- 7 June 2005 - Terrorist Attacks on London: Lessons for Civil ProtectionDAVID ALEXANDER
Objectives of this talk:...examine the emergency operations after the 7 July 2005 explosions in terms of...• their efficacy and efficiency• lessons to learn in order to improve response to similar events in the future• new event scenarios and new models of emergency response.
The Blitz of 1940-1: a period of history still fundamental to London culture
18,44 hrs, 8 September 1944 a supersonic rocket falls on Staveley Road, Chiswick, W. London 3 dead22 seriously injured6 houses demolished
....but theorganisation ofseach and rescueand civil defencewas trulyrudimentaryin those days.
Train crash at Harrow-and-Wealdstone October 1952: first use of triage in the UK
London:• 8.2 million inhabitants (25 million in the Home Counties)• occupies and area of 1,584 km2• 300 languages regularly spoken• 4 police forces.
Co-ordination Crisis Unit of of information to mass media National Civil Protection (COBR) LESLP Mass Chairman London media (Met. Government Fire service representatives Police) Office LFB Police: AmbulanceMet./BTP/ Service LASCoLP/MDP "Gold"-level National Co-ordinating Group Health Military forces Service Transport Health Local Providers Recovery emergency Protection authorities of basic Mgt. managers Unit services Units
LEAD GOVERNMENT DEPARTMENT OUTER Strategic Public CORDON levelenquiriesTemporary Strategic Co-ordinating Group The response Mortuary Police Local authority Fire Military forces Media Ambulance Government advisors Centre Casualty Bureau Other agencies Media environment Survivor Liaison Relatives’ Point Reception Reception Centre Centre Local Authority Receiving Voluntary Emergency Centre Hospitals Agencies Tactical level Body Incident Control Point Vehicle Holding Ambulance Police Marshalling Area Loading Fire Area Point Ambulance Operational Liaison level Site of Disaster Casualty Police Clearing Fire Station Ambulance Specialist advisors INNER CORDON
Rescuers Points of assembly point access to Public cordoned assembly area off areas IncidentCordon I Only rescuers Cordon Only authorised III for personnel Cordon II traffic control Multi-agency operations Pedestrians only command.
FuneralsAnatomy of a major incident Debriefings Anniversaries Plan revision Inquests Major Public enquiries incident Trials declared Awards Memorials Consolidation Recovery Training phaseResponse phase Court cases Emergency Stand-down isolation phase Investigation Time
The bombs (rudimentary construction, hydrogenperoxide base)
London has 40 yearsexperience of metropolitan terrorism
0947 hrs: explosion on no. 30 bus in Upper Woburn Square: it is full ofpassengers displaced from the Underground.
Relevant aspects:• concentrated blast, directed upwards and sideways• passengers on upper deck dismembered: difficult to reconstruct the bodies• immediate availability of medical doctors with experience of emergency medicine.
London Underground ("the Tube")• founded in 1868• 12 lines (408 km), 275 stations• 12,000 staff, 3 mn passengers a day• divided between cut-and-cover lines (the earliest) and deep lines• problems of access, maintenance, signage, safety procedures.
Oxford Circus underground stationcontains:• 25 stairways• 14 escalators• 9 km of walkways and platforms
Past disasters March 1943: panic and crush at Bethnal Green – 173 dead Nov. 1987: fire atKings Cross – 31 dead Feb. 1975: crash at Moorgate – 43 dead
7 July 20050900 hrs:evacuation of200,000 peoplefrom the centralzone of the Tube
Major incidents inthe Underground:• diffusion of smoke• intense heat• lack of space and ventilation• long-lasting crisis.
Liverpool Street-Aldgate Kings Cross-Russell Square: the exit of passengers from two stations instead of onemade it seem that there weresix incidents instead of four.
Blast injuries Primary injuries: • effects of blast pressure directly on body tissues • pulmonary barotrauma and effects on hollow organs of the body Secondary injuries: • impact of flying objects and shrapnel Tertiary injuries: • people are thrown against walls and objects.
Blast injuries Various forms of injury: • exposure to and breathing in of toxic materials • exposure to radiation • thermal and chemical burns • smoke-related asfixia in fires • inhalaion of dust (including asbestos) • crush injuries from collapse of buildings and fitments.
Effects of the Tube bombs:• blast contained and reflected off tunnel walls (rendered unstable)• concentration of blast force in confined space• derailment and crash of trains• fireballs and flashbacks.
Underground: the range of injuries• spontaneous amputation of limbs• deep damage to soft tissue, with exposure of internal organs• burns from flashbacks and fireballs• "compartment injuries", above all to lungs (barotrauma)• shrapnel injuries (transfiguration or penetrating laceration).
An effective emergency mortuary plan wasan important part of the London response The London temporary mortuary
Lessons of the London bombs• rescue should not begin before ascertaining that the site is free of CBRN contamination: this will take about 20 minutes• the delay in providing aid is critical and highly controversial.
Lessons of the London bombs• injuries caused by bombs can be very serious and complicated• lack of parallels with other types of incident (vehicle crashes - not much)• hospitals should prepare for many different types of trauma, complex triage, long-lasting surgical operations.
Lessons of the London bombs• bombs that explode in confined, crowded spaces inevitably cause many injuries• the seriousness of injuries increases exponentially with proximity to the location of the explosion (with complications caused by reflection of the blast from solid surfaces).
Lessons of the London bombs• in a confined space such as a tunnel rescue operations will be slowed down by the need to ensure absence of CBRN contamination and secondary bombs (UXB)• this requirement conflicts with the need to work with maximum haste in order to save the lives of injured people.
Lessons of the London bombs• regarding underground emergencies, new means of finding out what has happened are needed and so are robust methods of informing the people involved• new emergency planning methods are needed, with robust methods of identifying conditions in which a "red alert" needs to be declared.
Lessons of the London bombs• very seriously injured people need intensive pre-hospital case at the site before transport to hospital• this requires new equipment and new emergency medical organisation• blast and crush victims have an immediate need for fluids.
Lessons of the London bombs• even in deep tunnels in the midst of smoke and chaos, the incidence of panic is very limited: it is not a significant factor in emergency planning• the site of the blast is also a "scene of crime" and should not be disturbed more than necessary in order to provide effective aid to victims.
Lessons of the London bombs• an effective response to terrorist attacks requires excellent lines of communication between: - the intelligence services - the forces of law and order - civil protection services - emergency planners and managers.
• passive response demanded of citizens ("go in, stay in, tune in") not appropriate?• failure to declare major emergency in a prompt, synchronous way between emergency services• failure of gold command to function effectively either in central London or Hendon (suburbs).
Saint-Mary-le-Bow Bow bells"Now lettest Thou Thy servant depart in peace, For mine eyes have seen Thy salvation."