for PTSD terrorist-affected people. Twenty-eight survivors of terrorist attacks in southern Thailand were randomized to 8 sessions of either CBT or treatment as usual (TAU). CBT was modified to accommodate the realistic threats facing patients. There were independent assessments conducted before, immediately after, and 3 months following treatment. Main outcome measures included symptoms of PTSD (PTSD Symptom Scale Interview), depression (Beck Depression Inventory) and complicated grief (Inventory of Complicated Grief). CBT resulted in significantly greater reduction in symptoms, including PTSD, depression, and complicated grief, at follow-up than TAU. Relative to TAU, CBT had stronger effect sizes at follow-up for PTSD, depression, and complicated grief. More patients in the CBT condition (75%) achieved high end-state functioning than participants in the TAU (33%). This preliminary evidence suggests that PTSD, depression, and complicated grief can be effectively treated despite ongoing threats of terrorism. Further, it demonstrates that non-specialist mental health workers in a non-western setting can be efficiently trained in using CBT, and this training can translate into successful treatment gains in trauma-affected individuals.     

Individual attributes and party affect large carnivore attacks on humans

Wildlife managers, researchers and the general public have traditionally been demanding information on factors concerning the probability of risky encounters between predators and people, as well as how to react in those situations. This information is crucial to reduce the number of predator attacks, which in absolute terms have increased in the last decades. Here, we focus on the role of carnivore species and sex, as well as victim-related factors (i.e. gender, activities, party composition), as determinants of carnivore attacks on humans. Using a dataset on attacks by grizzlies (Ursus arctos horribilis), black bears (Ursus americanus), cougars (Puma concolor), wolves (Canis lupus) and coyotes (Canis latrans) in North America during the last five decades, we found that (1) male black bears were involved in attacks more frequently than females; (2) attacks by coyotes, cougars and wolves prevalently caused injuries, whereas cases of death were more frequent during grizzly and black bear attacks; and (3) people in a party were less vulnerable to an attack than a person alone. We identified risky situations and behaviours that should be avoided in areas where people and large carnivore share the landscape.     

Limitations and challenges in treatment of acute chemical warfare agent poisoning

Recent news from Syria on a possible use of chemical warfare agents made the headlines. Furthermore, the motivation of terrorists to cause maximal harm shifts these agents into the public focus. For incidents with mass casualties appropriate medical countermeasures must be available. At present, the most important threats arise from nerve agents and sulfur mustard. At first, self-protection and protection of medical units from contamination is of utmost importance. Volatile nerve agent exposure, e.g. sarin, results in fast development of cholinergic crisis. Immediate clinical diagnosis can be confirmed on-site by assessment of acetylcholinesterase activity. Treatment with autoinjectors that are filled with 2 mg atropine and an oxime (at present obidoxime, pralidoxime, TMB-4 or HI-6) are not effective against all nerve agents. A more aggressive atropinisation has to be considered and more effective oximes (if possible with a broad spectrum or a combination of different oximes) as well as alternative strategies to cope with high acetylcholine levels at synaptic sites should be developed. A further gap exists for the treatment of patients with sustained cholinergic crisis that has to be expected after exposure to persistent nerve agents, e.g. VX. The requirement for long-lasting artificial ventilation can be reduced with an oxime therapy that is optimized by using the cholinesterase status for guidance or by measures (e.g. scavengers) that are able to reduce the poison load substantially in the patients.     

Opinion Formation and the Collective Dynamics of Risk Perception

The formation of collective opinion is a complex phenomenon that results from the combined effects of mass media exposure and social influence between individuals. The present work introduces a model of opinion formation specifically designed to address risk judgments, such as attitudes towards climate change, terrorist threats, or children vaccination. The model assumes that people collect risk information from the media environment and exchange them locally with other individuals. Even though individuals are initially exposed to the same sample of information, the model predicts the emergence of opinion polarization and clustering. In particular, numerical simulations highlight two crucial factors that determine the collective outcome: the propensity of individuals to search for independent information, and the strength of social influence. This work provides a quantitative framework to anticipate and manage how the public responds to a given risk, and could help understanding the systemic amplification of fears and worries, or the underestimation of real dangers.     

Unnatural Deaths in Shanghai from 2000 to 2009: A Retrospective Study of Forensic Autopsy Cases at the Shanghai Public Security Bureau

Shanghai is the most developed city in China and has a soaring population. This study uses forensic epidemiology to determine the relationship between unnatural deaths and the development in Shanghai, based on recently released forensic autopsy cases from the 2000s at the Shanghai Public Security Bureau (SPSB). There were 5425 accidental deaths, 2696 homicides, 429 suicides, 186 natural deaths, and 1399 deaths of undetermined cause. There was a male-to-female ratio of 2.02:1, and the average age was 40.9±18.7 years. Traffic accidents (84.2%) were the number one cause of accidental deaths, which decreased during the study period. Sharp force injury (50.6%) was the leading cause of homicides, different from Western countries, where firearms are the leading cause. Hanging (24.5%) was the leading cause of suicides, whereas drug and chemical intoxication was the leading cause in the previous decade; pesticide ingestion decreased in the 2000s. In addition to traffic accidents, manual strangulation was the leading cause of death in childhood fatalities. Children under age 2 were vulnerable to homicides. In the 2000s, there were a large number of drug overdoses, and illegal medical practices and subway-related deaths first appeared in Shanghai. A new type of terrorist attack that involved injecting people with syringes in public places was reflected in the SPSB archives. The forensic epidemiology and changes in unnatural deaths in this decade reflected their relationship with the law, policy and changes in Shanghai. Illegal medical practices, subway-related deaths and terrorist attacks were closely related to the development in Shanghai. Identifying the risks of unnatural deaths will improve public health.     

