Attack offers lessons for volunteer medics

The 2025 Bondi Beach terrorist attack was different from other terrorism incidents. What stands out was the response.

Lifeguards, off-duty doctors and nurses, and members of the public worked alongside ambulance paramedics and community first responders to triage and treat the injured. In all, 15 people were killed, in addition to one of the gunmen.

I’m a paramedic, medical doctor, researcher and the clinical lead of Community Health Support (CHS), a volunteer medical first responder charity set up by the Jewish community in Sydney. I had been training our teams for a disaster like this for four years, and helped coordinate the organisation’s emergency response at Bondi that day.

In a paper published in the Medical Journal of Australia, my colleagues and I describe how our organisation prepared for and responded to the Bondi attack, how we helped our community recover, and the lessons we learned.

How the day unfolded

At 6.42pm, two gunmen began shooting at the crowd of about 600 Jewish community members celebrating Chanukah. Within minutes, emergency lines were overwhelmed with callers.

People sheltering from the bullets began applying first aid to the injured.

Local lifeguards and volunteer lifesavers rushed to the aid of the 42 injured survivors who went to hospital, and the many more who were treated at the scene. Doctors, nurses and nearby good samaritans also responded. These so-called spontaneous or “zero responders” arrived before first responders such as ambulance crews, CHS medics and police.

Two minutes after police declared the scene safe to enter, the forward commander for CHS entered the scene with the first few paramedics from NSW Ambulance. He radioed that it was safe for our team of 19 responders to follow him in.

Here’s what we learned at the scene.

Terror attack injuries are different

Sadly, the events at Bondi confirmed what experts had recently begun to suggest. The pattern of injuries seen in terror attacks is different from those typically seen in war zones. Soldiers wear ballistic vests and helmets, so when they are shot, it is usually in the arms and legs. When civilians are shot in a terror attack, it is more likely to be in the torso and head, making the injuries more deadly. This pattern also makes it much harder to stop life-threatening bleeding.

For heavily bleeding limbs, a specific type of tourniquet can be lifesaving. All CHS responders and ambulance paramedics carried these tourniquets in their medical kits at Bondi. Very few arterial tourniquets were needed because of the injury pattern of civilian terrorism.

For patients with penetrating trauma to the torso, the only definitive treatment is to get them into an operating theatre without delay.

We had to prioritise

CHS volunteers and NSW Ambulance paramedics are trained in triage during mass casualty incidents such as a terror attack. This system prioritises who to treat first to save the most lives in the short time before patients can bleed to death.

To an outsider, this may sound harsh, but we typically do not perform CPR during mass casualty incidents where people have been shot or stabbed.

That is because CPR works when someone’s heart is the first organ that has stopped, or when someone has stopped breathing from lack of oxygen. When there is no blood to circulate due to severe bleeding, CPR is mostly futile.

We found it emotionally difficult to keep treating the highest priority patients when others were asking for help to resuscitate victims, despite the unsurvivable nature of their injuries.

Ambulance services use a traditional triage tag system for mass casualty incidents. Patients are tagged red if critical, yellow for urgent, green for walking wounded and black for deceased. However, we felt it was psychologically harmful to ask our volunteers to potentially tag their own friends and family members as deceased. Instead, in preparation for incidents like this, we implemented the “ten-second” triage system from the United Kingdom. Patients are triaged faster and tagged as “not breathing” rather than deceased.

These people are placed on their side until there are enough trained medical responders to return and consider CPR after prioritising living patients with major bleeding.

We faced unknown risks

Police found several undetonated improvised explosive devices and began moving patients and rescuers away.

Terrorists don’t play by the rules, and situations change rapidly.

We suspect these homemade bombs could have been intended to inflict further injuries on responders rushing in to help. In the past, second waves of terror attacks have specifically targeted first responders.

In future, we need to think of risk as something that changes and occurs in phases, rather than fixed zones. This means emergency responders must remain on constant alert and keep teams in reserve in case of further attacks.

Reflections for the future

Thanks to preparation, our responders, ambulance teams and local hospitals rose to the occasion on an extremely difficult day. As we reflect on the lessons learned, we continue to share them with colleagues in disaster medicine globally and we hope these lessons help the next community prepare for tragedy when it inevitably strikes.

Aidan Baron is an adjunct senior lecturer in paramedicine. A version of this piece originally appeared on The Conversation and was published on The Times of Israel.