the london ambulance service (las) response to the 7th july explosions

The London AmbulanceThe London AmbulanceService (LAS) response toService (LAS) response tothe 7the 7thth July explosionsJuly explosions

All graphical contents of this presentation are protected by Copyright rightsby their respective owners. No infringements are intended.

• Profile of the LAS• Emergency Planning• 7th July response• Debrief and welfare• Media management• Lessons learnt – best practice issues,

areas of improvement, top tips

ContentsContents

•• 620 square620 squaremilesmiles

•• 70 ambulance70 ambulancestationsstations

London Ambulance ServiceLondon Ambulance Serviceprofileprofile -- resourcesresources

Source: London Ambulance

•• 4,000 personnel including:4,000 personnel including:• 750 paramedics• 1,500 emergency medical technicians• 350 control centre staff and officers• 200 sector officers (managers)• 5 emergency planning managers

•• 3000 calls per day3000 calls per day• 1100 are assessed as life threatening

“category A” calls, the rest as B or C calls• Total number of emergency calls received in

2003/2004 was 1 million 100 thousand



Photo source: London Ambulance Service

• Small team of emergency planners• Engaging with partners through multi

agency planning, training and trustbetween agencies

• Intelligence information• Internal major incident and ‘catastrophic

incident’ training• All work centred around the LAS major

incident plan

Emergency PlanningEmergency Planning

“Sir John Stevens,Britain's most seniorpolice officer, warnedearlier this week thata future terror strikein the UK wasinevitable”

March 2004

Risks and threatsRisks and threatsS

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• 191 emergency ambulances onduty at 0900hrs, 201 by 1000hrs

• 46 Fast Response Units on duty• 10 non emergency ambulances on

duty• 30 trained decontamination staff

available• 55 control room staff on duty• Emergency Support/Equipment

vehicle with a dedicated driver, plusan additional three vehicles

• 24 major incident pods available• Both Emergency Control Vehicles

available• Command unit unavailable

77thth JulyJuly ––LAS resourcesLAS resources

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• Senior LAS Officers conference in CentralLondon

• Police Counter Terrorism exercise SouthLondon

• Senior clinicians conference at the BritishMedical Association building

• Senior health service managers meeting atLambeth, Central London

• Senior clinicians meeting at the Royal Londonhospital helicopter landing pad

• London Health Service ‘Gold’ in a meetingwith the LAS Chief Officer


From midnightto 0850hrs

the LondonAmbulance

Service hadreceived 716

calls in thecontrol room

on the 7th

July 2005.


Source: LAS Emergency Planning

Incident locationsIncident locations

Source: www.skynews.com

0851hrs –British Transport Police report “believed explosion, station beingevacuated” at Liverpool Street Station

0855hrs – duty officer and ambulance deployed to Liverpool Street Station 0900hrs –British Transport Police report possible explosion at Aldgate

Underground Station 0902hrs – London Fire Brigade report an explosion near to Paddington

Station 0904hrs – Ambulance deployed to Aldgate Underground Station 0904hrs – London Underground report an explosion or train into a wall or

someone under a train at Edgware Road Underground Station 0904hrs – British Transport Police report train stuck in tunnel, smoke

inhalation, people on board Kings Cross Underground Station 0905hrs – response unit deployed to Paddington/Edgware Road Underground

Station 0907hrs – On call Emergency Planning Manager advises mobilisation of

support vehicles and hospitals to major incident alert 0908hrs – British Transport Police state believed to be a train collision – or

electrical explosion 25 walking wounded at Aldgate Underground Station 0909hrs – response unit deployed to Kings Cross Underground Station

Timeline of eventsTimeline of events ––initial calls and responseinitial calls and response

0914hrs – ambulance crew report from Edgware Road Underground –explosion on train, anything up to 1000 casualties – send as manyambulances as possible

0914hrs – ambulance crew report from Aldgate Underground – explosion – 5ambulances needed possible fatalities

0915hrs – on call emergency planning manager (not on scene) advises todeclare major incident

0918hrs – British Transport Police report explosion at Russell SquareUnderground Station 200+ persons injured

0921hrs – ambulance crew report from Kings Cross Underground Station –major incident declared – explosion

0924hrs – Emergency Planning Manager declares major incident at AldgateUnderground – explosion on train multiple casualties – 30 ambulancesrequested