Canadians' Representation of Chemical,Biological, Radiological,Nuclear, and Explosive (CBRNE) Terrorism: A Content Analysis

The global threat of terrorism raises questions about preparedness and risk communication in the context of public health and security. Although experts discriminate between chemical, biological, radiological, nuclear, and explosive (CNRNE) terrorist events, little is known about how the Canadian public represents these forms of terrorism. A stratified random sample of 1502 Canadians participated in a telephone survey on CBRNE terrorism. A word association technique was used to assess first words or images that came to mind while thinking about different types of terrorist scenarios. Content analysis of this data revealed a number of potential uncertainties and misconceptions regarding different types of terrorism scenarios. Despite most frequently providing agents in response questions surrounding chemical or biological terrorism, respondents frequently confounded agents of biological and chemical nature. Similarly, different aspects of nuclear events were not consistently distinguished. Most notably, however, a sizable proportion of respondents had difficulty providing word associations to the different types of terrorist events or only provided vague responses that closely mirrored the scenario in question. Finally, images regarding the potential impacts of scenarios were infrequent. Implications for risk communication and preparedness are discussed; in particular, the need to provide the public with more detailed information regarding the nature of different forms of CBRNE terrorism and how to best prepare for a potential event.     

What it Takes to Get Passed On: Message Content,Style, and Structure as Predictors of Retransmission in the Boston Marathon Bombing Response

Message retransmission is a central aspect of information diffusion. In a disaster context, the passing on of official warning messages by members of the public also serves as a behavioral indicator of message salience, suggesting that particular messages are (or are not) perceived by the public to be both noteworthy and valuable enough to share with others. This study provides the first examination of terse message retransmission of official warning messages in response to a domestic terrorist attack, the Boston Marathon Bombing in 2013. Using messages posted from public officials’ Twitter accounts that were active during the period of the Boston Marathon bombing and manhunt, we examine the features of messages that are associated with their retransmission. We focus on message content, style, and structure, as well as the networked relationships of message senders to answer the question: what characteristics of a terse message sent under conditions of imminent threat predict its retransmission among members of the public? We employ a negative binomial model to examine how message characteristics affect message retransmission. We find that, rather than any single effect dominating the process, retransmission of official Tweets during the Boston bombing response was jointly influenced by various message content, style, and sender characteristics. These findings suggest the need for more work that investigates impact of multiple factors on the allocation of attention and on message retransmission during hazard events.     

Biological weapons, genetics, and social analysis: emerging responses, emerging issues--II

Recent terrorist attacks in the United States have generated significant attention in many countries to the threats posed by biological weapons. In response to these events and the specter of future attacks, bioscientists and professional organizations have begun or intensified asking questions about the possible malign applications of their research. Part II of this two-part article examines the emerging responses initiated by biomedical organizations and spokespersons in the US and the UK. In doing so it considers how scientific and medical research communities are defining and policing notions of professionalism, responsibility and accountability in the responses made. Through an examination of these issues, suggested lines for future social analysis are offered.     

Preparedness for an anthrax attack

Bacillus anthracis is a long-known bacterial organism with a uniquely stable spore stage. Its stability and the lethal disease which results when the spore is inhaled made it a favorite of state-sponsored biological weapons programs throughout the Cold War era. It is also believed to be high on the list of candidate microbial agents which could be used by terrorist groups or lone actors. Its unique characteristics make protection of humans, especially civilians, from an intentional biological attack very difficult. The author argues that an all-hazards/public health approach – which would also be needed for any natural or deliberate outbreak, no matter the agent – should serve as a foundation of preparation for the specific anthrax countermeasures. Because B. anthracis is a unique organism, specific countermeasures for anthrax detection, diagnostics, prophylaxis and therapy, should be developed in nations or regions where the threat of biological attack is believed to warrant such preparation. Other considerations for a nation interested in anthrax preparedness are discussed.     

Biological weapons,genetics, and social analysis: emerging responses,emerging issues—II

Recent terrorist attacks in the United States have generated significant attention in many countries to the threats posed by biological weapons. In response to these events and the specter of future attacks, bioscientists and professional organizations have begun or intensified asking questions about the possible malign applications of their research. Part II of this two-part article examines the emerging responses initiated by biomedical organizations and spokespersons in the US and the UK. In doing so it considers how scientific and medical research communities are defining and policing notions of professionalism, responsibility and accountability in the responses made. Through an examination of these issues, suggested lines for future social analysis are offered.     

