Select Committee on Defence Minutes of Evidence

Examination of Witnesses (Questions 980 - 999)



  980. How much training goes on with those who are specialists in this field?
  (Mr Roberts) Again London is different, so I will let Peter answer for London. Generally, the training has been fairly local. We have not got a national doctrine, so what do you train in unless you know what you are training for, so I think there should be a step-by-step approach. Once we have the doctrine and the operational procedures in place, there needs to be a robust training programme. If you take the police, for example, there are 6, 8 or 10 people at Winterbourne Gunner paid full-time to take out the training to the police service. We have been able to borrow somebody from the London Ambulance Service and put him down there part-time for a few months, but there is a cost attached to it. Those are the kind of things we need to deal with with the Department of Health.
  (Mr Bradley) The training is a week's course at Porton Down but I think the police and fire are looking to set up a centre of excellence at Winterbourne where there will be a training centre for these types of incidents. All three services, we understand, will have access to that training. The London Ambulance Service training is a week-long training course and, helpfully, our specialists have had the opportunity to go through the white powder exercises, which was invaluable experience, since last September.

  981. What is your target level of those trained to deal with this?
  (Mr Bradley) 150 by the end of July.

  982. And as a percentage of the service?
  (Mr Bradley) That is around 7 per cent.

Mr Howarth

  983. Can I ask you an ancillary question on this. You have spoken about the difficulty of ambulance staff working in this equipment and the difficulty of communicating. Can you tell us about this at a practical level? How is a member of the Ambulance Service working in this cumbersome kit going to be able to communicate with the patient?
  (Mr Roberts) You can actually speak in the kit we have, it is not gas-tight. What we found with gas-tight kits was that you cannot communicate at all with the patient. The kit we have is a ventilator kit with air flow so you can speak to the patient, although with some difficulty. That is going to be particularly important in terms of people who are frightened, who are trying to be decontaminated; you really do need to do that. We did have some practical experience of that in London because we did decontaminate a reasonable number of people after the white powder incidents, and you can communicate with them. But there are other things as well. If you are going to do any treatment, you have to be able to feel, and you either have to compromise with your gloves or have two sets on.

  984. So there are some real, practical difficulties there which the national doctrine needs to address?
  (Mr Bradley) Yes. There are things like using warm water rather than normal cold water for hypothermia. There is also the fact we have to undress all the casualties completely, which is quite disconcerting, so it does require a degree of expertise and understanding by both staff and by the casualties.


  985. Thinking the unthinkable, if there is an absolute catastrophe and there were 30,000 casualties, how the hell would you fit into that process? What role would you have?
  (Mr Bradley) That is one of the big issues now which is exercising our minds. Mass decontamination is a huge problem because the through-put of casualties through a proper decontamination process is something in the 20s per hour; small numbers. So when you get into an incident involving thousands, a whole host of things are being considered, for example, using sprinkler systems in multi-storey carparks and things like that. We do not have a solution for mass decontamination. As Gron Roberts has said, trying to herd, as it were, patients or casualties through a process in itself presents practical difficulties. What we have found from previous experience is people are self-presenting to A&E departments who are then contaminating the accident and emergency departments, so there are huge issues which remain at this stage unresolved. We are working through them.

  986. When will they be resolved?
  (Mr Bradley) To be frank, I am not sure the scenario we have just talked about can be resolved. Is that fair?
  (Mr Roberts) Yes. Human nature is to run away from these incidents and then go to where you would normally seek treatment, your local hospital. The sarin incident showed us that self-evacuation is going to be a big problem, and therefore however good our plans at the front end, hospitals are going to have to do something about decontaminating at hospitals. There is not much evidence around about decontamination, not in a civilian way anyway, so we do not know what the best method is or how much is really necessary. Some people say that with many of the gases, for example, by the time you come to decontaminate, if you take their clothes off, 80 per cent of the contamination will have gone anyway. There is a lack of research evidence to say this is how we should do these things. We are learning by doing and we are getting better every day.

