[Resilience of German clinics in amok and terrorist situations : Results of an online-based survey in German emergency departments].

Background: As a critical infrastructure (CRITIS) and soft target with high symbolic power, hospitals have to prepare for terrorist attacks, rampages, and establish damage-prevention measures.

Method: The terrorist threat situation was quantified using an evaluation of the terrorist event database (TED) from 1970 to 2017. Additionally, the threat perception and precautionary measures were recorded by an online survey among the leaders of German emergency departments.

Results: The TED-evaluation shows an international increase in terrorist attacks on medical facilities, especially in civil war countries and the USA. The use of explosives caused a large number of injuries and deaths during the examined time period. Most online respondents felt that preparing the clinic for terrorist scenarios in their hospital emergency preparedness planning was important. Suitable measures were, however, often not established in hospital emergency preparedness planning. Only 59% dealt with the care of the injured due to a terrorist attack and only 34% with securing the infrastructure.

Conclusion: German clinics should consider themselves as critical infrastructure and potential targets of terrorist attacks and prepare themselves for terrorist threats. Many measures that could be implemented cheaply have not been utilized in the clinics and should be integrated promptly into both hospital emergency preparedness planning and daily routines.