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The London Bridge attack: managing multiple victims of penetrating trauma

02 December 2017
Volume 9 · Issue 12


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.

The actions of three terrorists on London Bridge on 3 June 2017 is well-known. Their attack caused 8 fatalities and left 48 injured, including 4 unarmed police officers.

London's emergency services have faced a number of mass casualty incidents over the years from terrorist activity and each event generates its own challenges.

We reflect specifically on an incident that generated multiple victims of penetrating trauma and discuss the related challenges from the perspective of an attending London Ambulance Service advanced paramedic practitioner (APP) in critical care.

Broadly speaking, the approach to major incidents involving significant casualty numbers has not changed in many decades. The process involves emergency staff arriving first on the scene to gain a prompt overview in order to establish an appropriate response in terms of incident approach and resourcing.

Systems are then put in place to facilitate primary triage, casualty extrication and re-triage, appropriate field treatment, and priority-driven transport of the injured to designated centres (National Ambulance Resilience Unit (NARU), 2015). These processes take time to establish and can stretch the capability of services considerably.

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