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Surge Capacity - the Surge Capacity - the Experience in London on 7Experience in London on 7thth
July 2005July 2005
Dr Penny BevanDr Penny Bevan
Head of Emergency PreparednessHead of Emergency Preparedness
Department of Health, UKDepartment of Health, UK
ContextContext
LondonLondon
Population 7.2 millionPopulation 7.2 million
Approx 2-3 million commuters per dayApprox 2-3 million commuters per day
Majority of people travel by public transportMajority of people travel by public transport
London underground system over 100yrs old in London underground system over 100yrs old in placesplaces
08.30 -> 09.00 hrs peak of the morning rush 08.30 -> 09.00 hrs peak of the morning rush hourhour
School term timeSchool term time
Emergency planning in LondonEmergency planning in London
30 yr history of Irish Republican Terrorism30 yr history of Irish Republican Terrorism
Fire, Police & Ambulance coterminousFire, Police & Ambulance coterminous
LESLEP GuidanceLESLEP Guidance
London Resilience Team in place 2 yrs London Resilience Team in place 2 yrs before any other resilience teambefore any other resilience team
Exercise, exercise, exerciseExercise, exercise, exercise[Atlantic Blue, Top Off 3, Triple Play[Atlantic Blue, Top Off 3, Triple Play]]
Health Services in LondonHealth Services in London
CurrentlyCurrently
5 Strategic Health Authorities5 Strategic Health Authorities
31 Primary Care Trusts31 Primary Care Trusts
One ambulance serviceOne ambulance service
33 hospitals with Emergency rooms33 hospitals with Emergency rooms
16,500 hospital beds [this includes mental 16,500 hospital beds [this includes mental health, care of the elderly and long stay]health, care of the elderly and long stay]
Health Services in LondonHealth Services in London
By the end of 2006By the end of 2006
One Strategic Health AuthorityOne Strategic Health Authority
31 Primary Care trusts31 Primary Care trusts
One Ambulance serviceOne Ambulance service
33 hospitals with Emergency Rooms33 hospitals with Emergency Rooms
Health Emergency Planning in Health Emergency Planning in LondonLondon
All health organisations have emergency All health organisations have emergency plansplans5 SHA areas have all planned and 5 SHA areas have all planned and exercised in their patch and cross Londonexercised in their patch and cross LondonLondon participated in Triple PlayLondon participated in Triple PlayHealth sits on the London Resilience Health sits on the London Resilience ForumForumHealth involved in all multi-agency Health involved in all multi-agency planning and exercisesplanning and exercises
77thth July 2006 July 2006
Shortly before 09.00 hrs on 7Shortly before 09.00 hrs on 7thth July an July an incident at Aldgate Underground Station incident at Aldgate Underground Station
Initially thought to be a Power surgeInitially thought to be a Power surge
London Underground SystemLondon Underground System
Incidents on 7Incidents on 7thth July July
Shortly after 09.00 hrsShortly after 09.00 hrs
three incidents reported on the “tube” three incidents reported on the “tube”
these were rapidly confirmed as IEDsthese were rapidly confirmed as IEDs
9.50 hrs bomb on bus in Tavistock Square9.50 hrs bomb on bus in Tavistock Square
Initial assessmentInitial assessment
At one hour At one hour – ??8 bombs ??8 bombs – ??1000 casualties??1000 casualties
By one and a half hours clearer idea on By one and a half hours clearer idea on number of incidents and number of dead number of incidents and number of dead and casualtiesand casualties
IEDS on UndergroundIEDS on Underground
Initial Health ResponseInitial Health Response
London Ambulance Service control alerted when London Ambulance Service control alerted when first incident reportedfirst incident reportedAmbulances deployed to all scenes [>4]Ambulances deployed to all scenes [>4]Helicopter Emergency Medical Service Audit Helicopter Emergency Medical Service Audit Day meant all staff at Centre – rapidly deployed Day meant all staff at Centre – rapidly deployed to the scenesto the scenesBus in Tavistock Square immediately outside the Bus in Tavistock Square immediately outside the British Medical AssociationBritish Medical Association7 Hospitals “on take”7 Hospitals “on take”Further hospitals “on stand-by”Further hospitals “on stand-by”
Difficulties with Underground sitesDifficulties with Underground sites
PowerPowerLightingLightingHeatHeatDustDustRestricted access to patientsRestricted access to patientsCrime scene (deceased are evidence)Crime scene (deceased are evidence)Secondary devices ?CBRNSecondary devices ?CBRNDistance from surfaceDistance from surfaceCommunicationsCommunicationsOther stationary trains on the systemOther stationary trains on the system
CasualtiesCasualties
52 plus 4 deaths52 plus 4 deaths700 “casualties”700 “casualties”350 transported to hospital by ambulance350 transported to hospital by ambulance103 patients admitted to hospital for at 103 patients admitted to hospital for at least one nightleast one nightNo inpatients aged over 60 yrsNo inpatients aged over 60 yrsNo inpatients were childrenNo inpatients were children12 with lower limb amputations12 with lower limb amputations
Blast injuriesBlast injuries
many self evacuated and later realised many self evacuated and later realised they were deafthey were deafmanagement of blast lung was not really management of blast lung was not really an issuean issue““tattooing” of victims with body parts and tattooing” of victims with body parts and bloodbloodconcerns re HIV and Hepatitis B & Cconcerns re HIV and Hepatitis B & Cwhat was released from the tunnels by the what was released from the tunnels by the blast?blast?
