'People can be affected for decades': first responders at a terror attack

Dr David Caldicott happened past and picked up the handset.

"This is the provisional IRA. The agreed code word is 'marigold'. An explosive device will be detonated on the south side of Hammersmith Bridge in 20 minutes," a well-spoken Northern Ireland man on the other end of the line said.

"This is not a hoax."

The line went dead.

There was no time for panic. He was only a junior doctor but Dr Caldicott knew exactly what it meant and now was not the time to freeze.

It was Ireland in the 1990s and it was a coded bomb warning.

A call to the counter-terrorism unit confirmed the authenticity of the message.

It wasn't a hoax and a bomb did go off that night, but fortunately there were no casualties.

Then there was the time he was doing his medical training in London, a time when his "countrymen were busy trying to blow up London".

"London in the 1980s and 1990s was a hairy place to be for many," he said.

There were three times he was confronted with patients whose limbs were mangled and destroyed by a bomb blast. Their faces are still etched in his memory.

In the bloody aftermath of terror attacks, first responders – police, paramedics, firefighters – have to act now, think later.

"If you have actually had to treat people who have been subjected to blast injuries, bullet injuries, it's not at all beyond the bounds of possibilities that it would have quite a significant emotional impact," Dr Caldicott said.

"I think most of us try very hard to get on with the problem at hand, to intellectualise it, remove the emotion and then to bottle it up later.

"The big problems occur for medical staff afterwards ... certainly emotionally, people who respond to this sort of environment, particularly where there are children involved, there is great potential for psychological harm in this space and people can be affected for decades after an event like that."

Now an emergency doctor at Canberra's Calvary Hospital and a senior clinical lecturer of medicine at the Australian National University, Dr Caldicott is the co-founder of a course aimed at first responders which deals with the clinical management of casualties following terrorism events.

For Dr Caldicott, the Nice terror attack, in which 84 people were killed and 202 were injured, is a brutal reminder of the time in which we now live – a "terrorist era" and one that is constantly evolving, he says.

"Any device, or physical entity, that can cause harm to multiple civilians, regardless of its original purpose can be adapted and redeployed to terrorist effect," he said.

"Responding to mass casualty events inevitably takes its psychological toll on the most hardened of professionals, that toll is accentuated when it becomes apparent that the source of the disaster has been a fellow human being and the action has been deliberate."

Dr Caldicott said France's medical system was well-equipped to deal with atrocities like Nice and there had been an "extraordinarily efficient response" to the 2015 Paris attacks.

He said it was unlikely an incident like Nice had been anticipated.

Dr Caldicott said events like the Nice attack, and especially those involving large numbers of child casualties, would likely have a profound effect on first responders.

"What has changed profoundly in the global scale now with religious fundamentalist terrorism, is that we're seeing the worst atrocity is the best outcome for [the] terrorist group involved," he said.

He said the changing face of terrorism had also meant the medical professionals were also now often targeted in attacks.

"That very much changes the way first responders react in this environment or at least it should do," he said.

He said although the chances of an attack like Nice happening in Australia may be "close to zero", the consequences of such an attack would be "catastrophic, indescribable, terrible".

"If you plot these things into a risk matrix, if you have a zero infinity problem, you should probably plan for it," he said.

Dr Caldicott said Australia had to be careful not to alienate religious communities because of global terror attacks, warning it could do irreparable damage.

"For every time we say something that is unfounded about an entire religion, we chip away at our most important protection which is the good will of the community in which this group of criminals can hide," he said.

"One of the worst things that can happen and one of the things that is guaranteed for Australia becoming a significant target for terrorism is if we are played by the terrorists and do what they want and turn on people who are in fact our best hope of avoiding this in Australia."