Unmanned aerial vehicles (UAVs), or drones, have rapidly diversified in capabilities and applications due to advancements in technology and increased affordability. While drones positively impacted sectors such as healthcare and consumer delivery, particularly in remote and austere environments, their use has also been exploited by Violent Non-State Actors (VNSAs) for terrorist attacks. This study aimed to analyze the global prevalence of drone-related attacks targeting civilians and critical infrastructure, focusing on enhancing hospital and prehospital care preparedness in response to these emerging threats.

A retrospective review of the Global Terrorism Database from 1970 to 2020 assessed the prevalence of drone-related attacks. Cases were excluded if they had insufficient information regarding drone involvement or if government entities conducted the attacks. Trends in the number of attacks per month, fatalities, and injuries were analyzed using time series and trend analysis.

The database search yielded 253 drone-related incidents, with 173 meeting the inclusion criteria. These incidents resulted in 92 fatalities and 215 injuries, primarily affecting civilian targets (76 events, 43.9%), followed by military targets (46 events, 26.5%). The Middle East was the most affected region (168 events, 97% of total attacks), with the Islamic State of Iraq identified as the most common perpetrator (106 events, 61.2%). Nearly all attacks involved explosive devices attached to drones (172 events, 99.4%). Time series with linear trend analyses indicated an upward trend in drone attacks by VNSAs over the years, leading to increased morbidity and lethality.

There has been a notable increase in drone attacks over time, characterized by higher lethality and morbidity. With injuries outnumbering fatalities, there is an urgent need for improved response strategies. Investment in training for medical personnel, bolstered security measures, and targeted research is essential for effectively managing mass-casualty incidents resulting from drone attacks.