The London Ambulance

Service (LAS) response to

the 7 July explosions
th

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by their respective owners. No infringements are intended.
Contents

• Profile of the LAS

• Emergency Planning
• 7th July response
• Debrief and welfare
• Media management
• Lessons learnt – best practice issues,
areas of improvement, top tips
London Ambulance Service
profile - resources

• 620 square
miles
• 70 ambulance
stations

Source: London Ambulance

London Ambulance Service
profile - resources

• 4,000 personnel including:

• 750 paramedics
• 1,500 emergency medical technicians
• 350 control centre staff and officers
• 200 sector officers (managers)
• 5 emergency planning managers

• 3000 calls per day

• 1100 are assessed as life threatening
“category A” calls, the rest as B or C calls
• Total number of emergency calls received in
2003/2004 was 1 million 100 thousand
London Ambulance Service
profile - resources

Photo source: London Ambulance Service

Emergency Planning

• Small team of emergency planners

• Engaging with partners through multi
agency planning, training and trust
between agencies
• Intelligence information
• Internal major incident and ‘catastrophic
incident’ training
• All work centred around the LAS major
incident plan
Risks and threats

“Sir John Stevens,

Britain's most senior
police officer, warned
earlier this week that
a future terror strike
in the UK was
inevitable”

March 2004
Source: www.skynews.com
7th July –
LAS resources

• 191 emergency ambulances on

duty at 0900hrs, 201 by 1000hrs
• 46 Fast Response Units on duty
• 10 non emergency ambulances on
duty

Source: London Ambulance

• 30 trained decontamination staff
available
• 55 control room staff on duty
• Emergency Support/Equipment
vehicle with a dedicated driver, plus
an additional three vehicles
• 24 major incident pods available
• Both Emergency Control Vehicles
available
• Command unit unavailable
7th July –
LAS resources

• Senior LAS Officers conference in Central

London
• Police Counter Terrorism exercise South
London
• Senior clinicians conference at the British
Medical Association building
• Senior health service managers meeting at
Lambeth, Central London
• Senior clinicians meeting at the Royal London
hospital helicopter landing pad
• London Health Service ‘Gold’ in a meeting
with the LAS Chief Officer
7th July –
LAS resources

From midnight
to 0850hrs
the London
Ambulance
Service had
received 716
calls in the
control room
on the 7th
July 2005. Source: LAS Emergency Planning
Incident locations

Source: www.skynews.com
Timeline of events –
initial calls and response

 0851hrs –British Transport Police report “believed explosion, station being

evacuated” at Liverpool Street Station
 0855hrs – duty officer and ambulance deployed to Liverpool Street Station
 0900hrs –British Transport Police report possible explosion at Aldgate
Underground Station
 0902hrs – London Fire Brigade report an explosion near to Paddington
Station
 0904hrs – Ambulance deployed to Aldgate Underground Station
 0904hrs – London Underground report an explosion or train into a wall or
someone under a train at Edgware Road Underground Station
 0904hrs – British Transport Police report train stuck in tunnel, smoke
inhalation, people on board Kings Cross Underground Station
 0905hrs – response unit deployed to Paddington/Edgware Road Underground
Station
 0907hrs – On call Emergency Planning Manager advises mobilisation of
support vehicles and hospitals to major incident alert
 0908hrs – British Transport Police state believed to be a train collision – or
electrical explosion 25 walking wounded at Aldgate Underground Station
 0909hrs – response unit deployed to Kings Cross Underground Station
Timeline of events –
initial reports

 0914hrs – ambulance crew report from Edgware Road Underground –

explosion on train, anything up to 1000 casualties – send as many
ambulances as possible
 0914hrs – ambulance crew report from Aldgate Underground – explosion – 5
ambulances needed possible fatalities
 0915hrs – on call emergency planning manager (not on scene) advises to
declare major incident
 0918hrs – British Transport Police report explosion at Russell Square
Underground Station 200+ persons injured
 0921hrs – ambulance crew report from Kings Cross Underground Station –
major incident declared – explosion
 0924hrs – Emergency Planning Manager declares major incident at Aldgate
Underground – explosion on train multiple casualties – 30 ambulances
requested
 0924hrs – Duty Officer at Edgware Road Underground declares major
incident
 0924hrs – response unit deployed to Russell Square Underground station
 0938hrs – Officer at Russell Square Underground declares major incident 50+
casualties – 15 fatalities
Aldgate Underground Station
Incident
Source: www.bbc.co.uk
Aldgate Underground Station
Incident

