Intended for healthcare professionals


Lessons in planning from mass casualty events in UK

BMJ 2017; 359 doi: (Published 25 October 2017) Cite this as: BMJ 2017;359:j4765
  1. Christopher G Moran, national clinical director for trauma1,
  2. Catherine Webb, national medical director’s clinical fellow2,
  3. Karim Brohi, clinical director, London Major Trauma System3,
  4. Martin Smith, clinical director, Greater Manchester Major Trauma Network4,
  5. Keith Willett, NHS England medical director for acute care and emergency preparedness5
  1. 1Nottingham University Hospital, Nottingham, UK
  2. 2NHS England, London, UK
  3. 3Queen Mary University of London, London, UK
  4. 4Salford Royal NHS Foundation Trust, Salford, UK
  5. 5University of Oxford, Oxford, UK
  1. Correspondence to: C G Moran chris.moran1{at}

Plan for long term disruption and enduring effects on healthcare staff

Mass casualty events are a global phenomenon, but the NHS in England has faced an unprecedented number of major incidents this year: the Westminster Bridge terrorist attack (22 March), the Manchester Arena bombing (22 May), the London Bridge attack (3 June), the Grenfell Tower fire (14 June), and terrorist attacks at Finsbury Park mosque (19 June) and Parsons Green underground station (15 September).

These events have tested the country’s major trauma systems. Each incident posed new challenges in differing environments, with different threats, resulting in different injuries.1System learning is critical: debriefing and sharing information so that lessons learnt can be rapidly incorporated into future plans. In England, “hot” debriefs took place within two weeks and “cold” multiagency debriefs after four weeks, with post-incident reporting beyond six weeks.2 Here, we share some of that new learning.

Emergency planning, resilience, and response commonly gives primacy to the initial stages of managing a major incident—first response, treatment on …

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