Run, hide, tell – treat? The public now has a role to play in Westminster-style attacks

While debate continues about whether the events that unfolded in London on March 23 amounted to an act of terrorism, it has many people thinking about how they would react in a similar situation.

The British government is constantly reviewing how prepared it is for terrorist incidents. Its official advice to those caught up in major incidents is to “run, hide, tell”. They are to run as far away as possible, but if they cannot reach a place of safety, they should hide, and if it’s safe to do so, they should use their mobile phone to call the emergency services.

However, the UK charity CitizenAID has suggested extending this advice to “run, hide, tell, treat”. Given recent changes to how the police respond to potential terrorist incidents, the idea is that the general public should be encouraged to do what they can to help injured people around them until ambulance crew can access the scene.

Evolving threat

Over the past few years, numerous attacks have shown how vulnerable we can be in public and in confined spaces. In 2013, 67 people were killed and more than 175 injured in the Westgate Mall siege in Nairobi, Kenya. In July 2016 a lone actor carried out a small arms attack at the Olympia shopping mall in Munich, killing ten people and injuring 36.

Following the attacks in Paris in November 2015, which resulted in 130 people being killed and 360 injured, mainly by small arms fire, the UK armed police changed their tactics for dealing with an attack by terrorists using small arms.

If such an incident now happens in the UK, armed police will ignore the dying and injured. Their primary aim is to eliminate the threat first. Training exercises carried out in British shopping malls, including the Trafford Centre in Manchester in May 2016, and in Meadowhall in Sheffield in March 2017, revealed that it can take over 100 minutes before armed police are able to eliminate the threat. And only once that has happened can paramedics be let onto the scene to treat the injured. Such a lengthy wait can result in many severely wounded people dying before they receive medical treatment.

CitizenAID’s recommendation that those caught up in a terrorist incident – many of whom may not be trained in first aid – should treat others with severe, life-threatening wounds by triaging and applying tourniquets is potentially controversial. But if it can take up to two hours before trained paramedics can get to the scene it becomes more of a pragmatic solution.

The suggestion is based on the military’s operational experiences in Iraq and Afghanistan in cases of severe injury. It has been found that first aid applied in the first ten minutes of a person sustaining the injury can save their life. Soldiers applying tourniquets and packing to life-threatening gunshot and bomb blast wounds has been shown to save many lives.

The charity has produced a free app to help people in this situation. Using mainly icons rather than words, it is has been designed to reduce anxiety from making difficult decisions in what would clearly be an unfamiliar situation.

People are willing to help others. We saw as much in the Westminster attack, when Conservative MP Tobias Ellwood gave mouth-to-mouth resuscitation to police officer, Keith Palmer. Medically approved guidance like the one provided by CitizenAID could help those applying first aid in such situations.

Their advice shows how those treating the wounded can improvise with what equipment is available to hand. Tourniquets, for example, can be made with scarves, socks or belts and clothing can be used as packing for life-threatening wounds.

Even though a person my not have any first aid experience, it’s important that severe bleeding is treated immediately. A victim can literally bleed to death within a few minutes, and bleeding from limbs in particular can be effectively stopped. CitizenAID is even looking to place medical equipment to treat such wounds at various locations such as shopping malls.

If the British government extended “run, tell, hide” to “run, tell, hide, treat” it could help save lives when an attack happens in a public place. If a similar approach was used at the likes of the Westgate Mall or Olympia Mall incidents, maybe the number of fatalities would have been reduced.

David Lowe does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.