There’s a therapeutic vacuum in the “hot zone” of a terror attack. Claire Park and colleagues describe efforts in the UK and beyond to deliver expert medical care to casualties trapped at the centre of an attack
Introduction:Terror attacks have increased in frequency, and tactics utilized have evolved. This creates significant challenges for first responders providing life-saving medical care in their immediate aftermath. The use of coordinated and multi-site attack modalities exacerbates these challenges. The use of triage is not well-validated in mass-casualty settings, and in the setting of intentional mass violence, new and innovative approaches are needed.Methods:Literature sourced from gray and peer-reviewed sources was used to perform a comparative analysis on the application of triage during the 2011 Oslo/Utoya Island (Norway), 2015 Paris (France), and 2015 San Bernardino (California USA) terrorist attacks. A thematic narrative identifies strengths and weaknesses of current triage systems in the setting of complex, coordinated terrorist attacks (CCTAs).Discussion:Triage systems were either not utilized, not available, or adapted and improvised to the tactical setting. The complexity of working with large numbers of patients, sensory deprived environments, high physiological stress, and dynamic threat profiles created significant barriers to the implementation of triage systems designed around flow charts, physiological variables, and the use of tags. Issues were identified around patient movement and “tactical triage.”Conclusion:Current triage tools are inadequate for use in insecure environments, such as the response to CCTAs. Further research and validation are required for novel approaches that simplify tactical triage and support its effective application. Simple solutions exist in tactical triage, patient movement, and tag use, and should be considered as part of an overall triage system.
Background: Terrorism is increasingly the aetiology of mass casualty incidents. Improved prehospital response capability targeted to the unique characteristics of high threat incidents is an area of urgent focus. Gaps in current knowledge coupled with inconsistent reporting and difficulties in accessing data create difficult conditions for capability enhancement.
Methods: A systematic literature review was conducted to describe the characteristics of prehospital response to terrorism from 2011 -2017. Papers were included if they described a prehospital response to a terrorist incident, were in English or translatable to English and full text was available.
Results: 6115 records were located in the initial search of grey and published literature, with 71 retrieved for full text after screening of title and abstract. 23 papers were included in the final analysis, describing 6 separate terrorist attacks. The majority of literature was published by physicians, all were from Western countries with advanced Emergency Medical Services(EMS) and a standard reporting template was not identified. The level of evidence was low to very low. Themes of tactical triage, coordinated activation and response, use of damage control resuscitation and tactical casualty care were common throughout the papers.
Conclusions: The paucity of high level evidence and systematic reporting of lessons learned in the prehospital terrorism response field requires a renewed push for access to data and the establishment of reporting systems that are inclusive of all responders.
Keywords: Terrorism, Pre-hospital, Response, Tactical Emergency Casualty Care, Tactical Combat Casualty Care
Prehospital terrorism response in Australia has been bolstered significantly in the past couple of years, however there are still large capability gaps. International best practice and identified lessons from previous attacks can provide guidance on moving forward, with a systems approach to robust high threat medicine provision. This Scholarship report identifies lines of action for local and national level enhancements in response capacity.
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