Increasing numbers of businesses are training their staff in how to help in the aftermath of a terrorist attack following concerns about how long it could take emergency services to reach victims.
It follows evidence at the London Bridge inquest about the delays in ambulance service paramedics getting to the injured amid fears of secondary attacks.
One resilience training company Sky News has spoken to has seen demand from businesses increase by 100% over the past two years.
This week, London Ambulance Service (LAS) senior managers will face tough questions at the inquest over whether their current major incident response plans are fit for purpose.
The inquest has already heard how paramedics did not reach the scene of most of the deaths at London Bridge for three hours after the attack began, even though the killers had been shot dead in the first 10 minutes.
Two police officers who had been stabbed were taken to hospital by police cars soon after the attack, because ambulances were initially held at a rendezvous point three miles (4.8km) away at Camberwell Green.
Ambulances were later moved to a staging post around 100 yards away from the main attack sites, but an apparent breakdown in communications meant police officers treating the badly injured did not know the medics were being held there.
At a training facility in Berkshire, staff from a data management company have just completed a course on how to react, if caught up in a terrorist attack, or other major incident.
The course, run by the security firm Pangolin, is one of a growing number across the country, aimed at teaching civilians the basics in how to respond in the event of an attack and how to administer potentially life saving medical aid to anyone injured.
Michael Heron, CEO of Pangolin Group, has seen demand for their classes double in the wake of recent terror attacks, where issues around a delayed response from fire and ambulance personnel have been raised.
“I think most paramedics would want to get in there and most police do want to get in there,” he said.
“So on an individual level, nobody does not want to help, that’s why they joined and I think that people would accept that level of risk, provided people are properly trained, properly equipped.
“Firefighters go into burning buildings to save people and some of them pay the ultimate price, but that is what they joined for.
“So I think at an individual level, people would accept the risk but at a corporate level, as in a managerial level, I think it’s different.”
The London Bridge inquest heard how PC Clint Wallis and his colleague PC Mia Kerr, a probationary officer, were first on the scene, and she stood guard with a baton, while members of the public treated Sebastien Belanger, who died a short time later.
Body-worn camera footage showed PC Wallis, shouting up from the courtyard of a bistro, where several of the victims lay: “Are you a paramedic? It’s all clear, we have got multiple victims down here.”
PC Wallis and PC Kerr were two of multiple officers, along with some members of the public, who fought to save the lives of those most badly injured.
A pathologist told the inquest that, although Mr Belanger was very severely injured, it might have been possible to save his life had medical help reached him quickly.
PC Stephen Attwood, a British Transport Police officer on his way home, tried to save James McMullan and told the inquest: “I believe he could have been saved. I believed he was seriously ill but in a critical condition.”
PC Attwood said he had received additional training as a firearms officer, but “nothing like a paramedic’s training” and did not have their equipment.
LAS paramedic Gail Collison, a member of the Hazardous Area Response Team (HART), had been given specialist training and personal protective equipment to work in areas of “high risk” where normal paramedics would not be allowed to go.
She was in west London when she was tasked at 10:33pm, 25 minutes after the attack began, but did not arrive at London Bridge until 11:18pm.
The inquest heard that it was 1:07am before she dealt with her first patient, Sebastien Belanger, who was already dead, and five minutes later she tagged her second fatality, nurse Kirsty Boden.
Two “tactical response” paramedics – Gary Edwards and Jake Carlson – were also trained to go into so called “warm zones” with armed police officers as cover.
They arrived five minutes after the attack but decided the situation was too dangerous and instead led casualties across the bridge to the north bank of the Thames, only returning an hour-and-a-quarter later.
Mr Heron said that with senior emergency service managers understandably unwilling to send their teams into harms way during marauding terror attacks, a radical change in approach was needed.
“Why not train armed police to have a higher level of trauma training? Than to try and actually protect paramedics,” he said.
“It is a decision for somebody to make and I think Manchester and London Bridge have illustrated there is a gap in the system.
“Armed response officers are interested in neutralising the threat, obviously, but then there is this gap whereby people can die of preventable injuries because of lack of treatment.
“The head policeman said it was like a war zone at the time of London Bridge, so you have to treat it like a war zone.
“In war zones there is actually a very, very high survival rate of injured soldiers because they have the right equipment, basic soldiers have got a lot better trauma training and therefore people survive.”
Legal counsel for the eight people who died at London Bridge and Borough Market have expressed concern at the effectiveness of the response from the London Ambulance Service.
Addressing the time taken by paramedic Gail Collison to treat her first victim, Gareth Patterson QC, for the families of six of the victims, said it showed a “remarkable lack of urgency”.
Senior ambulance service managers will have to address those concerns under questioning this week, as the inquest examines whether more could have been done to save the victims.
But in determining how best to respond to chaotic, violent and sustained terrorist attacks, there are no easy answers.
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