Lessons Learned: Mass Casualties and Communication Gaps

Emergency communications is key to incident management – and critical, both during and following, mass-casualty incidents (MCIs). On 7 July 2005, four suicide bombers detonated bombs between 8:50 a.m. and 9:47 a.m. on three underground commuter trains and a street bus in central London. Those bombings broke down the below-ground communications infrastructure, making it impossible to communicate with passengers trapped underground and extremely difficult to communicate with incident command agencies, and hospitals, in close proximity to the mass casualty incident.

The first bomb was detonated at 8:50 a.m. on the eastbound Circle Line train traveling from Liverpool Street to Aldgate station. One minute later, the second bomb exploded on a westbound Circle Line train leaving Edgware Road station for Paddington station. At approximately 8:53 a.m., the third bomb detonated, on a southbound Piccadilly Line train traveling between the King’s Cross and Russell Square stations. The fourth bomb exploded at 9:47 a.m. on the top deck of a double-decker bus at Tavistock Square. The four attacks caused 52 deaths and an estimated 700 injuries.

London’s primary emergency response organizations began responding to the incident by evacuating and rescuing victims at the four bombing sites. However, there were a number of passengers trapped inside the underground tunnels who could not be reached immediately because the explosions had so severely damaged the trains’ communications systems. Many passengers were totally unaware, of course, of what actually had happened and did not know if emergency responders were aware of the situation and/or if they were on their way to help. Smoke coming from the bombed compartments created additional fears among the surviving passengers. The overall confusion and panic was exacerbated considerably by the fact that the train drivers could not immediately communicate with the passengers or issue evacuation instructions.

Follow-Up Actions & Recommendations

According to a well researched follow-up report (Emergency Communications: Improving Communications with Train Passengers Trapped Underground following a Mass Casualty Incident – a Lesson Learned available only on Lessons Learned Information Sharing [LLIS.gov]), the London Assembly investigated the bombings and later recommended that Transport for London (TfL) – the principal transport service agency managing London’s entire transport network – update its train communications systems to help station staff and emergency responders provide critical information to train passengers much more quickly following a mass casualty incident. In any emergency incident, of course, communications should be initiated as soon as possible to alleviate confusion among victims and emergency responders.  In mass-casualty incidents, hospitals in the vicinity also should be quickly alerted so that they will be ready to respond and receive incoming patients as soon as possible.

Incident Management: Alerting Hospitals in Close Proximity to a Mass Casualty Incident – another Lesson Learned exclusive to LLIS.gov – further elaborates on the London Assembly’s recommendations that all hospitals in close proximity to a mass casualty incident be notified about the incident much more quickly, even those hospitals that have not been specifically designated as “receiving hospitals.” Following the London bombings, the National Health Service (NHS), the United Kingdom’s largest public healthcare provider, quickly alerted all designated receiving hospitals in London to increase their readiness, but did not formally notify specialist and non-acute care hospitals relatively close to the incident sites – apparently because those hospitals were not on the official list of receiving hospitals.

Unfortunately, many specialty hospitals located in close proximity to each of the casualty sites – e.g., the Great Ormond Street Hospital (GOSH), a specialty children’s hospital – did not know about the train bombings until paramedics arrived at the hospital asking for equipment and other assistance. Nonetheless, even though the GOSH staff had not been fully aware of what had happened, they were able to quickly set up a field hospital and to help emergency responders rescue and treat a number of injured victims. Staff members later commented that they would have benefited from NHS guidance on how to respond to the incident had they been notified at the same time as the staffs on the original list of receiving hospitals. The London Assembly’s report recommends that London’s emergency plans be amended to provide early notification to all hospitals in the vicinity of a major incident, even those hospitals not designated as possessing major accident and emergency departments.

Mass casualty incidents, whether caused by terrorist attacks or natural disasters, usually happen very quickly, and communications infrastructure is critical in maintaining the discipline and order mandatory for incident-command and emergency-response situations. Taking to heart the lessons learned from the July 2005 bombings and applying them to local and state operations plans will and should help mitigate miscommunication problems in future incidents and eliminate other communication gaps that may already exist.

Note: For additional information on mass casualty incidents and other content from the former LLIS.gov website, visit https://www.hsdl.org/c/