The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study

Elena A. Skryabina*, Naomi Betts, Gabriel Reedy, Paul Riley, Richard Amlot

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)
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Simulation exercises are an important part of emergency preparedness activities for the healthcare community but evidence of their impact on the response to real major incidents is limited. This project studied the impact of health emergency preparedness exercises (HEPEs) on the response to a mass casualty terrorist incident. The mixed methods study design was adopted comprising an on-line survey and follow up individual interviews. Participants were healthcare staff who took part in responses to three major terrorist incidents in the UK in 2017. Descriptive statistics and analysis of variance were undertaken with quantitative data. Content and thematic analysis methods were used for qualitative data analysis. The online survey generated 86 responses; 79 (92%) were from the responders to the Manchester Arena bombing. Twenty-one survey respondents shared their experiences in in-depth interviews. Healthcare staff who took part in HEPEs felt better prepared to respond than those who did not attend an exercise. The most commonly reported benefits from HEPEs were awareness of major incident plans and having the opportunity to practice responding to a similar scenario in the recent exercise. Specific benefits included: improved coordination of the response through adherence to recently practiced incident plans; confidence with response roles; real-time modifications of the response and support provided to staff who did not take part in exercises. Exercise recency was highlighted as an important facilitating factor. The study provides strong objective evidence that the response to a mass casualty terrorist incident was enhanced by training and service development achieved through HEPEs.

Original languageEnglish
Article number101503
JournalInternational Journal of Disaster Risk Reduction
Early online date1 Feb 2020
Publication statusPublished - Jun 2020

Bibliographical note

Funding Information: The study was funded by the National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response (NIHR HPRU ? 2012-10414) at King's College London in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or Public Health England. The authors would like to thank all study participants who volunteered their time to take part in the survey and the follow up interview and share their valuable experience and views. We also would like to acknowledge the support of multiple organisations and individuals with this study: PHE ERD Exercises and Training team leaders Charles Turner and Anthony Chapman, National Head of EPRR NHS England and NHS Improvement Stephen Groves and National Clinical Director for Trauma Professor Chris Moran; Greater Manchester Health and Social Care Partnership, NHS England EPRR North, NHS England EPRR London, and PHE EPRR North West Centre.
Authors Skryabina, Amlôt and Riley were employed by Public Health England's Emergency Response Department when the emergency preparedness exercises were delivered. However, they were not part of the exercise delivery teams.

Open Access: This is an open access article under the CC BY license (

Publisher copyright: Crown Copyright © 2020 Published by Elsevier Ltd.

Citation: Elena A. Skryabina, Naomi Betts, Gabriel Reedy, Paul Riley, Richard Amlôt,
The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study, International Journal of Disaster Risk Reduction, Volume 46, 2020, 101503, ISSN 2212-4209.



  • Disaster training
  • Emergency medical services
  • Emergency preparedness
  • Emergency preparedness exercises
  • HEPE
  • Manchester Arena bombing


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