Lessons identified from the 2017 Manchester and London terrorism incidents. Part two: the reception and definitive care (hospital) phases.

The provision of medical care during the reception and definitive care phases of a terrorist incident will likely take place in designated receiving hospitals such as Major Trauma Centres. There is a need for an enhanced capability in such units to receive, initially manage and hold casualties with more serious injuries. Also, even less severely injured casualties may require significant time and clinical input such as risk management in potential bloodborne viruses.The distribution of casualties from the incident scene requires advance consideration of the injury pattern and regional network organisation of specialist services, such as maxillofacial, neurosurgery or severe burns care. Paediatric centres are also more sparsely distributed and often only in large city networks which represents a significant challenge for planners and responders in other regions. An effective response relies on a coordinated multidisciplinary approach including emergency and front-of-house teams, surgical, medical and clinical support services.