Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
I read with interest the article on ‘Medical Response to Terrorism,’ in the latest BMJ. Before (and as the direct trigger for) becoming a junior doctor myself I deployed to Afghanistan with the British Army and witnessed first-hand the effect of mass casualty events and the importance of rapid triage in those first few crucial moments.
Accurate triaging of patients into categories T 1–3 (not in the least bit dissimilar from the present paramedic P 1-3 categories) and subsequent re-evaluation using an ‘ATMIST’ pre-alert allowed troops on the ground to quickly and efficiently assess the severity of injuries and update the medical teams waiting back at Bastion. The beauty of these triage systems was that they could be effectively done by almost anyone (including those soldiers injured yet conscious themselves) and awaiting support from their colleagues, who may have been busy winning the firefight/clearing the minefield.
Undoubtedly, lessons learnt in these kinds of conflicts aid to shape and evolve our own medical systems here and many of the mass casualty responses we see becoming scarily more prevalent on UK soil are taken almost verbatim from practices adapted and evolved from the battlefield. There is now even an app that is aimed at those caught up in domestic terrorist attacks, developed with military input for the UK public, called ‘CitizenAID’ which can talk you through how to triage an injured person all the way through to managing a traumatic amputation or gunshot wound.
In the face of these ever-increasing numbers of ‘major incidents’ it may therefore be more important that we look at ways to improve pre-hospital triage and basic management from the public themselves in those first few crucial moments in order to improve overall survival outcomes.