Call for surgeon trauma training

Hospitals should be prepared to treat hundreds of injured

The government should ensure more surgeons are trained to deal with trauma in the event of future terrorist attacks, warn medical professionals.

London hospitals coped well with treating the 700 injured in the bomb blasts 12 days ago.

However, next time the need may be overwhelming, surgeons believe.

The prospect of 200 casualties per hospital from chemical or biological attacks should be prepared for, says the Royal College of Surgeons.

We should encourage the department of health to train two or three surgeons per hospital as a minimum Professor Jim Ryan of University College Hospital in London

It currently trains 60 surgeons advanced skills each year, but says every hospital should have at least two with such experience.

Intensive courses such as this cost around £1,400, yet surgeons are only given an annual training allowance of £700 by their deanery, meaning they have to pay half of the cost from their own pocket.

'National requirement'

Professor Jim Ryan of University College Hospital in London, who led the hospital's emergency teams after the recent London bombings, said: "We are suggesting there is a national requirement for a certain number of surgeons to be trained.

"We should encourage the department of health to train two or three surgeons per hospital as a minimum."

However, Deputy Chief Medical Officer Bill Kirkup said: "All doctors in the NHS undergo thorough training including their contribution to incidents such as the July 7th bombings.

"The response then showed their skills at their very best.

"All emergency services will be carrying out a thorough 'debrief' over the coming weeks which for the NHS will include a review of staff skills."

Prepare for the worst

Professor Ryan and his colleagues at the college said they would be writing to the prime minister, the health secretary and every hospital chief executive, chairman and health authority in the country by the end of the week, informing them of this.

Hospital trusts already have a legal obligation to have a major incident plan in place and to exercise those plans at least once a year.

Professor Ryan said that although we are better prepared for such events as a nation than we have ever been, "in contemplating a future attack, we are too complacent.

"We should be looking at 200 patients per hospital of whom 50 will be critically ill.

"It's not just the number also its the nature of injuries."

He said it was possible that next time doctors would have to cope with the aftermath of a dirty bomb - hazardous chemical or biological substances - on top of the horrific injuries caused by the blast itself.

Dirty bombs

Professor Howard Champion, professor of surgery and senior advisor in trauma uniformed services at the University of the Health Sciences Maryland, the US, said: "The bombers are getting more and more sophisticated.

"They are using bigger packages of explosives and improvised explosive devices using nuts and bolts or things to increase the amount of damage and fragments.

"They are placing it in an environment that itself will produce secondary fragments...like the inside of a bus or a crowded room.

"The way bombs are being used is designed to produce lots of damage to lots of people."

The course teaches surgeons how to safely and rapidly access and treat wounds in parts of the body often novel to the surgeon.

He said that all regions of the UK should be prepared for an event, even the smallest hospitals.

He said that if an attack were to occur in London again, hospitals should be able to cope if the planning and preparation is done now.

"London has enormous resilience and reserve capacity if you can mobilise it, so yes we could cope with it.

"It would probably mean putting on stream far more hospitals than we have ever done."