Introduction: Coordinated Terror Attacks (CTAs) have evolved significantly with increased complexity and deliberate strategies to maximize casualties and societal impact. These attacks, characterized by multiple incidents across space and time, may target healthcare facilities directly or through secondary attacks. Recent events demonstrate a concerning rise in CTAs that pose a unique threat to the healthcare infrastructure, with complex challenges. This scoping review examines literature on CTAs targeting hospitals and hospital responses to recent major CTAs to identify potential gaps in preparedness and response. Based on these findings, the review offers policy recommendations to enhance hospital readiness, response protocols, and overall resilience. Methods: This scoping review used the Arksey and O’Malley five-step framework. Manuscripts were retrieved from six databases and search engines using keywords relating to coordinated attacks and hospital facilities. Analysis focused on evaluating whether the terror event can be characterized as a CTA, whether it directly targeted or impacted a healthcare facility, and how such a facility responded. Results: Of 1,616 papers screened, 26 met the inclusion criteria: seven addressed CTA events in which healthcare facilities were confirmed targets, 12 publications examined how non-targeted hospitals responded to CTAs, and six secondary data analyses examined the broader trend of terrorist attacks targeting hospitals. Notable CTA events were referenced as key examples for discussion. Characteristics of the attacks, hospital response, lessons learned, author recommendations, and proposed methods for CTA hospital preparedness were extracted. Conclusion: The findings highlight a gap in the literature and suggest an opportunity for further research into the threats CTAs pose to healthcare. Increasing evidence of CTAs underscores the need for hospitals to prepare specifically for CTAs. Hospitals must harden operationally and structurally, integrate system-wide communication, and systematically allocate resources in a stepwise fashion to improve the response to waves of casualties and maintain functionality during cascading, multisite, and/or prolonged attacks.
Boukai et al. (Sun,) studied this question.