• Priorities – primary command roles

• Priorities - safety issues
• Priorities – reporting to control using a METHANE message
• 5 casualties still on the train ‘trapped’, around 200 people
leaving the station (approximately 60 injured) and 15
seriously injured on street level in the foyer
• Additional officers arrived
• Silver meetings
• Challenges included – understanding the role of the first
ambulance, ambulance resources, lifting and other
equipment, communications, liaison with the Medical
Incident Officer from HEMS, secondary devices, the bigger
picture
Aldgate Underground Station
Incident
Aldgate Underground Station
Incident

• 17 ambulances deployed
• 2 response units
• 3 doctors

Source: www.cnn.com
• 1 hospital used
• 3 double decker buses
• 1 equipment vehicle

• 120 casualties (approximately)

• 8 fatalities
• “the worst I have ever seen”
• The appointment of the
command structure
• Scene cleared within 1 hour 22
minutes
Edgware Road Underground
Incident

• 9 ambulances
• 2 response units
• 7 officers
• 2 hospitals used
• Police/non emergency/
volunteer vehicles used
• 1 equipment vehicle

• 49 casualties approximately
(32 P3, 12 P2, 2 P1)
• 7 fatalities
• Marks & Spencer store used as
clearing station then London
Hilton Hotel due to secondary
device
• Scene cleared in 1 hour 34
minutes Source: msn picture gallery
Kings Cross to Russell Square
Underground Incident

Sourc e: www.bbc.co.uk
Kings Cross Underground
Incident

• 24 ambulances
• 4 response unit
• 4 doctors
• 5 officers
• 12 volunteer/mutual aid
ambulances
• 4 hospitals

• 130 casualties (approximately) Source: TfL

• 27 fatalities (between 2 sites)

• Entrance sites to the station
• Lack of initial command
equipment
• Too many silver meetings
• Scene cleared in 2 hours 26
minutes
Source: www.sky.com
“On Scene” at Russell Square
Underground: First crew experience

• Self activation to scene

• Arrival & Preparation -
Equipment priorities, Triage Packs, PPE.

• Command structure
Adherence to Major Incident Protocol.

• Scene of carnage
Layout of train, Types of injuries, Triage,

• Equipment & Communications

• Rest time and reintroduction to the
incident
Kings Cross to Russell Square
Underground Incident

Photo source: abc news

Kings Cross to Russell Square
Underground Incident

Photo source: abc news

Russell Square Underground
Incident

• 14 ambulances (approximately
– linked with bus bomb)
• 2 response units
• 7 officers
• 5 hospitals
• Hospital staff

Source: www.sky.com

• 40 casualties (approximately)
• 27 fatalities (between 2 sites)
• Casualty clearing in ticket hall
and priority 3 casualty clearing
in the x2 hotels
• Safety and secondary device
• Use of buses
• Scene cleared 2 hours 56
minutes
The effect at mid morning

Sourc e: www.sky.com
Source: www.sky.com
Summary time line of incident
calls received by the LAS
0904hrs Kings Cross
underground station (2 agency
calls)
0948hrs-
0956hrs
Bus
explosion
at Woburn
Place/ 0900hrs
Aldgate
Tavistock
Square (10 underground
public calls station (9
and 3 agency calls)
agency
calls)

0851hrs
0902hrs Liverpool
Praed Street
Street, underground
W2 station (1
(4 agency agency call)
calls)
Source: www.skynews.com

0918hrs Russell Square

underground station (1
public and 2 agency calls)
Tavistock Square Incident

Photos source: www.bbc.co.uk

Tavistock Square Incident

• 9 ambulances to convey
patients (approximately)
• 2 response unit
• 7 officers
• 2 hospitals

Source: www.sky.com
• 1st ambulance came across call

• 15 casualties-6 P1, 3 P2, 6 P3

(approximately)
• 14 fatalities
• North and south sites
• Casualty clearing in the British
Medical Association & County
Hotel
• Secondary device
• Scene cleared 2 hours 10
minutes
Hospitals and patient distribution

