Celebrations that followed the 2005 announcement of London's successful winning bid to host the 2012 Olympics were dramatically curtailed the following day as the UK witnessed its first terrorist suicide attack leaving 52 innocent people dead and over 700 injured, many seriously.
In order to manage such an event, ambulance services are required to have a major incident or emergency preparedness (EP) plan, and though terrorism is not generally associated with the UK, many key management objectives remain consistent across the globe, most notably, triage. Effective triage offers the greatest chance of survival and resources management (Moore, 2006; Akhtar, 2010). The provision of effective, life preserving triage is best achieved through integrated working with the other emergency services. Ambulance services have a distinct role as part of the multi-agency civil protection approach—and as part of the ‘vanguard of the emergency response’ (Civil Contingencies Act, 2004).
In order to meet this response, greater focus is required on developing and implementing greater inter-agency collaboration. The ambulance service functions autonomously—a unique service, providing first contact care to a wide range of undifferentiated patients. However, such exclusivity may lead to isolation—with a ‘silO' approach and lack of integration with other agencies and health care professionals. Frequently witnessed at incidents with multiple causalities, such as a multiple vehicular road traffic collision (RTC), where the paramedic and fire and rescue services roles could be further combined, with greater skill sharing and knowledge transfer providing improved patient care and scene management.
The emergent critical care paramedic (CCP) and hazardous area response team (HART) roles has gone some way to address this inter-agency collaboration, but such specialism may ignore certain basic skills being shared with ambulance paramedics. The 2010 Independent Inquiry by Lady Justice Hallett made a number of fundamental recommendations, including that major incident training for all frontline staff and the training of ambulance staff in multi-casualty triage should be reviewed, following concerns in the inquest that some casualties were not actually treated by paramedics who had triaged them (Coroners Inquests, 2011). It would appear that by ensuring that all frontline clinical staff have some basic major incident training, the confusion and communication failures on 7 July 2005 could have been minimised, even avoided.
The Olympics are now upon us—and the recent controversy over lack of security personnel at the various Olympic venues has again heightened our awareness of the potential of a terrorist attack. Perhaps the potential for terrorism in the UK is always imminent considering the global climate? To ensure that we are up-to-date with our organisation's EP Plan, we must work on more effective communication with our emergency service colleagues and learn from previous, tragic experiences.