  987. Seven or eight months after the crisis, one would have hoped that some thinking would now be a little more concrete.
  (Mr Roberts) I suppose one could hope that, that might have been the case. I think we are still distilling the lessons, we really are.

  988. But if a fresh crisis had come on fairly close to the 11 September incident, we would have been caught totally unprepared. There is a limit to the time one can pontificate on options and taking action. So far, fortunately, nothing has happened but there was no God-given certainty there would be no incident in this country after Washington and New York.
  (Mr Roberts) 11 September was not a chemical or biological incident.

  989. No, but there could have been a catastrophe.
  (Mr Roberts) I suppose we could argue that where we were a bit slow, and I would accept it, is that the sarin attack happened in 1996 in Tokyo and we are now running to catch up with the chemical lessons which we have had a lot longer to learn. As I say, emergency services in this country are quite good at dealing with major incidents, but with major catastrophes with 5,000 patients, the planning scenario shifts. You might do that if you are in Italy or Greece or Turkey where they have earthquakes, but we are not particularly well prepared in this country for that kind of casualty number.

  990. You feed into this civil contingency planning operation, and no doubt you would be an integral part of the process, but do you think local authorities are the best organisations to deal with major, major catastrophes, or might there have to be some other form of structure established, such as central government imposing structures if it is deemed local authorities can really only cope with the crisis up to a certain level?
  (Mr Roberts) I am not sure it is a structural issue. I think it is about how people work with each other. In a sense, if you look at the Health Service, it is outside the local government system as well, so wherever you draw boundaries there will be problems. What I think 11 September has brought home to us is that although the local approach to major disaster planning is still probably where things are most effective, CBRN incidents, large-scale incidents, disaster-type incidents, will need a national focal point, will need much more joint work than we thought in the past. I suppose the floods and other things which have happened in parts of this country had also started to shift our thinking to, "This will be beyond the capacity of one local ambulance service, one local health authority", so is it about creating a parallel structure or is it about making sure the structure we have learns to work well together.

  991. That is an interesting point, thank you.
  (Mr Bradley) I want to say during the six months when we did have the white powder incidents, London Ambulance Service did respond to other counties to help deal with their incidents. I think it is, as Mr Roberts has said, about mutual aid, having good arrangements in place. I think most services suffer from a degree of parochialism and there is a need to recognise that there are times when you cannot cope and services cannot expect to be able to resource up for those very rare events and therefore we have to have good robust systems for mutual aid.

Mr Howarth

  992. The Chairman said that we are now seven months on from 11 September and I will be interested to know whether you feel there really is a sense of urgency in tackling this? You have outlined to us this afternoon quite a range of difficult, technical issues which need to be addressed, the need to establish a national doctrine. We could have been subjected to an attack, we could be subjected to an attack now given that we are deploying combat troops into Afghanistan. Do you get a sense from your perspective as the Ambulance Service that there is a real sense of urgency to resolve these matters and they are not being allowed to drift?
  (Mr Roberts) I do get a sense that there is still a sense of urgency. The sense of urgency was heightened post 11 September, it was running at fever pitch for a few weeks. There is always a danger in these things that we are 12 months on and nothing else has happened and all the enthusiasm disappears; I do not sense that this time. I sense that there is a real engagement with the issues. Some of the issues are not amenable to short term fixes and there are still issues about funding.

  993. As long as we are clear there is a sense of urgency around. That is the answer to the question.
  (Mr Bradley) Can I just add to that. I think the important point is for us all to recognise that issuing personal protection equipment to ambulance staff, that could be seen as a quick fix and that is not the answer. It is important that the impetus is maintained once the equipment has been issued because it is more than just that, it is the ongoing support.