0924hrs – Duty Officer at Edgware Road Underground declares majorincident

0924hrs – response unit deployed to Russell Square Underground station 0938hrs – Officer at Russell Square Underground declares major incident 50+

casualties – 15 fatalities

Timeline of eventsTimeline of events ––initial reportsinitial reports

Aldgate Underground StationAldgate Underground StationIncidentIncident

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• Priorities – primary command roles• Priorities - safety issues• Priorities – reporting to control using a METHANE message• 5 casualties still on the train ‘trapped’, around 200 people

leaving the station (approximately 60 injured) and 15seriously injured on street level in the foyer

• Additional officers arrived• Silver meetings• Challenges included – understanding the role of the first

ambulance, ambulance resources, lifting and otherequipment, communications, liaison with the MedicalIncident Officer from HEMS, secondary devices, the biggerpicture


• 17 ambulances deployed• 2 response units• 3 doctors• 1 hospital used• 3 double decker buses• 1 equipment vehicle

• 120 casualties (approximately)• 8 fatalities• “the worst I have ever seen”• The appointment of the

command structure• Scene cleared within 1 hour 22

minutes

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Edgware Road UndergroundEdgware Road UndergroundIncidentIncident

• 9 ambulances• 2 response units• 7 officers• 2 hospitals used• Police/non emergency/

volunteer vehicles used• 1 equipment vehicle

• 49 casualties approximately(32 P3, 12 P2, 2 P1)

• 7 fatalities• Marks & Spencer store used as

clearing station then LondonHilton Hotel due to secondarydevice

• Scene cleared in 1 hour 34minutes Source: msn picture gallery

Kings Cross to Russell SquareKings Cross to Russell SquareUnderground IncidentUnderground Incident

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• 24 ambulances• 4 response unit• 4 doctors• 5 officers• 12 volunteer/mutual aid

ambulances• 4 hospitals

Kings Cross UndergroundKings Cross UndergroundIncidentIncident

Source: www.sky.com

• 130 casualties (approximately)• 27 fatalities (between 2 sites)• Entrance sites to the station• Lack of initial command

equipment• Too many silver meetings• Scene cleared in 2 hours 26

minutes

Source: TfL

• Self activation to scene• Arrival & Preparation -

Equipment priorities, Triage Packs, PPE.

• Command structureAdherence to Major Incident Protocol.

• Scene of carnageLayout of train, Types of injuries, Triage,

• Equipment & Communications• Rest time and reintroduction to the

incident

““On SceneOn Scene”” at Russell Squareat Russell SquareUnderground: First crew experienceUnderground: First crew experience


Photo source: abc news

• 14 ambulances (approximately– linked with bus bomb)

• 2 response units• 7 officers• 5 hospitals• Hospital staff

Russell Square UndergroundRussell Square UndergroundIncidentIncident

Source: www.sky.com

• 40 casualties (approximately)• 27 fatalities (between 2 sites)• Casualty clearing in ticket hall

and priority 3 casualty clearingin the x2 hotels

• Safety and secondary device• Use of buses• Scene cleared 2 hours 56

minutes

The effect at mid morningThe effect at mid morning

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Source: www.sky.com

0902hrsPraed

Street,W2

(4 agencycalls)

0948hrs-0956hrs

Busexplosion

at WoburnPlace/

TavistockSquare (10public calls

and 3agency

calls)

0851hrsLiverpoolStreetundergroundstation (1agency call)

0900hrsAldgateundergroundstation (9agency calls)

0918hrs Russell Squareunderground station (1public and 2 agency calls)

0904hrs Kings Crossunderground station (2 agency

calls)

Summary time line of incidentSummary time line of incidentcalls received by the LAScalls received by the LAS

Source: www.skynews.com

TavistockTavistock Square IncidentSquare Incident

Photos source: www.bbc.co.uk

• 9 ambulances to conveypatients (approximately)

• 2 response unit• 7 officers• 2 hospitals• 1st ambulance came across call

TavistockTavistock Square IncidentSquare Incident

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• 15 casualties-6 P1, 3 P2, 6 P3(approximately)

• 14 fatalities• North and south sites• Casualty clearing in the British

Medical Association & CountyHotel

• Secondary device• Scene cleared 2 hours 10

minutes

• 13 hospitals placed on major incident declaration, the first at0923hrs

• All 28 London hospitals placed on major incident ‘standby’• Use of Great Ormond Street paediatric hospital, ophthalmic

hospitals, walk in centres• 7 hospitals out of the 13 used:

St Thomas – 21 Royal Free – 59St Mary’s – 13 Royal London – 208Chelsea & Westminster – 6 University College – 60

• Patients presented themselves up to 9 hours after the incidents –the last patient was conveyed at 2304hrs, many patients went homeor to hospitals in their own area (Essex and Hertfordshire)

