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Public and private sector organisations are strongly encouraged to enhance their first aid preparedness and response planning, so it takes into account the likely injuries which can be the result of a malicious event, such as a terrorist attack.

This guidance, which is relevant to public and private sector organisations, has been produced to help organisations with their level of first aid preparedness during a terrorist attack. The guidance is not exhaustive, and further information on first aid preparedness can be found in the links within the document and towards the end of this guidance.

Organisational response

A terrorist attack will present challenges that may not be obvious during any other event, which results in life threatening injuries to any individual. 

Recent terrorist attacks within the UK have demonstrated a willingness from those individuals caught up in the attack to help where they can, and in particular, provide first aid to those who are injured.

To assist organisations on their counter terrorism (CT) first aid preparedness and response, this guidance will prioritise four key areas:

  1. First Aid Needs Assessment, which includes taking a risk based approach

  2. First Aid Response Plan

  3. First Aid Provisions

  4. Training


Ambulance first aid guidance


Those individuals caught up in the attack who are willing and able to administer first aid should not be discouraged from doing so. However, to support their actions there needs to be due regard for their safety to be able to administer first aid as safely and effectively as possible.

It is important to note that:

  • The response from the emergency services may be delayed - owing to the dangers that may be present, which may inhibit an effective response. 

  • The initial first aid response will place significant demands on the emergency services and wider healthcare system. This will be exasperated when there are multiple casualties spread over a wide area. 

  • Whilst the types of injuries during a terrorist attack may be no different to any other incident, the dangers posed by the attacker(s) will require greater planning on the level of first aid preparedness.


What you can do to improve your organisations preparedness

First aid preparedness is common within organisations, not only as a regulatory requirement, but as a means of improving the first aid resilience of a workforce. Safeguarding the interests of employees, visitors and any person within the immediate area of a business premises by providing humanitarian assistance to those in need. 

By enhancing their level of first aid provisions, an organisation will be helping to improve the resilience of the general population to effectively administer lifesaving first aid, which will almost certainly improve the chances of survival of a person with life threatening injuries. 

Organisations are well placed to bridge this time gap by:

It should be acknowledged that the sooner a person with life threatening injuries receives first aid, the greater their chances of survival. 

Organisational first aid

First aid preparedness should form an integral part of an organisations business continuity and emergency planning. 


Green first aid bag


Information on first aid at work is provided by the Health and Safety Executive (HSE), which should form the foundations to all first aid planning. Further information can be found on the HSE Website. An extract from the HSE website states:

“As a minimum, a low-risk workplace such as a small office should have a first-aid box and a person appointed to take charge of first-aid arrangements, such as calling the emergency services if necessary. Employers must provide information about first-aid arrangements to their employees.

Workplaces where there are more significant health and safety risks are more likely to need a trained first-aider. A first-aid needs assessment will help employers decide what first aid arrangements are appropriate for their workplace”.


Considerations around the potential challenges

Additional considerations need to be taken into account for the challenges that first aid during a terrorist attack may present.

Two considerable challenges which may impede an effective first aid response include: 

  1. The intent of the attacker(s) who may still be at large and present an unknown threat to any individual(s) within the area.

  2. A likely delay to the emergency services response.

Whilst there may be differences on the actual level of first aid preparedness by an organisation, the considerations, which help inform the assessment which in turn determines the actual level of preparedness should remain the same. 

Organisations should not be limiting their first aid preparedness to within the boundaries of their premises, and at a minimum should cover the immediate area outside their location


Potential injuries 

The type of injuries sustained as a result of a terrorist attack will most likely be no different to any other life threatening injuries.

These are: 

  • major bleeding (sometimes referred to as catastrophic bleeds) as the result of cuts, slashes and stab wounds. Shrapnel from glass and other debris. Gunshot wounds. Severed limbs and open wounds.

  • not breathing as a result of unconsciousness or an obstructed airway, typically after a head injury or cardiac arrest.  

