HEMS training and the 7th July 2005: a personal perspective.
Since the 7th July, the Civil Contingencies Act 2004 has now come into force. Emergency services are required to have plans in place to response to a range of major incidents. The role of pre-hospital physicians has been recognised for sometime and was highlighted during the inquiry by Hidden QC into the 1988 Clapham rail disaster. The medical response from both HEMS and London BASICS was extraordinary on the day due to the significant number of clinicians attending the clinical governance day. The three post 7/7 reports have made several recommendations, the main recommendations focusing on communications and the management of uninjured survivors and relatives. None of the reports were completely independent, apolitical or peer reviewed, but they do provide useful information for emergency planners and responders. The problem with the absence of peer review is that situations can be interpreted as either half empty or half full. The scrutiny committee of the London Assembly suggested that the time taken to clear the scenes (approximately 3 hours) was too long. Previous experience of 'one-under' incidents has shown that a single casualty trapped under a train can take up to 90 minutes to be safety extricated. The management of over 700 casualties with a 50% conveyance rate to hospital at four incident sites within the documented timeframe was an achievement, but it is important not to be complacent. After a major incident many responders are left with a feeling of frustration and sometimes anger. The frustration is often due to the limitations a major incident places on clinical practice. Senior clinicians may be required to assume non-clinical roles and this is outside their comfort zone. Psychological effects on first responders are not easily quantifiable but support mechanisms should be in place and offered. Some people remember certain details while others may have difficulty recollecting events. I found my role frustrating, as did many, but also rewarding. It was something I would not want to go though again and I still don't remember the faces of many of the responders or casualties while I know that others do. One of the most important factors during the response and the recovery phase was team spirit. On scene all responders from all services were cooperating and supportive of each other. Afterwards, there was an opportunity to unwind with colleagues and this was extremely beneficial. This form of debrief has been seen after operational deployments and critical incidents. On reflecting on the day's events it was a privilege to work with the teams responding to the event of that day. The training, planning and response proved that the team works.
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Emergency Department, Royal London Hospital, LONDON El 1BB.
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