• 13 hospitals placed on major incident declaration, the first at

0923hrs
• All 28 London hospitals placed on major incident ‘standby’
• Use of Great Ormond Street paediatric hospital, ophthalmic
hospitals, walk in centres
• 7 hospitals out of the 13 used:
St Thomas – 21 Royal Free – 59
St Mary’s – 13 Royal London – 208
Chelsea & Westminster – 6 University College – 60
• Patients presented themselves up to 9 hours after the incidents –
the last patient was conveyed at 2304hrs, many patients went home
or to hospitals in their own area (Essex and Hertfordshire)
• Total number of patients for the LAS – 404
• Total number of casualties – 775
• 27 remained in hospital, 6 in ICU, 2 critical as of the 20 th July 2005
• 8 remained in hospital as of the 19 th August 2005
• Total number of fatalities - 56
Support and technical

• Mutual aid (total of 41 resources though not all at the

incidents)
• Private, volunteer ambulance services, dial-a-cab
• Offers from around the country and an offer of 100
paramedics for a month from Australia
• 18 sorties by London HEMS, Thames Valley helicopter
dropped off a number of HEMS doctors, helicopter
from Northamptonshire supplying fluids
• Calls from our equipment and vehicle suppliers
• Radio communications
• Public telephone network, mobile phones/SMS and
over load systems
Debrief and staff welfare

• An operational ‘hot debrief’ took place at Millwall football club

• Some ambulance stations have carried out their own debriefs
• Each member of staff was asked to complete a debrief
questionnaire and each command officer or 1st crew staff an
incident report
• Each incident, the control room and Gold level officers received a
‘structured debrief’ after 4 weeks attended by command officers
and first crew on scene
• Listening, Informal, Non judgemental, Confidential (LINC) worker
system – 21 workers, 2 practitioners, 2 counsellors, 1 psychiatrist
• Trauma Risk Management (TRiM) assessment sessions have
taken around 80 hours - plus the 1 month follow up:
12 ambulance managers
63 ambulance staff
7 support staff
• 10 staff referred to counselling
• 2 occupational health referrals (1 body fluid splash, 1 cut wound)
Media management

• LAS communications department dealt with

700 calls during the day
• Proactive approach with over 100 press
interviews and many articles written after the
incidents
• BBC Trauma
• World’s press, lifestyle magazines, global
coverage, vigils, laying of flowers
• Media work is continuing with
documentaries
• ‘PR Week’ highlighted the effectiveness of
the on scene statement
• “My message to the terrorists is that we
Source: The Sun
won’t be defeated”
• Control of information to the media
Other facts

• LAS Gold control room closed at

1614hrs
• The LAS deployed 101 ambulances,
25 fast response units, 60 non
emergency ambulances and 31
officers with 85 control staff in two
control rooms, – around 450 LAS

Source: London Ambulance Service

staff were involved
• LAS invoked the extreme over
capacity plan – during the incident we
received 866 non related incident
calls and responded to 544 of those
calls (224 of those were category A)
• Workload was down by 30%, the
quietest day since 1993
• 135 suspect packages from 1st
January to the 7th, 313 from the 7th
July to 7th August
• Prime Minster Tony Blair visit
Summary of best practice issues –
what we felt we did well

• All staff (internal and external) ‘pulled together’

and acted as a team
• Staff support after the incident
• Early activation of major incident procedures
• Post incident operational debrief system
• Triage and treatment of patients
Summary of improvement issues –
what we could do better

• Communications at the incident sites and

communication into Gold Control
• Support equipment vehicles
• Patient tracking devices and the process of
monitoring hospital bed states
• Second wave response of ambulance resources
• Information flow and information management
in the central and Gold ambulance control
rooms
Summary of crew and command
staff ‘top tips’ for another incident

• Major incident procedures

• Don’t be afraid to make decisions
• Keep focused on your tasks
• Contact your relatives
• Major incident equipment and protective
equipment
What have we done since the 7th
July?

• Gold officer reserve and incident officer cells

• Re-introduced serious/major incident pagers to key staff
• Senior officers have received major incident clothing and
equipment
• Introduced a pre-determined attendance for major
incidents
• Major incident packs for all ambulances
• Pan London triage day
• Gold briefing room
• Areas of improvement action plan to be worked on over
the next year
Our vision:-
“A world-class ambulance
service for London staffed by well-
trained, enthusiastic and proud
people who are all recognised for
contributing to the provision of high-
quality patient care.”
MORE INFORMATION

Emergency Planning Unit

London Ambulance Service
Headquarters Annexe
18-20 Pocock Street
London SE1 0BW
Epu.temp@lond-amb.nhs.uk
 The London Ambulance
Service (LAS) response to
the 7 July explosions
th

All graphical contents of this presentation are protected by Cop yright rights
by their respective owners. No infringements are intended.