Clear Guidance how to help yourself and others and stay safe during a stabbing, terrorist attack or any other mass casualty incident.

If you are caught in a terrorist attack or any mass casualty event, your actions can make a vital difference to your safety and to others around you. In stressful moments, remember the simple mantra: “Run, Hide, Tell.” This is official police guidance for what to do during a firearms or weapons attack:

RUN:

If you hear gunshots or an explosion or see an attacker, run to a place of safety if you can. This is your first and best option. Get far away from the danger as quickly as possible. Leave belongings behind – your life is more important than bags or phones. Encourage others to go with you, but do not let their hesitation slow you down if they won’t move. Once you are clear of immediate danger, continue moving until you are sure you are safe. Then call 999 to report what is happening (further directions on the best way to do this, below). Never run towards the incident; always try to put distance or barriers between you and the threat.

HIDE:

If you cannot run – maybe the attacker is too close, or you’re inside and escape is not possible – then hide. Find cover from gunfire or blast. This means thick walls, sturdy structures, or anything that might shield you from weapons. Lock or barricade yourself in a room if possible. Stay quiet and silence your mobile phone (put it on silent and vibrate off). Stay out of sight – if you can see the attacker, they may see you. Avoid congregating in groups in one spot if you’re in an open area; spread out and seek cover. If hiding with others, try to stay calm and keep everyone silent. Remember: if you’re hiding, it’s because running isn’t safe at that moment – so do everything possible to remain unnoticed.

TELL:

When you are safe (or as safe as can be) and it’s possible to use a phone, call 999 and tell the police what you know. Don’t assume someone else has already called – multiple reports help build situational awareness. When speaking to the operator, give clear details: say exactly where the incident is (provide the name of the venue, street, nearby landmarks – the emergency services need a precise location). Describe the attacker(s) if you saw them – e.g. number of attackers, weapons (gun, knife, vehicle, etc.), what they look like (clothing, physical features). Describe the situation – are people injured? Are there fires or structural damage? This information will assist police and medics to respond effectively. Follow any instructions the emergency operator gives you. They may ask you questions – try to answer quietly and succinctly. If you cannot speak (because it might reveal your hiding spot), there is a system called the Silent Solution: dial 999, and if you can’t talk, listen and respond by coughing or tapping, then when prompted press 55 on your phone keypad. This alerts police that you’re in an emergency even though you’re silent, and they will trace and deploy resources to the call. (Note: pressing 55 works from mobile phones after the call is picked up – if you’re on a landline and stay silent, help should be sent automatically because the address can be determined.) Use this silent 999 method only for genuine emergencies when speaking might put you in danger.

For an easy reference you can keep on your phone or computer, download our free ebook ‘First aid for catastrophic bleeding and tourniquets’ which reinforces these step-by-step techniques.

Key Safety Tips to help keep yourself and others safe:

In addition to “Run, Hide, Tell,” here are other safety tips for the public during such incidents:

Be aware of your environment.

At the first sign of danger (e.g. gunfire, explosion, screams), act quickly. Don’t wait for others to validate your decision. If something feels very wrong (people running, unusual sounds), start moving away fast.

If driving

Pull over and leave the area on foot if an attack happens nearby (e.g. a vehicle ramming into a crowd). However, be careful to ensure your vehicle won’t impede the emergency services accessing the scene. Do not stop to film or to stare – this can delay your escape and put you at risk.

Help others if you can – but only if safe to do so.

Your priority is to save yourself, so you can then call for help. If a person near you is slower or needs assistance (an elderly person, someone injured), and you can help without significantly jeopardizing your escape, do so – e.g. help them up or guide them along. But if someone is unwilling to move or frozen in panic, do not let them prevent you from getting away. Shout at them firmly to follow but keep going if they won’t; you can still call 999 for them once you’re in a safe place.

When hiding

lock or barricade the door with heavy furniture, turn off lights, and stay low and quiet. Silence your phone! This cannot be overstated – a phone ringing or vibrating can give you away. If with a group, spread out (don’t huddle all together) and plan what to do if the attacker comes (perhaps ambush with improvised weapons). As a last resort, if you are directly confronted by an attacker and have absolutely no other option, you may choose to defend yourself using force – improvise weapons from nearby objects (chairs, fire extinguishers). This is not part of the UK’s official “Run, Hide, Tell” advice (which deliberately excludes “Fight”), but it is human nature to fight for your life if cornered. Only do this if running and hiding are truly impossible and your life is in immediate danger.

