Report of the 7 July Review Committee:Chapter 3

3.1 The rapid rescue and medical treatment of those who have been seriously injured is the most urgent priority for emergency services at the scene of a major incident. When there are three separate but simultaneous major incidents, followed less than an hour later by another incident, communications between each scene and their strategic (‘Gold’) commanders are vital in ensuring the effective deployment of appropriate and sufficient vehicles, officers and equipment to each scene and the effective dispersal of casualties to hospitals. Strategic co-ordination of the response 3.2 Strategic co-ordination of the response takes place at the Gold Coordinating Group. This is chaired by the Metropolitan Police Service and includes senior representatives from the other emergency services and other authorities involved in the response. The Gold Coordinating Group was initially located at New Scotland Yard, but at its first meeting, at 10.30 am, the decision was taken that it should relocated to a suite at Hendon.23 The suite had been used for emergency preparedness exercises in the past, and had good facilities. However, the relocation of the Gold Coordinating Group to Hendon caused some difficulties. The control rooms of the emergency services are all in central London. Moving the Gold Coordinating Group to Hendon meant that Gold commanders could not travel easily between there and their control centres. These difficulties were compounded by the fact that the Underground had been suspended and there was considerable congestion on the roads. 3.3 Sir Ian Blair, Commissioner of the Metropolitan Police Service, told us that although the decision to move to Hendon was the right decision at the time, the experience of 7 July had led the Metropolitan Police Service to review potential venues for a the Gold Coordinating Group. Several potential venues are under consideration, some of which will be more centrally located. It is unlikely that Hendon would be used again in the future because of its relatively remote location.24 Reliance on mobile telephones 3.4 The difficulties caused by the nature of the incidents were compounded by significant communications problems within the emergency services. Managers within the London Ambulance Service, the City of London Police, the Metropolitan Police and the London Fire Brigade relied to varying extents on mobile phones to communicate between the sites of the incidents and their Gold commanders. 3.5 As the news unfolded during the morning and early afternoon of 7 July, members of the public began calling their friends and family to check they were safe and not caught up 23 Transcript of Committee meeting, 3 November 2005, Volume 2, page 13 24 Transcript of Committee meeting, 1 March 2006, Volume 2, page 161 42 of 151 in the explosions. London’s telephone networks experienced unprecedented volumes of traffic. Vodafone experienced a 250 per cent increase in the volume of calls and a doubling of the volume of text messages. There were twice as many calls on the BT network as would normally be the case on a Thursday morning. Cable & Wireless handled ten times as many calls as usual to the Vodafone and O2 networks – 300,000 calls were placed every 15 minutes, compared to 30,000 on a normal working day. O2 would normally expect to handle 7 million calls per day. On 7 July, 11 million calls were connected – 60 per cent more than usual - and this does not include unsuccessful calls. .6 When we asked the emergency and transport services in November 2005 what impact mobile telephone network congestion had had on their ability to communicate, we were told that the difficulties with mobile telephones were an inconvenience, rather than a problem. For example, Ron Dobson, Assistant Commissioner of the London Fire Brigade, said, ‘Our at-scene command communications stood up and were functional right the way through the day with no difficulty whatsoever. I think the mobile phone system being interrupted in the way that it was, was inconvenient rather than a real problem’.25 Commander Chris Allison from the Metropolitan Police Service said, ‘It was an inconvenience but, because we all had radio systems that were working, the Command and Control facilities between us and the officers on the front line were working and the Command and Contro who Control room’. The London Ambulance Service’s Deputy Director of Operations, Russell Smith, said, ‘yes, mobile phones help them [managers at the he not critical because the managers also have VHF radios in all their cars’.27 3.7 Through further questioning, we have since learned that the telephone network congestion on 7 July resulted in some serious communications problems within some of the emergency services. 3.8 The London Fire Brigade has told us that managers in fact relied upon mobile telephones to communicate with their control room, and that this caused problems on the day. The London Fire Brigade’s de-briefing report, presented to the London Resilience Forum in September 2005, states that ‘Incident Commanders felt isolated as they were unable to get information about the other incidents from Gold Support … as mobile phones weren’t working’. The Fire Brigade’s Command Planning System was used to send messages, and this apparently worked well. The de-briefing report also notes that 3G telephones worked, and the TETRA police radio system worked well as a back-up system. (This system was in use by the British Transport Police, but no other emergency service, on 7 July. The City of London Police has since put in place TETRAbased digital radio.) 