Terrorism is one of the current challenges of emergency medical services (EMS) preparedness. A prominent change in EMS preparedness between 2000-2020 has been a shift from primarily preparing for chemical, biological, radiological, and nuclear (CBRN) terrorism to preparing for terrorism carried out with more conventional means like weapons, explosives, and vehicles.

The concept of EMS should be reformed to answer the demands of these modern-day threats. A change to proactive measures from the prevailing reactive actions demands a similar paradigm shift in EMS that police forces have undergone in the United States following Columbine and in Finland following Jokela and Kauhajoki. For EMS this could include adapting tactics and equipment that allow trained providers to operate closer to victims in an ongoing incident.

This review examines the preparedness of prehospital first responders to the threat of terrorism between 2000-2020 and collates best practices for the benefit of all actors in the prehospital field. The results of this review can be utilized in the planning and execution of pre-hospital medical response(s) at any level.