Essay: Responding to major incidents – emergency services

Introduction
A major incident can be defined as any emergency that requires the implementation of special arrangements by one or more of the Emergency Services, or local Authority for: The initial treatment, rescue and transport of a large number of casualties. This essay will take focus on a major incident that occurred on the 7th of July 2005 in London, also known as the ‘London Bombings’. It will look into what happened on the day when 4 suicide bombers detonated 4 separate bombs on the underground system in the heart of London, and how Emergency Services and the city reacted to this tragic event in which 52 people were killed and more than 700 injured. The essay will look at in particular the prevention of such an attack, the preparedness of both the Government and Emergency Services, the response these services had to the incident, and the recovery of everyone who was involved, and the lessons that were learnt from this major incident to help Emergency Services should such an incident occur again in the future.
Description of the Event
On July 7th 2005 London declared a major incident after fifty-two people were killed and more than 700 injured when a series of four co-ordinated suicide attacks struck central London. At around 0850 on the London Underground system: the first bomb was detonated on the Circle line between Aldgate and Liverpool Street, killing 7 people. The next bomb was at Edgware Road station, killing 6 people, and the third bomb detonated on the Piccadilly line between Russell Square and King’s Cross, killing 26 people. At 0947 a fourth explosion occurred on the upper deck of a London bus in Tavistock Place. The bombers, who were also killed in what are known to have been suicide attacks, have been identified as Mohammed Siddeque Khan, Hasib Hussein, Shazad Tanweer and Jermaine Lindsay. Investigations into these individuals and their associates are continuing. It was the worst terrorist attack in Britain since the Lockerbie bombing in 1988. Although there had been warnings of an attack on UK soil, this was the first time that new emergency plans had a chance to be tested, which had been significantly amended after the 11 September 2001 attacks in the US.
Prevention
As a health care worker, it is highly unlikely, if not impossible, to prevent an event such as a suicide bombing to occur. Either the police or counterterrorism for the United Kingdom would generally control this job. Although health care workers cannot prevent an event from happening, it is possible to firstly train paramedics and nurses to the highest possible standard to deal with a case such as this one, and to supply hospitals the correct equipment with the correct staffing should a major incident occur in the future, all clinical staff would be sufficient and have the capacity to cater to the patient’s needs to provide the best treatment possible. However, what made this case harder for the counterterrorism was that the 4 suicide bombers were classed as British Citizens, and therefore there were no ‘red flags’ to their names, meaning they could effectively go unnoticed to be able to pull off an attack on such a large scale.
Preparedness
The health services in London are, facing unprecedented demand by all measures and at the heart of many of the challenges facing the LAS are the lack of resources. However, progress is being made within the LAS to address the concerns of the Care Quality Commission, and it is evident in the passion and drive shown to improve the service for Londoners. The LAS is a commissioned service, with a commissioning lead through the North West London Clinical Commissioning Groups. In particular, it would appear that the funding by government fails to recognise the extent of the demands placed on the LAS by London’s place as the nation’s capital and as a major global city, for example, the number of visitors to the city, and the level of protests that take place here. London’s unplanned events, including protests or demonstrations, then, are effectively an unfunded demand on the LAS. The training given to front-line staff, from paramedics to call handlers, is thorough and covers responding to a terrorist atrocity on the scale feared. There are dedicated resources tactically located around London ready to deal with such an incident. These resources include clinical staff that have been specifically trained to operate effectively in these conditions, providing medical interventions of the highest standards, having the equipment to operate in areas of danger, and have the logistical support to deal with mass casualties.
It has been recommend that the Department of Health examines how extra resources can be provided to the LAS to reflect the additional demands placed on it as the provider of services to the capital city of London. This has undoubtedly been helped by the fact that all the emergency services now use Airwave. It has also been proposed for there to be four dedicated 24/7 Hazardous Area Response Teams in London and a similar number of Mass Casualty Vehicles, and should be strategically located around London for easy and quick access should a major incident occur again. The number of CBRN-trained LAS staff should be reviewed with a view that it should return to the higher levels previously seen in London over the past few years. The Home Office should also review the provision of CBRN-equipped response vehicles operated by the London Fire Brigade to ensure their numbers are sufficient. Personal radiation monitors, who should be available to fire, ambulance and police personnel, should routinely be used, as this is a sensible precaution and it ensures personnel that those going in to rescue people are not exposed to an unnecessarily high risk.