3.9 The London Ambulance Service also relied on mobile telephones as the primary means of communication between managers at the scene and the control room. It is true that managers have radios in their cars as well, but these did not work on 7 July either, as we 3 l facilities between the police services of London were working for the communities were all working very well in the Command 26 scene], but t and y are 25 Transcript of Committee meeting, 3 November 2005, Volume 2, page 24 26 Transcript of Committee meeting, 3 November 2005, Volume 2, page 24 27 Transcript of Committee meeting, 3 November 2005, Volume 3, page 16 43 of 151 discuss below. We questioned the London Ambulance Service again in writing early in 2006. Martin Flaherty, Director of Operations at the London Ambulance Service, told us, ‘We have acc te a communication tool and it is clear now that it cannot be relied upon in a complex 3.10 cision to activate ACCOLC can therefore be taken only at the ting Group. t, phones would not have been 3.12 2 round Aldgate Station. This was a f London Police were experiencing serious rea, and this was hampering their response. Despite down until 4.45 pm. During ep d that we have become too reliant on mobile phone technology as major incident scenario’. The London Ambulance Service is now issuing pagers to managers as a back-up. (These were withdrawn two years ago on the basis of the system being all but obsolete.) A system exists to restrict mobile phone network access to the emergency services within a specified area. This system, called the Access Overload Control (ACCOLC) is seen very much as a last resort. It is expensive to implement and can cause public distress or panic. The de highest level of command: the Gold Coordina 3.11 We asked representatives from the emergency and transport services whether ACCOLC had been activated anywhere in London on 7 July. We were told that the first meeting of the Gold Coordinating Group, at 10.30 am, considered whether to close down mobile phone networks to the public at any of the sites where the emergency rescue effort was being mounted. The London Ambulance Service told us that problems with mobile phones and radios led them to as the Gold Coordinating Group to activate ACCOLC in the area around Aldgate station, and that their request had been refused by the Gold Coordinating Group. It was decided that ACCOLC should not be activated, because of the risk of public panic and also because it was not clear that the right personnel would be carrying ACCOLC-enabled telephones.28 If they were not carrying this equipmen ACCOLC could have made matters worse. As it was, at least some mobile telephone calls were getting through some of the time. Had ACCOLC been activated, key personnel who were not carrying specially-enabled tele able to make or receive any calls. This is clearly a major flaw in the system: there is no point in having the technology to enable key people to communicate with each other if the relevant authorities do not make sure that the right people are in possession of that technology. We subsequently found out that in fact ACCOLC had been activated, by the City of London Police, on the O network in a 1km area a response to the fact that the City o communications difficulties in the a the Gold Coordinating Group decision, the City of London Police made a request at 12 noon to O2 to shut down the O2 network to the public in a 1km area around Aldgate station. O2 carried out the appropriate validation procedures, but these procedures, set by the Cabinet Office, do not include verifying the request with the Gold Coordinating Group. The O2 network was therefore closed to the public – outside the command and control structure - at about noon, and remained closed that period of time, O2 estimates that ‘Several hundred thousand, possibly maybe even more than a million’ attempted calls by members of the public were lost.29 8 28 Transcript of Committee meeting, 3 November 2005, Volume 2, pages 24-25 29 Transcript of Committee meeting, 1 December 2005, Volume 2, page 8 44 of 151 3.13 James Hart, Commissioner of the City of London Police, explained to us in writing, in February 2006, how and why the decision was taken, outside the command and control structure, to instruct O t provide police staff. She could not communicate with anyone until ACCOLC was activated and they were subsequently able to communicate with the Aldgate scene. Additionally, a City of London Police Press Liaison Officer could not properly manage the Press enquiries at the scene until ACCOLC was activated whereby effective information provision was established. Indeed, Affairs representatives could n mobile phone provider 2 to shut down its network to the public. He told us that the senior officer in the Command and Control room ‘witnessed a gradual deterioration of his ability to communicate with operational officers at the scene via the mobile phone system’. He further told us: ‘From a City of London Police point of view, operational police units at the scene undoubtedly benefited from