CHAPTER 6
Harnessing the trained volunteer
Introduction
While planning is essential to meet the demands upon emergency services arising from major disasters, this chapter is confined to the more localised disasters and accidents and indeed to events which may or may not develop into unexpected disasters or present other serious problems for the services.
In this respect I wish to concentrate on the support which can be, and is, given in varying degrees to the statutory services. In particular to First Aid, and sometimes more advanced medical back-up, given by St. John Ambulance.
For the benefit of readers from countries other than Britain and the Commonwealth (where St. John Ambulance also operates), St. John is an organisation composed of people of all ages, including doctors and professional nurses, who voluntarily give their time to be trained in first aid, nursing and other allied subjects. Members do not get paid, their work is entirely voluntary. They are readily recognised by their familiar uniforms when attending events where large numbers of people gather. Funding is also primarily by voluntary donations.
During the more than one hundred years that have passed since our foundation we have generally worked in harmony with the statutory services, the police, ambulance and fire brigade, but during the last thirty years we in London have been able to develop particularly close relationships with these statutory services at all levels. Before then I can still remember the time when I first became involved with the organisation and operation of public duties in London when our arrangements with the police were mainly through exchanges of letters (always very polite I assure you!). With the ambulance service we often had 'discussions' as to whose ambulance should take a patient to hospital!
This quickly changed and we had face-to-face, frequent productive discussions. Now we meet on a regular basis with all the statutory services and, although still remaining independent, we are part of a very strong team, and we are recognised as such. Much of our specialised training in London is now given by these services. All our vehicles are thoroughly inspected annually by the London Ambulance Service. At all major events all our ambulances are controlled by statutory ambulance officers so that all vehicle movements are integrated.
So the first, and in some ways the most important lesson I have learned – and one which I commend to everyone – is not merely that there should be close co-operation, but that positive and continuous efforts should be made to establish friendly links with one's opposite numbers. Only in this way will the inevitable hiccup be cured in the shortest possible time – the time involved in picking up the phone or calling round in person.
The role of St. John Ambulance in emergencies
What therefore would be our role in London in a major incident? Primarily the call would emanate from the London Ambulance Service or the Metropolitan Police and, according to the gravity of the situation and nature of the incident, it would be either ‘stand by’ or proceed to a specific rendezvous point.
It must be borne in mind that as we are a voluntary, part-time service our response time could be up to two hours. We do not have a body of full-time members permanently on call. Therefore, if the incident can be dealt with within that time we will not be needed at the scene of the disaster. Even if the statutory services cannot cope with the problems within that time, St. John Ambulance may still not be directed to the scene. Instead we may be sent to ambulance stations to take over the role of the statutory ambulances and crews allocated to the disaster, to handle routine emergency ambulance calls and to provide personnel to designated hospitals.
Our Mobile Units which are Mobile Unit First Aid Stations (normally a well equipped converted or specially made single deck bus) can be sent direct to incidents. They are currently used at public order events or traditional ceremonial occasions. In all types of disasters or major incidents they can be invaluable as many minor injuries can be treated to avoid hospitalisation or if necessary can be used for stabilising serious casualties awaiting transport to hospital.
The support which can be given by St. John Ambulance throughout the country to the statutory services depends largely on resources of personnel, vehicles, and other equipment, not forgetting the vital role of radio communications. Although our ambulance and first aid staff are all volunteers, the material resources all cost a great deal of money. St. John Ambulance is a charity dependent entirely upon the goodwill of industry, charitable trusts and the general public for finance and though we in London have enjoyed excellent support from these quarters, it is my impression that some other counties are not so fortunate.
I cannot emphasise this point strongly enough, firstly because we cannot do our job properly unless we are properly equipped, but – just as important – our volunteers, particularly the younger ones, are not prepared to give up their valuable time if they are expected to use second-rate equipment. I know this only too well from personal experiences.
Weaknesses in current emergency planning and management
Within disaster planning and management in Britain today an important question is whether the British approach to disaster and emergency planning matches the level of threat posed by accidents and disasters as recently experienced and as pessimistically anticipated. Perhaps I can concentrate on one area in which I have been very much involved, namely Safety in Sports Grounds, to point towards an answer.
