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Marauding terrorist attack (MTA): prehospital considerations
  1. Ravi Chauhan1,2,
  2. Bianca M Conti2,
  3. Damian Keene3
  1. 1Defence Medical Services, Lichfield, UK
  2. 2R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
  3. 3Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Dr Ravi Chauhan, R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA; ravi.chauhan{at}


Terrorist attacks are increasing each year as are the number of deaths associated with them. Recent incidents have seen a shift in tactics with the use of multiple terrorists across multiple locations with firearms or knives, referred to as the marauding terrorist attack. These methods are becoming more prevalent alongside the use of vehicles deliberately aimed at pedestrians. Management of these incidents can be challenging. Not only it involves a large number of casualties but also the management of a dynamic scene in terms of both location and threat from attack. In order to improve response, and potentially outcomes, a system or response needs to have preplanned and practised procedures in place. This article reviews major incident management for those unfamiliar with current prehospital practice and details some of the findings from recent marauding terrorist firearm attacks, in particular the evolution of newer scene management tools such as 3 Echo and THREAT. It highlights the importance of haemorrhage control and the public initiatives focusing on actions during a terrorist incident.

  • communications
  • disaster planning and response
  • emergency ambulance systems
  • gunshot
  • major incident, planning

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  • Contributors All authors were equally involved in the planning, preparation, review and writing of this paper. RC: planning, research and writing. BMC: review, research and writing. DK: planning, research and writing.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.