the activation of ACCOLC. Some examples are evident, such as an Inspector posted to the Royal London Hospital because the MPS could no until ACCOLC was activated. She was then able to assist more effectively at the point where casualties were being received. The City of London Casualty Bureau also suffered from a serious breakdown Metropolitan Police Service Directorate of Public not use their own mobile phones because their ow 45 of 151 system had collapsed (through the weight of usage by subscribers) and used the City of London Police Liaison Officer’s ACCOLC-enabled mobile phone because it was the only one working’. James Hart argued that the decision did not in fact go against a decision by the Gol Coordinating Group, because at the time the senior City of London Police officer m the decision, he was not aware o 3.14 d ade f the Gold Coordinating Group’s decision that ACCOLC should not be activated. The decision was taken by the City of London Police in the y tives .15 Sir Ian Blair, Commissioner of the Metropolitan Police Service, told us on 1 March 2006 rs to 3.16 s g 3.17 alleviate this problem up to a point. We will be closely monitoring progress in meeting the target of the end of 2007 for the rollout of Airwave, 3.18 ts 3.19 telephones, is based on an assessment of the balance between the extent to which the public interest will be best served by providing a continuing public telephone network or closing it down to facilitate an emergency response to an incident. The tension on 7 July was between the belief that this is a strategic decision, because it is broadly in the public interest, or an operational We are not in a position light of their own service needs. They were not in a position to assess the potential impact of the decision on the other emergency services. This is one of the reasons wh it is important that such decisions should be taken at a strategic level by representa from all the emergency services. 3 that the City of London Police’s decision to invoke ACCOLC was not appropriate and was reversed, and that City of London Police had since ‘reflected on their actions’. However, the City of London Police are adamant in their view that the decision was made ‘quite properly and in line with [the officer’s] training’. In fact James Hart argued that the procedure for activating ACCOLC should be reviewed, to enable commande activate it and the Gold Coordinating Group then to review those decisions. It ought to have been predictable that in the event of a major incident in London, mobile telephone networks would become congested and it would become difficult to make or receive telephone calls. It happens every year on New Year’s Eve. It happened on a larger scale after the 11 September attack in New York. London’s emergency services nevertheless relied to varyin extents on mobile phones to communicate internally among their senior officers. This led to some major communications problems on 7 July. The rollout of new Airwave digital radio communications across the emergency services will as we consider it to be an essential element of effective communications within and between the emergency services above and below ground. In the meantime, there is an urgent need for a wholesale review of how senior officers within the emergency services communicate with each other in the event of a major incident. At the moment, each of the services is reviewing i own communications, internally. There would be some benefit in the services cooperating to identify possible solutions, rather than each of them independently reinventing the wheel. The decision to switch off mobile telephone networks to the public, enabling a small number of key people to communicate using specially-enabled decision, given that it applies only to a localised area. 46 of 151 to second-guess whether it was the right thing to do from an operational point of view to invoke ACCOLC on the O2 network around Aldgate on 7 July. We were not party to discussions at the Gold Coordinating Group where the decision was made that ACCOLC should not be invoked. However, there are important lessons to be learnt from the experience. 􀁸􀀃 If ACCOLC is to be maintained as a system, it is essential that the relevant authorities ensure that at any given moment the right personnel are in possession of ACCOLC-enabled telephones. There is no point in a technical facility if the relevant authorities do not make sure that the right people have the equipment to use it. 􀁸􀀃 The current command and control structure provides that only the Gold Coordinating Group can decide to turn off the mobile phone networks to the public. The City of London Police acted outside this framework. This should not be allowed to happen again; the command and control structures that are put in place in the event of a major incident exist for good reasons, not least because the individual services are not in a position to assess the potential impact of ACCOLC on other services involved in the emergency response. To be effective, these structures must be observed by all concerned. 􀁸􀀃 Protocols for operating companies to verify requests should be consistent with whatever decision-making framework is in place. 