There should also be an assumption that there will be more than one casualty.

First aid needs assessment

Central to determining the level of first aid provisions an organisations has in place is a First Aid Needs Assessment. 

 “In order to decide what provision you need to make you should undertake a first-aid needs assessment. This assessment should consider the circumstances of your workplace, workforce and the hazards and risks that may be present. The findings will help you decide what first-aid arrangements you need to put in place”.  Health and Safety Executive

Prior to undertaking a First Aid Needs Assessment, organisations should ensure a good level of scrutiny has taken place on their terrorism risk assessments.

As with any other counter terrorism related planning, a sound understanding of risk management which takes into account the likely terrorism risks (likelihood v impacts) should help to inform the First Aid Needs Assessment.

Terrorist attacks will have unknown and/or high levels of risk which may be exacerbated by the nature of the attack (possibly marauding) and the unpredictable intentions of the attacker. 

Terrorism risk management is a challenging activity which requires knowledge of terrorism risks, methodologies and threats. 

Risk assessments should take into account any mitigation that is in place which limits the likelihood and impacts. 

“The Cabinet Office publish the National Risk Register which provides information on risks and is intended to encourage public debate on security and help organisations, individuals, families and communities prepare for emergencies”
Further information can be found on the National Risk Register pages


Assess the risks

The casualties from a terrorist attack are a consequence of a terrorism risk.

  • risk description: there are numerous terrorism risks which will all have differing outcomes. It is important that organisations assess all terrorism risks. 

  • likelihood: an assessment which best determines the likelihood of a terrorist related incident taking place.  

  • impact: an assessment which best determines the impact the terrorism risk will have. 

  • Reasonable Worst Case Scenario (RWCS): this is the final assessment once all the mitigation/controls have been put in place which reduces the likelihood and impact. 


Risk assessment

At what point would an individual be able to confirm if the incident is terrorism related?

Organisations intent on managing the INITIAL first aid response during a terrorist attack, prior to the arrival of the emergency services, must have carried out a risk based assessment.

This will help to determine the effectiveness of their response, and inform how the response will look once the emergency services arrive on the scene. 

As a minimum, the risk assessment for a first aid response plan should consider:

  • the safety of all individuals, which includes staff and visitors

  • the level of training staff have received

  • the capability of staff to perform (especially under a stressful event)

  • the availability of provisions and their location

  • the footprint of the premises and the area to be covered

  • legislative and regulatory compliance (Health and Safety regulations)

  • the likely emergency services response


Example of First Aid risk management

The following risk has been included within the Risk Register of a shopping centre located within a city centre.

  • risk description: an Improvised Explosive Device (IED) detonated within their main shopping area and where there are at least 50 casualties


First aid risk assessment likelihood and impact


  • the likelihood on the number of casualties cannot be reduced any further regardless of any protective security controls that are in place

  • the impact (relating to casualties) has significantly reduced (from very high), as measures have been put in place

These measures include:

  • messaging (such as RUN HIDE TELL) across the premises informing all persons what to do in the event of a terrorist attack

  • increasing the number of first aid trained staff

  • ensuring the First Aid Response Plan, which has a tried and tested command structure in place, is effective

  • increasing the number of first aid provisions (which includes PAcT First Aid Kits and Defibrillators) across the shopping centre premises

UK National (terrorism) threat levels

The UK National (terrorism) threat levels are designed to provide a broad indication of the likelihood of a terrorist attack. They are based on the assessment of a range of factors including current intelligence, recent events and what is known about terrorist intentions and capabilities. 


The five terrorism threat levels

Threat Level descriptions


SUBSTANTIAL and SEVERE threat levels indicate a high level of threat and that an attack might well come without warning.

CRITICAL is the highest level and during this level, organisations should put in place the maximum protective security and preparedness plans. This MUST include first aid.

