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CEEP does London

Education and entertainment in one of the world's disaster capitals

15 participants

from 5 countries

and 6 Canadian provinces,

visit 3 London hospitals,

get 2 aerial views of London,

7 cultural events,

8 nights in London,

and experience countless disasters (vicariously, not actually).

Conference? Hard to call it that. It was educational, for sure - mass gatherings, CBRN, mass casualty incidents were all part of the curriculum. The historical and cultural context made it inspiring and unforgettable in a way that I don't usually associate with a 'medical conference'.

London has seen its share of disaster events. Recent and historic events gave memorable context to the principles we discussed. Actually being on location of some of these events was invaluable:

Grenfell tower

- Grenfell tower fire. June 14, 2017, in which 72 people died. We got an account of the medical

response, including the challenges of clearing an already-full emergency department, being in short supply of cyanide antidote kits, managing volunteers and family members, and the involvement of other hospitals not fully equipped for the patients they received. See for BBC's report for lots of photos and details on the incident, the structural problems leading to the fire, the after-action report, and the victims. Most of these patients presented to St. Mary's Hospital.

- Wembley stadium riot. July 11, 2021. With England in the World Cup final for the first time since 1966 and stadium seats empty due to lingering COVID restrictions, the keyed-up crowd, gathering (and drinking) since 0700, stormed Wembley stadium in a historic display of aggression and abandon. Stadium security managers showed us the planning before, during, and after the event. Intense. Oh, and England lost.

-Westminster attack. March 22, 2017. Four killed and 50 injured by a man driving a van into pedestrians. Considerations that went into this MCI response plan were how to provide treatment (tetanus, antibiotics, TXA) and care spaces (on-way progression out of ER to radiology then to OR or ward) for arriving casualties. See the Guardian's account of this incident. Coincidentally, the BBC was on site doing a documentary on the financial side of hospital management. Instead, they got a first-hand report of a mass casualty response.

- London Bridge and Borough market attacks. On June 3, 2017, three terrorists killed 8 and wounded 48 by vehicle rampage then attacking people with knives (see the Sun's timeline of terror).


The cultural context was awesome. From our beautiful hotel in Shoreditch (I just like saying that) we walked through Whitechapel to check out the trendy Spitalfields market. I reflected that Jack the Ripper (the person or persona responsible for a collection of brutal murders in the late 1800's in east London) walked these very streets. Our motives differed, of course. Me looking for a deal on a herringbone tweed newsboy cap, Mr. Ripper looking to fulfill a different need. And they aren't the same impoverished, violent, overcrowded, and disease-ridden streets that Jack would have stalked.

Speaking of disease, London has seen some of the worst. We visited the Royal London Hospital, saw the very lab where Alexander Fleming discovered penicillin (even a portrayal of the very petrie dish where he saw S. aureus colonies staying clear of the bit of moldy bread he left there while away on holidays).

And cholera, killing thousands over the years, until another physician here, Dr. John Snow, traced an outbreak back to, not the air through which all infections were thought to be transmitted in those days, but to the water.

An allegory of cholera mortality. Etching by A. Burdet after A. Raffet. Wellcome Collection. Public Domain

By night, Dr. Snow removed the handle of the water pump that infected more than a few. This must have caused some inconvenience in Whitechapel. It definitely slowed the spread of that outbreak and advanced our collective understanding of infectious diseases.

How fitting that we would participate in a CBRN event with hospital staff here. It was also fitting, in a weird way, that we all looked a little like teletubbies. An unexpected cultural treat, I suppose.

Atop this hospital is housed the world-renowned London HEMS, which launches within 4 minutes of a call, and is advancing some of the most aggressive and optimistic trauma care in the world - blood transfusions, thoracotomies, intubations, central venous lines, arterial line, REBOA... on scene on the streets of London! I had a hard time just walking across the streets in central London.

Their approach to mass casualty events and violent assailants is similarly progressive.

The dying process does not wait for a warm or cold zone to be in place or for the threat to be completely suppressed. ... The strategy to improve outcomes is to identify potentially reversible pathology and ensure that medical providers at the appropriate level, whether police medics, paramedics, or doctors, can access the patients to provide the required intervention.

-Dr. Claire Park, speaking to us during our visit, citing the paper she authored with colleagues from London HEMS.

(Park, Claire L., et al. "How to stop the dying, as well as the killing, in a terrorist attack." BMJ 368 (2020).)

Roffey Park Institute

Moving outside of London to an executive education facility in the countryside in West Sussex, we were treated to two days of educational offerings from International Location Safety, a travel risk management organization. Some of the topics of these fascinating didactic and simulation sessions:

  • Safety and security - In assessing risk, one key difference is the intentionality of the threat. Safety is about unintentional hazards (think health and safety, earthquake safety, etc). Security usually refers to threats of intentional violence (think of what airport security means, or the role of security officers).

  • Security profile - Context is everything. What information is displayed and risk conveyed by one's gait, clothing, skin color, accent, etc? This differs from one context to the next. Your white coat, stethoscope around your neck, and neatly-coiffed hair, for example, may be a safety risk in one setting and a benefit in another. Some relevant resources:

    • Aid worker security database - "a global compilation of reports on major security incidents involving deliberate acts of violence affecting aid workers" organized by country

    • Humanitarian outcomes - "research and policy advice for humanitarian aid agencies"

  • Security planning, security strategies

  • Acute stress response - Acute stress vs chronic stress, recognizing and controlling

  • Team communication

  • Security in crowds

at Roffey Park Institute, safety and security training

The highlight was definitely a day of simulations to put these concepts to practice. To try to describe the scenarios would sound like I was totally making things up, or trying to deter anyone from attending future conferences. I will just say that I would not have imagined that being carjacked, shot at, detained in a hostile village, or accosted at an armed border crossing could be so fun, educational, and safe. It sounds like I'm making things up. Or trying to deter people from attending future conferences. Shoot. I mean, not literally. Anyway, it was exceptional.

Stay safe (and secure) till next year.

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