Managing biosecurity threats in China

Compared to the extensive literature on bioterrorism and biosecurity in the United States, less analysis has been conducted on similar challenges in China. This article seeks to fill this void by providing an integrated and updated assessment of 3 major biosecurity threats China faces: biowarfare, bioterrorism, and biocrimes. An analysis of China's biosecurity threats and biodefense building suggest varying levels of risk associated with each threat type. First, a direct bioweapons attack on China is highly unlikely, although the threat of biowarfare cannot be simply written off. Second, potential perpetrators of bioterrorism have capabilities at their disposal for carrying out such attacks. While terrorist organizations in China do not have a strong interest in bioterrorism, the limited state capability to counter such a threat may increase the risk in the future. Third, unlike the threats of biowarfare and bioterrorism, potential perpetrators of biocrimes have both incentives and capabilities, and biocrimes can produce reactions far out of proportion to the actual number of casualties. Despite the distinct biosecurity challenges it faces, China has yet to articulate a differentiated and coherent strategy to effectively tackle the challenges. Assessing different types of biosecurity threats in terms of degrees of risk not only provides greater analytical clarity but also has important implications for the strategies required to manage the risks.     

Biological weapons, genetics and social analysis: emerging responses, emerging issues--I

Recent terrorist attacks in the USA have generated significant attention in many countries to the threats posed by biological weapons. In response to these events and the spectre of future attacks, bioscientists and professional organizations have begun or intensified asking questions about the possible malign applications of their research. As Part I of a two-part article, this paper surveys how genetics might contribute to the development of novel forms of weaponry. It is further argued that the dilemmas and difficulties facing bioscientists pose pressing and thorny questions for the hitherto agendas and orientations of those concerned with the social, ethical and political implications of genetics. Part II will examine the emerging responses initiated by biomedical organizations and spokespersons in the US and the UK. This will be done with a view to asking how scientific and medical research communities are defining and policing notions of professionalism, responsibility and accountability. On the basis of this, suggested lines for future social analysis will be offered.     

Patients’ attitudes to the summary care record and HealthSpace: qualitative study

Objective To document the views of patients and the public towards the summary care record (SCR, a centrally stored medical record drawn from the general practice record) and HealthSpace (a personal health organiser accessible through the internet from which people can view their SCR), with a particular focus on those with low health literacy, potentially stigmatising conditions, or difficulties accessing health care.Design 103 semistructured individual interviews and seven focus groups.Setting Three early adopter primary care trusts in England where the SCR and HealthSpace are being piloted. All were in areas of relative socioeconomic deprivation.Participants Individual participants were recruited from general practice surgeries, walk-in centres, out of hours centres, and accident and emergency departments. Participants in focus groups were recruited through voluntary sector organisations; they comprised advocates of vulnerable groups and advocates of people who speak limited English; people with HIV; users of mental health services; young adults; elderly people; and participants of a drug rehabilitation programme.Methods Participants were asked if they had received information about the SCR and HealthSpace and about their views on shared electronic records in different circumstances.Results Most people were not aware of the SCR or HealthSpace and did not recall receiving information about it. They saw both benefits and drawbacks to having an SCR and described a process of weighing the former against the latter when making their personal choice. Key factors influencing this choice included the nature of any illness (especially whether it was likely to lead to emergency care needs); past and present experience of healthcare and government surveillance; the person’s level of engagement and health literacy; and their trust and confidence in the primary healthcare team and the wider NHS. Overall, people with stigmatising illness were more positive about the SCR than people who claimed to speak for “vulnerable groups.” Misconceptions about the SCR were common, especially confusion about what data it contained and who would have access to it. Most people were not interested in recording their medical data or accessing their SCR via HealthSpace, but some saw the potential for this new technology to support self management and lay care for those with chronic illness.Conclusion Despite an extensive information programme in early adopter sites, the public remains unclear about current policy on shared electronic records, though most people view these as a positive development. The “implied consent” model for creating and accessing a person’s SCR should be revisited, perhaps in favour of “consent to view” at the point of access.     

Estimates of radiological risk from a terrorist attack using plutonium

The possible use of radioactivity dispersal devices by terrorist groups has been recently reported in the news. In this paper, we discuss the threat of terrorist attacks by plutonium, with particular attention to the dispersal of plutonium by explosion or fire. Doses resulting from inhalation of radioactive aerosol induced by a plutonium explosion or fire are simulated using a Gaussian plume model (the HOTSPOT code) for different meteorological conditions. Ground contamination and resuspension of dust are also considered in the simulations. Our simulations suggest that acute effects from a plutonium dispersal attack are very unlikely. For late stochastic effects, the explosion poses a greater hazard than fire. However, even in the worst-case scenario, the dispersed plutonium would cause relatively few excess cancers (around 80 in a city of 2 million inhabitants) after many years from the explosion, and these excess cancers would remain undetected against the background of cancer fatalities.