The emergency response to 7/7. Flaws with the Family Assistance Centre

The emergency response to the terrorist attack of 7/7 was successful but in the event of further attacks or natural disasters there is room for improvement, Melanie Henwood suggests

Fourteen months after the terrorist bombings in London on 7 July 2005, two reports were published reviewing the emergency response.(1),(2)

The professionalism – and, indeed, heroism – of those involved in the emergency response has been well documented, and these reports again underline the vital contribution of the front-line response.

However, they also acknowledge that support for survivors and the bereaved could have been better, and there are some vital  issues for those providing humanitarian assistance, including social care agencies and the voluntary sector. While these findings are of direct relevance to the London bombings, they have a wider relevance to all civil contingencies.

The report by the London Regional Resilience Forum observes: “As far as we know, not one person lost their life because of a failure of the response. Many lived because of it. That is the true tribute.” Important as this is, the survival of people on 7 July is not the sole criterion of success and the recovery phase of emergency response services is in many ways just as important as the immediate “blue-light” response.

The voluntary sector played a significant role in many areas of the response including responding at incident sites; helping at the temporary mortuary, setting up and staffing the telephone support helpline; setting up first aid posts at railway stations; providing personnel for the casualty bureau, and helping with establishing and supporting the Family Assistance Centre.

Even before the 7 July attacks, guidance issued as a result of the Civil Contingencies Act 2004 had noted: “The recovery phase and the structures, processes and relationships that underpin it are harder to get right.”

It is not surprising then that the  overnment’s own report on the lessons learned from the emergency response acknowledges openly that “there was more that we could have done in supporting victims, their families and friends, especially immediately following the attacks”.(1) This is difficult territory, populated by multiple agencies with different skills, and getting an integrated and adequate response is not always straightforward.

How support for survivors and the bereaved could have been better raises issues particularly about the provision of information and of practical and emotional support. Contrary to what might have been expected, reception centres were not established immediately after 7/7. The failure  to do so meant that there was nowhere for either survivors or concerned friends and families to go.

This led to the much-reported spectre of people desperately searching for loved ones on the streets and in hospitals, posting “Missing” notices at stations and of some survivors simply being left to wander off and look after themselves.

Details were not collected from many of those directly caught up in the bombings which in turn meant “many survivors were left with no access to information and practical support to help them deal with what they had just experienced”. New guidance was issued in October (by the Department for Culture, Media and Sport and the Association of Chief Police Officers) reinforcing the importance of immediately establishing reception centres after an incident.(3)

Family Assistance Centre
Although reception centres were not established, an assistance centre was opened on 9 July. This was the first time that a Family Assistance Centre (FAC) had been established in the UK. Not only was there no prior experience to inform development, but there had been no forward planning because the guidance document on humanitarian assistance was still being drafted, was not in the public domain and had not been seen by the emergency responders. That it worked as well as it did is testimony to the commitment and professionalism of those involved. The FAC was intended to offer a one-stop shop facility to survivors, family members and friends.

Although there was much to applaud in the work of the FAC, many survivors did not hear about the centre, and some who did thought it would not be for them because of the reference to “family” assistance. A multi-agency debrief organised by the resilience forum concluded that “the word ‘family’ had been unhelpful and misleading, deterring some individuals from attending”.

The new guidance has redefined the concept of the FAC in terms of humanitarian assistance centres and emphasises centres’ importance in terms of ensuring people are properly informed about the existence of centres and addressing the multiple roles that they must fulfil.

The FAC continues to operate and in September 2005 was renamed the 7 July Assistance Centre. In addition to providing practical advice and emotional support, the centre facilitates contact between survivors or bereaved families and it is hoped that these groups will develop into selfsustaining support networks. Even after more than a year since the bombings, the centre continues to take on new clients. Not surprisingly, the first anniversary of the attacks was expected to lead to an upturn in demands on the centre as people relived their experiences.

The area of psycho-social support potentially involves a wide range of agencies, although social services have the overall lead responsibility for the initial response. The role of the NHS is also particularly important, especially for people who may need long-term specialist support after an incident such as a terrorist attack. It is believed that up to a quarter of people who  experience a traumatic event go on to develop post-traumatic stress disorder. It is now recognised that specialist counselling provided too soon after an event not only fails to prevent long-term effects, but can be harmful. Guidance issued by the National Institute for Clinical Excellence in 2005 cautioned against routinely providing debriefing as a response to trauma and recommended “watchful waiting” in the initial weeks.(4)

While trauma counselling should not generally be considered until at least six weeks after an event, in the interim it is important that people receive good support and this is a further reason why an assistance centre needs to be at the hub of response. As the government’s report remarked, “the quality of help received in the first few hours and days can determine for years to come people’s reaction to a terrible event of this sort”.

The willingness in civil contingency planning to be self-critical is a vital step towards ensuring improvement. The London  Regional Resilience Forum undertook an immediate multi-agency de-brief process to capture lessons. In October 2005 it began to address the issues identified. The Civil Contingencies Act created a framework for building resilience based on clearly defined roles and responsibilities and partnership working. The terrorist attacks in London provided a critical test of that framework and relationships. For the most part it worked well. Where it did not, the reasons have been identified and necessary steps to remedy the situation are being addressed.

MELANIE HENWOOD is an independent health and social care consultant. In 2005 she undertook a learning review for the British Red Cross of its response to the London bombings.

TRAINING AND LEARNING
The author has provided questions about this article to guide discussion in teams. These can be viewed at
www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

ABSTRACT
Two reports have addressed lessons from the emergency response to the London bombings on 7 July 2005. Both highlight major achievements in the courage, professionalism and humanity of the emergency services, but also underline the conclusion that more could have been done to support people caught up in the attacks. The importance of improving practical and emotional support has implications for social care agencies and the voluntary sector.

REFERENCES
(1) Addressing Lessons from the Emergency Response to the 7 July 2005 London Bombings, HM Government, 2006
(2) London Regional Resilience Forum, Looking Back, Moving Forward: The Multi-Agency Debrief,  2006
(3) Humanitarian Assistance in`Emergencies: Non-statutory Guidance, Department of Culture, Sports and Media, 2006
(4) Post-traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care, National Clinical Practice Guideline Number 26, National Collaborating Centre for Mental Health, 2005

This article appeared in the 23 November issue under the title “A suitable response”