Everyone remembers what they were doing when they heard about terrible incidents like the attack in London Bridge this June. My wife and I had just been out to dinner with friends. After a lovely evening, we thought we would check the headlines before going to sleep. It was only then that we became aware that something dreadful had happened.
I’d only been in my role as medical director for the NHS in London for six months. My job is to provide leadership to doctors across the capital, and on hearing the news, my first thoughts were for my team – and my first instinct was to help.
A string of incidents in the first few months of my job (the Westminster terror incident in March, and the NHS cyber-attack in May) meant I was already well rehearsed in responding to major incidents.
I knew that the NHS England team in London would be needed to support hospitals for far longer than the immediate event. We must continue ensure we are resilient for the hours, days and even weeks afterwards. This means working in shifts to prevent people from burning out.
By the time I began managing NHS London’s incident coordination centre the next day – just a stone’s throw away from the attacks – the sirens on London Bridge had died down, but business was by no means back to usual.
We spent the subsequent days and nights linking up with hospitals, taking shifts to communicate across the system regularly and ensuring that no hospital became overloaded. Our teams plan for years to ensure that we’re prepared for all manner of incidents, and everyone pulls together and functions like clockwork from beginning to end.
The incident centre is a state of the art situation room, the walls lined with panels of television screens and banks of computers; with phone lines able to contact any part of the NHS.
At headquarters, it is often only when things are slowly resuming back to normal and the flurry of activity has died down that we can truly reflect on the horrific reality of what has happened. We are all humbled by the dedication of staff on the ground.
As a paediatric consultant, I’ve seen the reality of devastating incidents through another lens. When I was a registrar, I treated traumatised young children for injuries from a house fire that killed their parents. I remember the smell of smoke pervading the A&E department; having to deal with the children’s lung damage. I have counselled relatives whose loved ones have sustained horrific injuries, explaining what needed to happen, while trying to provide comfort in the worst moment of their lives.
From the safety of the incident coordination room, it is therefore hard not to think of the paramedics who ran past police Swot teams toward danger despite the gun fire; the nurses who worked 36-hour shifts in their determination to keep patients alive; the junior doctors who came back into work on what should have been their day off.
Being a doctor changes the way you think about an incident like this. While managers might be thinking about the number of patients needing the most urgent medical attention and how to return to business as usual, I still had my clinical hat on.
I still remember what I learned from my own time at a major trauma hospital. From the control room, I found myself reminding hospitals’ medical directors to check that their staff weren’t trying to be heroic – a common issue in such intense circumstances.
After each incident, we take time to debrief, to reflect and learn from what happened. There are still some things to learn, and work is under way with colleagues in Manchester to help us better support people after incidents like terror attacks – for example, assessing whether they need support with post-traumatic stress disorder or bereavement counselling.
Despite this, we have seen that when crunch time comes, the system can respond magnificently. It was partly this remarkable resilience that attracted me to the NHS in London in the first place. The capital has a history of transforming the way we do healthcare. In 2010, London became the first city in the world to implement a coordinated trauma system for an urban population of 10 million people. Studies have shown that since the redesign, hundreds of patients now survive where previously they would have died.
The system was tested in these incidents, and many have commended the NHS for how it responded. Everyone came together as needed: from our doctors, nurses and the ambulance service, to those working in blood transfusion services and those who provide equipment and supplies. I continue to be proud to be part of London’s resilient and extraordinary NHS.
- Dr Vinod Diwakar is regional medical director for NHS England (London) and a consultant paediatrician at Birmingham children’s hospital.
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