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Patient Care

Eyewitness to Carnage

Craig Cassidy was in a bad place at a good time. A medic working solo in a fast-response car, he was en route to another call when he was flagged down by an officer outside the Aldgate station on July 7.

"He asked if I was there for the train crash," Cassidy recalls.

An ambulance had been waved down as well, and other responders were dealing with first-on-scene duties. Burned and cut patients were emerging from the station. Cassidy pulled his equipment bag and, joined by an arriving motorcycle medic, headed underground. Passing firefighters told them the scene was safe, that there were no more explosives. "This was the first point we'd heard the word explosives," Cassidy says.

With power shut off, the tunnel was illuminated only by dim security lights. A stream of passengers filed past, "very, very quiet." Smoke hung faintly in the air. Rounding a curve, the medics saw the blown-out third car. Farther down the track, firefighters were laying a blanket across a body.

With no raised platform in the tunnel, Cassidy and the other medic were lifted into the car through its middle set of doors. The explosion had occurred at the far end. To their left, a woman's body stretched across two seated survivors. Beyond them lay more bodies. Closer to the blast site was a man with catastrophic injuries to three limbs trying to drag himself up off the floor. "I had to make a split-second decision that he was beyond saving," says Cassidy.

Damage near the blast epicenter prevented the medics from going any farther, so they backed out of the car the way they'd come in and went down to the car beyond. Climbing in through a window, they approached the explosion site from the other direction.

To the left was a survivor so badly damaged, their gender was not discernable. To the right were two more alive, but with limbs missing. In front of them was the man on the floor, now dead. "I made the right choice," Cassidy recalls grimly. "But even so, it's still something I think about."

Surrounding them now were the remains of the alleged bomber, Shehzad Tanweer, as well as other victims and some survivors. By this time, firefighters had brought down generators and scene lighting, but after conferring, they decided not to use them. The survivors were aware of their own injuries, Cassidy says, "but I didn't want them to see what I was seeing by flashlight. So we just worked by flashlight, which meant you'd come across things and not know what you'd come across. You'd be standing there thinking, "What is that I'm sliding around on?'"

An entrapped female with the lowest GCS score among the immediate survivors became the top priority. Cassidy began a needle chest decompression. Her arms were so badly burned that he had to put an IV in her jugular vein, working backward from above her head. By this time a doctor from the city's air EMS service, HEMS, was on scene as well.

"He agreed with me on who was to be removed first," Cassidy recalls. "So while the fire service was removing her, we did some quick treatment for two others. It wasn't much, because obviously, the priority was to get the patients out of the train, and not hold up the scene trying to get IV access. With the massive blood loss, it was hard to find a site for an IV anyway."

Midway through this stabilization, a firefighter from outside the train called in an order to evacuate-there was a concern of a secondary bomb on the train.

"We all sort of stopped and looked at each other," Cassidy says, "and I basically decided it wasn't morally justifiable to leave these people. I couldn't really talk to them, because they were deafened by the explosion, but I'd indicated to them by a combination of sign language and touching them, "Don't worry, you're OK now.' It's something we do for patients in traumatic scenes-we always try to be upbeat with them. So I didn't feel it was morally justifiable to leave. And the fire service agreed with me, so we all stayed."

Once the three survivors were removed, Cassidy and the HEMS doctor did a quick pass to confirm that only fatalities remained. They then left the train and the tunnel, returning to ground level. Outside, a fleet of additional resources had arrived. Cassidy quickly rinsed off-"I had a lot of blood on my arms and clothing"-and then headed off to the King's Cross scene, where he helped treat patients being brought up. After that, it was on to debriefing and counseling for those who needed it.

"From the moment I came out at Aldgate to when I arrived at King's Cross, the first thing the officers were saying was, "Do you want to speak to someone? They're here now,'" Cassidy says. "And since the incident, I was phoned on a fairly regular basis by the counselors and various officers, just making sure everything's OK. Even other ambulance services got in contact to make sure you were OK. It worked very well.

"It's something you don't ever forget, but you move on."

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