Saturday, 30 October 2010

Tough decisions

I’ve been asked to comment on this article. Of course, being there on the day and having an active role in it, I have been following the enquiry very closely. I am used to hearing that we weren’t there when we were needed or that we were ‘too slow to arrive’ but, like every other mass casualty situation, there are elements in the event of the day that will never be understood by the general public, or in this case, supposedly panicking fire crews.

Now I wasn’t there to witness this particular exchange but if the paramedic has recorded it, then I have to assume it happened as he said. Nevertheless, regardless of the alleged arguments, the medic was correct; the first crew on scene must stay put and report back with casualty estimates, resources required, etc., otherwise, as they spend precious time dealing with injured people, others begin to die for lack of ambulances and paramedics. This a difficult task in the face of such a horrifying incident, so the paramedic who stuck to his guns deserved praise, not abuse. It must have been very hard for him to say no.

The military operate a system in war that saves those that can be saved – we do the same in scenarios like this; patients need to be triaged – sorted out in priority and if one patient is going to die while another could die but can be saved, then the higher priority is the latter, not the former. Otherwise ten dead people arrive at hospital because they could never have been saved, despite the best efforts of the crews, while ten more die needlessly because they lay waiting for immediate life-saving intervention. It’s a harsh reality.

Let me know what you think of the article and please, don’t get offended if you are a fire-fighter; this has nothing to do with the alleged exchange of words – the debate on the table is whether the Incident Officer role is fully understood, now that I’ve outlined it. Do you think the general public should be told all this? Do you think they’d want to know?

Be safe.


Greeny said...

The conclusion of the article leaves a bitter taste and seems to very subtley imply that said paramedic acted inappropriately.

Your service is no different to ours. First unit on scene becomes scene command until relief of an appropriate level arrives.

The people who would be outraged by one seriously injured having to wait would be equally outraged if the media were reporting that the ONLY ambulance on scene desserted 50 other seriously injured for the sake of one.

Do the general public need to know? I believe that it would be useful to have the role explained, whether it is taken on board is another issue entirely.

I'm inclined to believe that folks who take what the paper reports to be gospel may not be super sharp on the uptake of information relating to one death in compromise for the benefit of many.

For the rest, a little explanation for what multi cas is all about should prove to be beneficial in completing poorly constructed picture painted by the media.

Anonymous said...

I (random member of the public, albeit one who reads various EMS blogs with interest) think I knew about someone being in charge of initial triage. Or perhaps (also possible) I was just so unsurprised that this was how it works that halfway through the news item on radio 4 I felt like I already knew it. Either way, what shocked me was not that the paramedic didn't instantly leap to work on the nearest patient, nor the (very human) response of the firefighters, but the fact that apparently the firefighters, despite working in London where frankly if anything goes badly wrong (whether by act of man, of god, or of gas main..) a major incident is a only too likely, apparently hadn't been briefed that this would be how it had to work. That I found upsetting.


Anonymous said...

I think the first paramedic was absolutely correct, even as a first aider the first thing we do on scene is assess and get help before we do anything else. The article has been written in the wrong way and if the journalist had ALL the facts to hand maybe it would have been written fairly!

Uncle John said...

I can do no better than iterate what I posted earlier on 'Inspector Gadget' -

Trying (for once) to be ‘fair’ to the press – the primary evidence for what the first Paramedic on scene at Aldgate did came from – the Paramedic himself.

His evidence to the inquest was that he was REQUIRED to assume the Role of ‘Incident Officer’ – and that it appeared (some of the) fire-fighters on scene didn’t understand this and reacted badly.

Surely ‘look-learn-report’ is still fundamental to to the responsibility of each Service’s ‘first on the scene’? (I was involved in a draft Major Incident Plan (MAJAX) project at Police College 40 years ago that recommended just this.)

[I note that, last week, some similar 'disagreements' were reported when (other) fire crews wouldn't enter a tunnel on the assurance of a Police Officer that the track power was 'off'.]

Re; XF's Q&A -

1) - [Is] the Incident Officer role is fully understood? - Clearly not - even by some of the responders attending.

2) - Do you think the general public should be told all this? -Yes, but there would inevitably be 'demands' for the whole concept to change.

3) - Do you think they’d want to know? NO - 'they' mainly want to 'know' whose fault it is.

Philosphical point - after any MAJAX there is an inquiry, lessons are learned, policies are up-dated - BUT such process can all too easily focus on the presumption that the NEXT incident will be similar.

Anonymous said...

As a student paramedic myself, I know that sometimes you have to act thinking a few steps ahead with the full operation in mind, which to the untrained eye can look like you're not acting with enough urgency. To be honest, I can understand why members of the public may get abusive and demand a paramedic starts dealing with patients immediately as they don't understand what needs to be done to perform the full rescue operation efficiently, but I'd have thought fire-fighters (Especially London fire-fighters) would be well trained and experienced in major incident scenes so I think the conduct of these fire-fighters can only be described as very unprofessional.

Japh said...

I think the paramedic did the right thing. In the short/individual term maybe just taking all the patients might have been good but in the long term it's well pretty much crazy, people end up dying because they were not triadged. In the long term more people would have died. Not that anyone should have died that day in a situation like that.

I really admire fire fighters, just as much as paramedics. To be in the situation the fire fighter was in would have been terrifying and disturbing, not being able to help the people he obviously saw to be dying and suffering. I just think the pressure and stress was just too much for him. No offence to him at all, I would have been affected the same way. He just snapped and it's fine, we're all humans and want someone to vent to or blame.

