NEJM features on the London Bombing Medical Effort

This week’s New England Journal of Medicine has four free (no subscription needed) articles featuring British commentary on the emergency medical response to the London terror bombings of July 7th, 2005.  On the NEJM front page they’re under "Perspective" (toward the bottom of the page).

Each of these is worth reading, but I’m going to abstract a little here from my favorite:

Improvising in an Emergency

Peter J.P. Holden, M.B., Ch.B., F.I.M.C.R.C.S.Ed.

Thursday, July 7, 2005. A hot, humid day for London, and all the windows on the third floor of the British Medical Association (BMA) building are open. A last-minute change of plans at 9 A.M. leaves me working at BMA House, preparing for a meeting. This is to prove fateful. 

9:20 A.M. Colleagues begin arriving. There is more than the usual commotion from emergency-services vehicles. Ten minutes later, an emergency medical helicopter from the Royal London Hospital is hovering overhead. Newsflashes on our computer screens report power surges and incidents on the London Underground. We turn on the television: clearly, a major incident is unfolding. A chill runs down my spine. I sat in the same place watching the events of 9/11.

Suddenly, around 9:50, everything momentarily appears pale pink. There is an enormous bang. Some of my colleagues have looks of terror on their faces. We can see white smoke and debris raining down in the square. The fire alarms are sounding. 

Although staff members leave, the doctors stay, and we lower the blinds to give a modicum of protection from flying glass from any further explosion. After several minutes, we gingerly make our way to the front of the building and look down onto the stricken bus. 

Within a second, I recognize that we are dealing with multiple blast injuries. I grab some surgical gloves and my ambulance service physician identity card ? without it, we will be ignored by the London Ambulance Service. 

On arrival downstairs, I meet the deputy chairman of the BMA Council, who is coordinating the first aid response. Knowing of my prehospital emergency care experience, he asks me to take over the direction of clinical operations while he requisitions and gathers resources. My assets are a building offering protection from all but a direct hit and 14 doctors, most of them experienced general practitioners with some training in emergency medicine. But we have no equipment, no communications, and no personal protective clothing. Armed with nothing, we set about maximizing the victims’ chances of survival. 

I have trained for such a situation for 20 years ? but on the assumption that I would be part of a rescue team, properly dressed, properly equipped, and moving with semimilitary precision. Instead, I am in shirtsleeves and a pinstripe suit, with no pen and no paper, and I am technically an uninjured victim. All I have is my ID card, surgical gloves, and my colleagues’ expectation that I will lead them though this crisis.

Read them all, but it’s an interesting look into their event, and at the flexibility of individuals under stress.

Oh, and in one article "…penetration with biologicals…" is a nice way to say bones and bits from one victim blown into another.  Nice bit of understatement, that.