47 of 151 Recommendations 13 to 16 We recommend that the London Resilience Forum, as a matter of priority, coordinate a review across London’s emergency services of communications between managers at the scenes of major incidents, their respective control rooms and the Strategic Co-ordination Centre. We request that the London Resilience Team provide us with the results of this review in November 2006. Members of the London Resilience Forum should put in place regular checks to ensure that key senior officers are equipped with ACCOLC-enabled mobile phones. We request that the emergency and transport services provide us with details of their plans to conduct such reviews, showing what will be done, and how frequently, to ensure that the technology can actually be effectively used if necessary. The protocols which require mobile telephone operating companies to verify instructions to activate ACCOLC should be amended, so that any instructions are verified with the Gold Co-ordinating Group rather than the authority issuing the instructions. We recommend that the London Resilience Team review these protocols and report back to us by November 2006. All the authorities involved in the response to a major or catastrophic incident must operate within the established command and control structure. This is essential for the effective strategic management of the response. The City of London Police must provide the Committee with assurances that, in future, it will operate within the agreed command and control structures in the event of a major or catastrophic incident in future. Communications within the London Ambulance Service According to the London Emergency Services Liaison Panel’s Emergency Procedur Manual, the London Ambulance Service is the lead organisation responsible for 3.20 e the 3.21 we questioned Russell Smith, Deputy ing emergency medical response at the scene of any major incident. The London Ambulance Service shares responsibility for rescue and removal of the seriously injured with the police services and London Fire Brigade. The London Underground Emergency Response Unit also plays an important role in rescuing the injured when incidents occur on the Tube. At our first meeting, on 3 November 2005, Director of Operations for the London Ambulance Service, about the London Ambulance Service’s response to the 7 July attacks. He told us, ‘I think there is no doubt that this was a particularly testing day with four major incidents happen 48 of 151 simultaneously in London. It put us under some strain and we were tested but not found wanting’.30 We are in no doubt whatsoever that individual members of the London Ambulance Service, along with the other transport an 3.22 d emergency services, worked extremely hard, under exceptionally difficult circumstances, on 7 July. The m of many li red’ within manag fact th that three of them were in tunnels underground, made the emergency response very comple 3.23 On top Service appear managi problem 3.24 The Lon te radio systems. It employs UHF radios for manage dios for ambulances and key managers. The UHF communications system, used by managers at the scenes in the s artly because nes. 3.25 For communications between the scenes and the control room, managers tried to use the VHF radios. Dr Gareth Davies, a consultant in emergency medicine at Barts and The London Hospital, was Medical Incident Officer in charge of the scene at Aldgate. He came to our meeting on 11 January 2006. He told us that, ‘the radio problem was intermittent. I would say that about 10-15 per cent of radio traffic was actually getting through. You could get through the odd message. It was a case of pressing the button and nothing happening’.31 3.26 There were several factors contributing to the failure of the VHF radio system. a. Two channels were used, but they were both initially routed through one operator. Martin Flaherty, Director of Operations, told us that, ‘this undoubtedly compounded some of the capacity issues which have been reported and did not help in terms of managers being able to use the radios effectively to communicate with HQ’. ir any individual acts of courage, skill and initiative led to the saving ves that may otherwise have been lost. All four sites were ‘clea three hours, during which time almost 200 vehicles and 400 staff and ers were deployed, and 404 patients were transported to hospital. The at there were four separate incidents across London, and x and difficult to manage systematically and effectively. of the problems with the mobile telephone network, the London Ambulance response was hampered by problems with their radio systems. These problems to have been the result of failings in the processes that were in place for ng and monitoring radio traffic, rather than being entirely due to technical s. don Ambulance Service uses two separa rs to communicate locally at the scene, and VHF ra ab ence of a functioning mobile telephone network, did not work. This was p there were not enough handsets available for managers to use at the sce 30 Transcript of Committee meeting, 3 November 2005, Volume 2, page 16 31 Transcript of Committee meeting, 11 January 2006, Volume 2, page 131 49 of 151 b. Managers at the scenes did not know which channel to use – they would normally be instructed via mobile phone, but mobile phones were not working ve 3.27 r Gareth Davies told us that, ‘The lack of mobile phones and the clogging of the radio s … 3.28 he impact of these problems was that managers and other London Ambulance service s. . 