Are Perth hospitals prepared for mass casualty events?

Home Affairs Minister Tony Burke said when a man threw a pipe bomb into a crowd at an Invasion Day gathering in the CBD on January 26, the fact it did not explode to injure or kill people was simply down to luck.

Without that luck, there could have been hundreds of injured people needing urgent care at one of Perth's 11 emergency departments. Departments that are already under significant pressure. Departments that may not have had the room for these patients.

Medical Forum spoke to Dr Kate Jutsum, an emergency physician in Perth and an Associate Professor at UWA's Medical School, about what that could have looked like and whether the state's hospitals are prepared to respond to a mass casualty event.

Australia Day 2026

“I think the Australia Day incident was a wake-up call because that could have finished very differently, it was chance that it didn’t go off,” she said.

“It’s been easy for everyone to look at what happens on the other side of Australia and go ‘that’s them’, but I think everybody’s realised that it could happen here.”

Emergency physician and associate professor at the University of Western Australia’s Medical School Dr Kate Jutsum.

Dr Jutsum described the situation that could have been reality if the device retrieved from the January 26 event had exploded.

What happens in a mass casualty situation?

She said the “walking wounded” would present to the closest hospital, often before the news started to spread on social media or through news outlets.

“There would have been a lot of patients presenting in a short period of time to Royal Perth Hospital before agencies on the ground were able to respond,” Dr Jutsum said.

She said while emergency responders would try to distribute patients, they could not control the spread of those initial patients showing up to the nearest emergency department.

Looking at the experience of mass casualty events that have occurred in Bondi and Christchurch, Dr Jutsum said there was often a sudden influx of injured people, which threatens to overwhelm emergency departments before those who are critically injured even get there.

She said the State Health Operations Centre would coordinate the broad response, ensuring patients go to where they can be treated and where there is capacity.

“While Royal Perth would receive the walking wounded, they are also best equipped to deal with the critically ill patients. It’s likely that patients who aren’t walking themselves to Royal Perth and aren’t critically injured might be diverted to Sir Charles Gairdner Hospital or to one of the other metropolitan hospitals," she explained.

What constitutes a mass casualty event?

A mass casualty event is one where the number of casualties was so much that it would overwhelm the resources at a particular hospital.

Any sort of unexpected incident, such a terrorist incident or natural disaster, that overwhelms available hospital resources would be defined as a mass casualty event.

“In a rural site that might be three patients, whereas in Royal Perth or one of the other tertiary hospitals, you'd need far more than that. There isn't a specific number of patients that constitutes a mass casualty event," Dr Jutsum said.

While Royal Perth Hospital was used to managing multiple traumas at once, other non-trauma hospitals would find it difficult to manage an increased number of traumas simultaneously because of their lack of an impatient trauma service, she said.

A ‘major issue’ for WA

The current demand already on WA hospitals could also complicate potential responses should a mass casualty event occur.

“It depends on the hospital, it depends on staffing levels and it depends on how full the department is," Dr Jutsum said.

"One of the major issues that has been identified is that we’re already using surge protocol, so hospital departments are already entering code yellow because of patient overcrowding on a normal day.

"Were a mass casualty incident to happen in the middle of that, it would be even more difficult to clear the emergency department and have as many beds as possible available for those coming in. At the moment, with the state of emergency departments in WA, the overcrowding and bed block adds to an already difficult situation.

“The threshold for WA emergency departments - and all of those in Australia - is much lower than normal to be able to deal with these events as if we didn’t have access block and overcrowding."

Learning from the past

Dr Jutsum said the most recent in WA that would come close to being a mass casualty event would have been the Horizontal Falls boating incident in May 2022, when 26 patients were injured in the North West of the state.

“That was an Royal Flying Doctor Service (RFDS) response because it was in a completely remote area miles away from anywhere, so it was well managed by the agencies activated to respond. It's a bit different to a metro incident," she said.

Others include the Christmas Island boat tragedy in 2010 and Bali bombings in 2002 but, like Horizontal Falls, both of these incidents were a distance from Perth, so coordination could be done on a broader scale.

“The responses seen with the Horizontal Falls incident, and Christmas Island and Bali, have all been different because they have been remote responses which have allowed a large degree of control about where those patients are taken, so no individual hospital was overwhelmed."

She said it was fait to say that Perth hospitals had not had to deal with a mass casualty event.

“They’ve not had to deal with anything quite near the incident in Bondi and Christchurch where you get a sudden massive influx of patients which threatens to overwhelm responses before the critically injured people even get there," Dr Jutsum told Medical Forum.

Preparedness

While hospitals were meant to carry out simulated responses to prepare for these types of events, it is not necessarily happening.

Dr Jutsum, who was involved with the Australian College of Emergency Medicine's (ACEM) latest annual site Census said the data from 2025 - which is yet to be published - showed it was not happening often enough and when it was happening it was not always going far enough.

“Part of what our data discovered is that only 77% of the emergency departments surveyed in WA have a plan for an event like this. In terms of training, three quarters of EDs in WA are accredited with ACEM so do undertake training, but it doesn’t happen very often and it is usually didactic training which isn’t great for learning," she said.

"We know that training does happen but it doesn’t happen enough and it doesn’t involve the whole hospital team - it usually involves just the ED."

The 2025 ACEM Census survey went out to 130 emergency departments across Australia, 13 of which were from WA. The results are still being compiled for release.

Dr Jutsum said there were steps emergency departments could take to ensure their preparedness.

"In terms of backup systems, there are certain things all EDs should have, these include surge capacity protocols, alternative care sites, backup power and communication systems," she said.

"Only 40% of WA EDs have these in place, as opposed to 71% in the rest of Australia.

“Most of those are remote and rural sites which would be overwhelmed quickly anyway, so it is a bit of a concern.”

Action required

Dr Jutsum said hospitals needed to be better resourced as part of the solution. Increasing capacity, staffing and beds is fundamental.

"We need more state-wide solutions that address the rural and remote and private hospitals that have been shown in the ACEM data to be less resourced, less able to respond and less confident in responding," she said.

Medical Forum put questions to the WA Health Department about whether Perth’s hospitals are adequately prepared for potential mass casualty events.

A WA Health spokesperson said the state has a well-established Disaster Preparedness and Management Directorate staffed by health professionals with extensive expertise and experience in health disaster management, in WA, Australia and internationally.

"WA Health recognises the importance of preparedness and ensuring our system is ready to respond to disaster situations," they said.

They told Medical Forum the department was planning a health simulation exercise for later this year, which would involve health professionals from around the system.

"When a situation requires it, the department stands up a dedicated State Health Incident Coordination Centre (SHICC) to manage response efforts in a strategic, coordinated way, based on emergency management principles and structures."

The SHICC has been established in the aftermath of cyclones to coordinate the health response and ensure continued access to patient care.

WA Health also works closely with hazard management agencies including WA Police and the Department of Fire and Emergency Services to support responses to major incidents, they added.