  994. We were talking a moment ago about decontamination and there has been a change in the responsibility from your Service to the fire service. I understand that the Department of Health and the fire service have recently agreed a memorandum of understanding which gives the fire service responsibility for decontamination of mass casualties accompanied by around £50 million extra funding to enable the fire service to equip itself for this role. Were you consulted about this change? Would the Ambulance Service have preferred to have retained that role if the appropriate resources had been provided to you rather than the fire service?
  (Mr Roberts) Were we consulted? Yes, I think we were party to the discussions. The memorandum of understanding as I understand it does not give the responsibility to the fire service. The responsibility for decontaminating casualties remains with the Department of Health and in small numbers it remains with ambulance services and they have just been issuing equipment for us to do that. Where the fire service comes in is where there is mass decontamination, where basically everybody knows the quantity of water that is needed to squirt all these people down. Yes, they have been given £50 million which we would have liked as well and we have still got arguments about money. At the end of the day, I do not think we have delegated the responsibility. What the memorandum of understanding says is that they will support the health service in doing that. As the Ambulance Service, we still see it as primarily our responsibility. We will welcome, certainly, their assistance when there are mass casualties involved. Many of these people will be victims rather than casualties. We may need to start differentiating between people who are or might have been contaminated but are well and those people who are injured or ill as a result. As Mr Bradley says, with decontamination units, particularly if you have got stretcher cases, you are going to be lucky to put 20 to 30 people an hour through those things whereas if people have just been in the general area, you squirt them with water, that is mass decontamination.


  995. I was just pondering if there was a major disaster, 30 an hour.
  (Mr Roberts) It would take us a long time.

  996. It would take some time before you had got through the number of people.
  (Mr Roberts) Yes.

Syd Rapson

  997. You have talked already about your pride in the NHS and hopefully in a few minutes we will be doing something positive as a Government to assist in that. Can I go on to the emergency planning review. There was a review which came out The Future Emergency Planning in England and Wales and there was a consultation period until October last year. Most respondents were very supportive of local authorities having a lead role and the ambulance, for example, being a partnership in this arrangement, a sort of secondary position. 80 per cent of the respondents were fire and police, and it is not usual with local government backgrounds that they favour this. I wanted to tease out are you happy to support the proposals to be in this partnership arrangement with the local authorities having a lead nationally?
  (Mr Roberts) As I said previously we were not consulted and that in itself was an issue. We have made that point to them. Yes, generally, I think the public safety agenda is something which the Ambulance Service have a part to play in, as do other health services, but we also have a health service agenda to discharge. We work in partnership with local authorities day by day by day on accident prevention, on campaigns of various kinds, and we are very comfortable quite honestly in terms of local authorities having the overall strategic responsibility for public safety in their area. We do not have an issue on that.

  998. When you say you were not consulted, was it open for any consultees to put in information or were you waiting for someone to say, "Have you got a view on this"? Most consultations would be pretty widespread and would say, "Have you got something to say?"
  (Mr Roberts) I am not actually sure what the consultation process was. We managed to get hold of the consultation document after the closing date. You may say that means we were not very pro-active, but I do not think we knew the exercise was going on. That is typical because health services are health and local authorities and emergency planning are in a different silo sometimes in departments.

  Syd Rapson: You have been very loyal.

Mr Cran

  999. Just two questions, because time is pressing, on the Civil Contingencies Secretariat. That is pivotal in the situation we are in at the moment, the bringing-together, doing the thinking about what we do and how we react and so on and so forth. Can you tell the Committee what your experience of the CCS has been and your participation in it?
  (Mr Roberts) Our participation in it more latterly has been increasing by the day, so we have been asked and involved a lot more by them than we were. Again, we were swept up in this business of, "Ambulance is health, is it not, so if health is there, so is the ambulance service." What we have been trying to say to them in the past three months is that is an assumption they should not make. We welcome the fact there is a cross-government focus on emergency planning and contingency planning because it is the only way and we are looking forward to working a lot more closely with them.

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