This time it was not a drill

Editorial p 1018

The phone rang. It was ten past nine in the morning and I wasn't due to start work in the casualty department at St Mary's Hospital until the afternoon.

“Where are you? It's Dad here. There's been a major rail crash just down the road from you. Hundreds are injured.”

I quickly changed and ran downstairs. I weaved in and out of the traffic on my bicycle, and within two minutes I was at the police cordon. I flashed my identity badge and was led to the scene of the disaster.

“Keep your bicycle helmet on, Doc. The paramedics are over there with some of the wounded.”

Never had I imagined a major incident running so efficiently

One hour had passed since the fatal collision and already a slick rescue plan was in operation. There were five commuters lying on the ground, each white with fear, shivering, although it was not cold. They lay with charred or bloodied faces. Look- ing dazed and frightened, but all uncomplaining—happy just to be alive.

I approached the trauma triage coordinator.

“Hello, I'm a casualty officer. How can I help?”

I was directed to two wounded passengers yet to see a doctor. I felt as if I was on autopilot, driven by all the procedures that I had been taught and all the duty that had been ingrained in me. That feeling would continue for most of the day. Basics first—airway, breathing, circulation. I assessed a man with a blackened face. He was obviously in pain with a deformed broken lower right leg. A paramedic was squeezing a bag of fluid into his veins to prevent shock. It was soon emptied and we had to wait for the next fleet of ambulances for more bags. He was stabilised and put into an ambulance, all the while thanking those around him.

I caught sight of a woman on the ground being comforted by a friend. She was visibly shaking. I peered into a large gash in her forehead. We immobilised her spine and put her in an ambulance.

The coordinator told me that it was unlikely that anyone else would be brought out alive from the wreckage. It was time to go to Mary's now I grabbed my bike and sped down the main road still feeling as if some kind of compelling force was driving me. The whole experience was just so surreal. I had read the major incident plan two years before and remember being impressed by the precision and detail There would be a press room; one room would be set up as a mortuary I was reminded of the mock simulations of major incidents in my student days. Then volunteer students had been daubed in make up to act as casualties.

The accident and emergency department was a hive of activity. What struck me was that there seemed to be order, there seemed to be a plan—and it was working It quickly dawned on me why I had not been rung. Doctors from all departments and specialties had rushed to help.

I was allotted a patient to look after and immediately recognised her as the woman I had attended at the scene. Now, like all the other patients, she had a number and I would be responsible for her. Around every patient was a dedicated team of doctor plus nurse.

Never had I imagined a major incident running so efficiently, especially with the horrific severity of injuries. The major incident packs, used for the first time, had all the necessary forms. Medical students stood ready to rush blood samples to the laboratories. I glimpsed the sight of patients with major burns being whisked away for emergency surgery.

My duty was to stay with my patient to continually assess her condition, anticipate potential problems, investigate and repair her wounds and be her friend. She had a nasty head injury and remained pale and cold. My main concern after establishing that her airway, breathing, and circulation were stable was to recognise that she might have a skull fracture and underlying serious head injury. The appropriate monitoring and tests were done.

It is funny how little things impress on your mind—hearing about members of the public ringing to donate blood, the catering department sending down sandwiches and drinks for exhausted staff, the gratitude of patients All the while I was with my team, other teams were treating their own patients. Some were dreadfully burned, others had fractured limbs, ruptured spleens, or head injuries. I stitched up my patient's wounds with the help of a medical student. The nurses dressed her other wounds and we transferred her to the adjoining ward.

Suddenly the department was quiet and then the debriefing—lots of emotion, satisfaction, and pride on all sides for the sheer professionalism shown not just by the medical and nursing staff but by the porters, receptionists, police, security, and caterers.