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The United States Twenty-Year Experience With Bombing Incidents: Implications for Terrorism Preparedness and Medical Response

Kapur, G Bobby MD, MPH; Hutson, H Range MD; Davis, Mark A. MD, MS; Rice, Phillip L. MD

Journal of Trauma and Acute Care Surgery: December 2005 - Volume 59 - Issue 6 - p 1436-1444
doi: 10.1097/01.ta.0000197853.49084.3c

Background: Terrorist bombings remain a significant threat in the United States. However, minimal longitudinal data exists regarding the medical and public health impact because of bombings.

Methods: We conducted a retrospective analysis of the number of incidents, injuries, and deaths because of explosive, incendiary, premature, and attempted bombings from January 1983 to December 2002. Morbidity and mortality by motives, target locations, and materials used were evaluated.

Results: In the United States, 36,110 bombing incidents, 5,931 injuries, and 699 deaths were reported. There were 21,237 (58.8%) explosive bombings, 6,185 (17.1%) incendiary bombings, 1,107 (3.1%) premature bombings, and 7,581 (21.0%) attempted bombings. For explosive bombings with known motives, 72.9% of injuries and 73.8% of deaths were because of homicide. For incendiary bombings with known motives, 68.2% of injuries were because of extortion and revenge, and 53.5% of deaths were due to homicide. Private residences accounted for 29.0% of incidents, 31.5% of injuries, and 55.5% of deaths. Government installations accounted for 4.4% of incidents but were the site of 12.7% of injuries and 25.5% of deaths. In bombings with known materials, nitrate-based fertilizers accounted for 36.2% of injuries and 30.4% of deaths, and smokeless powder and black powder accounted for 33.2% of injuries and 27.1% of deaths.

Conclusions: Illegal bombings and related injuries commonly occur in the United States. Because of the easy availability of bombing materials, government agencies and healthcare providers should prepare for potential mass-casualty bombings.

From the Institute for International Emergency Medicine and Health (G.B.K., M.A.D.), Department of Emergency Medicine (P.L.R.), Brigham and Women's Hospital and Department of Emergency Medicine, Massachusetts General Hospital (H.R.H.), Harvard Medical School, Boston, Mass.

Submitted for publication July 28, 2004.

Accepted for publication February 1, 2005.

Address for reprints: G. Bobby Kapur, MD, MPH, The George Washington University, 2150 Pennsylvania Avenue, NW, Suite 2B-417, Washington, DC 20037; email:

© 2005 Lippincott Williams & Wilkins, Inc.