Examination of Witnesses (Questions 960
WEDNESDAY 17 APRIL 2002
ROBERTS OBE AND
960. But you would have to make a decision because
people would be ailing considerably. You would have to make a
decision half an hour, one hour, two hours, three hours, before
the specialist military units arrived to tell you what you were
(Mr Roberts) Yes, but we do have some intelligence
on what the most likely things which might be used are. We have
some kind of information about some of the signs and symptoms,
if you like, which might be produced by one type of agent. In
the beginning we are going to be dealing with things in that kind
of generic way. Our experience after the white powder incidents
was that it was sometime before you could get confirmation or
otherwise of what you had been dealing with, and that led us to
over-react on many occasions.
961. May I pursue this question of the potential
co-operation of the armed forces which you described as being
a bonus, and suggest that there is no kind of formal arrangement
in place. Are you undertaking any exercise with the military in
particular in relation to detection, decontamination and cleansing
in respect of chemical warfare?
(Mr Roberts) We are actively working with the military
at places like Winterbourne Gunner and using their experience
and their equipment. Detection is not generally something that
the Ambulance Service would tend to get involved in, quite frankly.
I am not aware there are any formal agreements. I think you would
have to address that question probably to the Department of Health.
That is where I would expect those agreements to come from.
Basically, at a local level, we tend to rely
very much on the common sense of the first responding crews and
that gives us real worries, and secondly, on the arrival of police
or fire to give us a first line. The first question is do we go
in or not and it is how do we stop the first attending crews who
will naturally want to go in from not going in because we cannot
drive around every day going to every incident that might be a
chemical or biological one in full PPE even if we had it on every
962. The point is there is an arrangement which
you have with the army which is more co-operative than the concept
of a bonus which is that they might pitch up in extremis.
(Mr Roberts) I think if they pitch up it will be a
bonus. We have got arrangements with them for training and other
things and, of course, if we request military assistance it may
arrive. Personally I am not clear about any time that has happened
and I know London have had a bit more experience in terms of working
with the military in exercises.
(Mr Bradley) Yes. The police have got arrangements
to be able to activate the military in certain circumstances.
Certainly over sustained incidents the military would be used.
963. On police initiative not on yours?
(Mr Bradley) Absolutely.
964. Do you exercise with the joint NBC regiment?
(Mr Bradley) No.
Patrick Mercer: It is not available.
It is deployed.
965. If you can get to Kabul they will be able
to help you.
(Mr Roberts) I am not an expert on much of anything
but the advice we have been given is that the military NBC is
perhaps a little bit different from the type of situation that
we would be trying to deal with in many significant respects.
We are trying to learn from them those parts which might be relevant
966. On 11 September many brave people in the
emergency services rushed to the World Trade Centre and did what
you were saying, straight in to save lives. In doing so they were
subsequently killed when the building collapsed which nobody foresaw.
Has there been any re-evaluation of slowing down the response
time? It sounds very odd but somebody has to consider that the
danger they put themselves in if the building collapses is enormous,
not least the loss of life, the loss of the facility to carry
on afterwards. The question is whether or not a hesitation should
be brought in to be careful that they do not get killed if a building
collapses before they have had a chance to save lives.
(Mr Roberts) I think there has been a lot of thinking
about this. The reality is that fundamentally protecting yourself
is an ingrained bit of your training. You should be making that
assessment every time you answer an emergency call. It might be
as simple as whether you are going to get some kind of blood borne
contamination or much more dramatic. At the end of the day though
when the adrenalin is running and you see those things happening,
it is very, very difficult to prevent the crews following their
instinct basically. Very often the first arriving officer in many
incidents has to pull them back, that is probably his first job.
967. How much was finally collected by the ambulance
services throughout the country? I know the West Midlands was
truly incredible. Several hundred thousand pounds was raised for
their colleagues in New York.
(Mr Roberts) I do not think we have a figure for the
Ambulance Service as a whole. Most ambulance services worked with
their local fire services to raise money and then sent it across
to their colleagues. It was a significant figure.
Chairman: It was truly amazing.
968. Gentlemen, a few technical questions on
protective equipment. We have covered some already but if you
do not mind I am going to go into it in a bit more detail. Asking
a general question: what types of protective equipment does the
Ambulance Service have, not necessarily just nuclear, biological
and chemical but what types of protective equipment do you have?
(Mr Roberts) Do you want to answer the general bit?
(Mr Bradley) Apart from the CBRN type of equipment
which is only issued to the specialist staff who attend the incidents,
we just have the normal infection control equipment which you
would expect to find in a hospital coupled with normal hard hats,
radio, telephone and reflectorised jackets and things like that.
