The London terror attack in March 2017 whereby pedestrians were mown down by a car on Westminster Bridge highlights the urgency needed for EMS preparedness. The 2016 ramming terrorist attack in Nice, France on Bastille Day with the loss of 84 people and over 200 injuries show just how deadly car ramming attacks can be. In Israel these car ramming attacks have become epidemic in the last year. There have been more than 31 ramming attacks since the first Intifada, with the most recent one in January 2017 when a truck ran into a group of soldiers, killing four of them.

Magen David Adom (MDA) is Israel’s national EMS for over 20 years, and has developed protocols for treatment and management of such scenes. MDA recommends that EMS consider the following protocols when dealing with scenes from ramming attacks:

Be Prepared

  • EMS should be prepared to ascertain if multiple reports coming in are actually car ramming terrorist attacks. If there are multiple hit and run accidents in the same vicinity this would be an indicator that there may be a deliberate attack.
  • Dispatchers should determine if the car stopped or continued to plow through the scene.
  • After several reports, dispatchers should call for extra response teams to go to multiple scenes with injured individuals.
  • Dispatchers should have protocols in place to know when to alert security forces to go assess the scene.

Scan the Scene

  • Be prepared to deal with an ongoing attack from terrorists with weapons or bombs once the car has been disabled.
  • A ramming attack can encompass a large area, so these scenes should be subdivided with an assigned commander who can clearly scan the area he or she is responsible for.
  • EMS should check the car to see if there are any hostages who may be injured.
  • Check surrounding areas for additional scenes in case eyewitnesses only saw a portion of the attack.

Be Aware of Types of Injuries

  • In car ramming attacks, most injuries are internal. Many individuals may be unconscious and more severely injured.
  • Victims will have multiple conditions, since the terrorist is trying to harm as many people as possible. In car ramming attacks, each individual will need to be assessed since there is no way to know how injured they are based on where they are located.
  • Most ramming attackers use private vehicles, but in some cases they can use larger vehicles too like tractors or heavy machinery to cause more injuries and fatalities.


Source: JEMS, “EMS Preparation and Response for Car Ramming Attacks, by Dr. Eli Yaffe, Head of Training at Magen David Adom, March 7, 2017

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