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Train accident in England 1999 – KAMEDO-report 80

The Kamedo-reports are published by the Swedish Disaster Medicine Study Organisation (Kamedo), at the National Board of Health and Welfare. Observers study the medical, psychological, organisational and social aspects of disasters. The results, with a focus on experiences gained, are presented in the reports.

This report is entirely in Swedish. Only summary in English.


The train collision that occurred on 5 October 1999 near Paddington, London, resulted in 31 dead and nearly 300 injured. The cause of the crash was that one of the engine drivers passed a red signal. A public inquiry, however, proved that multiple concurrent factors were behind the crash and contributed to the extent of the injuries. The inquiry resulted in recommendations for improving safety on English railways.
The pre-hospital medical response was led by the London Ambulance Service (LAS) and can most accurately be described as an application of the “Load and Go” philosophy. Despite the large number of injured, normal treatment principles could be applied, mainly due to very high access to ambulance resources and the ability to distribute the injured amongst several hospitals. The problem for the emergency command team was that they had too many resources, rather than two few.
The rescue effort was carried out according to the London Emergency Services Liaison Panel (LESLP) Major Incident Procedure Manual for interagency cooperation amongst emergency services organizations, which was implemented in London in 1993.
The major incident procedures evolved as the result of a number of train crashes and bombings, and worked to full satisfaction. The rescue effort was praised by the media and in the subsequent inquiry.

The observers’ conclusions
The disaster management plan formulated over the years by London authorities and organizations was rapidly deployed after the accident outside Paddington Station. This was one of several reasons that the entire emergency action proceeded with no subsequent evidence of significant problems. When disasters occur, it is important that a major incident is formally declared in time. Also, all individual organizations that are actively involved in the disaster response must be able to formally declare a major incident, even if there is some risk for “redundant declaration.”
The first fire brigade forces arrived quickly on the scene and fire fighting efforts began early. As in other transport accidents where a great deal of motor fuel was ignited, however, the fire was explosive. Fire fighters were forced to concentrate their efforts to the adjacent carriages. The passengers sitting in the fire-ravaged sections could not be saved.
The system of rotating command responsibility for medical response to major incidents seems to work well. The various levels of command in the English system, which are similar to those in Sweden, are described using simpler terminology than in the Swedish organization. Simplification of the Swedish terminology would probably clarify our Swedish command functions.
The English ambulance service has a strong position and role in managing disaster response efforts. This enables control over how the injured are transported to various hospitals, but it does require special training of the ambulance personnel who are called to the scene. Likewise, coordinators at the hospitals are essential.
When disasters happen, medical transport resources are seldom a problem in modern societies, but rather the resources often seem to be underutilized.
Problems with overloaded communications systems are common when major incidents occur. Concurrent utilization of multiple systems – landline telephones, mobile telephones, radio – is essential. Certain radio frequencies should be reserved for disaster situations. This worked well at Paddington Station.
With the exception of large regions in the third world, hospitals in advanced societies are well-equipped to manage disaster situations. When major incident plans exist and are applied, personnel flow in as needed, surgical resources are mobilized, and adequate numbers of hospital beds are readied. The volunteers who offer help are seldom needed.
A disaster often entails injuries to both adults and children. Accordingly, hospital disaster plans should include rules of action for taking care of injured people of all ages.
Psychosocial care programs are well established at all levels in the English major incident organization. Even the police organization includes “family liaison” officers to provide support to the families of the dead.
Computer systems are of tremendous value for registration and identification of everyone involved in a disaster. The Swedish personal ID number system is eminently useful in this context.

Read the full Summary


Susannah Sigurdsson
+46 (0)75 247 30 00