3.29 e call said that there were eight bombs. That was the last message that you had received. You therefore had a picture of Armageddon – you do not know what is going on. All you can ct and its plan is ve patients there’.33 t a rations at the London Ambulance Service, told us that, ‘it is clear that if. so this was not possible. c. There were problems caused by the huge volume of traffic generated by the fi separate sites. The result was an inability to get through for much of the time. D communications meant that the individual scenes were unable to communicate with Gold Health at the Ambulance Service and pass on information to the acute hospital All of the doctors who took on the [Medical Incident Officer] role at all of the incidents had that inability to speak with the receiving hospital and the inability to bring communications back to the ambulance headquarters’.32 T personnel at the Tube stations and at Tavistock Square were unable to communicate with the control room. Their requests for further ambulances, supplies and equipment did not get through. They did not know what was happening at the other incident They could not receive instructions as to which hospitals were still receiving patients Dr Gareth Davies explained how the situation on the day compared to the procedures set out in emergency plans. ‘Normally in an incident like this, we would pass the information to Gold Control. They would have an overview of the whole of London and would say, for example, ‘yes, the Homerton has not been hit. We have asked it to activate its plan. Patients can be decanted from the scene to that area’. However, the reality of the situation was that your last telephon rely on is the fact that the hospital you had just left was still inta able to cope with a certain number of people so you mo 3.30 The London Ambulance Service response was aided by the fact that the entire management of the London Helicopter Emergency Medical Service happened to be a meeting at Barts and The London hospital, and a number of the explosions took place close to major hospitals from where nurses, doctors and others came to the scenes to help. A large number of the Service’s senior managers were at a conference at Millwall, and were therefore despatched by face-to-face communication. Martin Flaherty, Director of Ope we had not been in this position our difficulties would have been more pronounced’ 32 Transcript of Committee meeting, 11 January 2006, Volume 2, page 123 33 Transcript of Committee meeting, 11 January 2006, Volume 2, page 123 50 of 151 Deployment of ambulances, officers, equipment and supplies to the scenes .31 The breakdown in communications within the London Ambulance Service had an impact 3.32 ur s site. .33 At all sites, the London Ambulance Service suffered from a lack of essential supplies 3.34 f patients to hospitals was uneven because of breakdown of communications within the Ambulance Service. In the event, this had minimal impact on the care of ed 3.35 in . At Aldgate, the London Ambulance Service response was rapid in the first instance. The first ambulances arrived at the scene at 9.03 am yed, as well as two Fast Response Units. At 9.14 am, the ambulance crew reported that there Emerge an equipm dgware Road 3.36 The response at the other scenes was less decisive. At Edgware Road, the scene was not cleared until approximately 12 noon, three hours after that explosion. We 3 on the Service’s ability effectively to deploy the necessary vehicles, personnel, equipment and supplies to the incidents. Survivors told us repeatedly of their surprise at the apparent lack of ambulances at the scenes, even an hour or more after the explosions. Angela told us that during the ho she spent in the ticket hall at King’s Cross, she saw only two paramedics. Rachel told u that at 9.35 am there were still no ambulances at Russell Square. Paul told us of the lack of ambulances, equipment and supplies at Edgware Road. This led us to ask further questions of the London Ambulance Service, about their response at each 3 such as fluids, tourniquets, triage cards (which are used by paramedics to assess casualties and assign a category which will dictate the order of priority in which they are treated) and stretchers. Dispersal o patients on 7 July, but we have been advised that it could have had a much greater impact if there had been more casualties or if specialist treatment had been required, such as for burns injuries.34 For this reason, it is essential that the problems experienc on 7 July are examined and resolved so as to ensure that the same problems do not arise again in the future. Aldgate The site to be cleared most rapidly of casualties was Aldgate, which was cleared with about 1 hour and 20 minutes. At 10.09 am, the Emergency Planner reported that the incident would soon be clear, and advised the control centre to consider deploying resources to another location (Liverpool Street) and 9.14 am (Aldgate). A total of 17 ambulances were deplo had been an explosion, and requested a further five ambulances. By 9.24 am, the ncy Planner declared a major incident and requested 30 ambulances, ent vehicle and a Medical Incident Officer. E 34 Transcript of Committee meeting, 11 January 2006, Volume 2, page 124 51 of 151 inte wed Kathy, a survivor of the Edgware