When police arrive:

Remember that they may not know who the threat is. They might be shouting commands, armed, and in a highly charged situation. Keep your hands visible and empty – raise your hands or spread your arms to show you are unarmed. Comply immediately with officers’ instructions – they might shout “Get down” or “Hands up” etc. Do not run toward them or make sudden movements that could be misinterpreted. Police will often evacuate people quickly; follow their route and don’t go back for belongings until cleared.

After an incident:

Even once you’re safe from physical harm, understand that witnessing such events is traumatic. It’s normal to feel anxious or have trouble coping. Seek support from friends, family, or professional counsellors in the aftermath. Also, if you took photos or video during the incident that might aid investigators, tell the police – they may ask for those later (there’s also a tool called ACT App or police webpages to submit footage of attacks). But do not share graphic images on social media; this can be distressing and unhelpful for the investigation.

Giving First Aid in an Attack

If people around you are injured in a mass casualty incident, you might be able to save a life before professional medics arrive. However, do not attempt to give first aid until you are sure that you are not in immediate danger. In a terrorist attack scenario, this means you should have either escaped the attacker or found a safe hiding spot first. Once you are relatively safe, you can turn your attention to helping the wounded.

Only help others if:

(1) You are not injured yourself, (2) You are in a safe position where you are not exposing yourself to the attacker, and (3) You feel capable of assisting. If these conditions aren’t met, focus on TELL (calling emergency services) and wait for trained responders. But if you can help, here are guidelines for treating life-threatening injuries in an emergency:

Prioritise casualties with life-threatening conditions

In a mass casualty event, some people may have minor injuries, and some may be critically hurt. You should focus your limited time on those who need immediate, life-saving aid. Specifically, look for:

• Victims with massive bleeding (spurting blood, partially severed limbs, or bleeding that is rapidly pooling).
• Victims who are unresponsive and not breathing normally (or only making gasping breaths). They will need CPR.
• Victims who are unresponsive and breathing normally – who should be rolled into the recovery position.

Those categories are the highest priority for first aid. Someone who is conscious and “only” has a broken arm or minor cut can wait. Only help one casualty at a time – do what you can for the most critical, then move to the next.

Severe Bleeding (Haemorrhage, Catastrophic or Life Threatening Bleed) Control

Heavy bleeding is a leading cause of preventable death in trauma. Your goal is to stop the bleed as quickly as possible:

1. Apply Direct Pressure: If you see a wound that is bleeding heavily, immediately cover it with any cloth or dressing you have and press down firmly. Use a gloved hand or, if you don’t have gloves, improvise with a thick cloth folded (to avoid direct contact with blood if possible, for hygiene). Push directly on the source of bleeding. If the blood soaks through, do not lift the pad up – add more cloth on top and keep pressing. Maintaining continuous, hard pressure can often control moderate bleeding.
2. Elevate if possible: If the wound is on a limb, and no bones appear broken, raise the limb above heart level while applying pressure. This may slow bleeding a bit. However, if a fracture is suspected, or moving the limb causes pain, focus on pressure alone.

Attending our catastrophic bleeding first aid course will give you hands-on practice in using tourniquets, packing wounds and managing life-threatening bleeding in real-world scenarios.”

Tourniquets

1. Use a Tourniquet for severe limb bleeding: If the bleeding will not stop with pressure and the injury is on an arm or leg, a tourniquet can be a lifesaving tool. A tourniquet is a band tightened around the limb to drastically reduce blood flow. Many public venues now have tourniquets in first aid kits. If a commercial tourniquet (CAT, SOFT-T, etc.) is available:
   • Position it a few inches above the wound (closer to the torso than the wound, but not over a joint).
   • Tighten it until bleeding stops or is greatly reduced. It will be extremely painful for the casualty, but you are trying to save their life. It needs to be put on very tightly.
   • Secure it in place. Never loosen or remove a tourniquet once applied – leave that to medical professionals when they arrive.
   • Note the time if possible (tourniquets can cause tissue damage if left for long, so medics like to know how long it’s been on, ideally not more than 1 hour or two).

If no proper tourniquet is on hand, you can improvise one: use a strong, broad material like a belt, scarf, or triangular bandage and a rigid object (a stick, pen, screwdriver) as a windlass. Tie the band tightly around the limb a few inches above the wound, then insert the stick and twist to tighten down the band like a crank. Twist until the bleeding significantly slows or stops, then secure the stick so it doesn’t unwind. This improvised method is tough but can work in dire circumstances. (Do not use thin cord or wire as these can cut the flesh – width of at least 1-2 inches is better.)