Response
In terms of the response times on the day of the attack, there was a reported delay of 52 minutes in getting ambulances to Tavistock Square, where 13 people died at the scene of the bus explosion. Crews were only sent to the bus attack after reports of a second blast at 1040 after a controlled explosion of a suspicious package. The first paramedic to reach Tavistock Square, had in fact been despatched to Russell Square and alerted control at 0957 BST, performed a quick reconnaissance, and called again at 1005 demanding back up. The delays at Tavistock Square followed a separate half-hour delay in sending teams to Russell Square underground station, where 26 people died, the greatest loss of life at the four sites. The first paramedic into the tunnel at Edgware Road called for eight more ambulances, but reported frustration to learn that crews from two stations nearby were not despatched. Overall, only half of the 201 available London ambulances on the day were sent to the attack scenes, where crews at nearby stations were ordered to hold back in case of further explosions. During the first few hours, LAS worked with other blue-light services such as St. John Ambulance and Red Cross to rescue and treat casualties, and take them to various London hospitals. St John Ambulance, the Red Cross, and surrounding ambulance services all supported one another; with more than 250 clinical staff involved in the emergency response and treatment of more than 400 patients, some of whom had significant life-threatening injuries. Emergency care and support was given, and within three and a half hours of the bombings-taking place, all of the patients were transported to hospital. For a short period of time, while under immense pressure, only life-threatening calls were attended to. Debriefs were held on the day and all staff who attended the scenes, or were involved in managing the incident, were offered counselling and welfare support.
“Putting in place an emergency response to rescue and treat the injured, care for survivors, and ensure the safety of the public, was an enormously complicated and difficult undertaking. It involved hundreds of individuals at the scenes, at hospitals, and within the emergency, transport and other services. It required the co-ordination of numerous different agencies under circumstances where communications were difficult when the causes of the emergency were unclear, and when future events were uncertain.” The speed of any response to a major attack is at least in part led by the manner in which the information coming into the organisation is received and assessed. Call handlers and their front-line managers play a pivotal role in this. The LAS deals with a high volume of calls and also has the capability to stay on the line with callers to assist them in providing first aid to those ill or injured. This is commendable and at normal times appropriate. The risk is that during a marauding attack call centres could become overwhelmed and working practices would need to change rapidly to meet the challenges of high demand. In order to test the readiness of the Ambulance Service, it is of the highest importance that the challenges of a multi-site attack are regularly practiced and tested. A recommendation for this is for a full testing and exercise programme should be developed to test the readiness of the LAS Control Room, including no-notice exercises.
Recovery
After the bombings occurred, it is important not only for the emergency services to recover from such an incident as this in order to better prepare for a future terrorist attack, but how the city can recover from this is even more important especially for the citizens of the country. Currently there are four major trauma centres in London which would deal with the most seriously injured patients, while others would be sent to other hospitals, which all have good alerting systems to ensure they are prepared and there are adequate numbers of staff available. There is also an ability, because of national structures, to move patients to other parts of the country if necessary. In the event of unusual or unexpected injuries there is provision to get advice from specialists from around the country. London’s emergency services have evolved massively and took the experiences of 7/7, and updated their operations. More staff across all the services are trained to a higher level of first aid. Medical equipment, from defibrillators to tourniquets, is more widely available across the city and carried in more emergency vehicles. Nationally, partly as a consequence of 7/7, the government rolled out the Joint Emergency Services Interoperability Programme in 2012. According to its website, it is “aimed to improve the ways in which police, fire and ambulance services work together at major and complex incidents”. In London, joined-up training takes place more intensively and frequently than ever before. Just ahead of the 10-year anniversary on 7/7, Operation Strong Tower took place on the city’s streets. Fourteen different agencies and 2,000 people took part in the drill. Balaclava-wearing actors marched through the streets with AK47s, setting off “bombs” and “killing” other actors as the emergency services practised their response. Heavy investment has gone into communications since 7/7, from better equipment and technology to more staff. Logs are now recorded digitally, not written on paper. Both the British Transport Police and LAS were quick to develop a communications and control network that can handle multiple major incidents all at once so they are not again overwhelmed. There had been some confusion about where exactly in the tunnels the Tube trains were. The London Fire Brigade struggled to work out where best to deploy them to enter the tunnels and most quickly reach the incident between Euston Square and King’s Cross. TfL now has a unique reference code for every tunnel and station and a single rendezvous point for emergency services each location. When an incident is reported, TfL is able to give precise locations and the response by the fire or ambulance services is efficiently and accurately coordinated What is more, TfL has installed a communications system that allows emergency service radios to work everywhere on the Tube network – enabling vital contact with control centres above ground – which was not possible before. There are now no dead signal spots. And there are medical kits in more places across the network – 170 locations in all. Though not, as was hoped, on the Tube trains themselves because of vandalism and space concerns. Underneath seats is essential equipment for the running of the train. There is also a “talkback” function installed on Tube trains. The driver is now able to communicate from his seat with passengers further down the train using a PA system when the emergency alarm is activated. All Tube staff now has a personal radio, as do all London’s firefighters. And the LAS have 20 ambulances automatically on standby to go straight to the scene of a major incident, without waiting to be called.