Road bomb who was among the last rs to be taken from the carriage. She told us that she was kept on the train for 45 minutes because of a rvie survivo an extra lack of ambulances being available to take her to hospital. She remained in the carriage for three hours after the explosion, her condition carriage help to arrive, told us that he waited for an hour before anyone arrived to help.36 3.37 orded uipment and requested an equipment vehicle. This failure to maintain records is not unique to the Ambulance 3.38 number of survivors from Edgware Road and Aldgate told us that they saw emergency e affected tunnels. We have received no explanation as to why this might have been the case, and the absence of records showing the times of arrival o investig King’s C 3.39 The firs and a m reporte and 15 m, almost an hour after the explosion. No further communications are recorded until 10.13 in the e 7 Ambulance Service’s response at King’s Cross, other than the time at which the scene was cleared of casualties – 2 hours and 26 minutes after the explosion. deteriorating all the time.35 John, who was himself injured but remained in the bombed with seriously injured people, trying to help and comfort them and waiting for Unfortunately, it is not possible to examine in detail the London Ambulance Service’s response to the Edgware Road explosion over the course of the morning, because records of the response were not maintained. The timeline provided to us by the London Ambulance Service contains no entries beyond 9.21 am, when it was rec that an ambulance crew stated they were running out of eq Service; the London Fire Brigade has also commented in its debrief report on the failure to record information about its response and the need to do so in future. The failure to maintain records of the response extends also to records of the times of arrival of the emergency services at the affected carriages of the bombed trains. A services personnel outside the stations soon after the explosions, apparently having been instructed not to enter th f the emergency services in the affected carriages means that we cannot ate the anecdotal accounts we have heard. ross t ambulance arrived at King’s Cross at 9.19 am, half an hour after the explosion, ajor incident was declared two minutes later. At 9.39 am, the ambulance crew d that there was still no officer at the scene, but that there were 400 casualties ambulances were needed. The first manager was sent to the scene at 9.46 a am, when the duty officer reported that there were still more than 50 casualties train, and requested a further ten ambulances and an equipment vehicle. At 10.22 am, four busloads of casualties were taken (by bus drivers who had taken the impressive individual initiative of offering their services) to The Royal London Hospital. They wer directed to the Royal London Hospital, despite a call to the control centre seven minutes earlier requesting that walking wounded be sent to Bart’s instead. At 10.2 am, the London Ambulance Service manager at the scene reported that there were still 50 people trapped in the train. No further information was recorded about the 35 Transcript of interview with Kathy, 13 April 2006, Volume 3, page 79 36 Transcript of Committee meeting, 23 March 2006, Volume 3, page 7 52 of 151 cords ervice, and from the accounts we have heard from survivors of the explosion who were brought out of the tunnel to Russell Square 3.41 instances of London Ambulance Service officers requesting more ambulances, supplies scene a major incident - reporting 50+ casualties and six to 15 fatalities - and stated that there was only one ambulance at the scene, along with the 3.42 e stretcher cases still in the tunnel. There was still only one ambulance on the scene at that point. 3.43 am an equipment vehicle was requested. At 10.27 am, the manager at the scene requested an estimated time of arrival of the ambulances that had been 3.44 of its detonated on the No. 30 bus. For some time after the bus explosion, ambulances destined for both sites were being directed to the same muster point on a road nearby. This was not realised until after t point, ambulances called to Russell Square were being diverted to Tavistock Square – a much more visible and immediately apparent emergency. 3.45 The London Ambulance Service has told us that, since 7 July, it has put in place new procedures for managing incidents. This includes the despatch of a predetermined number of ambulances to the scene, ‘even if there is a complete communications failure and before they are specifically requested’. We welcome the London Ambulance Russell Square 3.40 At Russell Square, the scene was finally cleared when the last patient was removed, almost three hours after the explosion. So far as we can tell from the limited re that were kept by the London Ambulance S station, the medical response relied heavily upon voluntary assistance from doctors and nurses from nearby hospitals. There was a shortage of ambulances until after 11 am, and delays in deploying the appropriate equipment, personnel, and vehicles to the scene. The information given to us by the London Ambulance Service shows repeated and equipment and receiving no response. The British Transport Police reported that there were at least 200 casualties at 9.18 am. A Fast Response Unit arrived at the 12 