Terrorist attacks are exceptional events that place paramedics in high-risk situations. When terrorist events occur, paramedics play an integral role in the response to, and management of, these events. Given that responding to terrorist events places paramedics at a high risk for a variety of health problems and injuries, it is imperative to adequately prepare for such events through the use of appropriate teaching and educational programs. These programs should be based on the direct experiences of paramedics responding to previous terrorist events.

This research utilized a series of focus groups in New York and London to investigate how paramedics experienced working during 11 September 2001 and the London bombings. Specifically, this research focused on what concerned paramedics about responding to terrorist events, whether they would be willing to respond again, and what can be learned from these experiences in regard to disaster response training and education.

Paramedics reported a number of primary risks that concerned them during their responses to 9/11 and the London bombings. These included injury, death, potential contamination, and exposure to unknown hazards and agents. Personal protective equipment (PPE), communication networks, and reliabilty of information all were areas of concern that must be addressed by disaster planners. Paramedics reported that the most negative aspect of responding to these terrorist events was the inability to communicate with loved ones and the lack of timely and accurate information regarding updates on the situation. Personal protective equipment was not always available, and at times the wearing the PPE interfered with providing optimal patient care.

Key lessons can be taken away from paramedics experiences during 9/11 and the London bombings. These include the need for dedicated communication channels, accurate and timely information, suitable training and education (including an emphasis on infectious agents), and the provision of suitable PPE conducive to optimal working conditions.

While several population-based studies have documented behavioral health disturbances following terrorist attacks, a number of mental health service utilization analyses present conflicting conclusions.

The purpose of this study was to determine if mental health service utilization increased following a terrorist attack by assessing changes in psychoactive drug prescription rates.

The rate of selective serotonin reuptake inhibitor (SSRI) prescriptions was measured among New York State Medicaid enrollees before and after the terrorist attacks of 11 September 2001. The association between geographic proximity to the events and changes in the rate of SSRI prescriptions around 11 September 2001 was assessed.

From September to December 2001, among individuals residing within three miles of the World Trade Center site, there was an 18.2% increase in the SSRI prescription rate compared to the previous eight-month period (p = 0.0011). While there was a 9.3% increase for non-New York City residents, this change was not statistically significant (p = 0.74).

There was a quantifiable increase in the dispensing of psychoactive drugs following the terrorist attacks of 11 September 2001, and this effect varied by geographic proximity to the events. These findings build on the growing body of knowledge on the pervasive effects of disasters and terrorist events for population health, and demonstrate the need to include mental and behavioral health as key components of surge capacity and public health response to mass traumas.

Psychological distress following disaster events may increase the risk of sudden cardiac death. In 2001, the Nisqually earthquake and the 11 September terrorist attacks profoundly affected Washington state residents.

This research investigated the theory that the incidence of sudden cardiac death would increase following these disaster events.

Death certificates were abstracted using a uniform case definition to determine the number of sudden cardiac deaths for the 48-hour and one week periods following the two disaster events. Sudden cardiac deaths from the corresponding 48-hour and one-week periods in the three weeks before the events, and the analogous periods in 1999 and 2000 were designated as control times. Using t-tests, the number of sudden cardiac deaths for the periods following the disaster events was compared to those of the control periods.

In total, 32 sudden cardiac deaths occurred in the four counties affected by the Nisqually earthquake during the 48 hours after the event, compared to an average of 22 ±3.5 (standard deviation) in the same counties during the control periods (p = 0.02). No difference was observed for the one week period (94 compared to 79.2 ±12.4,p = 0.28). No difference was observed in the number of sudden cardiac deaths in the 48-hours or one-week following the terrorist attacks compared to control periods.

A local disaster caused by a naturally occurring hazard, but not a geographically remote human disaster, was associated with an increased risk of sudden cardiac death. A better understanding of the underlying mechanisms may have implications for prevention of sudden cardiac death.