UK Medical Responses to Terrorism

This paper will consider the issues that affect UK medical responses to terrorism. It will place the medical response to terrorism in the context of the UK response to any major incident, and contrast responses to terrorist attacks with responses to other medical emergencies in the UK. In doing this, it will focus specifically on the elements within such responses that are unique to terrorism.

The first part of this paper will outline the legislation and guidance covering major incident response in the UK at the national, regional and local level. The Civil Contingencies Act 2004 will be considered in its context as the national framework for managing major incidents, and the national guidelines of the UK Government’s Department of Health, the National Health Service (NHS) and the Health Protection Agency (HPA) will also be discussed. At the regional level, London will be taken as a case study, outlining the roles of the London Resilience Team, the London Emergency Services Liaison Panel (LESLP) and the London Ambulance Service (LAS) in the medical response to terrorism. At the local level, the plans and response procedures relating to individual hospitals will also be examined.

The paper will then discuss how the medical response to terrorist incidents differs from the response to other major incidents, looking in particular at the number of casualties; the type of injuries; the command and control challenges of dealing with multiple incident sites; and the need to consider that the incident site is also a crime scene. Particular consideration will be given in this section to planning for and responding to a chemical, biological, radiological or nuclear (CBRN) attack.

The second part of the paper will explore the UK medical response to terrorism in more detail by focusing on two recent case studies: the 7 July 2005 suicide bombings on London’s public transport system and the poisoning of the former Soviet agent Alexander Litvinenko with the radiological isotope Polonium-210 in November 2006. These case studies will be used to identify specific challenges that arose during these responses. The unique challenges presented by each case will be directly contrasted with those of the other to show that a single medical response framework cannot deal with all terrorist incidents: different types of attack present different challenges that require different responses.

The paper will also consider the long-term psychological effects of terrorism and the healthcare provisions that need to be made before, during and after the incident, including the need for a robust system for recording those who may require follow-up health and psychiatric care to enable the availability of this care to be communicated to them.