Manchester Arena bombing: lessons learnt from a mass casualty incident

On 22 May 2017 Salman Abedi detonated an improvised explosive device in the Manchester Arena resulting in 23 deaths (including the attacker). This was the deadliest terrorist attack on UK soil since the 2005 London bombings, but was only one of five mass casualty terrorist attacks in the UK in 2017. Preparation for mass casualty incidents (MCI) is obligatory, involving such methods as multiagency tabletop exercises, mock hospital exercises, as well as simulation and training for clinicians in managing the injuries that would be anticipated in such an event. Even in the best prepared units, such an incident will pose significant challenges due to the unpredictable nature of these events with respect to timing and number of casualties. Following an MCI, local and national reviews are undertaken to assess the effectiveness of the response, but also to identify areas where lessons can be learnt and to disseminate these to allow inclusion in future planning. We present the experience following a mass casualty terrorist incident along with a number of lessons learnt from this event.

Download Full-text

Mass casualty incident after the Taba terrorist attack: an organisational and medical challenge

Disasters ◽

10.1111/j.1467-7717.2007.00343.x ◽

2007 ◽

Vol 31 (1) ◽

pp. 104-112 ◽

Cited By ~ 5

Author(s):

Erez Karp ◽

Gilbert Sebbag ◽

Jochanan Peiser ◽

Oleg Dukhno ◽

Amnon Ovnat ◽

...

Keyword(s):

Terrorist Attack ◽

Mass Casualty Incident ◽

Mass Casualty

Download Full-text

Maintaining Preparedness to Severe Though Infrequent Threats—Can It Be Done?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072385 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2385

Author(s):

Maya Siman-Tov ◽

Benny Davidson ◽

Bruria Adini

Keyword(s):

Emergency Preparedness ◽

Geographical Location ◽

Evaluation Process ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Medical Facilities ◽

Potential Risks ◽

The Impact ◽

And Training ◽

Secondary Contamination

Background: A mass casualty incident (MCI) caused by toxicological/chemical materials constitutes a potential though uncommon risk that may cause great devastation. Presentation of casualties exposed to such materials in hospitals, if not immediately identified, may cause secondary contamination resulting in dysfunction of the emergency department. The study examined the impact of a longitudinal evaluation process on the ongoing emergency preparedness of hospitals for toxicological MCIs, over a decade. Methods: Emergency preparedness for toxicological incidents of all Israeli hospitals were periodically evaluated, over ten years. The evaluation was based on a structured tool developed to encourage ongoing preparedness of Standard Operating Procedures (SOPs), equipment and infrastructure, knowledge of personnel, and training and exercises. The benchmarks were distributed to all hospitals, to be used as a foundation to build and improve emergency preparedness. Scores were compared within and between hospitals. Results: Overall mean scores of emergency preparedness increased over the five measurements from 88 to 95. A significant increase between T1 (first evaluation) and T5 (last evaluation) occurred in SOPs (p = 0.006), training and exercises (p = 0.003), and in the overall score (p = 0.004). No significant changes were found concerning equipment and infrastructure and knowledge; their scores were consistently very high throughout the decade. An interaction effect was found between the cycles of evaluation and the hospitals’ geographical location (F (1,20) = 3.0, p = 0.056), proximity to other medical facilities (F (1,20) = 10.0 p = 0.005), and type of area (Urban vs. Periphery) (F (1,20) = 13.1, p = 0.002). At T5, all hospitals achieved similar high scores of emergency preparedness. Conclusions: Use of accessible benchmarks, which clearly delineate what needs to be continually implemented, facilitates an ongoing sustenance of effective levels of emergency preparedness. As this was demonstrated for a risk that does not frequently occur, it may be assumed that it is possible and practical to achieve and maintain emergency preparedness for other potential risks.

Download Full-text

Distribution of Casualties in a Mass-Casualty Incident with Three Local Hospitals in the Periphery of a Densely Populated Area: Lessons Learned from the Medical Management of a Terrorist Attack

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004635 ◽

2007 ◽

Vol 22 (3) ◽

pp. 186-192 ◽

Cited By ~ 20

Author(s):

Yuval H. Bloch ◽

Dagan Schwartz ◽

Moshe Pinkert ◽

Amir Blumenfeld ◽

Shkolnick Avinoam ◽

...