Warning: Tourniquets are meant for life-threatening bleeding (bright red spurting or large volume). Do not apply for minor cuts. They will cause pain and potentially nerve injury, but when a limb wound is haemorrhaging, saving the person’s life takes priority over limb comfort.

Packing a wound:

1. Wound Packing

If the bleeding is from a deep wound on the neck, shoulder, or groin where a tourniquet can’t be applied, and direct pressure isn’t enough, you can perform wound packing. Take a clean cloth or gauze and stuff it into the wound cavity as much as possible, then press on top. This helps apply pressure to internal bleeding vessels. Some advanced first aid kits include haemostatic gauze (gauze treated with clotting agents) – use that if available, as it can speed up bleeding control. Pack the wound firmly and hold pressure.

2. Monitor and maintain pressure

Once you’ve controlled bleeding, keep pressure on the wound until paramedics take over. If the person is conscious, encourage them to also apply pressure themselves if they can, freeing you to help others. Severe bleeding can lead to shock quickly (see “Shock” below). By controlling haemorrhage, you give the casualty the best chance of survival until the ambulance arrives. Expect that a victim with heavy bleeding will likely need urgent surgery or blood transfusions – stopping the bleed is just the first step, but it’s the step that an immediate responder like you can do to save their life.

For more focused guidance on knife injuries, see our detailed article on first aid for stabbing victims.

Airway and Breathing

An unconscious person can die from a blocked airway (tongue or vomit obstructing breathing) even if their other injuries are survivable. Therefore your priorities are to Check breathing, Open airway, and Place in recovery position (if breathing).

1. Check responsiveness and breathing:

If you find a casualty lying still, try to rouse them. Tap their shoulder or gently shake and shout “Can you hear me?” If there is no response, assume they’re unconscious. Quickly check if they are breathing: look for chest rise and fall and listen/feel for air from their mouth or nose. Do this for no more than 10 seconds – if you’re not sure you see breathing, treat it as not breathing.

2. Open the Airway

An unconscious person’s tongue can collapse back and block the throat. To open the airway, perform the head-tilt, chin-lift manoeuvre: place one hand on the forehead and two fingers of the other hand under the chin, then tilt the head back gently. This lifts the tongue away from the airway. (If you suspect a spinal injury, do this very carefully or use a jaw-thrust if trained – but in a mass casualty event, airway takes precedence.) Gently tilting the head back can make a non-breathing person start breathing again in some cases, if the issue was just the tongue blocking the airway.

3. Is the person breathing now?

After opening the airway, check again for breathing. If they are breathing (normally) but still unconscious: Roll them onto their side into the recovery position. The recovery position (on the side, body supported by bent limbs) keeps the airway open and allows any vomit or blood to drain out, not back into the lungs. Ensure the head remains tilted back and the mouth is angled toward the ground. This position will help them breathe on their own while you monitor them. Also, re-check that any severe bleeding is controlled before stepping away.

Unresponsive and not breathing

If they are not breathing or only gasping, panting or taking irregular shallow breaths after you have opened their airway, move to CPR immediately (next section). If you have multiple casualties and one is not breathing at all (even after airway tilt), that person is in immediate arrest – if you’re the only helper and others are breathing, you might prioritize CPR on the non-breathing person. However, in a mass casualty scenario, professional guidance (like the Triage TST tool used by first responders) often considers non-breathing victims unlikely to be saved if resources are limited. As a lay helper though, if paramedics are not on scene yet and you have the capacity, you can attempt resuscitation.

CPR – Cardio Pulmonary Resuscitation

If a casualty is unresponsive and not breathing, they are in cardiac arrest – essentially clinically dead – and require CPR immediately. CPR is a life-saving procedure that keeps blood circulating to the brain and heart until advanced care arrives. Anyone can attempt CPR; even imperfect CPR is better than none. Here’s how to perform adult CPR (for a child, technique is similar but use one hand for compressions and gentler breaths):

1. Call for emergency help: Make sure 999 has been called or have someone call. If an Automated External Defibrillator (AED) is on site (many public areas have one – a small box with pads and a shock device), send someone to fetch it immediately.
2. Position the casualty: Lay them flat on their back on a firm surface. Kneel beside their chest.
3. Chest Compressions: Place the heel of one hand in the centre of their chest (between the nipples, on the sternum). Place your other hand on top and interlock your fingers. With your arms straight, press down hard and fast – about 5–6 cm deep at a rate of 100–120 compressions per minute (this is about 2 compressions per second, matching the beat of the song “Staying Alive”). Let the chest fully recoil (come back up) between compressions, but do not take your hands off the chest. These compressions pump blood for the heart.

