Among the many questions arising from the London Bridge and other terror attacks, and the inquest findings this year; what of the delay in getting help to the victims, in the confusion? Is it more or less inevitable? Mark Rowe asks.
To briefly recap the attack, the three attackers had deliberately driven a Renault van into pedestrians on London Bridge before crashing it into the railings on Borough High Street, next to the Barrow Boy & Banker public house. From the van, they attacked others with knives, heading into the Boro Bistro courtyard. All but one of the dead had injuries described by the coroner as ‘not survivable’, except for one who was given prompt treatment including CPR (cardiopulmonary resuscitation) by people nearby including police, at unknown risk to themselves during the attack, as the coroner pointed out. Despite those efforts the man was taken to an ambulance and assessed as dead by a paramedic.
The inquest set out the timing of the attack. Plato – a protocol for a pan-London response, including ambulances and hospitals, and informing the Home Office and military – was declared at 10.16pm. The incident – the three attackers using their hired van as a weapon on London Bridge – had begun at 10.06pm. The first call to the London Ambulance Service (LAS) was made at 10.07pm and answered 70 seconds later; about one of the victims on the bridge. The attackers were shot by police at nearly 10.17pm, in Stoney Street; and further shots – in all there were 46 – were fired (from the City of London and Metropolitan forces) over the next near 15 minutes. We now know that all the attackers were shot dead (‘neutralised’) within ten minutes; that the vests they wore as if carrying explosives were false; and that their van did not hold any booby-trap. None of that was known at once.
As the police superintendent in overall command of the policing response logged, as an early impression:
”Multiple casualties on the bridge. Van driven intentionally then additional location multiple victims of a marauding stabbing attack. I was thinking multi-seated marauding terrorist vehicle and knives.”
Those emergency responders at the scene had to work out what was going on, on the ground; they had to communicate that to their controllers and each other; and they then had to act on what they knew, to give aid to the injured and evacuated them and other survivors.
Put another way, the first responders have to make sense of the scene. They are trained in methods such as the Methane way of passing details about any major incident to control rooms, as part of JESIP joint doctrine for services to work with each other. Another part of JESIP is the concept of zones, graded by colour. A cold zone is safe. A ‘warm zone’ may have had terrorists pass through and they may pass through again; in that area are casualties, or unknown risks – a terrorist may have left a booby-trap, or started a fire. A ‘hot zone’ is where the terrorists are, or suspected to be; there (to quote from Lord Toby Harris’ 2016 report on London’s preparedness to respond to a major terrorist incident) armed police will ‘confront and neutralise’ the terrorist.
As the coroner noted from the evidence by the superintendent, ‘there might be an initial period during the response to a terrorist attack where hot and warm zones have not been formally designated, and responding units will have to make those categorisations based on their own perceptions. It takes time too for the designations to be made and recorded’
Another complication is that if terrorists are ‘marauding’, whether on foot or in vehicles (as in the Paris attack of November 2016), or spread separately about a city, what is hot, warm and cold may change. As an example of how badly wrong a response can go, consider the riots in many United States cities in the summer of 1967. The official Report of the national Advisory Commission on Civil Disorders the following year noted that at the time police (and press) widely reported ‘sniping’ by ghetto rioters; in reality, ‘most reported sniping incidents were demonstrated to be gunfire by either police or National Guardsmen’. In other words, anxious police or Guardsmen shot for little or no reason, which prompted others in the vicinity to shoot (including with machine guns), thinking the original shots were by rioters, which meant innocents were killed.
The London Bridge inquest set out that the problems were not such over-reaction but delay in reaching those in need. At the Counter-Terror Expo at Olympia in March, featured in the June print issue of Professional Security, Christian Cooper, head of compliance at the National Ambulance Resilience Unit (NARU), spoke of how much risk first responders should be exposed to. As such exposure is foreseeable (and not only acts of terrorism, but fires, accidents at height, and chemical hazards), ambulance crews have to be trained and equipped. Hence HART – Hazardous Area Response Teams – as the name suggests, tasked to enter the ‘hot zone’, or inner cordon, to triage and treat casualties in the most difficult places. As the coroner noted, once in a ‘warm zone’, ambulance staff ‘are to search for casualties, carry out rapid triage and basic medical interventions’; in other words, not do the normal ‘clinical interventions’.
The inquest heard how control rooms can become overloaded with information, precisely at the time, in the beginning of an incident, when it is most important to gain understanding of what is happening, where, and by whom. The total of 999 calls received by LAS from the first of the attack until 11pm was 134; that is, more than one a minute. What the coroner called ‘various resources’ were dispatched to the scene at 10.11pm. A paramedic made a Methane report at 10.23pm, of multiple people stabbed and shots fired – by the police, he presumed, but was not certain.
A concern aired by some security managers has been that in a terror attack, people may be on their own for a considerable time until armed response arrives. In the centre of London, that was not the case; what did occur was that ambulance responders were told to ‘evacuate off the bridge’. At 11.16pm, officers checked the dead attackers ‘and confirmed there were no visible explosive devices on them’. The Borough Market was made a ‘hot zone’, and the south side of London Bridge, and Borough High Street, a ‘warm zone’. At 11.50pm there was a report of a ‘potential IED’ in the attackers’ van; the van was reported ‘made safe’ at 11.54pm.
A first ambulance crew was not sent into Borough Market until minutes after midnight. As signs of the confusion – which makes the delay of deploying of medics more understandable – is that two hours after the incident, ‘multiple reports’ were still of ‘assailants at large, one with an assault rifle’. In other words, the risk remained of ‘blue on blue’, 999 responders being shot by police. Three hours after the incident began, police discussed whether to ‘use explosives as a method of entry’ to search Southwark Cathedral, ‘which was still a hot zone’. As early as 10.16pm, there was a message of casualties in Boro Bistro; as late as half an hour after, ‘nobody had got the message to those people in the courtyard that ambulance staff couldn’t get to them … a very chaotic scene’.
The inquest evidence suggests that in such a ‘dynamic situation’, it’s hard for any branch of the 999 response to get ‘full situational awareness’, first to identify what are the danger areas; and then to locate and aid casualties there. A HEMS (Helicopter Emergency Medical Service) doctor arrived in Tooley Street nearby at 10.25pm, but did not see a patient until 10.53pm. As police did some first aid, and evacuating of casualties, it might be of value, as the inquest suggested, to have LAS operators stationed in the police SOR (Special Operations Room). None of this is to question the ambulance responders there; the inquest heard the ‘HART team record a sense of frustration that they would have liked to have deployed sooner’.
For a statement after the inquest from the Association of Ambulance Chief Executives (AACE) visit the NARU website.
