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Citation
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Lohn J, Fong K, Dewar D, Mallucci P, McGuinness A, Floyd D, Ryan J, Montgomery H, Withey S. Inj. Extra 2007; 38(4): 113-113. |
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Abstract
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Introduction: July 7, 2005 saw the detonation of four terrorist devices in London, generating in excess of 700 casualties. We present our experience as one of three major receiving centres and the lessons learnt.
Methods: Prospective data were collected regarding the injury pattern and treatment of all patients admitted to UCLH and the manpower requirements to deliver treatment.
Results: Landline and mobile telephone communications were near impossible during the first 2 h with little information available from the scenes of the incidents. Early documentation was poor.
Sixty-seven patients were assessed in accident and emergency, 15 patients were admitted (5 to the intensive care unit). There was one in-hospital death. Characteristic patterns of blast injury were identified at point of admission, however, 8 significant injuries, including 2 spinal fractures, went undetected until the second day. These admissions had 52 surgical procedures over a 3-week period, 29 within the first 4 days. Definitive wound closure was achieved in most patients by their third visit to theatre (mean 6 days).
Conclusions: During this event the hospital's major incident plan was deployed and functioned adequately despite early failure of the communication cascade. The large volume of casualties arriving in a short period of time combined with difficulties in patient identification and tracking provided a significant obstacle to continuity of care.
Despite missing several significant injuries in the opening phase, no avoidable mortality or long-term morbidity occurred. Nevertheless, this highlights the importance of continual reassessment, with serial secondary surveys of all casualties. Continuity of care is integral to achievement of this goal. |