By Nick Triggle
BBC News Online staff
As the crews from the North East Ambulance Service sped to Newcastle city centre, all they knew was that there had been a sarin gas attack.
A terror attack would stretch the NHS
Arriving at the civic centre, they were met by chaos. Fourteen people were dead, 30 seriously injured and hundreds were choking on the deadly gas.
Fire crews and police were also on the scene and within minutes Newcastle General Hospital was put on emergency alert.
Fortunately, the attack described was not real. It was just one of 10 simulated emergencies organised by the Health Protection Agency in the last year to test the health service's response to major incidents.
Casualties with minor injuries were given disrobe packs and put through the fire brigade decontamination unit to allow the ambulance crews to deal with the most seriously hurt.
Wearing chemical suits, the paramedics rushed them through their own decontamination units before whisking them off to hospital.
But with so many people needing hospital attention two GP surgeries were forced to start treating the injured.
With many predicting the UK is next in line for a terrorist attack following the Madrid train bombings in March, the NHS is getting used to the increased focus on emergency planning.
The health service already had a duty to prepare for major emergencies, but the Civil Contingencies Bill, due to become law in summer, demanded a much more robust approach to planning and a closer working relationship with other emergency services.
The Newcastle exercise showed the city's health services were in a good position to deal with emergencies, but doubts still remain about whether the NHS can do all ministers are asking of it.
Jane Johnston, the emergency planning lead for Newcastle Primary Care Trust, said: "The exercise gave us a better understanding of what roles other agencies play, and should help the different parts of the NHS avoid duplicating each other.
"But there are issues to do with training and additional funding for things such as infection control, long-term support after a major incident and screening."
The HPA was put in charge of helping the health service prepare for a major emergency in April last year, at a time when it was becoming clear the NHS was not as prepared as it should be.
The public accounts committee warned just two weeks after the HPA was set up that health agencies were not prepared enough for a nuclear, chemical or biological attacks, with poor communication a key factor.
Only six months earlier a National Audit Office review had revealed the quality of the emergency plans was patchy from region to region.
But, more than a year on, the NHS is still finding itself struggling with the same issues.
Dave Jones, a member of the Emergency Planning Society and the head of emergency planning for West Midlands and Shropshire ambulance services, said communication remained a concern.
"First of all the NHS should be liaising with the other emergency services. But it must also be remembered that utility companies and voluntary agencies have expertise that can be tapped into."
However, he said improvements had been made, particularly within ambulance services.
Training was also an area of concern. NHS trust staff have started to be given training to deal with chemical, radiological, biological and nuclear attacks but as yet only about 15% of frontline staff have had this training.
And in a broadly positive report on the London Ambulance Service NHS Trust in March, the Commission for Health Improvement reserved some of its strongest criticism for the level of training, pointing out "many staff have had no specific training".
A LAS spokesman conceded there were areas that needed to be improved but pointed out NHS trusts have many competing demands on their time.
"There are 3,000 plus emergency calls in London alone and the service has to make sure there are the resources to deal with them."
The Department of Health was quick to counter any criticism.
A spokesman said: "NHS emergency planning has improved, it is in a better position than last year, new techniques are being developed and better equipment introduced to build on what there is."