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Research question:  How does the response and management of terrorist attacks by emergency medical services (EMS) in the United Kingdom (UK) compare to Europe and the United States of America (USA)?  Introduction:  Terrorist attacks and active shooter events account for a growing number of mass casualty and major incidents in the UK, Europe and the USA. In order to better prepare for future incidents, analysis of prior events is essential.  Methods:  Systematic literature searches of papers published between 1/1/2004 and 5/31/2018 were conducted using two key databases: CINAHL Plus and PubMed (indexed from MEDLINE). Key contents of identified papers were abstracted, including EMS response and patient management, with emphasis placed upon identified recommendations and lessons learned.  Results:  Four hundred and forty-two records were identified in the preliminary search, with 176 records further screened using the title and abstract. Ten papers were included in the final review, reflecting 13 events from five countries across two continents. Three major themes identified throughout the papers were emergency preparedness, resilience and response (EPRR), casualty triage, and tactical emergency medical services (TEMS). These themes were present in 90%, 70% and 40% of the papers respectively.  Conclusion:  New and innovative EMS response strategies occurred over the study period, in part due to the dissemination of lessons learned. Despite advances in response to mass violence events, significant gaps remain, in part due to lack of adoption of recommendations. Recent experience with advanced TEMS providers capable of operating within the inner perimeter suggests that this approach should be further evaluated as part of the response plan for future events.

How Does the Response and Management of Terrorist Attacks by Emergency Medical Services in the UK Compare to Europe and the USA?