When Karim Brohi, a trauma surgeon, was called to work at the Royal London Hospital at 11pm on Saturday, he was faced with a dozen seriously injured patients and no idea what would happen next.
“The biggest challenge is you’ve got a number of people lined up, more coming in, and you’ve got to rapidly determine where someone needs emergency intervention but you haven’t got long before you need that bed bay for someone else,” he said. “In the receiving phase, you’re completely on your own. You don’t know if you’ll be restocked with blood or how many patients or what the injuries are. You have to treat the hospital as completely isolated and protect blood, staff and resources.”
The Royal London, in Whitechapel, east London, dealt with 12 victims. Last night five hospitals across the capital continued to treat 36 of the 48 who were injured, with 21 remaining in a critical condition. Stab and crush wounds were the main causes of serious injury, requiring immediate surgery to stop patients bleeding to death or succumbing to brain damage.
More than 80 health staff were deployed to the scene to help prioritise the most severe cases and health chiefs praised paramedics who were on the scene within six minutes.
Theresa May visited the 14 patients who were taken to King’s College Hospital in south London, eight of whom are in critical care, while 12 patients, half of whom are critical, are still in the Royal London.
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Professor Brohi, 48, who acted as surgical commander on the night of the attack, said that the most crucial task was prioritising injuries. “Triage is a fundamental part of it — at the scene, at the front door of the hospital, at theatre. Who’s the sickest, who needs surgery, who can wait?” he said.
Once the most life-threatening injuries have been identified, surgeons can operate to repair the immediate damage. Within an hour and a half of the attack, more than 40 consultants had been called in and Professor Brohi was making decisions on which of the 12 victims needed surgery.
The Royal London is one of four major trauma centres in London and deals with horrific injuries every day. “It’s no different in terms of the things we were treating. It’s different in terms of the volume that was dumped on us in a short period of time.
“The whole system is geared up to make order out of chaos. I don’t think anyone in the hospital thought ‘this is a scary situation’. There are 27 major trauma centres around the country and their reason for existing is exactly this.”
For a unit that sees 40 or 50 serious cases a day, a surge of 12 is a busy day but by yesterday the hospital was getting back to normal. “If we’d had an incident the size of Paris or the Kabul bombing [which killed 130 and 90 people respectively], that starts to put a level of strain on the system,” he said. “But we felt we were within our capacity.”
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Malik Ramadhan, the Royal London’s divisional director of emergency care and trauma, said the hospital’s resuscitation bays were fully staffed within 30 minutes of the attack and praised the nurses, surgeons and doctors who volunteered to come to work. The hospital will be reviewing how to offer support to them as well as the victims and their families, he said.
“People who have gone through an experience more horrific than I can imagine were just sitting on trolleys, not speaking to anyone,” Mr Ramadhan told the Today programme on BBC Radio 4.