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Case study

'Instant A&E' plan a success

Great Ormond Street Hospital for Children does not have an A&E department and only treats adults under exceptional circumstances. However, on the morning of 7 July, two of the bombs which went off in London were in our immediate neighbourhood.

We immediately invoked our major incident plan, empowering a small team of hospital staff (a doctor, nurse and manager) to control resources, people and space, led by consultant nephrologist Dr William van't Hoff. All outpatient appointments and routine work were cancelled, but we remained open throughout for paediatric emergencies. Theatre space was cleared and 10 ITU beds made available for emergency use. Our café and staff canteen became a minor injury unit and a major injury and six-bed treatment area respectively, both fully operational in less than an hour.  

Dr Paula Lister, consultant paediatric intensivist, led clinical teams, with Mark Goninon, clinical site practitioner, as lead nurse, and Sue Lyons, general manager, acute medical services division as our lead manager for major incidents.

We set up the A&E unit from first principles. As a tertiary centre we could provide anaesthetists, cardiothoracic surgeons, orthopaedic and plastic surgeons and ITU nurses. Radiology provided portable X-rays, laboratory staff organised blood supplies, and pharmacy were on hand as needed. Mark Goninon ensured that care for existing patients was not interrupted, looking after crucial domestic issues such as feeding everybody and maintaining supplies. Ward amalgamation provided bed space for adult patients; we have beds and equipment large enough for adults as we treat teenage patients and many staff have had adult training before specialising. Senior clinical staff helped at Russell Square and provided supplies, as requested, to the ad-hoc treatment centre provided by the British Medical Association.

Great Ormond Street Hospital treated 22 patients that day, all adults, two of whom required surgery and one of whom was admitted to ITU. Four stayed in the hospital overnight and all had been discharged to other hospitals or home by Monday evening, 11 July.

Our staff were remarkable and did more than anyone could have expected. Two members of our staff died in the attacks, and one remains critically injured. Our thoughts are with the families.

London's healthcare community takes action

Healthcare staff across London extended their roles to take pressure off busy A&E departments during the major incident.

At Edgware Road, Christine Hunter, head of occupational health at Westminster PCT, set up a triage at the local Marks & Spencer store where over 25 staff from a variety of services across the PCT provided first aid to casualties. Once Lynda Hamlyn, chief executive at the trust, was satisfied with the numbers of staff there, Soho NHS Walk-in Centre (WiC) treated casualties, closing the centre to patients and quickly assembling 30 staff, including GPs, nurses and first-aiders, to handle the walking wounded, some for smoke inhalation.

Westminster rehabilitation service co-ordinated the care for the early discharge of over 100 patients from St Mary's Hospital, Paddington, and GPs and community staff were also made available to provide intensive support to those discharged early and those being cared for at home, taking pressure off St Mary's Hospital. Lynda Hamlyn extended her sincere thanks and appreciation to everyone for their support.

Sonia Hall, lead nurse for unscheduled primary care at Tower Hamlets PCT, was working at Whitechapel NHS Walk-in Centre when, at 09:20, staff were alerted to a major incident at Aldgate station. Situated opposite the A&E entrance at the London Hospital, staff at the WiC extended their remit to minor injuries to support A&E and nurses paired together to take a consulting room each. Jane Bickerton, nurse consultant, supported nurses in the treatment area; Jane Bayliss, operations manager, organised and supported the reception team, and Sonia Hall managed the flow of patients, streaming them into treatment rooms, observing them and liaising with A&E.

The first patients arrived at approximately 10:00 in a double-decker bus. They were initially triaged at the entrance to A&E and allocated an incident number. All category three patients were escorted to the WiC. Anyone with obvious cuts or bleeding was seen first, the rest were seated in the waiting room, comforted and given refreshments.

The constant stream of patients lasted for just over two hours with the WiC treating 88 of the 208 patients seen at the London Hospital. Local GPs closed their surgeries and former members of staff came from all over London to help. Sonia Hall thanks all the staff at Whitechapel WiC and out-of-hours service for all their hard work during the incident and to all the other WiCs who offered their help and support.

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