Keyword(s):

Medical Management ◽

Terrorist Attack ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Lessons Learned ◽

Suicide Bombing ◽

Populated Area ◽

Medical Response ◽

Ambulance Dispatch ◽

To Receive

AbstractIntroduction:A mass-casualty incident (MCI) can occur in the periphery of a densely populated area, away from a metropolitan area. In such circumstances, the medical management of the casualties is expected to be difficult because the nearest hospital and the emergency medical services (EMS), only can offer limited resources.When coping with these types of events (i.e., limited medical capability in the nearby medical facilities), a quick response time and rational triage can have a great impact on the outcome of the victims. The objective of this study was to identify the lessons learned from the medical response to a terrorist attack that occurred on 05 December 2005, in Netanya, a small Israeli city.Methods:Data were collected during and after the event from formal debriefings and from patient files. The data were processed using descriptive statistics and compared to those from previous events. The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology.Results:Four victims and the terrorist died as a result of this suicide bombing. A total of 131 patients were evacuated (by EMS or self-evacuation) to three nearby hospitals. Due to the proximity of the event to the ambulance dispatch station, the EMS response was quick.The first evacuation took place only three minutes after the explosion. Non-urgent patients were diverted to two close-circle hospitals, allowing the nearest hospital to treat urgent patients and to receive the majority of self-evacuated patients. The nearest hospital continued to receive patients for >6 hours after the explosion, 57 of them (78%) were self-evacuated.Conclusion:The distribution of casualties from the scene plays a vital role in the management of a MCI that occurs in the outskirts of a densely populated area.Non-urgent patients should be referred to a hospital close to the scene of the event, but not the closest hospital.The nearest hospital should be prepared to treat urgent casualties, as well as a large number of self-evacuated patients.

Download Full-text

Charlie Hebdo Attack and Discourses of Muslims in British and Danish Newspapers: A cross-cultural critical discourse analysis of four newspapers

Networking Knowledge: Journal of the MeCCSA Postgraduate Network ◽

10.31165/nk.2019.121.546 ◽

2019 ◽

Vol 12 (1) ◽

pp. 23-44

Author(s):

Michelle Lawrie

Keyword(s):

Discourse Analysis ◽

Critical Discourse Analysis ◽

Terrorist Attack ◽

The Press ◽

The Media ◽

Muslim Communities ◽

The Uk ◽

The Right ◽

London Bombings ◽

Charlie Hebdo

A perceived shift to the right when representing Muslims in the press in Europe has beenevident in recent years. Events such as 9/11, the July 2005 London bombings, broaderEuropean discussions and mainstreaming of populist discourses have marked a significant shiftin the media focusing on Muslims living in Europe. This paper outlines the discourses used to represent Muslims, via conducting multimodalcritical discourse analysis. The paper focuses on the 2015 Charlie Hebdo terrorist attack andcross-culturally compares four newspapers in two countries – the UK and Denmark. Resultsindicate a recontextualisation of the terrorist attack situating the threat within each country,with newspapers positioned as ‘left’ utilising the same framing and discourses of right leaningnewspapers. This situated threat is demonstrated through discourses framing both countries incontrast to Muslim ‘values’. Furthermore, both countries focus on utilising Muslim ‘voices’who are part of a Star System that are critical of Muslim communities.

Download Full-text

(A23) Mass Casualty Incident and Terrorist Attack Preparedness of German Hospitals and Physicians Compared to Austria, Switzerland, the USA and a Worldwide Collective

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11000367 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s7-s7

Author(s):

P. Fischer ◽

C. Nitsche ◽

K. Kabir ◽

A. Wafaisade ◽

S. Müller ◽

...

Keyword(s):

Terrorist Attack ◽

Treatment Strategies ◽

The United States ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Terrorist Attacks ◽

Online Questionnaire ◽

Pipe Burst ◽

Increased Risk ◽

The Usa

ContextBecause of worldwide increase of catastrophes and recent terrorist attacks, hospitals and physicians are devoting increased attention to disaster and mass casualty incident (MCI) preparedness not only outside but also inside hospitals. In case of a terrorist attack physicians have to cope with injuries caused by conventional, biological, chemical, or radioactive weapons.ObjectiveThe aim of this study was to evaluate the current state of preparedness of German hospitals and physicians in case of an MCI or terrorist attack and to compare those results to the preparedness of hospitals and physicians from Austria, Switzerland, the United States of America and a worldwide collective.Materials and MethodsUsing an online questionnaire, we interviewed 1343 physicians in Germany, Austria, Switzerland, the US and a worldwide collective. The replies were analyzed statistically with the Shapiro-Walk test and the Mann-Whitney-U test.Resultsin Germany physicians are less prepared than their colleagues worldwide for disasters inside and outside hospitals. 48,4% of German physicians (37% worldwide) did not know their area of responsibility as a physician in case of an “internal” emergency (fire, water pipe burst, power cut), even though 30,2% of German physicians (29,1% worldwide) have already had a real emergency in their hospital. Only 65,3% of physicians in Germany (75,5% worldwide) knew their area of responsibility in case of an MCI; MCI training was given less often in Germany (42,7%) than worldwide (64,3%). Most physicians in every country were unaware of injury patterns and treatment strategies in patients following bombings or nuclear, chemical and biological contamination.ConclusionsHospital Physicians are insufficiently prepared for internal emergencies and MCIs. There is a need for more drills in hospitals. In spite of the recent threat of terrorist attacks, the physicians' emergency training should be modified to accommodate the increased risk of catastrophes and terrorist attacks.

Download Full-text