Increased threat of suicide attack: a need for NHS ambulance services to adapt?

Abstract

Suicide attacks are an emerging threat within the UK that carry with it specific risks which must be managed in order to ensure safety and minimise injury and loss of life, both to emergency services personnel and bystanders. Major incident planning is usually based on an ‘all-hazards approach’. The aim of this article is to evaluate the current ‘all-hazards’ approach taken by NHS ambulance services for responding to a major incident and recommend if any changes need to occur as a result of the current threat from suicide attacks. In the same way that chemical, biological, radiological, and nuclear (CBRN) was the new emerging threat a few years ago, it could be argued that suicide attacks are the new emerging threat that requires a rethink on how the ambulance service operates. Scene safety is the main issue raised in this article. Solutions ranged from the adoption of US-style tactical medicine allowing paramedics to work within the ‘hot zone’ to training police firearms officers in triage and more advanced skills of clinical care. Some of these solutions assume deployment to the scene in the first place and it is considered what level of risk is acceptable when operating in a hazardous area such as this. Further issues identified were adaptations required to time on scene and whether to screen casualties for explosives and firearms, so as to avoid an armed terrorist being conveyed to hospital. The recommendations from this report rely heavily on cooperation between emergency responders not only during the time of a suicide attack but also during the pre-incident planning phase. Although modifications to the ambulance service response are suggested within the recommendations they do not present a radical change to how the ambulance service operates at present.