This Is London Calling …
(Written July 8, 2005)
What follows is my overview of London's response to yesterday's events. I would like to first say that I personally played no part in this - having literally just returned from San Francisco I'm not due to start back to work at the Royal London until this Monday. The information here is from conversations I've had at various stages during the past 24 hours with friends at the Royal London and other services who have been working very hard. Some information may not be accurate at this stage.
Where was I when it all happened? On another bus, about 500 metres from Edgeware Road underground station.
London's response to yesterday can be summed up in three words: Very, very impressive. It is difficult to over-emphasize how impressive the response was in dealing with four major incidents efficiently and effectively while ensuring the safety of the rest of London.
As you all know by now there were 4 bomb blasts yesterday within the space of about an hour, three on the London underground and one on a London bus. These were not small devices as you can see from the pictures of the bus and trains that were essentially ripped apart – each is estimated at abour 10 pounds of explosive.
Of course we have been expecting this and planning for it since 2001. London also has unfortunately a great deal of experience with terrorist bomb attacks and other major incidents such as train crashes. The London Disaster Plan was put into effect as soon as it was known that a serious incident had occurred and prior to the knowledge that this was a terrorist incident.
London is a city with a population of 8 million people which swells to something in the region of 18-22 million during the day. The London underground carries 3 million people per day. Greater London covers an area of over 600 square miles and metropolitan London at Its centre about 40 square miles.
Within 2 hours of the first bomb the whole of central London was effectively locked down by the police. All underground trains and buses had been evacuated. All overground trains had been halted at London's perimeter stations. Whole areas were cordoned off (at this time it was though there might have been 7 devices) and access routes cleared. All communication networks had switched over immediately to emergency plans including a very impressive response from the cellphone companies who immediately switch to priority calls for rescue services and 'half-rate coding' which reduces the quality of voice calls and eliminates data calls over the network but thus allows up to 4 times as many calls to be made over the network. Information and communications to my view was FAST - and prioritized to those who needed it.
The London Ambulance Service is the largest ambulance service in the world, and handles of the order of 300 emergency calls per day. It is a huge behemoth of an organization that can be the most frustratingly slow and ponderous body to deal with. Yesterday it dispelled all those comparisons with rapid implementation of the emergency plans, transfer of operations to Gold control, management of communications and deployment of LAS staff to incident scenes while calling in staff to maintain normal coverage for the rest of the city. By all accounts all LAS technicians and paramedics performed to the highest standards of calm professionalism - in the extraordinarily difficult environment of the London Underground. Again it's hard to over-exaggerate how difficult the underground is for rescue personnel. In my year on HEMS the call for a 'one-under' (a train) would always give me that sinking feeling - and those were incidents that occurred at stations. Communications are extra-ordinarily difficult, the environment is hot, smoky and dangerous with potentially live rails and exposed power cables. Mounting a rescue operation down there requires the coordinated skills and experience of the London Underground emergency staff, the British Transport Police, the fire brigade and the medical services. These situations are practiced as part of the London Disaster Plan. Simulations of chemical attacks on the tube have been carried out and - only 6 months ago - almost this exact scenario was simulated of multiple conventional attacks at multiple sites on the Underground.
Approximately 700 people were injured of which around 400 were taken to hospital. The rest were given first-aid in makeshift field stations set-up in hotels etc. Approximately 37 people are reported to have died at scene, although there is still a recovery operation going on at King's Cross and the immediate death toll is expected to be around 60. There were 45 major injuries. Patients were triaged to 4 teaching hospitals - the Royal London Hospital, St Mary's Hospital, University College Hospital and the Royal Free Hospital. All hospitals have well-rehearsed disaster plans which were implemented immediately.
The Royal London is the main trauma centre for London and is situated in Whitechapel in the east end, and will be the designated trauma centre for the 2012 Olympics. Normal workload is about 600 ISS>15 patients/year with a 25% penetrating injury rate. The London Helicopter Emergency Medical Service sits on the roof, is tasked only to major trauma and carries a doctor and paramedic. The task of HEMS in these major incidents is primarily to deploy medical teams to the incident and not for patient transport. On-scene teams are responsible for medical incident control, triage, patient disposition and casualty care, integrating with the LAS. HEMS deployed I believe 18 doctor/paramedic teams to the 4 incidents. Note that these are not drawn from in-hospital staff but are specifically trained and deployed pre-hospital specialists. HEMS has attended every terrorist bomb blast and train crash in the past 14 years and has a wealth and depth of experience in these situations that is almost unparalleled.
The Royal London's disaster plan was put into action immediately and some staff called in from home. Others (me included) were put on stand-by for shift relief should extra resource requirements continue for a long period. The London received 19 majors and over 200 minor injuries. Injuries were primarily typical blast patterns with head, chest & abdominal injuries, burns, amputations and fractures. The number of lower-limb amputations leads to the suspicion that the bombs on the underground were on the floor - but this is just conjecture. 9 fully staffed operating theatres ran concurrently and there was one thoracotomy, three laparotomies and multiple guillotine amputations & other haemorrhage control procedures. Subsequent wound and fracture fixation was performed on the more stable. Currently there are 19 in-patients and 7 on ICU. There was one in-hospital death. The situation was described as challenging but never chaotic and again the hospital response was apparently very impressive in terms of its command & control, resource utilization and clinical response.
It's difficult to fault any aspect of the response from any of the services. I was personally impressed also by the response of the government, the Prime Minister and the Mayor of London. I was impressed with the London Underground staff who were, in effect, the first-responders to the incidents. But most of all I have been impressed by the people of London. People who, trapped on hot, smoky tube trains not knowing what was going on, tended to each other, passed around water and helped each other to safety. Shop workers who pulled clothes off the racks to cover victims, hotels that set up temporary first aid & triage facilities and strangers who comforted the wounded and brought food to the rescue services. But most of all who, as a people, totally kept their cool, acted appropriately to the situation, facilitated the work of the emergency services, got themselves home and returned London to normal as rapidly as possible.
Today most of the tubes, trains and buses are working normally. Shops & restaurants are open for business, the conversations have turned back to the nuisances of road works and the price of milk. Attention is turning once again to the events in Edinburgh, which are fundamentally far more important for our future and the future of our planet.
I was born at the Royal London (or the London Hospital as it was then). The Elephant Man lived out his days there (no direct connection!). Many, many historically important doctors and nurses have tended the sick there since it was founded in 1740. The few square miles around the Royal London are the most ethnically diverse area on the planet, with over 200 cultures and more than 30 languages spoken. Signs at the hospital are in 14 different languages. These people live side by side, work side by side and their kids play side by side. The people who have shown such capacity and resilience are not 'the English' but are people from all over the world who have become Londoners. The East End was raised to the ground during the Blitz with 9 months of continuous bombing. According to George Orwell the only change he noticed was 'that people were more likely now to talk to strangers in the street.' London's spirit permeates you, no matter where you came from, no matter what your background - and I think yesterday we served as a model for how the world should respond to these incidents.
"The way was long and weary,
But gallantly they strode,
A country lad and lassie,
Along the heavy road.
The night was dark and stormy,
But blithe of heart were they,
For shining in the distance
The lights of London lay.
O gleaming lights of London,
that gem of the city's crown;
What fortunes be within you,
O Lights of London Town!"
— George Robert Sims