Understanding the psychological impacts of responding to a terrorist incident.

Background: Responding to a mass casualty event can cause significant distress, even for highly trained medical and emergency services personnel. Objective: The purpose of the study was to understand more about first responders' perspectives about their participation in major incident responses, specifically how and which individual and system factors contributed to their preparedness or may have enabled or hindered their response. The aim of the work was to improve preparedness and response for future incidents. Methods: This study reports a detailed analysis of qualitative interview data from frontline staff who responded to a large mass casualty terrorist incident in the UK in 2017. Data highlighted the psychological distress caused by responding to terrorist events and thus became the focus of further, detailed analysis. Results: Participants (n = 21) articulated in their own words the psychological distress experienced by many of the first responders to the event. Participants reported that they were not prepared to deal with psychological impact associated with this mass casualty terrorist incident and their role in the response, and that follow-up support was inconsistent. Multiple factors were identified as potentially increasing psychological distress. Social support provided by peers and organizational debriefs were identified as two most common support mechanisms. Organizational support was identified as inconsistent. Conclusions: This research contributes to the literature the voices of first responders to UK terrorist incidents, building on existing findings while further contributing unique contextual perspectives. This research reinforces the importance of psychosocial support for those who respond to these tragic incidents, and offers a number of recommendations for organizational preparedness for future events. Abbreviations: A&E: Accident and Emergency; EPRR: Emergency Preparedness, Resilience and Response; ERD: Emergency Response Department; HEPE: Health Emergency Preparedness Exercise; PHE: Public Health England; PHE REGG: Public Health England Research Ethics and Governance Group; MCI: Mass Casualty Incident; NHS: National Health Service.

Antecedentes: Responder a un evento con presencia masiva de víctimas puede causar una angustia psicológica significativa, aún para el personal médico y de emergencias altamente entrenados.Objetivo: El propósito del estudio fue tener una mayor comprensión acerca de la perspectiva de los primeros respondedores sobre su participación en la respuesta a incidentes mayores, específicamente cómo y qué factores individuales y del sistema contribuyeron a su preparación o que pudieron haber habilitado u obstaculizado su respuesta. El objetivo del trabajo fue de mejorar la preparación y respuesta para futuros incidentes.Métodos: Este estudio reporta un análisis detallado de los datos de entrevistas cualitativas realizadas al personal de primera línea que respondieron a un gran incidente terrorista con víctimas masivas en el Reino Unido durante el 2017. Los datos destacaron la angustia psicológica causada por responder a eventos terroristas y, por lo tanto, se convirtieron en el foco de un análisis más detallado.Resultados: Los participantes (n = 21) articularon en sus propias palabras la angustia psicológica experimentada por muchos de los primeros en responder al evento. Los participantes reportaron que no se encontraban preparados para lidiar con el impacto psicológico asociado con este incidente terrorista con víctimas masivas y su rol en la respuesta, y que el soporte durante el seguimiento fue inconsistente. Se identificaron múltiples factores con pueden incrementar la angustia psicológica. El apoyo social proporcionado por los pares y el 'debriefing' organizacional fueron identificados como los dos mecanismos de apoyo más comunes. El apoyo organizacional se identificó como inconsistente.Conclusiones: Esta investigación contribuye a la literatura las voces de los primeros respondedores a los incidentes terroristas del Reino Unido, basándose en los hallazgos existentes y, al mismo tiempo, aporta perspectivas contextuales únicas. Esta investigación refuerza la importancia del apoyo psicosocial para quienes responden a estos trágicos incidentes, y ofrece una serie de recomendaciones para la preparación organizacional para eventos futuros.

UK healthcare staff experiences and perceptions of a mass casualty terrorist incident response: a mixed-methods study.

