MoD briefs SHAs on war casualties

The Ministry of Defence last week briefed the 28 strategic health authorities about plans to fly back army casualties to the UK in the event of war on Iraq, HSJ has learned.

At the regular meeting of SHA communications leads, discussions centred on the main receiving hospitals and designated airports to take casualties.

Those attending were tightlipped about the content of discussions, but the Department of Health - which hosted the gathering - confirmed that the meeting last Wednesday discussed 'how we need to prepare to bring injured armed forces back from the Middle East' if Britain goes to war.

A spokesman added: 'We discussed a series of processes which would be achieved if necessary to ensure that if casualties were relayed to the UK, the NHS could cope.' He stressed: 'None of this means the use of force is inevitable.'

Communications leads who attended the meeting said they were told to expect guidance shortly about releasing patient information to the public.

Britain has six MoD hospital units integrated with the NHS.

But a high proportion of their staff have already gone overseas with British troops, severely limiting their capacity.

HSJ sources with experience of NHS planning around the Gulf War said that in the event of conflict, acute hospitals in London - and those near military and civilian airports designated to receive casualties - were likely to prepare to take casualties.

Acute hospitals able to respond to the effects of chemical and biological warfare may also have a role in the event of conflict. And three regional centres for plastic surgery and burns located near airports have been identified as possible receiving hospitals for casualties.

Managers at acute trusts said they expected key decisions from the DoH and MoD on where casualties were being sent to be relayed directly from the centre to acute and specialist trusts.

Under current guidance from the DoH's emergency planning unit, distribution of casualties within the UK would be controlled from the medical evacuation unit in Wilton near Salisbury.

Civil airports which might receive casualties have been identified, based on a combination of airport and local NHS facilities.

The list of airports which could be used is maintained by central government.

In the past, the allocation of casualties to UK hospitals followed a four-stage process, with capacity being used first at MoD units, then within nearby hospitals, then across regions and finally across the country. This time the decision is understood to have been taken by central planners to choose from the whole of the NHS as soon as MoD capacity is filled.

Philip Selwood, assistant chief ambulance officer for London Ambulance Service trust, said LAS would expect to be informed when decisions were taken on which hospitals could receive casualties from conflict. But he said no warning had yet been given.

'Planning for that is led by the DoH to ensure the LAS arrangements reflect the need for ambulance transport and medical care between airports and hospitals, ' he told HSJ.

'We would expect to get prior warning and to be involved in discussions. We have had no prior warning as far as casualties are involved, ' he added.

Mr Selwood said emergency planning had altered dramatically since the terrorist attack on the World Trade Center in New York.

'Prior to September 11, we would have thought it was very bad if we were dealing with 50 casualties, or 100 casualties, but since then we have been trying to think in terms of 500 to 1,000.

How does any ambulance service cope with that?'

He said the ambulance service had further refined its protocols following the security threat to Heathrow airport earlier this month which saw emergency planning stepped up.

Mutual aid agreements between LAS and three bordering ambulance trusts close to Heathrow have recently been expanded to cover the area from Oxfordshire to Sussex, and will form the basis for a national memorandum of understanding likely to be published next month, Mr Selwood said.

He said emergency planning - and the recent threat to airports - had a 'significant' impact on management capacity in the service, necessitating 'a lot of high-level meetings' between relevant authorities as well as staff briefings.

Mr Selwood said: 'It is just something we have to do. But we still have to do the day job, to meet the government targets...people are still getting ill and injured and losing their lives all the time, so it is about looking after the core business as well.'

1991: Gulf War support The Department of Health's plan to provide medical support for Operation Granby, the British contribution to the Gulf War in 1991, provides clues to the key issues in NHS contingency planning now.

Restricted documents seen by HSJ were issued to regional health authorities well ahead of action in the Gulf, with RHAs asked to confirm their plans by 21 December 1990, almost a month before Allied operations began on 16 January 1991.

Each of the 14 RHAs had a designated airhead and lead hospital to take casualties.

The airheads were a combination of military and civilian airports.