Following the Bradford Football Ground fire in May 1985 I took a personal interest in the Popplewell Inquiry because I was very much aware of the inadequacies of medical provision at major sports grounds. Following the Interim Report of that Inquiry, I discussed with the then Greater London Council the recommendations relating to the medical content of this report (Home Office 1988).
A clear and concise paragraph was inserted in all Safety Certificates issued to Football Clubs in London and following the abolition of the Greater London Council the licensing role was designated to the Licensing Officers of the thirty-three London Boroughs. A similar role is performed by county and local authorities in the rest of the United Kingdom.
When the Fire Safety and Safety of Places of Sport Act 1987 was passed in Parliament it unfortunately did not include any reference to medical requirements. The Home Office passed all responsibility for the stipulation of these requirements to local licensing authorities. Eventually I carried out a survey of all football grounds in England and Wales through my St. John counterparts and soon found out that licensing authorities were not performing their role adequately and some grounds had little or no medical/first aid facilities. Some had no accommodation and others totally inadequate accommodation.
I therefore entered into correspondence with the Home Office requesting that they add a more definitive clause to the Act making adequate provision of first aid facilities a mandatory requirement. I again emphasised this point when I met the Minister of State but the Home Office would not accept our recommendation. In my letter of reply I prophesied that one day another serious incident would occur which could embarrass the government. Some weeks later the tragedy at Hillsborough occurred, subsequent to which the government appointed Lord Justice Taylor to hold an Inquiry. The Interim Report was published at the beginning of August 1988 and made recommendations – the majority of which the Government said should be implemented at football grounds without delay. In the Report the work of the St. John members on duty was praised.
As I indicated earlier I am responsible for the twelve London Clubs which had already made significant progress since the Bradford fire. Three of the Clubs had already built new First Aid Posts and others have done so since. Within a week of the Hillsborough disaster all London Clubs had agreed to purchase substantial quantities of additional capital items and are now fully equipped.
I do not know if similar progress has been made outside London – but we must ask once again do we have to wait until there is a tragedy before we provide proper and adequate accommodation and equipment which in any case should be available. I am sure, however, that lessons have been learned. Time will tell whether these are fully effective.
Although not spelt out in the Report the vast majority of the trained first aiders – one to a thousand spectators – will be provided by St. John Ambulance. These volunteers need to be highly trained and to be readily able to assist should any emergency arise. We must ask whether the evidence of the approach to disaster planning in the context I have outlined gives us confidence that this is sufficient.
Other aspects
Although I have spoken about the important role played by St. John Ambulance in a disaster situation there are of course many other voluntary organisations who contribute equal support and the real support to the statutory bodies comes from those voluntary organisations who are in close contact with them on a regular and continuous basis.
What else do I consider essential?
(i) The statutory services will in the event of a major disaster welcome the support and assistance of the voluntary organisations but more especially those who are well organised and highly trained. Together with the statutory services we must constantly consider and develop plans to meet emergencies of all types.
(ii) There is an urgent need to modernise, improve and increase the medical resources of the recognised support organisations; in particular, ambulances, mobile first aid units, radio communications and medical equipment. At present these are only obtainable by us from donations, gifts or fund-raising events. Our sister organisations in Germany are more fortunate as they are supplied with money or equipment for nearly all their front line and disaster items from either insurance companies, the Church or government.
(iii) If we have more resources, including residential training centres, I am sure it will encourage more young people to join and practice regularly the techniques and expertise which they would employ in an emergency. They will become competently trained and regularly tested in their particular skills. Young people will respond but only if we have the right type of equipment and adequate and realistic training facilities. I know only too well in London how helpful have been the police, ambulance service and fire brigade, but this unfortunately is not the case throughout the country.
There is in London, as many of you will know, a co-ordinating body, namely the London Fire and Civil Defence Authority, which is responsible for co-ordinating the major disaster plans of all thirty-three London Boroughs. In addition there is the Joint Executive Emergency Committee which co-ordinates the St. John and Red Cross activities under the auspices of Regional Health Authorities. Hopefully in this chapter I have presented the value of, and the need for, the trained volunteers.
