On 07 July 2005, four bombs were detonated in London, killing 52 members of the public. Approximately 700 individuals received treatment either at the scene or at nearby hospitals.

Significant concerns about the potential long-term psychological and physical health effects of exposure to the explosions were raised immediately after the bombings. To address these concerns, a public health register was established for the purpose of following-up with individuals exposed to the explosions.

Invitations to enroll in the register were sent to individuals exposed to the explosions. A range of health, emergency, and humanitarian service records relating to the response to the explosions were used to identify eligible individuals. Follow-up was undertaken through self-administered questionnaires. The number of patients exposed to fumes, smoke, dust, and who experienced blood splashes, individuals who reported injuries, and the type and duration of health symptoms were calculated. Odds ratios of health symptoms by exposure for greater or less than 30 minutes were calculated.

A total of 784 eligible individuals were identified, of whom, 258 (33%) agreed to participate in the register, and 173 (22%) returned completed questionnaires between 8 to 23 months after the explosions. The majority of individuals reported exposure to fumes, smoke, or dust, while more than two-fifths also reported exposure to blood. In addition to cuts and puncture wounds, the most frequent injury was ear damage. Most individuals experienced health symptoms for less than four weeks, with the exception of hearing problems, which lasted longer. Four-fifths of individuals felt that they had suffered emotional distress and half of them were receiving counseling.

The results indicated that the main long-term health effects, apart from those associated with traumatic amputations, were hearing loss and psychological disorders. While these findings provide a degree of reassurance of the absence of long-term effects, the low response rate limits the extent to which this can be extrapolated to all those exposed to the bombings. Given the importance of immediate assessment of the range and type of exposure and injury in incidents such as the London bombings, and the difficulties in contacting individuals after the immediate response phase, there is need to develop better systems for identifying and enrolling exposed individuals into post-incident health monitoring.

Terrorist attacks are exceptional events that place paramedics in high-risk situations. When terrorist events occur, paramedics play an integral role in the response to, and management of, these events. Given that responding to terrorist events places paramedics at a high risk for a variety of health problems and injuries, it is imperative to adequately prepare for such events through the use of appropriate teaching and educational programs. These programs should be based on the direct experiences of paramedics responding to previous terrorist events.

This research utilized a series of focus groups in New York and London to investigate how paramedics experienced working during 11 September 2001 and the London bombings. Specifically, this research focused on what concerned paramedics about responding to terrorist events, whether they would be willing to respond again, and what can be learned from these experiences in regard to disaster response training and education.

Paramedics reported a number of primary risks that concerned them during their responses to 9/11 and the London bombings. These included injury, death, potential contamination, and exposure to unknown hazards and agents. Personal protective equipment (PPE), communication networks, and reliabilty of information all were areas of concern that must be addressed by disaster planners. Paramedics reported that the most negative aspect of responding to these terrorist events was the inability to communicate with loved ones and the lack of timely and accurate information regarding updates on the situation. Personal protective equipment was not always available, and at times the wearing the PPE interfered with providing optimal patient care.

Key lessons can be taken away from paramedics experiences during 9/11 and the London bombings. These include the need for dedicated communication channels, accurate and timely information, suitable training and education (including an emphasis on infectious agents), and the provision of suitable PPE conducive to optimal working conditions.