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Code Brown is a nationally recognised code for an external emergency that threatens to overwhelm the capability or capacity of a hospital. On December 14th 2025, several hospitals in Sydney activated their code brown procedure in response to the Bondi Beach shooting attack. Dr Matt Oliver is an Emergency Physician and Co-Director of Trauma at Royal Prince Alfred (RPA) Hospital, one of Sydney’s Major Trauma Centres, and was on duty in the ED when this situation unfolded. In this episode Matt describes how a Code Brown, or Mass Casualty Incident unfolds in real life, in an Australian Major Trauma Centre. Matt provides a unique insight into what actually happens before, during and after a Code Brown/Mass Casualty Incident, tips for clinicians and hospitals on preparing for these events, and some really useful, practical pearls that came from being directly involved in treating patients on this day, and in the days and weeks that followed.
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PLEASE NOTE: Code Browns and Mass Casaulty Incidents are rare events. The purpose of this episode is to educate clinical staff in hospitals about how these events unfold, to share experience and provide expert insights from a senior clinician who was directly involved in this event. Out of respect for the victims, their families, witnesses, first-aiders, the Bondi Life Guards, first responders including Paramedics and Police, hospital clinicians, and anyone else directly or indirectly affected by this tragedy, we do not discuss any individual cases, nor any specific clinical situations that could indentify any of the victims.
ETM would like to formally acknowledge the bravery, skill, compassion and care displayed by all who helped on this day, as well as commend everyone in the NSW Health System for being able to provide such a high level trauma care to so many people in what was an incredibly demanding and stressful situation. If you live in NSW and need support related to this incident, the NSW Government has provided a large list of resources/supports you can access here.
If you want to read up about the clinical management of the common types of injuries seen in Mass Casualty Incidents, check out or followup post here: Clinical Guidelines for Major Incidents and Mass Casualty Events. This post provides a quick overview of and link to the UK/NHS guidelines on this topic, with excellent infographics and detailed information on the full range of potential ijnuries, common pitfalls, mass casualty triage and more. Highly recommended.
Do you treat Tox patients in the ED? If so, you need to do the Tox Course at ETM Online!
The Tox Course is a multi-module online toxicology course covering the essentials of Emergency Toxicology, common ED tox presenations, and the latest module, Module 4, is on bites, stings and envenomation featuring world renowned snakebite and tox expert, Professor Geoff Isbister. Check out the Tox Course at ETM Online today!