Organisations should be flexible on their approach, and be able to change their posture dependant on the threat level. 

Further information on threat levels can be found on the MI5 Website.

Building response levels

There are 3 types of building response level: ‘Exceptional’, ‘Heightened’ and ‘Normal’.

Building response levels provide a general indication of the protective security measures that should be applied at a given time. They are informed by the UK National threat level, but also take into account specific assessments of vulnerability and risk.

Building response levels tend to apply to sites, whereas the UK National threat levels usually relate to broad areas of activity. There are a variety of site specific security measures that can be applied within each building response level, although the same measures will not necessarily be found at every location.

The security measures deployed at different response levels should not be made public to avoid informing terrorists about what we know and what we are doing about it. However, signage should be displayed which informs the Building Response Level. 

Further information can be found on the Publicly Accessible Locations Guidance.

Building response plans

In addition to the guidance provided by the Health and Safety Executive, organisations should consider the:

  • threat the attackers present, which includes how many there are, where they are and what they are armed with

  • unknown number of casualties and their types of injuries

  • availability, training and competence of individuals present to administer first aid during a terrorist attack

  • availability of first aid provisions for life threating injuries

  • likely emergency service response (capability and arrival time)

  • environmental challenges, which include damaged buildings and vehicles

First aid response plan

Organisations should have a First Aid Response Plan, which provides strategic oversight, management and direction setting for the administration of first aid. 


first aid response plan checklist


This plan, which is most likely to be generic for any first aid related event, should have an appreciation of the challenges terrorist attacks present.  

The overall aim of the First Aid Response Plan is to improve the survivability of a person with life threatening injuries however, there also needs to be due regard to that of the person performing the first aid. 

The First Aid Response Plan should dovetail into all other emergency plans, and in particular, an organisation’s evacuation and invacuation plan, and should be regularly tested and exercised.

During a terrorist attack, there should be assumption that (in no particular order):

  • there is a continuing threat of immediate, life threatening danger to any person

  • those with injuries will most likely be life threatening

  • there will be more than one casualty

  • the emergency services response may be delayed


Having a collaborative plan

The plan should be developed in collaboration with neighbouring organisations and the emergency services. This introduces situational awareness and an enhanced level of knowledge of each other’s capabilities. This will also help the emergency services understand the level of first aid preparedness an organisation has in place and where possible, work towards a common approach that is understood by all parties. 

Where possible, consider possible locations for the emergency services to convene prior to attending the actual venue (known as a Rendezvous Point or RVP). A degree of flexibility is required as this location may change dependant on the type of incident.

The plan should take into account the National Stay Safe guidance RUN HIDE TELL provided by Counter Terrorism Policing for those caught up in a terrorist attack.  

All individuals should carry out a dynamic risk assessment prior to administering first aid.

Individuals should not be discouraged from providing first aid, yet this should only be considered if:

  • The injured person cannot help themselves

  • The first aider is not injured themselves

  • The first aider is able and willing to help others

Information on actual first aid techniques can be found on the “how to” pages on the St John Ambulance website


There should be a belief that the attackers may still be in the immediate area, so always plan for an escape route should the attackers return. 

There may be more than one casualty. Those with life threatening injuries should be treated first over those with minor injuries, such as small cuts and bone breaks. 

However, not all casualties will require first aid.  Some may be able to help themselves.

There must be an appreciation that the actions of individuals caught up in an attack, who may be suffering from confusion, shock and hearing loss, may result in their actions becoming unpredictable.  

Ideally, you should only administer first aid to one casualty at a time, unless you are able and confident to help more than one.


  • never assume someone else has called the emergency services 

  • the emergency services will be interested in the location of the attackers, the number of casualties and the types of injuries 

  • the emergency services response may take time to arrive depending on the type of incident and the dangers that are present 

  • armed police may be the first emergency service responders to arrive and will prioritise dealing with any attackers over administering first aid

  • the emergency service personnel may be wearing enhanced protective equipment such as body armour and helmets

Effective public communications

First aid messaging should take as much primacy as all other safeguarding messaging such as the National Stay Safe message RUN HIDE TELL and fire evacuation.


