Nick Brown, Keir Rutherford
Journal of Paramedic Practice, Vol. 9, Iss. 12, 01 Dec 2017, pp 512 - 514

For clinicians arriving first at mass casualty incidents, one of the greatest challenges is not
focusing attention on one individual patient, but to assess the needs of the many in order
to establish prescribed procedures and the resources required. However, for the victims of
potentially lethal stab wounds, there is often little that prehospital clinicians can offer over
very rapid transport to in-hospital surgical intervention. In this article, the authors explore
the conflict between the established and often protracted major incident approach against
the immediate needs of someone who has just been stabbed, in contrast to the different
management challenges of victims of blunt trauma. A view of the London Bridge attacks
is presented from the perspective of a London Ambulance Service advanced paramedic
practitioner in critical care. The advantages of having an experienced advanced clinician able
to offer early clinical and on-scene leadership manifested in several ways, and these will be
highlighted here.

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