1. Parish, Colin RN

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More than 50 people were killed and 700 injured in the July terrorist attacks in London; the injured streamed into the city's many hospitals-in some cases literally by the bus-load. And according to one nurse manager, the emergency response from nurses and other health care workers went "like clockwork."


Just before 9 AM on July 7, the entire underground railway network ground to a halt. Initial news reports suggested that a power surge had caused the loud explosions heard at King's Cross, Edgware Road, and Aldgate stations. The three train bombs exploded within a minute of one another, but there was a delay in piecing the information together-and, subsequently, a delay in the emergency response.


But within an hour, after a bomb ripped apart a double-decker bus, it was clear that technical problems were not to blame for the underground explosions, and the city's emergency services put their major disaster plans into action, treating 390 people throughout the city.


Every hospital in London was put on alert, and those closest to the bombings prepared to receive casualties. And as nurses were to tell Nursing Standard the next day, the response was swift and often successful.


The most severe blast injuries were organ damage from shrapnel, limb amputations, head injuries, and burns. The bombs were at floor level on the train cars, so many injuries affected the lower extremities.


The Royal London Hospital, in the heart of the city's East End, treated 208 people within four hours. It's a center for major trauma and has London's only emergency medical helicopter, which was used to shuttle medical teams to the casualty sites while other staff waited for the injured.


Consultant nurse Toni Lynch, the most senior clinical and research nurse at the hospital, says the response of nursing and other staff was "fantastic."


"We had eight to 10 critically injured patients, and four full trauma teams were working simultaneously," Lynch said. "And it really shows: we had just one fatality."


Officials had stopped traffic in the city, including public transportation, but emergency crews realized that large buses would be the most efficient way to transport the wounded. Charge nurse Adam Tinney said there was very little information coming from the scenes of the bombings, so it seemed unreal, at first, when a double-decker bus arrived without warning with 50 or more "walking wounded" on board.

FIGURE. Britains Que... - Click to enlarge in new windowFIGURE. Britain's Queen Elizabeth II is introduced to emergency staff by senior charge nurse Paul Courtman, second from the left, at the Royal London Hospital in London on July 8, the day after the bombings.

"We had to be very flexible in just dealing with whatever came through the door", he said.


Nurse Elaine Cole at Royal London said, "These were ordinary people going about their business who were flung into the most horrendous situation. "They were all sitting there with cuts and bruises and singed hair, but they were handing out business cards so they could keep in touch."


The Royal Free Hospital treated 61 casualties. The hospital's lead accident and emergency nurse, Jane Wadley, said that the staff were prepared and responsive. Many who were called in for emergency response arrived long before the injured did, given the difficulty in getting the injured from the city's underground system.


"At one point we seemed to have hundreds of staff here, and all we needed were the patients," she recalled. "We felt we could have coped with twice the number of patients we had."


As with the terrorist attacks in the United States in 2001, many worried family members and friends left photographs and messages at the scenes of the bombings. They also canvassed the hospitals looking for relatives. A special help line was set up by the Metropolitan Police to coordinate searches for lost relatives, and up to a week after the blasts victims were still being identified.


The Great Ormond Street Hospital for Children doesn't treat adults, nor does it have an EDit's not even expected to respond to major incidents. But its proximity to two of the blasts put it at the center of rescue efforts, and the hospital treated 22 patients with blast injuries and burns. Two triage areas were set up at the front and back of the hospital, and a group of staff went to help at the scene of the bus bomb.


The hospital's director of nursing, Judith Ellis, says there was no choice.


"There was gridlock in the area, and we had to respond-it felt as if the bombings were in the middle of the hospital," she said. "It was quite traumatic for the staff, but they were extremely calm and collected."


Over the last year or so, accident and emergency departments have been under pressure to meet a strict government target: 98% of patients must be seen, treated, and admitted or discharged within four hours. Nurses said their efforts to meet that target paid off on July 7.


Katherine Fenton, director of nursing at the Royal London, said the biggest problem she faced was getting staff home after their shifts. And on July 7 her hospital met the four-hour government target in every case.


60 Years at AJN

AJN production manager Josephine Esposito celebrated her 60th year-that's right, 60 years-with the journal in June. The occasion, attended by dozens of coworkers past and present, was far from a retirement celebration. Jo, as she is known to hundreds of people who have worked for AJN and its parent companies through the years, has no intention of retiring. In fact, those of us who work with her can hardly imagine putting out the journal each month without her well-honed expertise. Using a device known as the "board"-a giant steel-and-wood "canvas" that hangs in our office-Jo coordinates the layout of each issue; the board, which she designed, tracks the evolution of every page, from the placement of ads to last-minute changes.


Jo, a Brooklyn native, began working at AJN right after graduating from high school in June 1945. On VJ Day-the official end to World War II on August 14, 1945-the AJN offices were closed early after the announcement came over the radio airwaves. Jo walked down to Times Square to watch the celebration. Sixty years later she still talks about that day with her coworkers, many of whom weren't born yet-many of whose parents weren't born yet.


AJN 's parent company, Lippincott Williams and Wilkins, honored Jo with a luncheon on June 21 at a New York restaurant and with gifts that included a CD player and CDs of some of Jo's favorite opera singers, as well as a musical performance by New York opera singer Nina DiGregorio, who launched into Mimi's waltz aria from La Boheme-Jo's favorite opera-and "Some Other Time" from On the Town, Leonard Bernstein's love-letter musical about postwar New York City. And Jo beamed, a dedicated worker who started making sure each issue of AJN was shipshape at the same time Bernstein's musical was originally on Broadway-right down the street from her office.-David Belcher, associate editor

FIGURE. AJN producti... - Click to enlarge in new windowFIGURE.
FIGURE. Josephine Es... - Click to enlarge in new windowFIGURE. Josephine Esposito at the