You can’t move for breaking news headlines these days and within the emergency services we brace ourselves for what it might be. It’s not just news for us – we could end up being directly involved.
This week we woke to news of the attack in Finsbury Park. The result – one death and 10 injured, all distributed to major trauma centres within London. One trauma call will need manpower of up to 10 people around the bed, then you’ve got those needed for the CT scans to run, the urgent blood tests, blood supplies and the labs urgently cross matching samples. It can, in those early hours, take at least 20 people. And that’s without including the surgical and intensive therapy unit (ITU) teams needed for poly-trauma patients, typical from a major incident, so multiply that number by 10. But we don’t have 200 people in one place to do all that. So things get shared, redistributed and there’s plenty of concurrent activity. It’s an exercise of open communications, thinking on your feet and leadership. Sadly, the teams are getting used to it.
I know Finsbury Park well. My Algerian husband is from the area and he prays in the mosque that was attacked. The recent attack on London Bridge and Borough market was carried out by men from Barking. I was born in Barking. It’s all feels so close to home. As a humanitarian doctor and filmmaker I have worked mainly overseas, often in war zones. What I have seen and witnessed elsewhere in places like Libya and Syria – the tension, the injuries, the mass casualty scenarios are now taking place in my home city, London.
A Libyan doctor living in Tripoli who I worked with on the frontline during their war in 2011 messaged me, asking if I was OK following the recent spate of events. You know things are bad when that happens.
The net of support is being drawn out wide between major trauma networks that span the country. I work in the emergency department of Ysbyty Gwynedd, Bangor, and when the Manchester attack occurred, there was a callout for medical volunteers to help repatriate Welsh patients within critical care units in Manchester back to north Wales. Bed space is premium at this time. My sister is a GP from east London and she received notification of volunteer requests to work in West London within GP out-of-hours services following the Grenfell Tower fire. She responded but was told they had been inundated with responses and had enough. There is no problem getting medics to offer to help at times of need.
In a world where the blame game is raging – who radicalised who to bring about these attacks – it’s good for the soul to belong to the family of doers and those who have some practical worth in a time of need. But this pattern can’t continue indefinitely. We see things and it affects us and when we keep pushing ourselves without pause or time to recover we, like anyone else, suffer. Interestingly, following 7/7, some frontline staff did relocate to quieter locations or even gave up their jobs as they were unable to recover from what they had worked through.
I spoke to a colleague who had been working in London during the recent incidents – including the Grenfell Tower fire – he sounded tired but there was a battle-hardened tone to his voice. I’ve heard it before when speaking to humanitarian doctors working in a crisis overseas. He described how teams are now constantly expecting the next event. No one switches their phones off any more. Husband-and-wife doctor teams plan childcare well in advance between them. Nannies, au pairs and childminders are prepped and warned in advance. Everyone is pulling together. Everyone thinks carefully before consuming alcohol – checking for the latest breaking news headline first.
And it’s not just the emergency teams that rush in. Consultants running medical wards arrive to see how they can safely discharge to make space.
One of the main learning points and challenges is to ensure that the day after a major incident, the hospital still functions. A hospital and the emergency services will still have sick patients and elective cases to deal with. Staffing to deal with patient care not related to major incident victims has to be maintained. Elective work inevitably takes a back seat – I’ve encountered this personally. My father’s knee operation was cancelled following the London Bridge attack because beds were full of victims. The relatives’ accommodation was full of parents, siblings and partners. It was absolutely right to leave that space for them and return on another day.
If anyone was thinking of brushing up on their first aid skills, now would be a good time. Members of the public are often first on the scene in some harrowing situations. It might be just minutes before help arrives but those minutes when you have injured or dying people in front of you are vital. Knowing what to do could save a life but it will also help that first responder – often a member of the public – cope with the mental fallout days later. They will know they were able to do something to help.
Like so many things that have emerged from our politics that seem to go in the opposite direction of the ethos we should work towards – the proposal to teach first aid in schools as a compulsory lesson was thrown out. Why on earth equipping children with skills that could save lives is not a good idea I don’t know.
This is a time for people to pull together against the odds and that’s what has happened thus far. The emergency services remain on a heightened sense of anxiety and preparedness. The next breaking news headline might bring the next major incident.