Effective communication during the first few minutes are critical  

  • there should be a risk based approach used to decide the level of messaging, and what message should be delivered

  • in large premises, and those where there is a public address (PA) and visual messaging systems, consider what message could be shared, if any at all

  • pre-recorded PA messages (such as those for fire evacuation) which repeat messaging every couple of minutes are a good secondary option yet, where possible, there should be an ability to deliver instantaneous messaging


effective public communications billboard


  • Visual messaging systems such as those seen upon entering a building and/or those located across the premises are ideal for illustrating messaging 

  • Keep messaging simple, one which may inspire/prompt an individual to do something


First aid messaging should be: 

  • clear

  • to the point

  • as minimal as possible

Long messages may only add further confusion. 

We recommend all messaging is done in English, unless an assessment has been made otherwise. 

The messaging should not give away positions of people and/or equipment as this may draw the attackers to an area. For instance, if a message informs that first aid kits are located in the reception area, people may go there along with any attacker.

Leadership & chain of command

Considerations before the emergency services arrive

The period before the arrival of the emergency services is CRITICAL for immediate, lifesaving actions.

The vast majority of people within the UK will not have been caught up in a terrorist attack. Which is why it is important that organisations do not assume how people (employees and non-employees) will react if they are caught up in one. 

Consider, at what point would it become apparent that a terrorist attack has taken place?

In the first instance of planning, organisations will need to undertake an assessment which best determines whether it is achievable for staff to carry out certain functions during a terrorist attack, which they may ordinarily be able to carry out during a non-terrorist attack. 

A clear understanding of the level of expectations, will help determine what can be best achieved for the benefit and safety of all individuals. This includes the safety of employees to carry out functions, and the safety of non-employees who may well be looking for guidance on what to do.



Organisations intent on managing the INITIAL first aid response during a terrorist attack, prior to the arrival of the emergency services, must have carried out a risk based assessment which determines the effectiveness of their response. 


First Aid


Structure plays an important role in any response, and as part of the First Aid Response Plan, organisations should have some degree of command and control, which directs the human aspect element of managing a first aid response.

These roles and responsibilities will be dependent on a number of factors, yet will most likely be influenced by the level of risk involved and the resourcing and capability of staff (see previous section - First Aid Response Planning).

Consider what actions staff and visitors are likely to carry out, and use this as a foundation for what can be put in place so this can be achieved as safely and effectively as possible.

As mentioned earlier in the document, previous events have shown that there may be a proportion of people involved who are willing and able to help where they can.


Roles and responsibilities

ANY member of staff should be able to carry out ANY role, provided they are willing and able to do so.

It is strongly suggested to keep the roles as simple and to task as possible.

The roles and responsibilities should remain flexible and seniority should not be a deciding factor, although this is a decision for an organisation to assess and confirm how this is to be managed. 

Consider what the other roles and responsibilities individuals will hold during a terrorist attack and how this may affect the first aid response plan? 

“The Joint Emergency Services Interoperability Programme, also known as JESIP, sets out a framework all members of the emergency services, and wider responders work to during major incidents”. 
Further information can be found on the JESIP website.

The National Protective Security Authority (NPSA) have published guidance which covers a host of areas, and whilst it is designed for security control rooms, there is information which is relevant for all organisations. Further information can be found on the

Example of a command structure during a terrorist attack

  •  a large sports arena has a dedicated security team who will assume the Command and Control for theimmediate response to the terrorist attack, prior to the emergency services arriving

  • the organisation has provided in house training for all security staff who, for resilience planning, are able to carry out all roles 

  • they have undertaken a risk assessment on the actions that staff can take

  • it has been determined that the level or responsibility for their command structure will follow the level of supervisory responsibility 

The roles and responsibilities are defined below:

example of command strucutre


 The table below outlines the broad level of first aid related activity an organisation can measure themselves against. 