Mutual AidMutual Aid
Initial uncertainty about numbersInitial uncertainty about numbers
Ambulance service requested mutual aid Ambulance service requested mutual aid from outside London – Co-ordinated by from outside London – Co-ordinated by ASAASA
Offers of beds/ITU/Burns beds received by Offers of beds/ITU/Burns beds received by DH from all around the countryDH from all around the countryAmbulance support from voluntary aid Ambulance support from voluntary aid societies (Red Cross / St John’s societies (Red Cross / St John’s Ambulance)Ambulance)
Hospital ResponseHospital Response
Seriously injured casualties were distributed Seriously injured casualties were distributed around the nearest hospitalsaround the nearest hospitals
All were teaching hospitalsAll were teaching hospitals
A significant number needed immediate A significant number needed immediate lifesaving support/surgerylifesaving support/surgery
Staff were called in or told to wait until next shiftStaff were called in or told to wait until next shift
Additional supplies requested from NHS Additional supplies requested from NHS Logistics [5hr delivery time when traffic not Logistics [5hr delivery time when traffic not gridlocked]gridlocked]
e.g.e.g.
3 patients transported to one hospital3 patients transported to one hospitalAll had lower limb amputationsAll had lower limb amputationsThese 3 patients used 87 units of O neg These 3 patients used 87 units of O neg blood before bleeding was controlledblood before bleeding was controlledAll survived without ARDS/DIC or renal All survived without ARDS/DIC or renal failurefailure
Only three patients died after reaching Only three patients died after reaching hospitalhospital
Effect on hospitalsEffect on hospitals
Routine work suspendedRoutine work suspended
Long stays in ITU for some patientsLong stays in ITU for some patients
Claims of significant effect on some Claims of significant effect on some hospital year end financial position.hospital year end financial position.
Communication and MediaCommunication and Media
Massive, almost immediate, international Massive, almost immediate, international media coverage media coverage
No scenes to film at resulted in enormous No scenes to film at resulted in enormous pressure on hospital switchboardspressure on hospital switchboards
Interviews are important both leaders and Interviews are important both leaders and front line stafffront line staff
Joint Agency Working criticalJoint Agency Working critical
What worked well with the MediaWhat worked well with the Media
Crisis training and planning put into Crisis training and planning put into practicepractice
Effective joint agency communicationEffective joint agency communication
Ability to influence normal emergency Ability to influence normal emergency demanddemand
““crisis” was played downcrisis” was played down
Lessons learnt from the mediaLessons learnt from the media
Access to timely and accurate informationAccess to timely and accurate information
More focussed coordination of VIP visitsMore focussed coordination of VIP visits
Visual record of emergency responseVisual record of emergency response
Being prepared for long-term press Being prepared for long-term press investigationsinvestigations
Real difficulty with media trying to get into Real difficulty with media trying to get into hospitalshospitals
Things that went wellThings that went well
HEMS Clinical Governance DayHEMS Clinical Governance Day– 18 pre-hospital doctors available18 pre-hospital doctors available– Provided good medical support on each siteProvided good medical support on each site
LAS Senior Managers ConferenceLAS Senior Managers Conference– 100 managers in one place100 managers in one place
Bus explosion outside the BMABus explosion outside the BMA– experienced doctors on siteexperienced doctors on site
Health Gold at LAS HQ for meetingHealth Gold at LAS HQ for meeting
Two neighbouring Directors of Ops attended HQTwo neighbouring Directors of Ops attended HQ
Lessons LearnedLessons Learned
Communications – mobile and fixed line Communications – mobile and fixed line telephony failed telephony failed
All minor injuries taken to one hospital All minor injuries taken to one hospital [due to above][due to above]
Minor injuries went to hospital with large Minor injuries went to hospital with large number of major casualties [due to above]number of major casualties [due to above]
Transport for staff to get to and from workTransport for staff to get to and from work
Identify research issuesIdentify research issues
Lessons LearnedLessons Learned
Blood – the needs were great and there Blood – the needs were great and there were some difficulties communicating with were some difficulties communicating with the blood banks – have a dedicated linethe blood banks – have a dedicated line
Skin – plan to use banked skin Skin – plan to use banked skin appropriately or identify additional sourcesappropriately or identify additional sources
Surge in switchboard capacity Surge in switchboard capacity
When telephony failed most staff had When telephony failed most staff had stopped carrying their pagersstopped carrying their pagers
StaffStaff
Staff are people as well as professionalsStaff are people as well as professionals
HCWs were killed and bereavedHCWs were killed and bereaved
Manage staff so all do not come in a first Manage staff so all do not come in a first response – you need staff for further shiftsresponse – you need staff for further shifts
Transport and access Transport and access
Support for those distressed by the eventsSupport for those distressed by the events
particularly those affected and staff at particularly those affected and staff at scene.scene.
AftermathAftermath
2121stst July – 4 failed bombs July – 4 failed bombs – BMA Memorial ServiceBMA Memorial Service
Heightened awareness and alerting meant many Heightened awareness and alerting meant many false alarm callsfalse alarm calls
Ambulance in support of Police response to Ambulance in support of Police response to these callsthese calls
Mental Health consequencesMental Health consequences
Research - contaminants and blast injuriesResearch - contaminants and blast injuries
Sharing the lessons learnedSharing the lessons learned
2121stst July 2006 July 2006
any questions?any questions?
Department of Health Department of Health Emergency Preparedness Emergency Preparedness
DivisionDivision