Terrorism in Australia: A Decade of Escalating Deaths and Injuries Supporting the Need for Counter-Terrorism Medicine.

BACKGROUND Australia is ranked 71st on the Global Terrorism Index (GTI; 2019), a scoring system of terrorist activities. While it has a relatively low terrorist risk, events globally have wide-ranging repercussions putting first responders and emergency health workers at risk. Counter-Terrorism Medicine (CTM) is rapidly emerging as a sub-specialty needed to address these threats on the front line. This study aims to provide the epidemiological context for the past decade, detailing the unique injury types responders are likely to encounter, and to develop training programs utilizing these data. METHODS The Global Terrorism Database (GTD) was searched for all attacks in Australia from the years 2009-2019. Attacks met inclusion criteria if they fulfilled the following terrorism-related criteria as set by the GTD. Ambiguous events were excluded when there was uncertainty as to whether the incident met all of the criteria for inclusion as a GTD terrorist incident. The grey literature was reviewed, and each event was cross-matched with reputable international and national newspaper sources online to confirm or add details regarding weapon type used, and whenever available, details of victim and perpetrator fatalities and injuries. RESULTS Thirty-seven terrorist events occurred in the study time period. Of the thirty-seven incidents, twenty-six (70.2%) involved incendiary weapons, five (13.5%) involved firearms, four (10.8%) involved melee (bladed weapon/knife) attacks, two (5.4%) were explosive/bombing/dynamite attacks, and one (2.7%) was a mixed attack using both incendiary and melee weapons. All except one firearms-related incident (four out of five) resulted in either a fatality or injury or both. Every melee incident resulted in either a fatality or injury or both. CONCLUSIONS In the decade from 2009 to 2019, terrorist attacks on Australian soil have been manageable, small-scale incidents with well-understood modalities. Eleven fatalities and fourteen injuries were sustained as a result of terrorist events during that period. Incendiary weapons were the most commonly chosen methodology, followed by firearms, bladed weapons, and explosive/bombings/dynamite attacks.