Dr Hartle is a consultant anaesthetist and intensivist at St Mary’s Hospital in Paddington. When the 7/7 attacks struck London in 2005, he treated casualties from the Edgware Road Tube bombing. His comments that the 2012 games had brought closure to London after 7/7 during a chance meeting with Lord Coe, were described by Lord Coe as a ‘seismic moment’ and he named that conversation as the moment of the Games that stood out for him. Dr Hartle was President of the Association of Anaesthetists of Great Britain and Ireland from 2014-2016. The full transcript is available here.
The two of us had just gone through the double doors into the anaesthetic room when the trainee’s pager went off, and I sort of rolled my eyes ‘cause I was assuming it was going to be cardiac arrest somewhere, the trainee was going to disappear and I wouldn’t see them again for a couple of hours. But it actually said, ‘Major incident at St Mary’s’ which wasn’t what I was expecting and maybe turned a bit cold.
I’m pretty certain that almost as soon as I arrived in resus someone mentioned bombs and that all of a sudden the very cold reality check that that’s not the sort of thing people make up, that’s not a rumour.
“Almost as soon as I arrived someone mentioned bombs”
We were all just waiting and no one knows anything, it’s the sense of the unknown and also sense of anxiety. Although I’d been in the military I seem to have spent vast amounts of my career doing exercises and practising for major incidents, I’d never actually done one.
The First Casualties
Our very first patient arrives and there’s so many different bits of that mental picture that I can’t forget. I’ve never seen anything like it. He was covered in soot and smoke and black from top to bottom, absolutely devastating injuries.
The paramedic who I knew quite well was a very sensible chap, the sort of guy you would want to be there and he just looked unlike I’d ever seen him before. He had his day-glow jacket which was covered in soot and dirt and whatever, and he was bright red in the face and the sweat was pouring off him and clearly… he was in control but he wasn’t the normal calm, whatever he’d been to and seen was clearly utterly different from anything he’d ever seen before.
“The resus bay was just absolute carnage”
When the first patient left the first bay and went up to theatre, a huge gaggle of people around them, that resus bay was just absolute carnage. I mean the floor was soaked in blood and clothes and bandages and dressings and all sorts, it was just… and I can remember the cleaner turning up with his mop and bucket and he just got on and started cleaning the bay ready for the next one in the middle of all this chaos this guy was basically just doing his job, which to say so, we were all just doing our jobs, we were just doing slightly not the job we’d expected to do when we got there.
Virtually none of the patients could hear you, they were all deaf, an awful lot of them had got eardrum injuries enough ENT surgeons don’t have a big role in a major incident. So I got hold of them and they came round and started seeing all these patients with tympanic injuries. So they all got their ENT review really very quickly.
One of the things I’ve thought about recently is that with a major incident like this, each hospital becomes very introspective, you know what’s going on at your place but you’ve no idea what’s happening at Charing Cross or Hammersmith or Chelsea and Westminster. The mobile phone network had completely crashed, which was probably predictable, and so we improvised quite a lot for communication within the hospital. We used runners, lots of medical students turned up to help and I think they quite wanted to be on the action. They were incredible useful for carrying messages. And I think they were perhaps a bit disappointed that that’s what they were used for. The use of runners goes back to ancient times on the battlefield. And it has to be said medical students are a slightly better calibre of runners because the message doesn’t get garbled, they were very effective.
“We are going to work as normal tomorrow. We are not going to let the terrorists shut us down”
I remember having a conversation with chief executive about what are we going to do tomorrow. And I can remember him clearly saying, ‘We are going to work as normal tomorrow, we are not going to let terrorists shut us down.’
One of the things I’m particularly proud of, even after all these years, each patient that got to St Mary’s survived, no one died.
Actually there was quite a lot of pride that we’d done a good job and that everyone was still alive. The orthopaedic surgeons had been in theatre for most of the day amputating and debriding so they had probably had a far more difficult day than I had, ‘cause actually my clinical experience, my shock, had been very focussed in the first 30-40 minutes so they’d been exposed to it all day. God forbid that I ever have to do it again, though very often with major incidents you focus on what happens in the emergency department and resus and then the immediate live saving at surgery, but you forget that there’s a whole tail of patients with lesser injuries or patients who go back to theatre, that the knock-on effect for theatres is for days and days afterwards.
“One of the things I’m particularly proud of: each patient that got to St Mary’s survived, no one died”
We actually know that it’s a very tried and tested terrorist tactic, it was used a lot in Iraq, it was used a lot in Afghanistan, you set off one device, injure a couple of people and then you wait an hour and you set off a second device to take out the rescuers and the medics and everyone that’s come in. And I do know that the guys that I saw I consider genuinely were heroes because they were pretty certain what they were going down to and it’s quite clear to me that certainly the first patient would not have survived if the paramedics hadn’t gone in and got him out because he would’ve had his cardiac arrest not in resus bay 1 but in a tunnel and he wouldn’t have survived. So he certainly owes his life to some very, very brave paramedics who did their jobs and got him out, but put themselves at considerable personal risk.
