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Tuesday, 5 October, 1999, 21:52 GMT
Emergency services swing into action

Doctors and paramedics work to a well-defined plan

Hospitals and ambulance services plan for years so they can cope with a disaster on the scale of the one at Paddington.

The government sends out guidelines on how police, fire, ambulance and doctors coordinate their efforts to make sure that the most severely injured get the right medical help as soon as possible.

London Train Crash
Once every couple of years, hospitals hold simulations, involving actors playing casualties, to make sure their procedures run smoothly.

It is reported that emergency teams attending the crash had rehearsed their own procedures only a couple of weeks ago.

In this case, the worst injuries were sent to St Mary's Hospital - only half a mile from the scene, and those needing specialist attention for burns to Hammersmith Hospital, the Royal Free Hospital and Charing Cross.

The emergency services response is mapped out from the moment that the call comes that a major incident has taken place.

Put on standby

When the first emergency services reach the scene - and confirm the scale of the disaster, phone calls are made to nearby hospitals and the ambulance service to put them on standby.

All non-urgent operations are cancelled and the hospital calls staff who are not on duty and asks them to come in.

Accident and emergency departments will be cleared of all but the most seriously ill patients in preparation for accident victims.

Dr David Mitchell, Medical Director at St Mary's, which cared for 51 injured people, told the BBC: "Given the circumstances we have coped remarkably well.

"The first call came in at 8.30am and we had all our surgical and medical teams in place when the first victims arrived at 8.50am.

"By mid-morning things were very busy and at one time we had six people in six operating theatres.

"We could have coped with more, but mercifully we did not have to."

Col Tim Hodgetts runs courses for doctors, ambulancemen and the other emergency services - which are based at St Mary's - and use Paddington Station as the location for a simulated train crash training exercise.

He said: "The doctors at St Marys should be extremely well-equipped for this type of incident."

The disaster victims can be divided into three types, says Dr Matthew Cooke, a consultant in A&E medicine from Walsgrave Hospital in Coventry.

He is an expert on the delivery of immediate care following a major incident.

There are the most seriously injured, who require medical attention straight away - these are tagged with red labels so that they are prioritised.

They are sent to the nearest hospital - in this case St Mary's.

Prioritising the injured

There are those with moderate injuries, which require swift treatment but are not immediately life threatening - these are tagged with a different colour, and sent further away for treatment so that St Mary's is not overloaded.

Doctors prioritise which cases need immediate treatment
And there are far greater numbers of people with lesser injuries, the so-called "walking wounded".

"In a train crash, there are a lot of people thrown around, who perhaps have a cut face or broken arm - still very distressing, but not immediately life-threatening."

Dr Cooke said: "With these people - if you can get them into a coach and send them further away, perhaps to somewhere like Wexham Park Hospital in Slough, it helps a great deal."

Doctors, although not those from the hospital closest to the crash, come out to set up "field hospitals" in controlled areas next to the scene.

In this case, a mobile medical team has been despatched from the Royal Free Hospital.

In this case, a supermarket car park and school playground have been used.

"These are like a mini A&E," said Dr Cooke, "and they can handle anything which doesn't involve the patient going into the operating theatre."

Where there are large numbers of casualties, the chief skill is juggling, constantly monitoring the numbers of patients the closest hospitals can take, and diverting them elsewhere when necessary.

There have been complaints in the past that doctors rarely get to experience a full disaster simulation - research showed that because of changing shift patterns, it was highly unlikely a doctor would be working when the simulation took place.

However, the situation has improved in recent years, with many hospitals holding simulated major incidents far more frequently than the two-yearly minimum demanded by the Department of Health.
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