Twenty-five years of violence: the epidemiology of terrorism in South America.

INTRODUCTION: Terrorism is a global public health burden. South Americans have been victims of terrorism for many decades. While the causes vary, the results are the same: death, disability, and suffering. The objective of this study was to perform a comprehensive, epidemiological, descriptive study of terrorist incidents in South America. METHODS: This is a cross-sectional, descriptive study. Data from January 1971 to July 2006 was selected using the RAND Terrorism Chronology 1968-1997 and RAND-Memorial Institute for Prevention of Terrorism (MIPT) Terrorism Incident database (1998-Present). Statistical significance was set at 0.05. RESULTS: The database reported a total of 2,997 incidents in South American countries that resulted in 3,435 victims with injuries (1.15 per incident) and 1,973 fatalities (0.66 per incident). The overall case fatality ratio (CFR) was 35.8%. Colombia had the majority of incidents with 57.9% (1,734 of 2,997), followed by Peru with 363 (12.1%), and Argentina with 267 (8.9%). The highest individual CFR occurred in Paraguay (83.3%), and the lowest in Chile with 4.8%. Of the total injuries and deaths, Colombia had 66.1% (2,269 of 2,997) of all injuries and 75.2% (1,443 out of 1,920) of all deaths. Living in the country of Colombia was associated with a 16 times greater likelihood of becoming a victim of terrorist violence [odds ratio (OR) 16.15; 95% CI 13.45 to 19.40; p < 0.0001]. The predominant method of choice for terrorist incidents was the use of conventional explosives with 2,543 of2,883 incidents (88.2%). CONCLUSIONS: Terrorist incidents in South America have accounted for nearly 2,000 deaths, with conventional explosive devices as the predominant method of choice. Understanding the nature of terrorist attacks and the medical consequences assist emergency preparedness and disaster management officials in allocating resources and preparing for potential future events.

Weapons of mass destruction preparedness and response for the XIV Pan-American Games, Santo Domingo, 2003.

The Pan-American Games are considered to be the fourth most important international athletic event in the world. Hosted by the city of Santo Domingo, Dominican Republic, the XIV Pan-American Games lasted from 11-17 August 2003. In preparation for the Games, the Security Directorate developed and deployed a Weapons of Mass Destruction (WMD) Unit. For operational support, two strike teams (Alpha and Bravo) were active at any given time. Each team consisted of five members including a team leader, field physician, explosive ordinance disposal (EOD) officer, and two tactical officers. Three hospitals-two military and one civilian--were designated as primary medical centers for the event. With the assistance of the WMD Unit, emergency department staff were trained in the medical management of a WMD event, response protocols for WMD were created, and special decontamination areas were designated. Syndromic surveillance was performed by means of direct communications between the hospitals and units, as well as use of an electronic, Web-based surveillance tool.