Rapid deployment of trained prehospital medical teams and triage* to a specialist trauma centre is likely to have reduced deaths in those critically injured in the London bombings on July 7, 2005, according to an Article in this week's issue of The Lancet.

The multiple bomb explosions in London on July 7, 2005, resulted in the largest mass casualty event in the UK since World War 2. Karim Brohi (The Royal London Hospital, UK) and colleagues assessed the response by the Royal London Hospital, which received 194 casualties from the incident and is London's primary trauma centre.

The researchers looked at over-triage rates, where non-critically injured causalities are assigned to a high priority for early evacuation and treatment. They found that the Royal London's Helicopter Emergency Medical Service (London-HEMS) achieved low over-triage rates (33%) at Aldgate and King's Cross when compared with the other sites and other previous events, such as the Madrid train bombing in March 2004 (89%). They also found the death rate among critically injured was 15% - lower than that of most previous terrorist mass casualty events. The improved triage by London-HEMS and the "damage control" response of the Trauma Centre is likely to be responsible for the low rate of death among the critically injured say the authors.

Dr Brohi comments: "A 'damage control' response shifts the trauma centre to an almost military footing, where all efforts are directed precisely at saving life and limb while maintaining the hospital's casualty receiving capability." (Quote by e-mail; does not appear in published paper)

The authors conclude that reducing the death rate in urban terrorist events requires a robust trauma system combining advanced prehospital teams and dedicated trauma centres.

See also accompanying Comment.