minutes later, at 9.30 am. At 9.38 am a London Ambulance Service Professional Standards Officer declared Fast Response Unit. At 9.40 am, the Metropolitan Police Service requested the London Ambulance Servic to ‘send every unit that you have got’. At 9.48 am, one ambulance was despatched from University College Hospital. At 10.02 am, a request was made for five ambulances and a bus. At 10.13 am, the manager at the scene reported that there were 40-50 walking wounded and 100 At 10.22 requested. There was no reply from Central Ambulance Control. At 10.42 am, the manager made a further report to Central Ambulance Control, and again requested an estimated time of arrival of the equipment. At 11.10 am, there were still only three ambulances at the scene, and a further ten were still needed. Finally, at 12.12 pm, the scene was clear of casualties. The response of the London Ambulance Service at Russell Square can be partly explained by the general communications problems the service experienced across London on 7 July. These problems were exacerbated at Russell Square because proximity to Tavistock Square, where the bomb was 11am. Until tha Eventually, a system of runners was set up between the two scenes, and ambulances were redirected to Russell Square to take casualties to hospital. 53 of 151 Service’s acknowledgement of the issues, and its commitment to improve its proces in the future. We would emphasise that, despite these problems, individuals working to rescue the injured at Russell Square managed to save lives and look after the seriously injured until ambulances became available. Staff from Great Ormond Street Hospital attended the scene ‘in some numbers’ to tend to the seriously injured and take them to Greater ses 3.46 Ormond Street Hospital for treatment. Judith Ellis, Chief Nurse at Great Ormond Street 3.47 hanks to the efforts of individual doctors, nurses, transport workers and emergency services de by /or possible death that day’.37 are alties 3.49 uly, those on the front line were let down to varying degrees by a significant breakdown of communications within the London Ambulance Service. London Ambulance Hospital, described how staff from the hospital set up a field hospital near to Russell Square station. Gill, who was severely and permanently injured in the King’s Cross/Russell Square explosion, told us that on her arrival at hospital she had only four minutes’ worth of blood left in her body. She was resuscitated for a total of 27 minutes on 7 July, and was expected to lose her life. Carol told us how she was rescued from the tunnel and in theatre undergoing major surgery within an hour of the explosion. It was t personnel at the scene, paramedics en route to hospital, and doctors and others at hospitals that Gill’s and Carol’s lives were saved. Gill summed this up when we interviewed her in April 2006: ‘It’s important for me to say that however haphazard and makeshift it was, whatever went wrong that day, went right for me, because I am here and I am here literally by the skin of my teeth, so to speak. It was the decisions ma a few that changed the course of my life and Tavistock Squ 3.48 The first ambulance arrived on the scene at Tavistock Square at 9.57 am, having come across the explosion (as opposed to having been specifically despatched there). There is little detail available of the response in the following hour, because the information was not recorded. However, it is known that there was a shortage of fluids, reported at 10.27 am, despite the fact that eight casualties with serious amputations had been reported 22 minutes earlier. It was not until 11.31 am that the tactical, or ‘Silver’, officer at Tavistock Square reported that they had enough vehicles. It turned out that this was the result of ambulances destined for Russell Square being directed to the same muster point as those despatched to Tavistock Square. At 12 noon, the London Ambulance Service manager at the scene reported that the remainder of the casu still needed to go to hospital. London Ambulance Service response - findings Even allowing for the difficult circumstances that prevailed on 7 J 37 Transcript of interview with Gill, 13 April 2006, Volume 3, page 151 54 of 151 service personnel at the Tube stations and at Tavistock Square were unable to communicate with the control room. Their requests for further ambulances, nd likely to 3.51 ced with its radio systems on 7 July. t at nt of this problem, and its statement of intent to address it. 3.53 inquiry following a major incident. nnel supplies and equipment did not get through. They did not know what was happening at the other incidents. They could not receive instructions as to which hospitals were still receiving patients. This breakdown in communications led to a failure to deploy the right numbers of ambulances to the right locations; a lack of necessary equipment and supplies at the scenes; delays in getting some of the injured to hospital; and a failure to manage strategically the despatch of ambulances from the scenes to hospitals arou the city. 3.50 The impact of the inadequate deployment of ambulances to Russell Square was have been on the speed with which the less severely injured were taken to hospital. It probably did not delay the rescue of the severely and life-threateningly injured, who were cared for at the scene by