James Fraser Horwood, Charlotte Melling, Bashar Aldeiri, Jigna Sheth, David Wilkinson, Paul Farrelly, Ross Craigie
Royal Manchester Children's Hospital, Manchester, United Kingdom


Aims of the study:  The frequency of terrorist attacks in the UK is rising, with 2017 seeing 5 major events.  It is with great sadness, and the utmost respect for the victims of these attacks that we find ourselves in a position to report on our experience managing a paediatric mass casualty event.  The current threat level for international terrorism in the UK remains severe.  Our aim here is to disseminate the valuable lessons we have learned from this experience in the hope that we might all be more fully prepared for future events.

Methods:  We retrospectively reviewed the injuries sustained by (table), and the care provided to 14 children involved in a recent terrorist attack.  All patients were managed in line with our major incident protocol.  Survival rate, time to CT, operative burden and length of stay were reviewed.  Wound infection rates were analysed. We reviewed our capacity to manage multiple trauma victims, alongside everyday emergency and elective obligations.  Areas for potential improvement in management of a mass casualty event were explored.

Main Results:  Survival was 100% in children with signs of life at presentation.  Mean time to CT was 32 minutes.  13 patients underwent surgery within 24 hours of presentation, with a total of 40 theatre episodes over subsequent weeks.  Maximum theatre time per patient was 7 hours, maximum theatre episodes were 9, and maximum length of stay 18 weeks.  There have been no reported delayed wound infections.

Conclusions:  Structured and meticulously followed major incident plans are imperative for management of paediatric mass casualty events.  Rehearsal of plan implementation allows identification of limitations.  Damage control surgery principles and management of shrapnel wounds/missed injuries are being integrated into our revised major incident response protocols, along with the inclusion of a multiple-injury theatre WHO checklist. 

Table:  Injuries sustained.