• Total number of patients for the LAS – 404• Total number of casualties – 775• 27 remained in hospital, 6 in ICU, 2 critical as of the 20 th July 2005• 8 remained in hospital as of the 19th August 2005• Total number of fatalities - 56

Hospitals and patient distributionHospitals and patient distribution

• Mutual aid (total of 41 resources though not all at theincidents)

• Private, volunteer ambulance services, dial-a-cab• Offers from around the country and an offer of 100

paramedics for a month from Australia• 18 sorties by London HEMS, Thames Valley helicopter

dropped off a number of HEMS doctors, helicopterfrom Northamptonshire supplying fluids

• Calls from our equipment and vehicle suppliers• Radio communications• Public telephone network, mobile phones/SMS and

over load systems

Support and technicalSupport and technical

• An operational ‘hot debrief’ took place at Millwall football club• Some ambulance stations have carried out their own debriefs• Each member of staff was asked to complete a debrief

questionnaire and each command officer or 1st crew staff anincident report

• Each incident, the control room and Gold level officers received a‘structured debrief’ after 4 weeks attended by command officersand first crew on scene

• Listening, Informal, Non judgemental, Confidential (LINC) workersystem – 21 workers, 2 practitioners, 2 counsellors, 1 psychiatrist

• Trauma Risk Management (TRiM) assessment sessions havetaken around 80 hours - plus the 1 month follow up:12 ambulance managers63 ambulance staff7 support staff

• 10 staff referred to counselling• 2 occupational health referrals (1 body fluid splash, 1 cut wound)

Debrief and staff welfareDebrief and staff welfare

• LAS communications department dealt with700 calls during the day

• Proactive approach with over 100 pressinterviews and many articles written after theincidents

• BBC Trauma

• World’s press, lifestyle magazines, globalcoverage, vigils, laying of flowers

• Media work is continuing withdocumentaries

• ‘PR Week’ highlighted the effectiveness ofthe on scene statement

• “My message to the terrorists is that wewon’t be defeated”

• Control of information to the media

Media managementMedia management

Source: The Sun

• LAS Gold control room closed at1614hrs

• The LAS deployed 101 ambulances,25 fast response units, 60 nonemergency ambulances and 31officers with 85 control staff in twocontrol rooms, – around 450 LASstaff were involved

• LAS invoked the extreme overcapacity plan – during the incident wereceived 866 non related incidentcalls and responded to 544 of thosecalls (224 of those were category A)

• Workload was down by 30%, thequietest day since 1993

• 135 suspect packages from 1st

January to the 7th, 313 from the 7th

July to 7th August• Prime Minster Tony Blair visit

Other factsOther facts

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• All staff (internal and external) ‘pulled together’and acted as a team

• Staff support after the incident

• Early activation of major incident procedures

• Post incident operational debrief system

• Triage and treatment of patients

Summary of best practice issuesSummary of best practice issues ––what we felt we did wellwhat we felt we did well

• Communications at the incident sites andcommunication into Gold Control

• Support equipment vehicles

• Patient tracking devices and the process ofmonitoring hospital bed states

• Second wave response of ambulance resources

• Information flow and information managementin the central and Gold ambulance controlrooms

Summary of improvement issuesSummary of improvement issues ––what we could do betterwhat we could do better

• Major incident procedures

• Don’t be afraid to make decisions

• Keep focused on your tasks

• Contact your relatives

• Major incident equipment and protectiveequipment

Summary of crew and commandSummary of crew and commandstaffstaff ‘‘top tipstop tips’’ for another incidentfor another incident

• Gold officer reserve and incident officer cells

• Re-introduced serious/major incident pagers to key staff

• Senior officers have received major incident clothing andequipment

• Introduced a pre-determined attendance for majorincidents

• Major incident packs for all ambulances

• Pan London triage day

• Gold briefing room

• Areas of improvement action plan to be worked on overthe next year

What have we done since the 7What have we done since the 7thth

July?July?

Our vision:Our vision:--“A world-class ambulance

service for London staffed by well-trained, enthusiastic and proudpeople who are all recognised forcontributing to the provision of high-quality patient care.”

Emergency Planning UnitLondon Ambulance Service

Headquarters Annexe18-20 Pocock Street

London SE1 0BW

[email protected]

MORE INFORMATIONMORE INFORMATION

The London AmbulanceThe London AmbulanceService (LAS) response toService (LAS) response tothe 7the 7thth July explosionsJuly explosions

All graphical contents of this presentation are protected by Copyright rightsby their respective owners. No infringements are intended.

the london ambulance service (las) response to the 7th july explosions

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