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Feature Medical Response to Terrorism

“It wasn’t a medical miracle—we made our own luck”: lessons from London and Manchester terror attacks

BMJ 2017; 358 doi: (Published 19 September 2017) Cite this as: BMJ 2017;358:j4309
  1. Anne Gulland, freelance journalist, London, UK
  1. agulland{at}

A week after another UK hospital had to declare a major incident as a result of a terror event, Anne Gulland reports on what lessons doctors can learn from how those in London and Manchester have dealt with the spate of attacks this year

Last week London’s St Mary’s Hospital had to declare a major incident after a terror attack on an Underground train at Parsons Green. The explosion once again highlighted the challenges for doctors and medical teams—hospitals in London and Manchester have already been tested by four major terror attacks in 2017: Westminster Bridge, Manchester Arena, London Bridge, and Finsbury Park mosque.

The Parsons Green victims mainly sustained burns, but each of the attacks have presented different challenges. The Westminster Bridge attacker rammed a vehicle into pedestrians, and most patients brought to hospital had blunt trauma. At London Bridge, the attackers used both a vehicle and knives and many patients presented with stab wounds. In Manchester the attacker detonated a shrapnel loaded device and patients presented with complex, multiorgan injuries.

At a conference at the Royal Society of Medicine in London earlier this month, doctors who treated those patients shared what they have learnt. The NHS was widely praised for its response; however, Duncan Bew, a trauma specialist at King’s College Hospital in south London where many of those injured in the Westminster and London Bridge attacks were treated, told the meeting: “We cannot rest on our laurels. Because we have done well in this incident, it doesn’t mean we’ll do well in the next one.”

Patients present before major incident declarations

Early reports of a terrorist attack often say that a major incident has been declared, giving the impression that some magical switch is flipped and a well oiled emergency plan kicks in.

Malcolm Tunnicliff, clinical director for emergency and acute care at …

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