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President’s update: December 2017

Black Friday was once the term the emergency services designated for the Friday before Christmas itself, because of the large numbers of inebriated people staggering out of their work parties, and ending up in A&E or a police cell. But more recently it has Americanised, and now is usually used for the Friday after Thanksgiving, marking the start of the Christmas season and the busiest shopping day of the year. Or perhaps it refers to any Friday when Donald Trump tweets.

But all of those at the RSM during this year’s Black Friday will remember it for a different reason.

At around 4.30pm the police started to receive reports of shots being fired at Oxford Circus tube station, or along Oxford Street, or even at Bond Street. Crowds of people started running out of the underground and into the street. Within minutes there were other reports as well – one national newspaper, ever helpful, switched its front page to a report of a truck being driven at shoppers. And so it went.

And so went a lot of people running into the RSM – mainly shoppers plus the entire staff of the cosmetics and lingerie department of the House of Fraser department store. Staff quickly took the decision to let the several hundred people streaming in our direction into the building, proving as ever that common humanity and co-operative behaviour is always to the fore in these situations.

By now we were also seeing messages from the police advising all buildings in the area to go into lockdown, which is also part of our own emergency plan, and which we then did. So we now had 300 or more people in the building – we haven’t seen such a rush since the Hawking vs Hunt show in August. The place was overflowing, and everyone was going to have to stay inside until the all clear came.

But the building had not been empty when the alarms sounded. Far from it. We already had a full crowd for our Patient Safety Day amongst others. So what to do? Staff started distributing water, brought in chairs, and provided information, easily the most important intervention in these circumstances. But that was still not enough. And at this point we entered the stuff of legend.

One of our speakers was the irrepressible Mark Stacey, an obstetric anaesthetist, ready to talk on safety and childbirth. But the auditorium was now packed with a rather different audience. And so he switched his presentation to one on sesilience and stress at work. And this being 2017, people started to first to watch, then listen, and then Tweet.

And when this got picked up by Jack Monroe and then Sue Perkins, Mark aka @Airwayman1, entered the world of legend. Being Twitter of course, the spirit of Pedanticus remains alive and well, as some started to spot the occasional grammatical error in his slides – I suspect with their tongues firmly in their cheeks.

Afterwards we were deluged with supportive letters and emails from members of the public and also from those whose day on patient safety had been so rudely interrupted by events, dear boy, events.

I wasn’t there that afternoon. But I must declare an interest in what happened. As I write this, I am about to chair the annual get together of our multi-centre research unit, which goes by the somewhat cumbersome title of NIHR Health Protection Research Unit in Emergency Preparedness and Response. And what we do is study from a variety of perspectives how we respond to emergencies, exactly like the Oxford Circus tube incident of last Friday.

I could, and do, bore for England on this topic, but will restrain myself and just make four points.

First, all the media without exception described the scenes at “panic”. They were wrong. Exiting a tube station where you believe you are under attack is not panic. It’s the sensible and right thing to do.

Plus it is what the police are telling you to do. Every time you watch clips of people racing out of Brussels Airport, or from Westminster Bridge, watch carefully. There will always be heavily armed police at the back shouting at people to do just that.

There are very few situations where a genuine panic takes place – the classic and frequently lethal one is a fire in a crowded place such as a nightclub with the means of exit are blocked. Left to themselves most people evacuate in an orderly fashion – the evacuation of the World Trade Center buildings on 9/11, was organised by the people themselves, rather than the emergency services.

And as ever, altruistic behaviour usually comes to the fore. Subsequent accounts told of how those escaping made sure to help those with disabilities down the stairs. And during the 2005 London bombs there were numerous examples of altruistic behaviour.

Time now to make someone blush. Step forward Group Captain Craig Staniforth, until recently the President of our Military Medicine Section, who organised the symposium that I chaired a week previously, together with our moving Service of Remembrance. He received a bravery award for helping people on the trapped and smoke-filled train at Edgware. Not as a member of the emergency services, but because he was a passenger. Read what he did here.

Second, rumour and lies. It is increasingly apparent that a large section of what is said on social media during and immediately after one of these incidents is at best exaggerated, and at worst invented[1].

It’s an area we are actively researching at the moment. For that reason responsible media, such as the BBC, will be careful not to broadcast everything they are seeing on Twitter, and will stick close to trusted sources, such as the police or London Transport. We should all do the same.

Third, just as people rarely panic in the short term, we also know that populations are often much more resilient than we give them credit for[2].

For example, in the build-up to the Second World War, it was a fixed belief by everyone in authority, that when the bomber “got through”, in Baldwin’s famous phrase, the result would be panic. People would flee the city, workers would refuse to come to work, rates of psychiatric disorder would soar, morale plummet, and we would lose the war almost before it started. Now we know that didn’t happen.

There were isolated pockets – control was lost in Belfast and Birmingham, but only for a night, and there was a terrible civilian stampede at Bethnal Green Tube station that cost 173 lives [3], all three events being covered up. But these were atypical, and in the end historians conclude that the greatest damage done to mental health was not the actions of the Luftwaffe, but the forced separation of families and the evacuation of thousands of children[4].

And finally, we are getting good at this. The incident was “declared” at 16.00, and the first police response was one minute later. Impressive. But even more impressive was that everyone was stood down just 90 minutes later. During that time the services managed to establish that there were no gunmen, lorries, unexploded bombs and so on, and that the cause was two men fighting on the platform. That’s really impressive, although it was still long enough for the hashtag #prayforlondon to trend on Twitter [5].

And so back at the RSM our unexpected guests had only a brief stay with us before being allowed back into the Christmas lights. They were not only safe, but thanks to our local hero Mark Stacey, also much better informed.

To contact the President you can email or follow him on Twitter @WesselyS



[1] Here Is All The Fake News About The Manchester Terror Attack. Buzzfeed News.

[2]Simon Wessely, S. 2004. Victimhood and Resilience. The New England Journal of Medicine.

[3] WW2 People’s War. BBC.

[4] Jones, E., Woolven. R., Durodie, E., and Wessely, S. 2004. Civilian Morale During the Second World War: Responses to Air Raids Re-examined. The Society for the Social History of Medicine.

[5] We should also collectively pause for a moment and reflect on the fact that on the same day over 300 worshippers at a mosque in the Northern Sinai were murdered by terrorists linked to ISIS. Yet there was no hashtag for them as far as I can see.

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