Lessons Learned
The LAS learned a great deal from the tragic events of 7 July 2005 and have made a number of significant developments and improvements so that the emergency services and staff are better prepared if anything similar happens again. These include an introduction of the Airwave digital radio system, which includes coverage on the underground, sending a pre-determined response to a major incident, including 20 ambulances, 10 officers and all available emergency support vehicles carrying extra equipment, replacing previous incident control rooms with a new purpose-built one, able to help manage multiple simultaneous major incidents, improving major incident training for staff, and introducing new medical equipment for the treatment of seriously injured patients. Some of these changes were already in progress when, in June 2006, the London Assembly’s 7 July Review Committee published the findings of its review of the response to the bombings. It praised the courage and determination of emergency service staff on the day, but said that some of the processes used by the organisations involved needed to be addressed. Overall, the response to the bombings demonstrated the strength and flexibility of the UK’s emergency response arrangements; The need to better share information and provide practical and emotional support to bereaved and survivors, the importance of establishing Reception and Assistance Centres quickly, and the telecommunications equipment used by the emergency services worked well although older systems did not perform as efficiently. But, however inspiring the individual acts of heroism preformed by police officers, fire fighters and paramedics, the uncomfortable truth is that the emergency services’ response to 7 July was hampered by delays, communication failures, tactical confusion and a jobsworth adherence to protocol that at times defied common sense. Again and again, survivors spoke of the appalling wait for rescuers, even as they felt themselves slipping ever closer to death. Fire crews did not arrive at Edgware Road until an hour after the attacks. The first paramedic on the scene called urgently for ambulances; he learned later that ambulances from two stations nearby had not been dispatched. Paramedics intended for Russell Square were sent to the wrong location, meaning they also arrived almost an hour after the attack. Fire fighters arrived at King’s Cross-station at 9.13am but did not go to the scene of the blast until 9.42am because of communication protocols. Police and fire fighters were forced to use runners between tunnels and station concourses because their radio system at the time did not work underground.
Most worrying, perhaps, was what emerged at the inquest about the “Gold” command centre at London Ambulance Service headquarters. This was a scene of barely contained chaos, in which staff could not log on to computers, messages were scribbled on pieces of paper and subsequently lost, and a single operator was handling every 999 call and radio message relating to the four bomb sites. Three hours after the first attacks, the inquest heard, those in charge of the ambulance response were still unclear about how many bombs had exploded and where. Ambulances were not even dispatched to Tavistock Square, scene of the bus bomb, until 52 minutes after the blast. The ambulance service was also forced to admit that it “did not provide a complete picture” to a London Assembly inquiry in 2006 into the emergency response, giving an account, which suggested a speedier and more efficient response than, had actually taken place. “There was no intent to deceive,” insisted an ambulance spokesman.
Conclusion
In conclusion, any major incident in any major city is going to cause mass panic among citizens, emergency services and staff, and government, and in this case, it could never have been prevented. It will always put a strain on hospitals in terms of bed space and staffing, emergency services in terms of responding times and getting the correct services in a timely manner, especially in a city as busy as London, in peak hour traffic, it makes for longer transit times. Ways in which to improve however include constant training for all clinical staff and emergency services, better communication between all of the services as well as reducing the amount of radio black spots around the city and underground, higher quality training such as advanced first aid especially when dealing with mass casualties, it’s important to be able to address the most critical first to increase the chances of survival. Considering the London Bombings on the 7th of July 2005 was the biggest act of terrorism to occur on British Soil, emergency services responded very well to this incident as they only had international events prior to learn from their mistakes to improve the way it could be dealt on home soil. There will always be room for improvement and emergency services will always be under the microscope after an event such as this major incident, but the response and treatment from emergency services was well handled and has been improved for an even better outcome in case a major incident ever occurs in the United Kingdom in the future.