The amazing responses of the of the NHS to the recent atrocities & fire in Manchester and London is a testament to the dedication of the critical care teams as well as other medical staff in those hospitals involved.  An overriding desire to help when adversity struck was the hallmark of their attitude.  The last five years in the NHS has been punctuated with feelings of doom at times – not enough money, not enough staff, too much poorly considered change etc, etc. It’s all too easy to forget why we entered our professions in the first place.  This blog by Dr Andrew Bently, Clinical Director of the University of South Manchester adult critical care unit might help jog our memories.

Gary Masterson, ICS President

 hand-and-pen-blog

Dr Andrew Bentley, Clinical Director
Adult Intensive Care Unit, University Hospital of South Manchester

The reflections, comments and views expressed in this blog are my entirely my own.

The events on the night of the 22nd May horrified us all.

The response of the personnel in the Manchester emergency services and acute hospitals was remarkable in its efficiency. The teams involved demonstrated a selfless sense of duty.  We managed to draw order out of the chaos due to recent rehearsals of a major incident plan.  I cannot emphasise enough how important this was in our response and I would encourage readers to revisit their own.  After all; practice makes perfect.

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The teams involved demonstrated a selfless sense of duty.

The rapid deployment of 60 ambulances was achieved with the assistance of units from surrounding Ambulance Trusts.  Creating additional critical care capacity was key, we were fortunate to have some spare critical care capacity on the night, and rapidly created 5 level 3 beds. This was facilitated by good communication from the scene, understanding the dispersal arrangements and knowledge of expected numbers of casualties.

The general medical team may not have a high profile in major incident plans, however, the actions of the senior medical teams made a dramatic difference.  Walking the wards, they reviewed in-patients and rapidly freed up beds for new patients and ICU discharges. There was a change in the mindset of ward patients with the realisation that “someone needs the bed more than me”.

I would like to express a special thanks to the paediatric teams.  Keeping casualties from the same family together was a priority for the Royal Manchester Children’s Hospital.  This meant staggering planned operations so that parent and child did not undergo surgery on the same day.

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This led to immediate, spontaneous offers of assistance from all staff groups

The major incident was declared through media outlets.  This led to immediate, spontaneous offers of assistance from staff of all groups and grades willing to come in off duty.  Social media platforms, such as WhatsApp, were invaluable as a means of communicating. They were used to co-ordinate additional staff requirements and plan for the aftermath of the incident.

Everyone wishes to contribute immediately, but longer-term consequences and service provision need to be considered. Don’t underestimate the potential negative emotional impact of informing staff that they are not required immediately. Though the circumstances are tragic, the experience is regarded as one that cannot be missed.

The control centre coordinated the immediate management of Priority 1 (P1) casualties.  The attendant anaesthetic staff, as part of the trauma teams, followed the patients through to theatre and subsequently to adult intensive care.   Additional medical and nursing staff for intensive care were required more for the following day than during the first night. We therefore made a decision not to call in staff unless we had received further information from the control centre at the scene.

Our acute general intensive care unit admitted 4 patients from theatre, the first arriving at 07:00 the following morning. We deployed additional staff to support this.  With the nature of the injuries it was clear that secondary transfers for specialist care might be required following original damage limitation surgery. It should also be remembered that a normal service has to be maintained too; we had two emergency admissions the following day, one with severe sepsis.

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we had to be conscious of both blast and ballistic injuries

By the very nature of the incident we had to be conscious of both blast and ballistic injuries.  This influenced the number of trips to theatre, length of stay in ICU and impact on vascular, orthopaedic and plastic lists. It is often unfair to single out individuals or individual groups for praise, but I must to mention the plastic surgeons based at University Hospital of South Manchester who operated at hospitals across the city from the time of the incident onwards.

Coordinating orthopaedic, plastic and vascular surgery required planning, but importantly reduced the number of visits to theatre. We were very grateful for the early de-brief by the military team from QE Hospital, Birmingham. This provided reassurance that our management was appropriate, and provided advice in areas we may not routinely have thought of.  One example was the requirement for audiology input.

It would not be appropriate for me to comment on any specific injures at this time. I must emphasise the importance of taking into account the psychological trauma for patients and staff. We have to care for the carers.  Many of the critical care staff will not have not seen anything like this before, nor indeed, wish to see it again. Down time to express their feelings and discuss concerns is paramount. This was arranged, but making clear how to access the support right from the start is critical.  Individuals will have different needs and the provision of one to one consultations, as well as group psychological de-briefs, maybe necessary.  A lesson learned was that our trainees could not immediately access psychology support by the Trust as their line of communication was through the North West Deanery who employs them. This, fortunately, was quickly resolved.

I would like to thank and express my gratitude to all the services that responded to the dreadful events on the 22nd May with dedication, an unerring sense of duty and professionalism.

 

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