Recent developments
Lord Justice Taylor's Report was published in 1989 and defines adequate facilities at football grounds which include attendance of statutory ambulances and trained first-aiders (Home Office 1989). The following is an extract from that report:
First Aid, Medical Facilities and Ambulances
The scale of available medical facilities has been the subject of controversy. After Hillsborough, there were complaints of insufficient basic equipment such as stretchers. I repeat what I said in my Interim Report at paragraphs 298 and 299:
“298. It would be unreasonable to expect, at any sports stadium, medical facilities capable of dealing with a major disaster such as occurred. To have in advance at the ground, oxygen, resuscitators, stretchers, other equipment and medical staff sufficient to deal with over 100 casualties is not practicable.
299. What is required is a basic level of provision for first aid, for professional medical attention and for ambulance attendance, together with a system of co-ordination with the emergency services which will bring them to the scene swiftly in whatever numbers are required. What will amount to an appropriate basic provision for the future, e.g. the equipment in a first aid room, requires expert evaluation and advice.”
The Scottish ambulance service has developed a ’major incident equipment vehicle’ designed and equipped to deal with up to 50 casualties. It is packed with 50 stretchers, blankets, and medical supplies and is in effect a travelling storehouse for such equipment. A vehicle of that type is deployed in addition to other ambulance attendance at matches with crowds over 25,000. This provision goes a long way towards meeting the criticism raised after Hillsborough and I recommend that it be adopted elsewhere.
I repeat the Interim Recommendations I made under this heading subject to two variations. First, it has been sensibly urged that it is unreasonable to require a medical practitioner to be present throughout a match where attendance is very small. At such a match it is suggested that to have a medical practitioner on call would be sufficient. I agree with this and recommend that the full-time presence of a doctor should not be required where this is no reasonable expectation of more than 2,000 spectators attending.
Secondly, some clubs have told me that they can secure private ambulance services more economically than those from the appropriate ambulance authority. They accordingly wish to have freedom to choose. I modify my Interim Recommendation in deference to this argument by requiring at least one fully equipped ambulance from, or approved by, the appropriate ambulance authority should be in attendance at all matches with an expected crowd of 5,000 or more.
REFERENCES
Home Office (1988). Committee of Inquiry into Crowd Safety and Control at Sports Grounds – Interim Report (Chairman: Mr Justice Popplewell), (Cmnd 9585), HMSO, London.
Home Office (1989). The Hillsborough Stadium Disaster, 15th April 1989. Inquiry by the Rt Hon Lord Justice Taylor, (Cmnd 765), HMSO, London.
SECTION SUMMARY II:
The current malaise
The five chapters in this section provide a critical perspective on emergency planning and disaster management in Britain. The section focused primarily upon the shortcomings of institutional arrangements and policies and aspects of the disaster management process conceptualised in Chapter 1, which also demonstrated the string of severe accidents, emergencies and disasters which occurred in Britain in recent years. The model developed in Chapter 1 emphasises the complexity and interrelated nature of the disaster creation and management process. These processes extend well beyond the local and even the national levels, through both the machinery of European government and the activity of national and international non-governmental organisations in the environmental arena.
Certainly, the existing arrangements for hazard and disaster management, especially those for emergency planning, appear to be performing poorly. We might reasonably ask what is being done to improve the situation?
The answer is that much is happening in terms of problem recognition and consensus forming within professional academic circles, but that too little has happened in terms of new policy or action on the ground. There are now many conferences and workshops on the subject of disaster management and emergency planning; there is growing academic activity, for example the Disaster Prevention and Limitation Unit has been established at Bradford University; new journals are appearing; the emergency planning professional bodies are more organised and projecting a near-unified set of demands; and the government has held a Review of arrangements for dealing with civil emergencies in the UK. However, for some time policy change has been negligible; emergency planning policy has been constipated by the fixation of civil defence wartime emergency planning; and the government continues to treat peacetime emergency planning as a low priority.
The Review
The Home Office Review was based on a discussion paper released in 1988. Comments were solicited and a senior level seminar held on these. Finally, in June 1989, the Review was released.
