Terror attacks have long-term effects for healthcare staff, say experts

Traumatic incidents can have profound psychological implications for all people involved and the wider community.

The physical and psychological effects of mass casualty events on healthcare staff are ‘severe, under-reported, and underappreciated’, experts have said.

Events including terror attacks and the Grenfell Tower tragedy have ‘tested’ the NHS this year, and the effects of such incidents could be felt for months in nearby hospitals, according to an editorial published in the British Medical Journal.

The authors say that, as well as the extra resource demands, the NHS needs to prepare for the physical and psychological demands on staff, giving them time to recuperate physically and psychologically after the extraordinary demands placed on them in the immediate aftermath of such events.

‘Healthcare teams must care for patients under tragic and exceptional circumstances,’ the authors wrote.

‘They often witness death and life-changing injuries against a backdrop of physical exhaustion. They are required to function at a high level in an extremely high pressure situation.’

Authors, including NHS England national clinical director and trauma surgeon Chris Moran, said that the psychological needs of staff should be recognised as an important reason, in addition to demands on physical resources, for a delay before ‘normal’ elective work resumes.

‘The front door of the hospital being open for regular activity is not a signal that all inpatient services are back to normal.’

Major incidents

The authors say that the health service in England has dealt with an unprecedented number of major incidents this year, including the Westminster Bridge attack, the Manchester Arena bombing, the London Bridge attack, the Grenfell Tower fire, and terrorist attacks at Finsbury Park mosque and Parsons Green underground station.

Emergency planning, resilience and response are rehearsed in desktop and simulation exercises, and coincidentally were undertaken by the Manchester and London trauma teams shortly before the first attacks.

While these rehearsals were found to be valuable during the emergencies, they usually give primacy to the initial stages of managing major incidents, the authors said.

‘However, it has become increasingly clear that the effect on hospitals and staff endures well beyond the first 24 hours,’ they added.

The article describes the clinical response to such incidents, including resuscitation and surgery for people with immediate problems, and secondary procedures in subsequent days – which are often more ‘resource intensive’ – followed by rehabilitation.

Mass casualty events also have long-term implications for community services, the authors wrote, with some patients requiring prolonged treatment, rehabilitation, and support.

Psychological stress

Meanwhile, traumatic incidents can impose profound psychological stress on patients, their families, the bereaved, witnesses and the wider community.

The authors conclude: ‘Hospitals should expect and plan for effects lasting weeks or even months after a mass casualty event.

‘Demands on resources remain high, including physical, emotional, and psychological demands on healthcare staff.

‘Supporting them 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”.’

Further information

• Lessons in planning from mass casualty events in UK
• Well-being advice issued for those affected by Manchester terror attack

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