969. The general protective equipment is held
(Mr Bradley) Yes.
970. The specialist stuff, where is that located
exactly, the nuclear, biological, chemical, CBRN stuff, where
(Mr Bradley) In London it is personally issued to
those people so they carry it themselves.
971. It is not a central store?
(Mr Bradley) No.
972. The equipment that you have got, the CBRN
equipment you have got, presumably it is designed primarily to
deal with an accidental chemical spill. How suitable is it for
the wider protective role for perhaps biological attack or a more
complex biological attack?
(Mr Roberts) I think the specification for the equipment,
it is not the gas tight suits, it is meant to be for working in
the warm zone rather than the hot zone. As you know, when we are
dealing with an incident, the seat of the incident, the highly
contaminated bit would be dealt with by the fire service and that
is the hot zone and there would be a cordon around that. In the
warm zone, that is where we do the decontamination and that is
where this equipment is intended for people to work. It is not
the gas tight army or fire service type suits. We have had a working
party for two years basically looking at what kind of level of
protection you should offer, what will protect against what and
for how long and what filters to use. Some of that discussion
is still ongoing. The equipment which has been issued currently
affords general protection against most of what could be commonly
used, so contaminants, but not biological.
(Mr Roberts) As I say, the biological issues, in a
way that is a health surveillance a week down the line issue rather
than for ambulance services answering 999 calls except, of course,
for the white powder: "what are we dealing with here".
The national working party on that is still sitting because the
police and fire have not decided what equipment they are going
to wear in the warm zone either or what specification they will
use. We do have this Department of Health national committee still
sitting and it has decided now that another set of personal protective
equipment will be available from this March, so that is just about
coming through, which offers greater protection against a wider
range of things and for longer periods. The doctrine I think we
are adopting currently is that nothing offers complete protection
against everything for always.
974. How much interface has there been with
the Ministry of Defence for the national specification?
(Mr Roberts) I could not really answer with any degree
of certainty because the working party is a Department of Health
one and it is one of the working parties where we feel we need
more representation on because it is our people who have to wear
these suits so confidence in them is a big issue for us.
975. From a relative layman's point of view,
it strikes me that the armed forces have gas proof suits. Interestingly,
you mentioned earlier on that you reckoned there is only 30 minutes
durability of working in the equipment that you have currently.
The standard Ministry of Defence suit has got much greater durability,
they will be in that suit for a much greater period of time although
there will be a degree of degradation. It would seem sensible,
I would have thought, to purchase and perhaps adapt or just a
straight purchase from MoD stocks. Has that been looked at?
(Mr Roberts) I think it has been considered. As I
say, I am not an expert in the matters. My understanding is that
the military protective equipment is basically designed to protect
the soldier so he can continue to fight so it is a bit about weathering
the storm whereas I think there is a balance somewhere between
equipment that you can work in, from a health care point of view
you cannot do much in a gas tight suit. You cannot even talk to
976. That is true.
(Mr Roberts) There are differing operational needs,
if you like. I am fairly certainyou could certainly check
it out with the Department of Health who run this Committeethat
the military experience has been captured by this organisation
called the National Focus who look at chemical incidents.
977. Moving on, if I may, it has been said there
has been a lack of involvement in this process by those who are
going to be most at risk, ie the front line staff, in these discussions
in the choice of equipment and consequently there is a lack of
operational confidence amongst the staff. You have talked already
about confidence and the lack thereof. Could the staff have been
more involved in this process? Does it help to improve confidence?
(Mr Roberts) Very personally I think it would, yes.
I think the Ambulance Service involvement, that is one of the
issues we have had about not being involved. If we are expected
to put people in there, they have to be pretty confident about
the decisions which have been made and simple things, the military
in particular and the police as well, they expect people to wear
suits and work in them, they have usually gone through a process
probably at Winterbourne or somewhere where you can wear the suit
and test it and be confident in it, and those facilities are things
which we are only now starting to access. We put this kit out
there and we have said to people "This is how you put it
on. This is what you do with it" but at the end of the day
they have never been in a situation where they know it works.
978. Is the lack of confidence in the process
of making decisions or in the equipment itself when it turns up
on the ground?
(Mr Roberts) It is probably in the fact the decisions
have been made without involvement and therefore we do not really
understand basically. You cannot involve all the 17,000 ambulance
people around the country in the decision, but as the managing
authorities we have to find a way of making them confident in
the use of the thing in case they have to do it for real.
979. Presumably an increase in confidence will
come with an increase in familiarity, which means a higher degree
(Mr Roberts) Yes.