Warning: this article contains details of injuries sustained during a terrorist attack.
The 2025 Bondi Beach terrorist attack was different to 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, 16 people died, including one of the gunmen.
I’m a paramedic, medical doctor, researcher and the clinical lead of Community Health Support – 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 co-ordinate 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 on December 14 2025 two gunmen began shooting at the crowd of about 600 Jewish community members celebrating Hanukkah at Bondi Beach in Sydney.
Within minutes, 000 emergency lines were overwhelmed with callers.
At the same time, people sheltering from the bullets began applying first aid to their injured friends and family.
Local lifeguards and volunteer lifesavers rushed to the aid of the 42 injured survivors who ended up going to hospital, and the many more who were treated at the scene. Doctors, nurses and good samaritans, who just happened to be nearby, also responded. These so-called spontaneous or “zero responders” arrived before “first responders” such as ambulance crews, Community Health Support medics, and police.
Two minutes after police declared the scene safe to enter, the forward commander for Community Health Support entered the scene with the first few paramedics from NSW Ambulance. He radioed it was safe for our team of 19 responders, about 500 metres away, to follow him in.
Here’s what we learned as we helped triage and treat survivors 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 we see in terror attacks are different to those typically seen in war zones, despite the same weapons being used.
Soldiers wear ballistic vests and helmets, so when they are shot, it is usually in the arms and legs.
When civilian victims are shot in a terror attack, it is more likely in the torso and head, making these injuries more deadly. This pattern of injuries also makes it much harder to stop life-threatening bleeding.
For heavily bleeding limbs, a specific type of tourniquet can be lifesaving. This arterial tourniquet is a bandage-like device with a windlass (winding rod) in the middle to tighten it and compress the artery.
These devices became widely used during the Iraq and Afghanistan wars and became synonymous with military medicine.
All Community Health Support responders and ambulance paramedics carried these tourniquets in their medical kits at Bondi. Unfortunately, tourniquets can’t be improvised using belts or clothing – these just don’t work. 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
Community Health Support 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 don’t do CPR (cardiopulmonary resuscitation) during mass casualty incidents where people have been shot or stabbed.
That’s because CPR works when someone’s heart is the first organ that has stopped, or someone’s stopped breathing from lack of oxygen. Unfortunately, when there’s no blood to circulate due to bleeding out from a gunshot or stabbing, CPR is mostly futile.
We found it was 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 with a red tag 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 mass casualty incidents like this, we implemented the “ten second” triage system from the United Kingdom. This is where patients are triaged faster (in about ten seconds), and tagged as “not breathing” rather than “deceased”.
These people are placed on their side until there are enough trained medical responders to go back and consider CPR (after prioritising living patients with major bleeding).
We faced unknown risks
Within an hour of the shootings starting, police found several undetonated improvised explosive devices (homemade bombs) and began moving patients and rescuers away.
This turns on its head the traditional idea adopted during the Cold War to classify zones as hot, warm or cold. Back then, these labels categorised the level of risk to rescuers entering an area where a nuclear or chemical weapon had detonated. This thinking, of categorising areas based on an unchanging perception of risk, has continued to this day.
But it suffers from one small drawback: terrorists don’t play by the rules, and situations change rapidly.
We suspect these homemade bombs could have been used to inflict more injuries to responders rushing in to help the wounded. In the past, such second waves of terror attacks have specifically targeted first responders.
So in the future, we need to think of risk as something that changes and comes in “phases”, rather than simply in terms of zones. It means emergency responders need to be on constant alert, and keep teams in reserve in case there are other nearby attacks.
Reflections for the future
It is essential communities prepare themselves for disasters. Thanks to preparation, our responders, the ambulance teams, and local hospitals rose to the occasion on an extremely difficult day.
As we reflect on lessons learned, we continue to share these with our colleagues in disaster medicine globally.
We hope our lessons go some way to helping the next community prepare for tragedy when it inevitably strikes.
Dr Aidan Baron was the medical incident controller for the Jewish community on the day of the Bondi Beach attack, and is the clinical lead with Community Health Support.
This article was originally published on The Conversation. Read the original article.
