The Millennium Dome is expected to bring up to 12 million visitors a year to one of London's most deprived areas. Will Greenwich health services be able to cope 12 months from now? Wendy Moore reports
It could be a scene from Apocalypse Now. In less than 400 days, staff throughout the NHS will have to cope with the casualties generated by two weeks of partying, binge drinking and general public mayhem, possibly exacerbated by chaos caused by year 2000 computer hitches.
For health staff in Greenwich - home of the Meridian line, base for the Millennium Dome and natural focus for celebrations - the task looks awesome. Not only are thousands of revellers expected to congregate in Greenwich on the night itself, but the Dome, scheduled to open on millennium eve, is billed to attract up to 55,000 visitors a day, a total of 12 million people in the course of the year 2000.
So how will Greenwich health services - with a modest-sized district general hospital set to close in 2001 and typically mixed London primary care serving a heavily deprived population - cope with the demand? Some local primary care staff are worried that Greenwich services will not be cope, causing problems for local people. Karim Jan-Mohamed, who works in the Vanbrugh Hill health centre, next to Greenwich District Hospital, says local GPs believe medical provision at the Dome will be inadequate, and fear the burden will fall on local services.
Alan Bennett, manager of the Fairfield Grove group practice, which is nearest to the Dome, believes extra demand on Greenwich services will be 'inevitable'. But experience elsewhere in the NHS has taught him that Greenwich District Hospital 'will have to cope'.
Greenwich health managers, however, insist the impending challenge is not the end of the world, but a new beginning. While confident they can manage casualties on millennium eve and throughout the year - including contingency plans for a major incident at the Dome - they also hope the ambitious regeneration scheme around the site will benefit the health of local people.
Michael Kerin, chief executive of Bexley and Greenwich health authority, believes the focus on Greenwich is an 'opportunity' for local services to 'do something substantial for health as well as healthcare in the year 2000'.
'The Dome is but one part of a massive regeneration programme going on in this area which will lead to significantly improved housing, job opportunities, a new school and health centre, which ought to have a major impact on people's health in the longer term,' he explains (see box, right).
He is confident that local health services will cope with the extra demand caused by the Dome as long as the likely extent of casualties is accurately predicted and there are sufficient medical services provided on site. Since the HA will receive no extra funds for the task, it will have to calculate carefully likely out-of-area treatment during the celebration period, he says.
David Astley, chief executive of Greenwich Healthcare Trust, believes that extra demand on Greenwich Hospital will be 'marginal', provided the on-site medical care, to be funded by the Dome's organisers - the New Millennium Experience Company (NMEC) - is adequate. The average 35,000 visitors expected daily is fewer than the attendance at a large football match, he points out.
Mr Astley is equally sure that staff will meet demand on millennium eve, when 50,000 people are expected to attend an open-air concert in Greenwich Park, with 12,000 VIPs at the opening party in the Dome and numerous smaller celebrations at the nearby Cutty Sark, Royal Observatory and other local venues.
Original plans meant that anyone taken ill on the night would have visited the brand new Queen Elizabeth Hospital in Woolwich. But delayed opening until spring 2001 - due to protracted private finance initiative negotiations - means the dilapidated Greenwich District Hospital will remain open as the main casualty centre serving the Dome. There is no expected delay, however, to the closure of nearby Guy's Hospital casualty department in November 1999. Mr Astley says: 'We will be able to cope.'
Ambulance crews have also been heavily involved in emergency planning for the millennium. London Ambulance Service is expecting a busy night on millennium eve, but a spokesperson insists that its new computer system - which replaced a much-criticised predecessor - is up to the job. All equipment has been tested for year 2000 problems.
Barry Davies, LAS emergency planning manager for south London, expects 'phenomenal' numbers to descend on Greenwich on the night. Emergency services, which have been developing plans for two years, are considering setting up first-aid posts and even triage centres at various points, as well as banning traffic from the area. All-night drinking will exacerbate the potential problems. LAS is to train Dome staff in first aid, and may also provide on-site ambulances.
'It is going to be a challenge to make sure we get it right,' says Mr Davies. 'But I am fairly confident the work going into it now means we will be as well prepared as anyone else in the world would be.'
But the risk of a major incident at the Dome presents unusual challenges, says Mr Davies, who has had 24 years' experience dealing with emergencies, including IRA bomb attacks. During any major incident, 999 services will follow the usual procedures laid down in the London emergency services liaison panel manual. But the guidance, which details responses to situations ranging from an air crash to a terrorist attack, will need adapting to the special circumstances of the Dome site. Although it will be the largest building of its kind in the world - big enough to hold two Wembley stadiums - the Dome itself presents few emergency problems. Mr Davies says it is regarded as a low fire-risk and the sides open easily for evacuation.
But the site presents unique problems because it is mainly car-free. About 60 per cent of visitors are expected to arrive on the Underground - if finished in time - emerging at the new North Greenwich terminal, the biggest Tube station in Europe. A further 1,000 people an hour are expected to arrive by river at the new Millennium pier. Emergency staff will run several 'live' practices to test responses to accidents at both terminals. Large-scale evacuation might make use of the river, says Mr Davies. A safety boat can take casualties across the Thames to the Royal London Hospital, if necessary.
Experts in providing medical aid at large events - known as 'mass-gathering medicine' - generally support the confidence of Greenwich managers.
Lieutenant Colonel Tim Hodgetts, consultant in accident and emergency medicine at Frimley Park Hospital, Surrey, has helped crowds at Wembley stadium avoid major health problems for many years. As senior medical officer to the stadium, which hosts crowds of up to 80,000, he agrees that demand on local hospitals should be minimal if adequate medical aid is provided on site.
The Wembley medical centre - actually called the 'hospital' - is staffed for major events by three senior doctors, usually consultants in casualty, anaesthesia and radiology, and equipped with
x-ray facilities and six resuscitation areas. It is also backed by nine first-aid posts. Someone with a broken ankle can have an x-ray, get their foot plastered and return home without ever visiting the local hospital, says Dr Hodgetts.
Any large event generates common underlying medical complaints, he says. 'We see it at Wembley all the time. If you have tickets to Wembley and you are sick on the day, you still go to Wembley.' Casualties can range from 0.1 per 1,000 people at a seated event for fairly young people to 40 per 1,000 at a rave. Ailments may include everything from epileptic fits to heart attacks, with alcohol typically doubling the number of casualties. The Wembley 'hospital' opens a room it dubs the 'vomitorium' for events at which alcohol is served. With adequate medical support, only 2 to 3 per cent of casualties should need to be transferred to hospital, he says.
Judith Fisher, consultant in accident and emergency at the Princess Alexandra Hospital, Harlow, agrees. Local casualty services should not need extra resources, she suggests from her experience organising medical cover for major golfing tournaments. About 20 per cent of casualties are due to pre-existing illness. From a typical golfing crowd of 50,000, only four or five would need to attend hospital and possibly one be admitted. 'Most of the stuff is bread-and-butter accidents that can be dealt with on-site,' she says.