Those who were hoping for any major changes were to be disappointed. The arrangements stand more or less as before, with the addition of the Civil Emergencies Adviser. As no new resources are to be made available to the newly named Emergency Planning College it is unlikely to be able to have any impact for some time. Of considerable interest is the Civil Emergencies Adviser, as he is the major outcome of the Review. His appointment was timely and his tasks, set out in Chapter 2, are formidable, yet he appears to have no authority to change anything and has very limited resources. To his credit the Civil Emergencies Adviser has consulted widely and submitted his report quite rapidly. It is by no means clear that he and his recommendations have political support or that his views will not be emasculated by forces associated with the civil defence review and the recently announced review of local government arrangements following the government's review of the ‘poll tax’.
The assertion concerning political support is reasonable given that the Review is essentially a document protecting the existing system. Furthermore, the opportunity to announce policies for dealing with hazard and emergency management, or to establish a conceptual framework was not taken. Experience elsewhere has shown the difficulties faced by a relatively powerless agency (the US Federal Emergency Management Agency) charged with trying to coordinate or influence large government departments. Presumably an individual will find the task even more difficult.
Failure to learn
The Times (15 August 1989) pointed out that:
‘One lesson has emerged repeatedly from the recent inquiries into disasters, including those at Zeebrugge, King's Cross, Hillsborough, Clapham Junction and Lockerbie. In every case someone had given warnings which were not taken seriously enough …. The same must not happen in the case of pre-disaster planning itself.’
Disaster learning takes place basically through direct experience or through sharing the experience with others, training, effective debriefing, and critical independent reviews. Of course, individuals and organisations must be receptive to criticism, able to respond positively and prepared to adapt. However, both sharing experience and training appear to have been poorly catered for in Britain. In Chapter 5 Moore points to the political nature of inquiries. There is a strong case for the whole issue of learning from past experience to be more institutionalised. The Civil Emergencies Adviser's awaited revisions of the Home Office Guidance Notes promise to be just one small step forward in this learning process, important as this step may be.
Resistance to change
From a variety of perspectives, the contributors to Section II and others report on the result when positive change has been advocated. Whether the issue is legislative change, safety at football grounds, planning for accidental radiation releases (Barker 1990), the safety of ferries (Cook 1989), or the provision of information about chemical hazards to those at risk, there is a strong resistance to change. Reasons for this are explored in the next section.
A key example concerns legislative change which Gainsford calls for in Chapter 3. The major organisations in emergency response in Britain strongly advocate that local authorities be given a statutory duty to plan for civil emergencies. They argue that a statutory duty would help ensure that the necessary resources are forthcoming. The government, through the Home Office also rejected Fenton's suggestion (Chapter 6) that the provision of first aid facilities at sports grounds be mandatory. And this after the Hillsborough disaster, and after a survey by Fenton showing that local authorities were not performing their role adequately.
Milne-Henderson puts the question most directly when she asks why, given all the feedback, quality control appears to be so limited and how a system which is demonstrably inadequate can be maintained.
Absence of national policy
National health and safety regulations, and the occasional application of common law as a test of performance provide some uniformity to British emergency planning and management. However, there is no legal requirement for emergency planning and ‘no national uniformity of guidance for the production of such documents’ (Gainsford). Relief has been particularly ad hoc. Absolute uniformity would be impossible and stifling, but the absence of any explicit national policies over and above those likely to appear in revised guidance notes, makes the establishment of priorities and the allocation of resources difficult. Arguably this failure prevents adequate linkage of hazard and emergency management: an essential prerequisite for progress.
Concluding comment
British disaster management, and emergency planning in particular, has been locked into a ‘no change’ policy position for some time – the ‘current malaise’. There are now some positive signs of this position being lubricated but the consistently low priority afforded to this policy area by central government, and wider economic and political issues, threaten to continue to prevent some constructive change. The next section considers some underlying explanations of the malaise affecting disaster management.
REFERENCES
Barker, F. (1990). The role of local government in the national response plan for dealing with overseas nuclear accident, paper presented at Emergency Planning in the 1990s, Disaster Prevention Limitation Unit, University of Bradford, Bradford.
Cook, J. (1989). An accident waiting to happen, Unwins, London.