Surge Capacity - the Experience in London on 7 th July 2005

1. Surge Capacity - the Experience in London on 7th July 2005 Dr Penny Bevan Head of Emergency Preparedness Department of Health, UK

2. Context London • Population 7.2 million • Approx 2-3 million commuters per day • Majority of people travel by public transport • London underground system over 100yrs old in places • 08.30 -> 09.00 hrs peak of the morning rush hour • School term time

3. Emergency planning in London • 30 yr history of Irish Republican Terrorism • Fire, Police & Ambulance coterminous • LESLEP Guidance • London Resilience Team in place 2 yrs before any other resilience team • Exercise, exercise, exercise • [Atlantic Blue, Top Off 3, Triple Play]

4. Health Services in London Currently • 5 Strategic Health Authorities • 31 Primary Care Trusts • One ambulance service • 33 hospitals with Emergency rooms • 16,500 hospital beds [this includes mental health, care of the elderly and long stay]

5. Health Services in London By the end of 2006 • One Strategic Health Authority • 31 Primary Care trusts • One Ambulance service • 33 hospitals with Emergency Rooms

6. Health Emergency Planning in London • All health organisations have emergency plans • 5 SHA areas have all planned and exercised in their patch and cross London • London participated in Triple Play • Health sits on the London Resilience Forum • Health involved in all multi-agency planning and exercises

7. 7th July 2006 • Shortly before 09.00 hrs on 7th July an incident at Aldgate Underground Station • Initially thought to be a Power surge

8. London Underground System

9. Incidents on 7th July Shortly after 09.00 hrs • three incidents reported on the “tube” • these were rapidly confirmed as IEDs • 9.50 hrs bomb on bus in Tavistock Square

10. Initial assessment • At one hour • ??8 bombs • ??1000 casualties • By one and a half hours clearer idea on number of incidents and number of dead and casualties

11. IEDS on Underground

12. Initial Health Response • London Ambulance Service control alerted when first incident reported • Ambulances deployed to all scenes [>4] • Helicopter Emergency Medical Service Audit Day meant all staff at Centre – rapidly deployed to the scenes • Bus in Tavistock Square immediately outside the British Medical Association • 7 Hospitals “on take” • Further hospitals “on stand-by”

13. Difficulties with Underground sites • Power • Lighting • Heat • Dust • Restricted access to patients • Crime scene (deceased are evidence) • Secondary devices ?CBRN • Distance from surface • Communications • Other stationary trains on the system

14. Casualties 52 plus 4 deaths • 700 “casualties” • 350 transported to hospital by ambulance • 103 patients admitted to hospital for at least one night • No inpatients aged over 60 yrs • No inpatients were children • 12 with lower limb amputations

15. Blast injuries • many self evacuated and later realised they were deaf • management of blast lung was not really an issue • “tattooing” of victims with body parts and blood • concerns re HIV and Hepatitis B & C • what was released from the tunnels by the blast?

16. Mutual Aid • Initial uncertainty about numbers • Ambulance service requested mutual aid from outside London – Co-ordinated by ASA • Offers of beds/ITU/Burns beds received by DH from all around the country • Ambulance support from voluntary aid societies (Red Cross / St John’s Ambulance)

17. Hospital Response • Seriously injured casualties were distributed around the nearest hospitals • All were teaching hospitals • A significant number needed immediate lifesaving support/surgery • Staff were called in or told to wait until next shift • Additional supplies requested from NHS Logistics [5hr delivery time when traffic not gridlocked]

18. e.g. • 3 patients transported to one hospital • All had lower limb amputations • These 3 patients used 87 units of O neg blood before bleeding was controlled • All survived without ARDS/DIC or renal failure • Only three patients died after reaching hospital

19. Effect on hospitals • Routine work suspended • Long stays in ITU for some patients • Claims of significant effect on some hospital year end financial position.

20. Communication and Media • Massive, almost immediate, international media coverage • No scenes to film at resulted in enormous pressure on hospital switchboards • Interviews are important both leaders and front line staff • Joint Agency Working critical

21. What worked well with the Media • Crisis training and planning put into practice • Effective joint agency communication • Ability to influence normal emergency demand • “crisis” was played down

22. Lessons learnt from the media • Access to timely and accurate information • More focussed coordination of VIP visits • Visual record of emergency response • Being prepared for long-term press investigations • Real difficulty with media trying to get into hospitals

23. Things that went well • HEMS Clinical Governance Day • 18 pre-hospital doctors available • Provided good medical support on each site • LAS Senior Managers Conference • 100 managers in one place • Bus explosion outside the BMA • experienced doctors on site • Health Gold at LAS HQ for meeting • Two neighbouring Directors of Ops attended HQ

24. Lessons Learned • Communications – mobile and fixed line telephony failed • All minor injuries taken to one hospital [due to above] • Minor injuries went to hospital with large number of major casualties [due to above] • Transport for staff to get to and from work • Identify research issues

25. Lessons Learned • Blood – the needs were great and there were some difficulties communicating with the blood banks – have a dedicated line • Skin – plan to use banked skin appropriately or identify additional sources • Surge in switchboard capacity • When telephony failed most staff had stopped carrying their pagers

26. Staff • Staff are people as well as professionals • HCWs were killed and bereaved • Manage staff so all do not come in a first response – you need staff for further shifts • Transport and access • Support for those distressed by the events particularly those affected and staff at scene.

27. Aftermath • 21st July – 4 failed bombs • BMA Memorial Service • Heightened awareness and alerting meant many false alarm calls • Ambulance in support of Police response to these calls • Mental Health consequences • Research - contaminants and blast injuries • Sharing the lessons learned

28. 21st July 2006

29. any questions? Department of Health Emergency Preparedness Division