INTRODUCTION: System learning from major incidents is a crucial element of improving preparedness for response to any future incidents. Sharing good practice and limitations stimulates further actions to improve preparedness and prevents duplicating mistakes. METHODS: This convergent parallel mixed methods study comprises data from responses to an online survey and individual interviews with healthcare staff who took part in the responses to three terrorist incidents in the UK in 2017 (Westminster Bridge attack, Manchester Arena Bombing and London Bridge attack) to understand limitations in the response and share good practices. RESULTS: The dedication of NHS staff, staff availability and effective team work were the most frequently mentioned enabling factors in the response. Effective coordination between teams and a functional major incident plan facilitated an effective response. Rapid access to blood products, by positioning the blood bank in the ED, treating children and parents together and sharing resources between trauma centres were recognised as very effective innovative practices. Recent health emergency preparedness exercises (HEPEs) were valued for preparing both Trusts and individual staff for the response. Challenges included communication between ambulance services and hospitals, difficulties with patient identification and tracking and managing the return to 'normal' work patterns post event. Lack of immediately available clinical protocols to deal with blast injuries was the most commonly mentioned clinical issue. The need for psychosocial support for responding and supporting staff was identified. DISCUSSION: Between-agencies communication and information sharing appear as the most common recurring problems in mass casualty incidents (MCIs). Recent HEPEs, which allowed teams, interdisciplinary groups, and different agencies to practice responding to similar simulated incidents, were important and informed actions during the real response. Immediate and delayed psychosocial support should be in place for healthcare staff responding to MCIs.

The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study.

Simulation exercises are an important part of emergency preparedness activities for the healthcare community but evidence of their impact on the response to real major incidents is limited. This project studied the impact of health emergency preparedness exercises (HEPEs) on the response to a mass casualty terrorist incident. The mixed methods study design was adopted comprising an on-line survey and follow up individual interviews. Participants were healthcare staff who took part in responses to three major terrorist incidents in the UK in 2017. Descriptive statistics and analysis of variance were undertaken with quantitative data. Content and thematic analysis methods were used for qualitative data analysis. The online survey generated 86 responses; 79 (92%) were from the responders to the Manchester Arena bombing. Twenty-one survey respondents shared their experiences in in-depth interviews. Healthcare staff who took part in HEPEs felt better prepared to respond than those who did not attend an exercise. The most commonly reported benefits from HEPEs were awareness of major incident plans and having the opportunity to practice responding to a similar scenario in the recent exercise. Specific benefits included: improved coordination of the response through adherence to recently practiced incident plans; confidence with response roles; real-time modifications of the response and support provided to staff who did not take part in exercises. Exercise recency was highlighted as an important facilitating factor. The study provides strong objective evidence that the response to a mass casualty terrorist incident was enhanced by training and service development achieved through HEPEs.

Public perceptions of emergency decontamination: Effects of intervention type and responder management strategy during a focus group study.

In the event of an incident involving the release of a hazardous chemical, first responders may decide to initiate emergency decontamination in order to remove any contaminant from affected casualties. Recent initiatives such as the UK Home Office-led Initial Operational Response Programme have introduced new evidence-based decontamination protocols that reduce the time taken to initiate the decontamination process, including an increased emphasis on rapidly removing contaminated clothing (disrobe), and the use of improvised dry decontamination methods. The current study used a series of focus groups to examine public perceptions of different decontamination interventions and responder management strategies. Results revealed that a decontamination shower was perceived to be more effective than dry decontamination methods and that a management strategy that included effective responder communication resulted in increased willingness to comply with the need for decontamination. This study demonstrates that public understanding and acceptance of novel decontamination methods such as dry decontamination may present additional challenges for first responders. Increased emphasis on effective communication during decontamination is needed. Furthermore, provision of information during the focus group study resulted in an increase in participants' knowledge and confidence in taking recommended decontamination actions, which was maintained three months after the study. The longitudinal nature of these effects suggest that it may be possible to increase public awareness about actions to take during chemical incidents by developing pre-incident public education; however, further research is needed to examine this more fully.