Terrorist attacks on American fast-food restaurants: A counterterrorism medicine analysis.

OBJECTIVE: Terrorist attacks targeting American fast-food restaurants remain an underexplored threat, given their high volume of civilians, predictable operating hours, and limited security. However, there remains limited data available on the extent and characteristics of these attacks. DESIGN: A retrospective search and descriptive analysis of the Global Terrorism Database was performed, querying attacks targeting American fast-food restaurants between 1970 and 2020. Keywords were used to identify attacks involving the top 15 American fast-food franchises by annual revenue. Attacks were analyzed by geography, modality, weapon type, and perpetrating group. RESULTS: There were 72 reported attacks on American fast-food restaurants, leading to 112 injuries and 26 deaths. McDonalds (45.8 percent) and Kentucky Fried Chicken (26.4 percent) were the most frequently targeted establishments. Most attacks took place in the United States (US) (19.4 percent). A disproportionate share of deaths occurred in the Middle East/North Africa (30.8 percent), while a large proportion of nonfatal injuries occurred in East Asia (27.7 percent). Bombing accounted for the majority of attacks (59.7 percent), deaths (76.9 percent), and injuries (99.1 percent). Vehicle-based explosives were used in only 4.2 percent of attacks but carried an outsized share of deaths (42.3 percent) and injuries (30.4 percent). The Animal Liberation Front (ALF) (11.1 percent) and Tupac Amaru Revolutionary Movement (6.9 percent) were the most commonly identified perpetrators. In the US, animal rights extremist groups such as the ALF and the Earth Liberation Front together accounted for most domestic attacks (50.0 percent). CONCLUSIONS: American fast-food restaurants are an uncommon but symbolic target for terrorist attacks, leading to deaths, injuries, and damage worldwide. Future efforts should seek to prioritize corporate investment in protective infrastructure upgrades, integrate real-time threat intelligence systems, conduct routine emergency response drills, and expand public health initiatives such as tourniquet access and "Stop the Bleed" training.