Reflections & Silence
I suddenly stopped thinking about it as just a doctor who treated some patients and I began to think about it as someone who lives in London. Now quite by chance on the Monday, Tuesday and Wednesday of that week I had been on a district line train going through Edgware Road tube station at ten-to-nine – going in the opposite direction; I wouldn’t have been on that train. I always assumed this wouldn’t happen to me ‘cause I walk to work, I live close enough, I walk to work, but actually I analysed and said, actually you do travel on the tube and who’s to say it hadn’t been the Wednesday or the Tuesday or whatever. The impact it had on London was astonishing, the one bit of the tube I use regularly didn’t reopen for three months and I began to think of it much more as an attack on London and on me, than I had done on the Thursday.
I can remember a very, very emotional moment the following week on the 14th when they were going to do the two-minute silence. I didn’t know who would respond, I knew I wanted to go and have my two minutes. And I wasn’t really quite sure what the public response to this would’ve been and I can remember being completely gobsmacked looking out over Paddington Basin and just seeing hundreds, hundreds of people, possibly even thousands, but just emptying out of all the office buildings and just a sea of people there and very, very moved, got slightly tearful that this was the public response. And that was mirrored across the whole of London, the whole of London had responded to this and I think it was viewed by most people that this was an attack on London and there were 50-something very unlucky victims who died and many hundreds of people who were injured, but this could’ve been any of us and I think there was a sense of vulnerability; this could have been me.
The only thing that anyone had been talking about on the way to work on the 7th of July was the Olympics. And I wasn’t actually a great fan, I wasn’t hugely supportive, I thought it was going to be a huge disaster and I was planning to go away for the whole of the Olympics.
The difficulty was that that classic same footage of Jacques Rogge announcing the award of the games and the crowd going absolutely bonkers in Singapore and in Trafalgar Square and then I went to work and then the bombings happened. So those two things were just linked. And as we got closer and closer to the Olympics those clips kept being shown and I couldn’t separate them.
“The Olympics and bombings were just linked. And as we got closer and closer to the Olympics those clips kept being shown and I couldn’t separate them”
Just when the torch hit London and people got really quite excited that there was just something in the air that again was quite different to anything I’ve ever experienced. And I can remember just this sense of excitement and quite emotional feeling, I couldn’t explain why it was, maybe it was that this journey seven years in the planning and whatever was coming over. And I sorted of realised, I had a good cry at the opening ceremony, I don’t know why but there were tears streaming down my face. And then I went to the ExCel the next day, first day the sports started and I kept having to pinch myself and say, ‘You are actually here, this is the Olympics.’ But all the anxiety had gone, it wasn’t about the bombings anymore.
A rather strange coincidence of my life was I was on the tube travelling to ExCel on the Monday morning, a stop after me Sebastian Coe got on the tube train and I didn’t even recognise him. We nodded to each other than he came over and chatted to me and then we moved apart, and then I rather school-boyishly asked him for his autograph in my Games Makers log book. So we started talking again and he said thank you for being a volunteer and I said thank you for bringing the games to London and making it such a success and we sort of danced backward and forward about who was thanking who. And I actually said, ‘I think this has been really important to me because I was there on the 7th of July and this has been a huge success and this has been closure and it’s shown that London is not just about the bombings, London is about something fantastic.’
“London is not just about the bombings. London is about something fantastic”
And I think quite a lot of people felt some disquiet that the Olympics were almost ignoring the 7th of July, ‘cause I think for many people those two events were completely linked. I think quite a lot of us thought that if the bombings had happened on the 5th of July and not the 7th of July London wouldn’t have got the games and it would have gone to Paris. And then little did I know that obviously whatever I’d said had made quite an impact on Lord Coe because he then mentioned me in an interview on Radio 5 Live, the middle weekend of the games.
So the next thing I know I’m doing all sorts of press interviews and stories and stuff, which was interesting and I have some interesting stories to tell and I was saying lots and lots of nice things about the Games Makers ‘cause the Olympics was a truly amazing experience. But I did feel slightly fraudulent ‘cause I didn’t do anything during the Olympics, I just expressed an idea that I think resonated with a lot of other people. But then it obviously did make an impact because Seb Coe then talked about that in his closing speech and his Made In Britain speech at the Paralympics. I think I just put into words what an awful lot of people were thinking. After seven years I can now separate the Olympics, because they’ve actually happened and they were better than we ever imagined from the 7th of July, but I suspect I will still, if I see that film clip, think about them but the Olympics now stand in their own right.