Underground Attack

For Londoners, terrorist bombings are nothing new. Those of a certain age survived the World War II aerial blitz by Hitler. Later generations endured years of violence at the hands of the Irish Republican Army (IRA), including bombings in and around London in 1981, '82, '83, '90, '91, '92, '93 and '96. According to researchers with the University of Ulster's CAIN (Conflict Archive on the Internet) project, the IRA killed more than 1,700 people during a period generally known as "the Troubles" (roughly from 1969 through the mid or late 1990s), including 497 civilians.

So if you're wondering about the famed stoicism with which the Brits handled the events of July 7 (and the unsuccessful sequel of July 21), that's part of it. And if you're wondering how it was that the city's emergency services fared so well under such duress, it's important background to know.

"Second to None"

Terrorist incidents, as EMS providers know, require an efficient and coordinated response by a number of important entities. Foremost among these are the emergency services. Law enforcement must secure scenes, gather evidence and pursue those responsible. The fire service must eradicate life threats and ensure scene safety. And EMS must evaluate, treat and transport casualties. Accomplishing these discrete jobs requires working together, and that's much easier when you have compatible protocols, command structures and terminologies, and scopes of responsibility that dovetail neatly with each other.

In the U.S., real efforts toward achieving this have only recently-with the creation of NIMS (the National Incident Management System)-begun. In London, they're more than three decades old.

The mechanism by which it happened is the London Emergency Services Liaison Panel (LESLP). Since 1973, it has provided a forum for the city's major emergency-service providers-the London Ambulance Service (LAS), the London Fire Brigade, and city, metro and transit police, as well as others potentially involved in major-incident response (the military, port authorities, etc.)-to prepare jointly for the Next Big Thing. It meets quarterly.

The LESLP's Major Incident Procedure Manual is the emergency services' bible for such events. This publication (available at www.leslp.gov.uk) describes the responsibilities and agreed-upon procedures for each agency involved in a response like that of July 7: generally, who does what, when and how. "In this way," it states, "the overall response of the emergency services will be greater than the sum of their individual efforts."

"The whole idea behind having that kind of multiagency document," says LAS emergency planning manager Jonathan Edmondson, "is that everybody will have an understanding of each other's roles. That's important, because I think there can be a perception by other emergency services about what the ambulance service does during a major incident. They might think we'll turn up, grab a patient and take them to the hospital. But in a major incident, it doesn't work like that. The first couple of ambulances at the scene don't actually treat anybody. And that's why that document is important: to try to get that through to all of the agencies at all levels."

Notwithstanding the specific priorities of the first personnel on scene, the LAS has distinct duties at a major incident. These include:

• establishing effective triage;
• treatment, stabilization and care of the injured;
• providing transport and other resources as appropriate;
• providing communications and other resources for the National Health Service (NHS);
• selecting and alerting hospitals to receive the injured.

The smooth operations of 7/7 resulted in no small part from adherence to the plan.

"As an emergency planning manager, I'm remarkably critical about how we respond to major incidents," Edmondson says. "But I have to say, how our staff, the Fire Brigade, the police, the London Underground and members of the public actually responded on July 7 was second to none."