In the world of homeland security, hospitals often receive a lot of focus about their preparedness to treat hundreds of victims in the event of a terrorist attack or natural disaster. But are our hospitals prepared if they Are in fact the target of an attack?

A recent study revealed that hospitals in the U.K. are vulnerable to a terrorist attack.ⁱ We can assume that U.S. hospitals have similar vulnerabilities.

Just imagine this scenario: a bomb explodes at the Boston Marathon, and the victims are being rushed to local hospitals. Then, secondary bombs explode in the emergency rooms of those hospitals.

Don't think it can happen here? It has happened at least three times within the last year in the Middle East. And one thing we have learned is that terrorist tactics are copied and then applied elsewhere around the world.

Recent Attacks on Hospitals

In this June attack in Pakistan, a bus carrying female university students exploded, killing 14 and injuring 19. Then, when the victims from the bus were brought to a hospital, a suicide bomber detonated a bomb in the door to the emergency room. This was followed up by terrorists storming the hospital, where they exchanged gunfire with hospital security and held police at bay for hours. Finally police were able to regain control of the hospital, but not before 11 more people were killed. The al-Qaeda affiliate group, Lashkar i Jhangvi, claimed responsibility for the attacks.ⁱⁱ

In both September and November 2012, the al-Qaeda affiliate Jabhat al-Nusra (JN) attacked hospitals in Syria through the use of suicide bombers.ⁱⁱⁱ

Terrorists Learn from Past Successes

By now, it has been widely reported that the Tsarnaev brothers used pressure-cookers to assemble their bombs at the Boston Marathon. But the tactic of using pressure-cooker bombs was being reported by the Department of Homeland Security in 2010. This was after pressure-cooker bombs had been used in Afghanistan, Pakistan, India, and Nepal. In addition, these tactics were promoted by al-Qaeda through their Inspire magazine.^iv

Clearly, the Tsarnaev brothers learned about the use of pressure-cookers and then applied it to their Boston attacks. However, more recently, this tactic was copied once again in Canada, where a Canadian couple plotted to bomb the legislative building in British Columbia through the use of pressure-cookers.^v

Old Threat, New Success

The threat of hospitals being attacked is nothing new to homeland security officials. Just consider these previous warnings and plots:

• In November 2002, the FBI issued an alert to hospitals in San Francisco, Houston, Chicago, and Washington, D.C. warning of a vague terrorist threat. 
• In August 2004, the FBI and DHS issued a nationwide terrorism bulletin warning that al-Qaeda may attempt to attack Veteran's Administration (VA) Hospitals throughout the U.S. 
• In November 2005, London police arrested two suspected terrorists accused of plotting a bomb attack. One of the suspects had a piece of paper with the words in Arabic, "Hospital = Target." 
• In April 2005, the FBI and DHS investigated incidents of imposters posing as hospital accreditation surveyors, prompting a security alert to hospitals.^vi

But while the threat is not new, it is a tactic that has now been successfully used by al-Qaeda and their affiliates. History has proven that it will arrive in the U.S. as well.

History has also proven that al-Qaeda and their affiliate groups have the imagination and capabilities to execute attacks on multiple locations simultaneously. We have seen this most notably with the 9/11 attacks and with the 2008 Mumbai, India attacks. We should not assume that it can't happen here again.

Hospitals Must Be a Priority

Law enforcement must make securing hospitals a primary concern in the aftermath of a terrorist attack. This must include deploying bomb-sniffing K-9s and a few other officers to hospitals to look for suspicious packages, vehicles, and persons.

Most challenging, though, is that law enforcement, EMTs, and hospital employees must remember this tactic at the exact time when it will be very difficult to remember -- in the midst of chaos. Due to the demands that will be placed on hospital staff in the event of a terrorist attack, it will be incumbent upon law enforcement to secure the emergency room and remind the hospital staff of the possibility of a secondary device at the hospital.

While we can never fully prepare for, or anticipate, every possible style of attack, recent history has shown us that hospitals are on al-Qaeda's radar. Research is also showing our vulnerabilities to an attack at a hospital. Regardless of the location of an attack, though, we are guaranteed that hospitals will play a critical role in treating the victims. As a result, we must ensure that our hospitals are secured in the aftermath of a terrorist attack.

Most cities have the resources to prepare for this possibility. If we fail to learn from both history and research, and utilize our resources strategically, then only we are to blame. And failure to learn in the world of terrorism results in loss of life.

Matt Ernst is a law enforcement officer and also an independent national security analyst. Read more of his work on his blog, Straight Talk.

ⁱDenis Fischbacher-Smith & Moira Fischbacher-Smith (2013) The Vulnerability of Public Spaces: Challenges for UK hospitals under the 'new' terrorist threat, Public Management Review, 15:3, 330-343, DOI: 10.1080/14719037.2013.769851. Pg. 333. Extracted July 11, 2013. http://dx.doi.org/10.1080/14719037.2013.769851

ⁱⁱPakistan assaults leave 22 dead. THE PHILADELPHIA ENQUIRER. Abdul Sattar and Rebecca Santana. June 16, 2013. Extracted July 11, 2013.
http://articles.philly.com/2013-06-16/news/40008123_1_30-people-afghan-taliban-hospital

ⁱⁱⁱAl Nusrah Front claims suicide attack at hospital, joint operation with Chechen fighters. THE LONG WAR JOURNAL. Bill Roggio. Nov. 23, 2012. Extracted July 11, 2013 http://www.longwarjournal.org/archives/2012/11/al_nusrah_front_clai_8.php

^ivBoston Marathon Bomb Probe Focusing on Pressure Cookers. INVESTIGATIVE PROJECT ON TERRORISM. IPT News. April 16, 2013. Extracted July 12, 2013. http://www.investigativeproject.org/3972/boston-marathon-bomb-probe-focusing-on-pressure

^vCouple Charged in Foiled Terror Attack on Canadian Legislature. Abha Shankar. INVESTIGATIVE PROJECT ON TERRORISM. July 3, 2013. Extracted July 12, 2013. http://www.investigativeproject.org/4069/couple-charged-in-foiled-terror-attack-on

^viShould Hospitals Be Considered a Significant Target Of Terror? GovLoop.com. Henry Morgenstern. March 12, 2012. Extracted July 12, 2013.
http://www.govloop.com/profiles/blogs/should-hospitals-be-considered-a-significant-target-of-terror