UK healthcare staff experiences and perceptions of a mass casualty terrorist incident response: a mixed-methods study

Abstract

IntroductionSystem learning from major incidents is a crucial element of improving preparedness for response to any future incidents. Sharing good practice and limitations stimulates further actions to improve preparedness and prevents duplicating mistakes.MethodsThis convergent parallel mixed methods study comprises data from responses to an online survey and individual interviews with healthcare staff who took part in the responses to three terrorist incidents in the UK in 2017 (Westminster Bridge attack, Manchester Arena Bombing and London Bridge attack) to understand limitations in the response and share good practices.ResultsThe dedication of NHS staff, staff availability and effective team work were the most frequently mentioned enabling factors in the response. Effective coordination between teams and a functional major incident plan facilitated an effective response. Rapid access to blood products, by positioning the blood bank in the ED, treating children and parents together and sharing resources between trauma centres were recognised as very effective innovative practices. Recent health emergency preparedness exercises (HEPEs) were valued for preparing both Trusts and individual staff for the response. Challenges included communication between ambulance services and hospitals, difficulties with patient identification and tracking and managing the return to ‘normal’ work patterns post event. Lack of immediately available clinical protocols to deal with blast injuries was the most commonly mentioned clinical issue. The need for psychosocial support for responding and supporting staff was identified.DiscussionBetween-agencies communication and information sharing appear as the most common recurring problems in mass casualty incidents (MCIs). Recent HEPEs, which allowed teams, interdisciplinary groups, and different agencies to practice responding to similar simulated incidents, were important and informed actions during the real response. Immediate and delayed psychosocial support should be in place for healthcare staff responding to MCIs.

Understanding the psychological impacts of responding to a terrorist incident

“…Responders to three mass casualty incidents in the UK in 2017 (the Westminster Bridge attack, the Manchester Arena bombing and the London Bridge attack) were invited to participate anonymously in an online survey exploring their experiences with the response, and how aspects of their training had supported and prepared them to respond to those incidents (Skryabina et al, 2020 ). Participants were then asked provide contact details if they were willing to participate in further semi-structured follow-up interviews, which were conducted by telephone.…”

“…Participants were then asked provide contact details if they were willing to participate in further semi-structured follow-up interviews, which were conducted by telephone. The overall aim of the study was to explore the perceptions and experiences of first responders and clinical staff regarding both the individual and system response to a major incident, and specifically to identify factors helped to pre limit and enhanced their abilities to respond effectively to such an incident (Skryabina et al, 2020 ; Skryabina, Betts, Reedy, Riley, & Amlôt, 2020 ). The subset of data analysed here was generated from the interviews of first responders and clinical staff about their experiences and perceptions in responding to the Manchester Arena bombing (22 May 2017) (Craigie et al, 2018 ) and included a significant focus on the psychological impact of this mass casualty terrorist incident on responders.…”

“…The interviews explored participants’ experience with the response (to explore specifically aspects of the response that worked well and those that did not work well); experience with recent HEPEs; exercises’ impact on the response; and emergency preparedness training. Qualitative data from both interviews and surveys produced themes around these topics, and are reported separately (Skryabina et al, 2020 ). Interviews were conducted by telephone from October to December 2017 by members of the research team (ES and NB), both of whom have experience in conducting and reporting qualitative research (Skryabina et al, 2016 ).…”

“…This study reports a detailed analysis of a subset of data from a larger mixed-methods study of frontline staff who responded to three large mass casualty terrorist incidents in the UK in 2017 (Skryabina et al, 2020 ). The purpose of the study was to understand more about first responders’ perspectives about their participation in major incident responses, specifically how and which individual and system factors contributed to their preparedness or may have enabled or hindered their response.…”

Preparing for mass casualty events despite COVID-19

“…Based on citations from experts that have participated in terror-related multiple casualty incidents Tallach and colleagues 12 highlight the need for “education on specific injuries, revision of plans, and exercises”. Lack of immediately available clinical protocols to deal with unique and specific injuries has also been noted as a major area of vulnerability 18 . As physicians and surgeons increasingly subspecialize, they may struggle to treat the wide range of injuries faced in MCEs.…”