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‘You could see the shock and fear on patients’ faces when they came in’

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Incidents like the recent London Bridge terror attack sadly show both nursing and the NHS at its best, according to two of the capital’s nurses who were involved in treating the victims.

Nurses at the Royal London Hospital’s trauma centre see and treat the victims of violence on a daily basis, including those seriously injured in knife crimes and road traffic accidents.

“A lot of them weren’t speaking and you could just tell they were in shock”

Fay Kidney

But the night of Saturday, 3 June, was different as teams in emergency, theatre and critical care swung into action to care for those wounded in a terrorist attack in the heart of the city.

Staff first learned of the attack in London Bridge from the London Ambulance Service, said Fay Kidney, one of the senior sisters in the hospital’s emergency department. Soon afterwards a major incident was declared.

“We had very little information initially but were told there was the possibility of car-related and maybe some penetration injuries – stab wounds – but were unclear on anything else like numbers,” she said.

Her priority as a senior nurse was to ensure the department was ready, she told Nursing Times.

“I wanted to get the whole department set up and everybody ready for what was coming in,” she said. “I delegated nurses, explained everybody’s roles, had discussions with the team, explained what was going to happen for junior members of staff and made sure they were supported.

“I walked around the department checking every areas and making sure everyone knew their exact roles,” noted Ms Kidney.

“Incidents like this show nursing and the NHS at its best”

Nicola Rudkin

In the end, Nursing Times understands that the hospital, which is part of Barts Health NHS Trust, received nine “priority 1” patients, and 12 in total. Their injuries were nothing unusual for the trauma teams but the circumstances were, highlighted Ms Kidney.

“We see these traumas regularly and so basically acted as we normally do – in a calm, professional manner but it definitely felt different – you could see the shock and fear on patients’ faces when they came in,” she said.

“A lot of them weren’t speaking and you could just tell they were in shock from what happened,” she said. “From a staff perspective – we all live and work in London and have all been to London Bridge, Borough Market – one of us could have been out there with friends that night – so it really hits home.”

Nursing staff and colleagues were well-prepared for a major incident, thanks to training that is regularly updated. A&E and trauma courses available to Barts Health staff both include major incident training. It is often the focus of monthly teaching sessions, and monthly team days led by the senior sisters also include major incident updates, explained Ms Kidney.

Additional staff were called in under major incident protocols but many also volunteered their services.

“We had a nurse that lived nearby who heard about it, rang me and then came in straight away,” said Ms Kidney, adding that she “couldn’t be prouder” of the way all staff at the hospital responded.

“We had so many nurses in, and they all gave 100%,” she said. “Every single nurse in this department should be immensely proud of everything they did that night – they really came together as a team.”

While casualties were being stabilised in the emergency department or were in theatre, staff in the hospital’s adult critical care unit were ensuring everything was in place to receive them.

Among their number was matron Nicola Rudkin, who usually works Monday to Friday but came in to support her team.

Major incident procedures included setting up a control room in the unit and assessing which patients could be safely moved out of critical care onto a ward or transferred to another critical care unit.

London Bridge area

Special report: Nurses recall silent victims of London attack

Source: Josep Renalias

Borough Market near London Bridge

“Tasks included ensuring we have got enough equipment, disposables, pharmacy supplies, making sure the physical bed spaces were cleaned and set up to receive patients and ensuring nursing staff at the bedside were completing all transfer paperwork as quickly as possible, so everything is done and the beds are available for those patients to move out,” said Ms Rudkin.

Fortunately, that night the usually busy unit was comparatively quiet, she explained.

“We take a lot of trauma within London so are often at our bed capacity and it’s a case of one patient in, one patient out – but that night we had five empty beds,” she said. “It was unusual for us, but it meant our ability to respond was greater and we could respond more quickly in terms of being able to accept casualties.

“In critical care, there is often a delay before patients get to us so we have the luxury of time to be able to forward plan,” she said. “I was able to release one of our nursing staff to go down to the emergency department and into the resus room to support them, because they were bearing the brunt of the casualties at the front door.”