1.Rescue Breaths (if willing and able):

After 30 compressions, open the airway again (head tilt) and give 2 rescue breaths. Pinch the person’s nose closed, make a seal with your mouth over theirs, and blow to make the chest rise. Give one breath (~1 second), see chest rise, then give a second breath. If the chest doesn’t rise, reposition their head and try again (it could be blocked). Note: In the context of a terrorist incident, you may be hesitant to perform mouth-to-mouth, especially on a stranger – if you are uncomfortable, do hands-only CPR (compression-only). Continuous chest compressions are effective at keeping some blood flow. If doing compression-only CPR, aim for ~100-120 per minute nonstop. If you are able to do breaths, they are recommended particularly in cases like drowning or smoke inhalation where lack of oxygen is the cause.

2. Continue CPR

Keep repeating cycles of 30 compressions and 2 breaths. Minimize any pause between compressions and breaths – get back to compressions quickly. If you have others who can help, swap the compressor role every 2 minutes to avoid fatigue (CPR is tiring). Do not stop CPR unless: the person clearly revives (starts moving or breathing normally), you physically cannot continue, or a trained responder tells you to stop. In a mass casualty event, if you’re alone and also trying to help others, this is a judgment call – performing CPR on one person will occupy you entirely. If there are multiple casualties and additional help has not arrived yet, you might do 2 minutes of CPR on one, then check others, etc. But if possible, once you start on someone in cardiac arrest, give them as much attention as you can until professionals take over.

3. Using an AED

If an Automated External Defibrillator is available, turn it on and follow its voice instructions. Expose the chest, attach the adhesive pads as shown on the pad pictures (one pad goes below the right collarbone, one on the left side of chest). Make sure no one is touching the person when it analyses heart rhythm, and during shock delivery. If it advises a shock, press the shock button when prompted. This can restart a heart in certain types of arrest. After the shock, continue CPR. AEDs are very user-friendly – use them if you have them.

CPR can be performed for a long time – it significantly improves the chance of survival, especially if started early. Many victims of attacks who appear “dead” can be saved with prompt CPR and defibrillation. So, do not hesitate to help if you are able. Once paramedics arrive, they will take over and may ask you for details on how long you did CPR.

Burns and Scalds

In the chaotic environment of a bombing or fire, burn injuries are common. Severe burns can be life-threatening due to shock, infection, or airway damage if the face is burned. First aid for burns focuses on cooling the burn and protecting the burned skin:

1. Move away from the heat source

First, stop the burning process. If someone’s clothing is on fire, douse flames with water or smother them with a heavy cloth (have them STOP, DROP, and ROLL if they are able). Get the person to a safe area away from fire or chemicals.

2. Remove any restrictive items

Quickly (but carefully) take off jewellery, belts, or tight clothing near the burned area, before the area starts to swell. Do not peel off anything that is stuck to the burn, and do not remove clothing that has melted into the burn.

3. Cool the burn with water

This is the most important treatment for burns. Run cool (not ice-cold) water over the burn for a full 20 minutes or more. Ideal is gently running tap water; if not available, use any clean cool water (bottled water, etc.). Cooling is effective even if done a bit later – it can reduce pain and depth of injury, especially within the first 20-30 minutes. Do not use ice or very cold water, as that can further damage tissue. Also do not apply butter, oils, or creams at this acute stage – they can trap heat in and cause infection.

4. Keep the casualty warm

This sounds counterintuitive (cool the burn but keep the patient warm). Cooling a large burn can drop body temperature, so while cooling the injured area, use a blanket or coat to cover the person’s other areas and keep them warm. Just avoid covering the burn itself with a blanket that could shed fibres into it – after cooling, you will cover the burn with a clean dressing (next step).

5. Cover the burn loosely

After thorough cooling, protect the burn from contamination. The best burn dressing in first aid is cling film (plastic wrap) – lay a layer of clean cling film over the burn area. It keeps air out (reducing pain) and bacteria out. Do not wrap it tightly (and never wrap circumferentially around a limb, as swelling could occur). A clean plastic bag can be used for a burned hand – simply slip it over. If no plastic is available, use the cleanest cloth you have. Do not use fluffy cotton or anything that will stick. The covering is just until medical care takes over.

