Christchurch mosque terror attacks: US expert's review of medical response to shootings praises first responders

The fast-thinking, cool-headed actions of the first police officers at the Al Noor mosque mass shooting have been praised in a US expert's review of the medical response to New Zealand's worst terror attack.

The officers, who entered the Christchurch mosque 15 minutes after the Australian terrorist opened fire, eventually shooting dead 42 dead before driving across the city and killing nine more at Linwood Islamic Centre, were met with a bloody, distressing and chaotic scene.

They quickly, and "rightfully", identified survivors and prioritised securing a corridor of access for ambulance personnel, according to a new report by an American professor of emergency medicine at the University of Minnesota, which has been prepared to help with the coronial inquiry into the March 15, 2019 attacks.

Amid the chaos, the first officers came across a backpack thought to have been a bomb, it's been revealed for the first time.

And then everyone was ordered to "get down" after fears of a possible second gunman. Later, as ambulance staff were getting to the victims, the response operation was temporarily frozen when delayed livestream video implied that the shooter was returning to the Deans Ave mosque.

The first police officers on the scene of the mass terror attack have been praised for their quick actions.

"Despite the chaos and multiple hazards, the police are to be commended for an extremely rapid securing of the scene for medical personnel as well as for starting the assessment of victims and providing initial care including chest seals and bleeding control," says Dr John Hick, who has been involved in improving medical responses to terrorist attacks, mass shootings and other disasters for more than 20 years.

"This greatly accelerated the work of ambulance personnel and likely saved lives."

The 14-page report, which references the Mumbai terrorist attacks, and mass shootings at Pulse Nightclub in Orlando, Florida, and Century 16 movie theatre in Aurora, Colorado, provides incredible detail of the emergency services' response on March 15, 2019, calling on police, St John and medical examiner reports, hospital records, photographs and radiologic images.

Dr John Hick is a professor of emergency medicine at the University of Minnesota. Photo / Supplied

Four police officers and two ambulance personnel who formed "entry teams" to assess and move victims were praised for the move, despite it not seeming to have been part of advance planning.

It also helped that two senior supervisors from police and ambulance recognised each other on scene in the early minutes and established a plan of ambulance personnel entry.

"It is fortunate that this relationship existed and could be rapidly leveraged to gain ambulance personnel access," Hick said.

"The officers are to be further commended for asking ambulance personnel to triage based on 'alive or dead', which saved valuable time."

The rapid securing of the scene and priority on ambulance personnel access and correct prioritisation of triage assessments and transportation "all certainly contributed to lives saved".

It took just 33 minutes from when the first ambulance arrived at the mosque to have all patients ready for transport. Hick said that was "exceptional" and "far faster than most incidents of mass violence" where the scene often takes longer to secure and evaluation/patient movement also takes significant time.

During the response, 18 ambulances were used and seven rapid response vehicles, five supervisor, and two mass casualty incident (MCI) units responded.

Twenty-five patients were transported by ambulance.

Once the scene was felt to be adequately safe and ambulances arrived to the mosque there was "no shortage of ambulances nor delays", Hick concluded.

And the fact that 14 victims were earlier transported by private vehicles "with encouragement by police personnel" was also best practice, Hick said, noting some US cities encourage police transport of shooting victims when ambulances are not immediately available.

Christchurch Hospital was also commended for its response, especially given it rarely sees penetrating trauma, and on March 15 received 48 gunshot injuries in less than 45 minutes.

Twelve patients received immediate operations for life-saving procedures, including a child who arrived by private vehicle on the verge of cardiac arrest and was able to survive with immediate resuscitation and surgery.

"This case is clearly a welcome exception to expected outcomes and is a credit to both her age, time to transport to a trauma centre (the child was immediately carried from the mosque and placed in a car with arrival at the hospital minutes later), and the availability of skilled physicians and surgeons," Hick said.

The vast majority of the injuries were non-survivable, Hick found. None of the deaths of patients who were alive on police arrival could have been averted with on-scene interventions, he said.

"All of the deaths were expected based on the gravity of the injuries," he concluded.

In considering recommendations for any future events, Hick said while the response was "extremely successful", training and policy changes "may enhance future effectiveness in the unfortunate event of a similar future incident".