London Ambulance Service staff and volunteers from nearby hospitals. We welcome the steps the London Ambulance Service is taking to address the problems it experien 3.52 The experience of 7 July showed the London Ambulance Service’s lack of capacity to deliver equipment and supplies to the scenes of major incidents a multiple sites. As a result of this, there was a lack of basic equipment, such as stretchers and triage cards, and a lack of essential supplies, such as fluids, the affected Tube stations and at Tavistock Square. We welcome the London Ambulance Service’s acknowledgeme There was a general failure to maintain records of the response of the emergency services on 7 July. It is understandable that emergency services personnel will be inclined to attend to the urgent and immediate priorities of rescuing the injured, but it is important that records are kept so that lessons can be learnt from the response. It may also be important from the point of view of any investigation or 3.54 There is a perception among some survivors that emergency services perso were prevented from entering the tunnels to rescue the injured. We have not been able to establish the extent to which this happened, or why it may have happened, because of the lack of records of the response. 55 of 151 Recommendations 17 to 20 We request that the London Ambulance Service provide us with an update on progress in reviewing and improving its communications systems in time for our follow-up review in November 2006. We request that the London Ambulance Service provide us with details of its plans to increase its capacity to deliver supplies and equipment to the sites of major incidents in time for our follow-up review in November 2006. We recommend that the London Ambulance Service and London Underground review the potential for storing rescue and medical equipment at stations. We request that they report back to us by November 2006 telling us what progress has been made in conducting this review, and what options are under consideration. We recommend that the London Emergency Services Liaison Panel review its emergency plans with a view to identifying a lead agency for maintaining accurate records of the response to major incidents. At each scene, there should be a nominated individual who is responsible for carrying out this task. Notific 3.55 rovide for an even distribution of casualties among major accident 3.56 to 3.57 Ormond Street was not alerted, despite its close proximity re station: ation of hospitals in the vicinity of the incidents Emergency plans p and emergency departments at London’s acute hospitals. When a major or catastrophic incident takes place, designated receiving hospitals are placed on alert, and will increase their state of readiness to receive casualties on the basis of information that becomes available during the day about numbers of casualties and the nature of their injuries. The NHS in London managed to clear 1,200 hospital beds within three hours, ready receive casualties.38 This is a remarkable achievement and is clearly an aspect of the emergency plans that worked well. Not all hospitals close to the scenes of the explosions were formally notified of the incidents. Specialist and non-acute hospitals were not apparently alerted to the incidents. For example, Great to Russell Square Tube station. Judith Ellis, Chief Nurse at Great Ormond Street, told us how staff there had found out about the incident at nearby Russell Squa ‘We are not one of the 11 acute hospitals. We are not informed of any incident. For us, the communication problem was particularly important. We did not have any, apart from people hammering on the back door and asking for help. We 38 Transcript of Committee meeting, 11 January 2006, Volume 2, page 130 56 of 151 are next to Russell Square, so that was coming from the ambulances who were at the scene. We were asked for equipment … We were not told of anything that was going on until we found our nurses’ homes had been sealed in the police activity and I could not get staff in or out. We were not told because it was not an NHS incident so they felt that we did not need to kno London picture is vital to the whole NHS’. w. Knowing the 3.58 n- 59 Staff from Great Ormond Street Hospital played a crucial role in the rescue and ut amedics arrived asking for equipment and assistance. The lesson to be learnt from this is that hospitals in the vicinity of a major incident 39 Communications between Great Ormond Street and Russell Square station were no existent, so medical students acted as runners between the two. 3. treatment of the injured at Russell Square, even setting up a field hospital. It is reasonable to anticipate that staff from hospitals close to a major incident will be likely to volunteer their assistance. On 7 July, Great Ormond Street Hospital was not notified of the incident at Russell Square, and only found o about it when par need to know about it as soon as possible, and would benefit from guidance as to how to respond. Recommendation 21 We recommend that emergency plans be amended to provide for the notification of all hospitals in the vicinity of a major incident, even if they are not designated hospitals with major accident and emergency departments. 39 Transcript of Committee meeting, 11 January 2006, Volume 2, page 125 57 of 151 58 of 151