6. Do not burst blisters or apply creams/ointments

Leave blisters intact – breaking them can invite infection. Likewise, at the scene, do not put ointments or household remedies on a severe burn. The hospital will do appropriate burn treatments. The one exception: chemical burns – flush with lots of water and remove any contaminated clothing; certain chemical burns might have specific antidote washes, but when in doubt, water is the priority.

7. Manage pain and shock

Burns are very painful. If the person is conscious and you have access to pain medication (and it’s safe to administer), you can give over-the-counter painkillers like paracetamol or ibuprofen. But in a mass casualty incident, this may not be readily available. Primarily, cooling the burn will help pain. Watch for signs of shock (pale, cold, fast pulse, faintness – see shock section). Elevate burned limbs if possible to reduce swelling. Keep the person warm and calm.

8. Seek medical attention

Any serious burn (large area, deep burn, electrical or chemical burn, burns on face/hands/feet/groin, or burns causing white/charred skin) requires emergency medical care. In an ongoing incident, tell responders about burn victims as a priority, since burns can cause hidden complications (like airway swelling if inhaled smoke).   Burns and scalds first aid can be remembered as “Cool, Call, Cover.” Cool the burn with water, Call for help if severe, and Cover the burn with a sterile covering. This immediate care will improve outcomes significantly.

Treatment of Shock

“Shock” in first aid refers to a state of collapse of circulation (not the emotional shock, but a medical emergency where organs don’t get enough blood/oxygen). Shock often results from severe bleeding, extensive burns, or other major injuries. The signs include: pale, cold, clammy skin; rapid weak pulse; rapid shallow breathing; weakness or confusion; maybe bluish lips; and possibly unconsciousness. If you’ve controlled bleeding and managed airways, you must also treat for shock in any seriously injured person.

To treat for shock you need to:

Lie the person down

On their back if possible. This prevents fainting and helps blood flow to vital organs.

Elevate the legs

about 30cm (12 inches) if there’s no injury to the legs or spine. Propping their feet up on a jacket or rubble can help blood return to the heart and brain. (Do not elevate if it causes pain or if there is a trauma to legs/pelvis – in those cases, keep them flat.)

Loosen tight clothing

around the neck, chest, or waist. For example, loosen belts, ties, or shirt collars to aid circulation and breathing.

Keep them warm and calm.

Cover them with a coat or blanket (under and over if possible to retain body heat). Preventing hypothermia is particularly crucial in trauma – a warm patient has a better chance. Speak reassuringly: tell them help is on the way. Do not give them anything to eat or drink, because surgery might be needed (and with abdominal injuries, food/drink could be harmful). If they complain of thirst, you can moisten their lips with a little water but do not let them gulp water.

No food or drink

(As just noted, absolutely no alcohol as well.)

Call 999

(or ensure it has been done). Shock is life-threatening – they need hospital treatment (IV fluids, blood transfusions) ASAP.

Monitor responsiveness and breathing.

Be prepared to roll them to recovery position if they vomit and be ready to commence CPR if they stop breathing.   Always treat seriously injured people for shock. By laying them down, raising legs, warming them, and reassuring them, you maximize their odds until paramedics arrive. Even after visible bleeding is controlled, internal bleeding could be causing shock, so these steps are critical.   Following the above guidance – Control major bleeding, Open airways, Breathe for them if needed, Cool burns, Treat for shock – encapsulates the essential life-saving first aid interventions in the critical minutes after an incident. The UK has been promoting public awareness of such actions (through initiatives like CitizenAID and first aid training) because bystanders truly are the first responders in the initial moments. Your actions could very well keep someone alive until professional rescuers reach the scene.

About us

First Aid for Life provides award-winning first aid training tailored to your needs. Please visit our site and learn more about our practical and online courses. It is vital to keep your skills current and refreshed. We are currently providing essential training for individuals and groups across the UK. In addition, we have a great range of online courses. These are ideal as refreshers for regulated qualifications or as Appointed Person qualifications. You can attend a fully regulated Practical or Online First Aid course to understand what to do in a medical emergency. Please visit https://firstaidforlife.org.uk or call 0208 675 4036 for more information about our courses. First Aid for Life is a multi-award-winning, fully regulated first aid training provider. Our trainers are highly experienced medical, health and emergency services professionals who will tailor the training to your needs. Courses for groups or individuals at our venue or yours. First Aid for life provides this information for guidance and it is not in any way a substitute for medical advice. We are not responsible or liable for any diagnosis made, or actions taken on this information.

Author: Emma Hammett