Just my opinions.


Anonymous said...

I completely agree with you on this. I like that the article is not judgemental of either side: the paramedic was doing a necessary but difficult job, and no-one can blame the firefighters for panicking, which in the circumstances was only human. Being involved neither in medicine or firefighting myself I think the general public should know this sort of thing, if only to remind them that the emergency services are real, practical and very brave people, not superhuman miracle workers!

Anonymous said...

Am just an ordinary member of the public. My opinion for what it is worth. Common sense says that someone with medical knowledge had to be able to assess the situation and report back to LAS. No matter how well coordinated the efforts on the ground were there must have been initial major confusion and frustration on behalf or all those having to hang back from what you all ( being the emergency services) do best which is help people.
I am not defending the firefighters words but maybe he felt he would be actually doing something, anything.
I think it is time for everyone to stop apportioning blame and to accept that a lot of lives were saved by ordinary people doing extrodinary jobs that day.
Just my tuppence worth

Xf said...


Absolutely. The Fire-fighters are going through a bad Press time as it is and it's kind of obvious that the last few stories to have come out of the enquiry just happen to be denigrating; funny that, eh?

As far as I'm concerned (as a grown up) - the fireman in question wanted to do something about injured people - his mind saw nothing else as a priority at that time. He was being human.

Anonymous said...

It does sound as though the fire officers on scene weren't aware of ambulance procedure at a major incident, which is a concern. I think one simple thing the ambulance service could do, which they may do in LAS but they don't in the ambulance service I work for, is have 'incident officer' jackets or something identifiable on EVERY vehicle so that the first paramedic on scene who will become incident officer until relieved of the role by a superior, can be identifiable as such and therefore all fire/police/other crews etc can recognise the role that person plays in managing the incident. My experience is that even at an RTC it can be confusing to people that don't know the crews personally as we all have the same uniform, then maybe half an hour later someone will turn up with an incident officer jacket on.

Xf said...


That's a very good idea. We don't do this but it is worth asking about. It makes perfect sense. Thanks for the input.

Malcolm Thurling said...

I'm sure the public should be told, but, come the day when hey are at a similar incident, will they care? I don't think so - and that is understandable - because THEIR first concerns is the person that they may be giving aid to. Was the firefighter's reaction helpful? No, of course not, but we don't know what frustrations they had encountered in the 20 mins or so before the paramedics arrival. Sadly, when the culture is 'where there's blame, there's a claim', it's all too tempting to nudge any potential blame somewhere else.

Steve A&ES said...

As an ex Firefighter I can understand the frustration of the troops. Crap handheld radios that die after 10 minutes.I have great respect for the Paramedic for sticking to his procedures. We had little interface with the LAS (apart from "Thank God, they're here" on a job).I certainly don't remember being briefed on their procedures.I hope the inquest recommends closer working between Poice, LAS and LFB. Ironic, though, that as a Paramedic is being praised for adhering to his procedures, Firefighters are being slagged off for adhering to theirs.
I don't care how many Coppers dance on a live rail in insulated DM shoes, unless LFB Control are informed by LUL control that the power is OFF it is still LIVE. It could be a temporary power loss, or automated switching could be re-routing power. Personally, and individually, I would assess the risk and carefully avoid and treat the rail as live. I would not think less of anyone who remained behind. After all, the LFB would not support me if it all went titsup.

Xf said...


That's a fair comment. I too noticed the sudden appearance of damning stories about LFB and I can only say that the Press were, once again, selling their rags on the basis of current popular hatred due to the industrial dispute.

As for live rails - two of my colleagues almost got killed when they were told the power was off and it wasn't - both received nasty shocks whilst under a train, so caution is critical with the underground jobs.

Uncle John said...

THIS is from the "London Emergency Services Liaison Panel" [LESLP] MAJAX Manual 2007

IMHO, the different wordings take into account the likihood that - whilst 'First on Scene' for Police & Ambulance will be a single individual or 2-person crew (any one of whom may suddenly find themselves 'Incident Officer') - the Fire Service response will (more usually) be an 'Officer' whose pre-designated role is supervision, and a 'team' (crew) who CAN go forward and both assess and start to 'deal'?

Police - The primary duty of the first Police Officer on scene is to ensure that appropriate
information is passed back to their control room ... The first officer on scene must not get personally involved in rescue work in order to fulfill
the functions listed above.

Fire Brigade - ... the Incident Commander of the first attendance will assess the situation
and report.

Ambulance - The first member of ambulance staff will undertake the function of the Ambulance Incident
Officer (AIO) prior to the arrival of an LAS officer.

Proud said...

I understand the importance of investigations in that we can evaluate performance and strategies, learning and improving for future events but why are we always looking for organisations and single names of staff to blame. The suicide bombers caused this mess. They are to blame. They actively set out to ruin the lives of many. All multidisciplinary staff who played a role in the event hold my utmost respect. They sought to provide help where they could, to the most they could.

Anonymous said...

I think that this firefighters comments were outrageous,common sense should prevail here,in that,the first crew could not arrive on scene,pick up a wailking casualty,and make their way to hospital.Im currently employed within an ambulance service and have to deal with firefighters attitudes on a regular basis,which doesnt make my job any easier!

Anonymous said...

Taxi drivers in green uniforms deciding who lives and who dies. It's all wrong. They should be treated by qualified doctors who should be making those decisions.

Anonymous said...

Yeah... like Dr Harold Shipman for example.
You truly are an ignorant person who is obviously neither a doctor nor a paramedic!