Westminster attack: 'You can't help but be humbled by how our staff responded'
When nurses, colleagues and patients found themselves drawn into the centre of the terrorist attack on Westminster this month, just metres from a major London hospital, their response was admirable.
When nurses, colleagues and patients found themselves drawn into the centre of a terrorist attack on Westminster earlier this month, just metres from a major London hospital, their response was admirable.
St Thomas' Hospital is beside Westminster Bridge, where the incident, which claimed five lives including the attacker's, unfolded on March 22.
'We were, in effect, part of a crime scene,' Guy's and St Thomas' NHS Foundation Trust (GSTT) chief nurse Eileen Sills says.
About a dozen staff raced from the hospital to help treat injured people after attacker Khalid Masood drove a car at speed along the busy pavement on the bridge, hitting pedestrians.
He crashed the hired vehicle and then fatally stabbed police officer Keith Palmer, before being shot dead. Three of those struck by the car on the bridge died, and at least 50 are believed to have been injured.
Dame Eileen says the historic hospital's location put its staff in the front line of the response. 'So many of our staff and patients saw what unfolded from the windows,' she says. 'There were hundreds of people with clear views. For nurses, doctors and therapists who witnessed it, the first response was to get to the victims on the bridge. We know a number of staff went out without even thinking about their own safety. They stayed until the emergency services took over.'
Praise for the actions of NHS and emergency services staff flowed on social media as images of staff tending to the injured dominated television and radio reports.
Dame Eileen says that the hospital immediately activated its major incident plan, which included readying the emergency department and relevant teams for casualties.
But the proximity of the attack, and the uncertainty about its potential scale meant the hospital faced extra challenges. The large teaching hospital, which has more than 800 beds, was told to 'lock down' as there were fears there could be more than one attacker. The trust's social media account was updated to tell staff, visitors and patients to stay put.
'We stayed in lock down for 24 hours, which was quite tough for staff and patients,' Dame Eileen says. 'Every entrance was locked and for a short period of time we didn't let anyone leave as we had to make sure that everyone leaving would be safe.'
The hospital took in two casualties from the attack, both of whom have since been discharged. The rest of the injured were taken to other hospitals across the capital, including King's College Hospital and St Bartholomew's Hospital.
For Dame Eileen and many other nurses, the event evoked memories of working through the terror attacks of 7 July 2005, when bombs exploded on three crowded underground trains and a double decker bus during morning rush hour in central London, claiming 52 lives and injuring more than 700 people.
One of the key lessons from the 7/7 attack was the importance of swift support for staff, she says. This time, mental health teams, psychologists and chaplains were made available immediately at GSTT for any staff who may want to talk through what they had witnessed.
'It did bring back painful memories of 7 July. There was quite a lot of emotion,' Dame Eileen says. 'I think anyone who was around on 7 July had a moment during the Westminster attack when they reflected on the events of that day. We wanted to make sure we provided that immediate support and reassurance for our staff, as the impact is quite acute.'
Senior nurses visited wards and departments to speak to their colleagues and provide a visible presence and support, and staff will continue to be offered support, she says.
'The senior nursing team, including myself, walked the floors,' Dame Eileen says. 'It is a simple thing but we wanted to tell all the staff to ring home and let their families know they were safe, as they would be worrying. We went round again the following day and at the weekend. We want to be there for staff who might want to have conversations.'
The hospital had an immediate 'debrief' on the day following the attack, which was open to anyone who wanted to discuss what had happened, and will have another in two weeks' time, three weeks after the attack.
'It was quite eerie while the bridge was closed,' Dame Eileen says. 'But the moment it reopened, traffic started flowing and people were walking and there was a feeling of reassurance, that things were getting back to normality.'
She adds that staff acted with the highest level of professionalism on the day that terrorism came so close to their workplace.
'I am enormously proud of how everyone responded... Our staff were absolutely fabulous. You can't help but be completely humbled by our staff in terms of responding in the way they did.'
The after-effects of a terrorist attack on staff
Being involved in the response to a terrorist attack can have a lasting impact, say leading nurses.
RCN professional lead for acute, emergency and critical care Anna Crossley urges staff to look out for each other, as they can be the first to pick up signs if someone is not coping.
'Everyone is different in the way that they deal with things, and it takes time to process the event,' she says. 'It is so unexpected and, no matter your level of training, you are not ready for that. Your colleagues may recognise if something is not quite right, even if you don't recognise it yourself.'
Deputy director of nursing at Croydon Health Services NHS Trust Mike Hayward, a former emergency planning and resilience manager and former RCN lead for major incidents, is calling for a greater focus in the NHS on psychological support for staff.
'Every NHS organisation has to demonstrate rigorous preparedness and nearly all emergency departments are full of experienced and heavily-trained people who are adaptable and flexible enough to get on top of any major incident,' he said. 'The bit we haven't covered enough is the psychological impact, particularly from a staff perspective.'
He says that employers may not understand the depth of impact that such an event can have, and adds that ongoing psychological support is 'not quite as resourced as it should be'.
While all trusts must have a major incident plan, he believes training and planning is struggling to keep up with changes in terrorist attacks. Following the 7 July attacks, the focus in preparing shifted to bombs and chemical weapons, but attacks in France and Westminster have shown a shift towards hitting people with vehicles, and using guns and knives. 'The nature of emergency preparedness needs to change to address the current threat,' he says.