As in emergency, nurses not already on duty were calling in to offer their services.

“We had lots of nursing staff make contact with us. Some were due on duty the following day so our message to them was to stay at home, get some rest, we need you tomorrow as planned,” said Ms Rudkin.

“We kept a list of those that weren’t due to be on duty and their availability,” she said. “At that point in time we didn’t need them, but in a major incident often the first night is not too bad and it’s the subsequent days that you need to maintain staffing levels and the momentum of your response.”

In the days after the incident, the unit did indeed need to boost nursing staff numbers due to an increase in Level 3 patients needing intensive one-to-one care.

On the night itself, Ms Rudkin described the mood throughout the hospital as “fairly sombre”, with the recent attack in Manchester fresh in everyone’s minds.

“Everyone just tried to focus on the job in hand, as opposed to thinking about the bigger picture,” she said. “But when staff were on breaks it was difficult not to look at the television and see what was happening.

“When it came to treating patients, they were able to get on, do their job and do it very professionally,” she said. “However, it did become more emotive once relatives started arriving, particularly if they had been at the scene and escaped injury. They gave their personal accounts and shared their stories and that was quite difficult for staff to process.”

Ms Rudkin told Nursing Time she was immensely proud of the way her team had handled the situation.

“The band 7 nurse in charge of the shift led that shift incredibly well, and staff really pulled together and worked as a team to support, not only the patients from the incident, but also those in our other beds, which were all full,” she said.

Support on offer to staff in the aftermath of the incident includes help from the trust’s in-house clinical psychology team. A series of debriefs have also taken place for individual teams as well as staff hospital-wide.

Barts Health NHS Trust

Special report: Nurses recall silent victims of London attack

Nicola Rudkin (left) during a recent royal visit by Prince Charles and Camilla

“The overall conclusion was that things went very much to plan and we felt we did a good job,” said Ms Rudkin. “Despite that, everyone has been really proactive in thinking: What could we do differently? What could we learn from this? What could be put in place?”

This includes thinking about how systems would cope should there be a much larger incident.

“In terms of scale, this was manageable for us – our unit took six patients but it is not out of the ordinary for us to take six patients on a night shift on a Saturday night,” she noted.

“If this was a different type of incident – a blast with a much higher volume of casualties – then it would be more challenging,” she said. “If the numbers are bigger, what else do we need to do and plan for? It is really good we are asking those questions now, as opposed to being faced with it and not having those plans in place.”

As well as looking at lessons learned, the days after the incident have also been a time to recognise and thank everyone for their efforts. Ms Rudkin was among those to greet Prince Charles and the Duchess of Cornwall when they visited the hospital to express their gratitude, which was “a good morale boost” for all staff.

While all casualties who were treated at the hospital survived, she was only too aware that others lost their lives in the attack.

Those who died include nurse Kirsty Boden who worked at Guy’s and St Thomas’s NHS Foundation Trust. Ms Rudkin admitted that it had been particularly upsetting news for herself and her nursing colleagues.

“This was someone whose career and profession was dedicated to helping people and, even in this terrible incident, she went towards danger to help people again,” she said. “I offered my condolences on behalf of our unit to Guy’s and St Thomas’. It is incredibly sad and could easily have been one of our staff.”

Ms Rudkin, who started working at the Royal London the week following the London bombings in 2005, said the inescapable fact for NHS staff in London and elsewhere was not being sure they would not be called on to deal with similar atrocities in the future.

“In the current climate, we don’t know if or when this is going to happen again. But I am reassured because my team were brilliant and if we do have to face something like this again, then I know we would do the best we possibly could,” she added.

“Incidents like this show nursing and the NHS at its best, in terms of the commitment and team spirit, and the fact people are willing to drop everything and come to work and help in any way they can. It shows how much our staff care and says a lot for us as a profession,” she said.

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