The table covers the four key areas discussed above in the guidance. This is not exhaustive and organisations are encouraged to go above and beyond this. 

first aid related activities

A more thorough checklist can be found below:

First aid action/checklistFirst aid action/checklistFirst aid action/checklist


Health and Safety (First Aid) Regulations 1981 

Requires employers to provide adequate and appropriate equipment, facilities and personnel to ensure their employees receive immediate attention if they are injured or taken ill at work. 

The Regulation sets out the essential aspects of first aid that employers have to address within all workplaces.

As a minimum, there must be:

  • a suitably stocked first-aid kit

  • an appointed person to take charge of first-aid arrangements;

  • information for all employees giving details of first-aid arrangements


Social Action Responsibility and Heroism Act 2015 (England & Wales)

Legislation is in place to support the actions of individuals acting for the benefit of society or intervening to help someone in an emergency.


Manual Handling Operations Regulations 1992

There must also be compliance with any overriding Health and Safety Regulations such as Manual Handling Regulations 1992.



A First Aid Needs Assessment, in addition to a training needs analysis, will determine the level of first aid training employees receive, and the level of awareness non employees may require. As a minimum, organisations should ensure all safeguarding training (such as fire safety and first aid) covers terrorism related first aid. A holistic approach should be taken to all levels of training related to first aid. Consider the leadership and chain of command and what training would be required to fulfil each role.


Accredited first aid training

Organisations should ensure mass casualty and catastrophic bleed injuries are included within their training. 

  • Levels of first aid training: explore opportunities to enhance and professionalise, with training, the roles and responsibilities of staff during a first aid response. This will ensure a structured and targeted approach to the first aid response. 

  • St John Ambulance: accredited first aid training is undertaken by St John Ambulance. Further information can be found on the SJA website. St John Ambulance also have a free to download mobile app, which provides prompts on first aid treatment. 


ACT Awareness e-Learning

The ACT Awareness e-Learning is a counter-terrorism awareness product designed for all UK based organisations and individuals. It provides nationally accredited, corporate CT guidance to help industry better understand and mitigate against current terrorist methodology.

In addition to the ACT Awareness e-Learning, a 90 second media clip and self-delivery power point is available free of charge for any person and provides information on how to provide first aid as safely and effectively as possible during a terrorist attack. Further information on this can be found here.


Testing and exercising 

In addition to training, organisations are encouraged to support, and where possible, participate in exercises held by the emergency services. These are an excellent opportunity to familiarise response plans and help inform any training needs requirement.


St John Ambulance – Accredited first aid training and suppliers of first aid products.

citizenAID - Free information on how to stay safe and treat casualties before the 999 services arrive. Suppliers of first aid products.

Faculty of Pre Hospital Care – Information on pre hospital clinical standards. 

Resuscitation Council UK – Information on CPR and defibrillators. 

British Heart Foundation – Information on defibrillators

JESIP - The Joint Emergency Services Interoperability Programme, also known as JESIP, sets out a framework all members of the emergency services, and wider responders work to during major incidents.

Health & Safety Executive – Guidance for employers on first aid.

UK National (Terrorism) Threat Levels – Information on UK Terrorism threat Levels.

National Risk Register – Information on the National Risk Register.

Local Resilience Forums - Local resilience forums (LRFs) are multi-agency partnerships made up of representatives from local public services, including the emergency services, local authorities, the NHS, the Environment Agency and others. These agencies are known as Category 1 Responders, as defined by the Civil Contingencies Act.

Lynne Baird Foundation Control the Bleed Kits – Information on control the Bleed Kits.

City of London Emergency Trauma Pack (ETP) Scheme  - Information on the City of London Police Emergency Trauma Packs. 

First Aid
Emergency Planning