The London Bridge attack: managing multiple victims of penetrating trauma

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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