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NHS must plan for long-term effects of mass casualty events

Physical and psychological effects on staff are severe, under-reported, and underappreciated

Ingrid Torjesen

Thursday, 26 October 2017

UK hospitals should plan for long-term disruption and enduring effects on staff after mass casualty events, such as the Westminster Bridge and London Bridge terrorist attacks and the Manchester Arena bombing, say experts writing in The BMJ .*

This year, the NHS in England has faced an unprecedented number of major incidents. Chris Moran, national clinical director and trauma surgeon at Nottingham University Hospital and colleagues, say “perhaps the clearest lesson to emerge from recent incidents is that the physical and psychological effects on healthcare staff at receiving hospitals are severe, under-reported, and underappreciated”.

Debriefing and sharing information is critical so that lessons learnt can be rapidly incorporated into future plans, they explain. “However, it has become increasingly clear that the effect on hospitals and staff endures well beyond the first 24 hours.”

For instance, over 350 hours of extra surgery were required in the week after the terrorist attack in Manchester. “Hospitals should not underestimate the need for operating rooms, blood products and other consumables, intensive care provision, and coordinated multidisciplinary intervention,” the authors say.

Mass casualty events also have important long-term implications for services allied to medicine, primary care and community services, they add.

Rehabilitation begins early “and requires intensive multisystem input from medical staff and allied health professionals such as physiotherapists and occupational therapists.” Patients with severe physical injuries require prolonged treatment, rehabilitation, and support, while patients, their families, the bereaved, witnesses, and the wider community may develop mental health complications, including depression, anxiety, and post-traumatic stress disorder.

Healthcare teams must care for patients, often witnessing death and life changing injuries against a backdrop of physical exhaustion, say the authors. “Staff need time to recuperate physically and psychologically after the extraordinary demands placed on them during the initial response.”

Commissioners and providers must reach a mutual understanding that recognises the need for a recovery period, they say. Hospitals should expect and plan for effects lasting weeks or even months after a mass casualty event. Supporting staff is a critical component of medium and long-term planning, along with a recognition of the effect their experiences will have on their capacity to return to “business as usual”, they conclude.

* Moran CG, Webb C, Brohi K, et al. Lessons in planning from mass casualty events in UK. BMJ 2017;359:j4765. DOI: 10.1136/bmj.j4765

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