Minor musings on a Major Incident 

This week, London experienced the type of incident some would say we have been anxiously dreading, having watched our European neighbours in Paris, Berlin and Nice suffer similar senseless violence in recent months. A vague unease that ‘something might happen here’ suddenly became realised, the picture pulled into focus as an anticipated nebulous threat materialised into a set of concrete events.

Five people (at the time of writing) have lost their lives. Many others have suffered unimaginably; some lives will never be the same, and it is impossible to say where the ripple effects of this incident will stop. What shone though the chaos, though, was the calm, professional response that demonstrated how well prepared our emergency services are to step up and respond. This is what we train for and it shows.

The following thoughts are a few reflections on being (very) peripherally involved in a professional capacity – some notes to myself to keep filed away in memory for a future disaster that hopefully won’t come.

Read. Your. Major. Incident. Plan. Like they told you to at induction. One day, you might need it at short notice.

Look after yourself. If you are concerned that friends or family may be involved in an incident, make a quick phone call and check they’re OK. You won’t be able to concentrate on your job – and you won’t be doing the best for your patients – if you are preoccupied with worry.

Look after each other. No one came to work today expecting this; everyone is working outside their comfort zone. Be on the alert for people struggling.

Keep off social media. The media are instantly on the hunt for facebook quotes and tweets from anyone medically involved. And if you answer the desk phone to someone asking for information (journalists try this trick) – politely direct them to the hospital website or communications team.

Waiting… is the worst. Nervous energy is contagious in the calm before the storm. Where we were, one of the consultants did an impromptu teaching session on the history of the triage system – which not only kept everyone’s mind busy, but stopped us from pacing the department waiting for patients to arrive.

Stay informed… one screen with a reputable news source for live updates. Don’t speculate, and remember ‘fake news’ spreads fast. If media was graded like evidence based medicine, anonymous twitter sources would be sub-level 5.

What are the patients seeing? In paediatric ED, children are normally carefully separated from the adult waiting room to shield them from what can be very scary sights and sounds. If the department ‘flow’ has to change as patients are triaged to different areas, how will you shield vulnerable patients from seeing things they shouldn’t have to?

Be the small cog in the machine. A department which runs smoothly in a crisis is as much (if not more) down to the people reliably performing the simple day to day tasks, than those who are sprinting from one code red to another. The baseline workload is still there and still needs to be seen to safely.

Thoughts of solidarity, sympathy and respect to patients, families and colleagues affected by the events of this week.

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