NHS England has published a new document setting out how it plans to respond to a mass casualty incident. The plan should be read with other NHS England documents and form part of any organisation’s Emergency Preparedness, Resilience and Response (EPRR) portfolio.
The plan defines a mass casualty incident as one where the location, number, severity or type of live casualties requires extraordinary resources or where available healthcare resources are overwhelmed, against the casualty demand. This does not include occasions when the resources of an emergency department are exceeded due to systemic operational pressures in the system, or if the incident is the result of a rising tide event. The most likely causes of a mass casualty incident are a man-made disaster or emergency incident such as transport or industrial accident, an act of terrorism, or an event involving chemical, biological, radiological or hazardous materials.
Severe
In May this year, the Joint Terrorism Analysis Centre (JTAC) raised the terrorism threat level across the UK to ‘Severe’, which means an attack is highly likely*. The threat level was raised following the Golders Green stabbings in April. It was not as a result of those attacks directly, but more generally, the UK has been experiencing a gradual increase in terrorist threats for some time, driven by a rise in Islamist and Extreme Right-Wing threat from individuals and groups**.
Bed capacity
The plan sets out some specific requirements and expectations around bed capacity, stating that all receiving hospitals should enact plans to free up 20% of their total bed base with 12 hours, with 10% to be freed within six hours. Furthermore, hospitals with level 3 intensive care capability “should prepare to surge to double their normal level 3 ventilated bed capacity and maintain this for a minimum period of 96 hours.”
‘Concept of operations for managing mass casualties’ may be downloaded here.
* There are five terrorism threat levels – Low, Moderate, Substantial, Severe, Critical.
** This was detailed by counter-terrorism expert, Figen Murray, talking at HEFMA’s 2026 National Leadership Forum. For a full report and separate interview with Figen, see the July/August issue of HEFMA's Pulse magazine.
