The Casualty Clearing Station – Dr Abby Astle Team Doctor Kendal MRT

February 23 is always important to me – it’s my birthday! This year, I arrive home at 8.20pm after a 12 hour day at the practice. A few family and friends are there – my husband, Paul, has arranged a surprise birthday curry. We crack open a bottle and sit down to the meal when our pagers go off, ‘Major Incident –train crash at Grayrigg, control ASAP’.

Rapid apologies as Paul and I throw on some kit, grab our maps and torches, switch on the radio and head towards the scene. We radio in to Base and get the grid reference of the access point. As we approach the incident, a sea of blue flashing lights invades the night sky. Quickly, we locate KMRST vehicles and the rest of our team and we begin our well-drilled approach to the incident site.

You can’t get there easily. The fields and tracks are a quagmire which we wade through laden with stretchers, casbags, oxygen and Entonox cylinders and medical equipment. I appoint some folk to ‘stay near me with the medical kit’, while other members assume their roles as radio operators, leaders, runners, scribes etc.

My first glimpse of the fated Pendolino fills me with abject horror. I am about 100 yards from the train that is partially lit by Fire & Rescue Service floodlights. It appears to have fallen down the embankment and the carriages are skewed at odd angles – one of them seems to have upended. There isn’t enough light to see the carriages have not crumpled, so I shiver at the thought of tens dead and many more with horrific injuries, trapped inside amidst twisted, broken metal, darkness and fear. Fortunately, I am prepared. As well as being a GP, I’ve worked in an A&E department. I regularly update myself with pre-hospital emergency care courses, where we train with paramedics, doctors, nurses and the fire services, to deal with the approach to trauma victims with multiple injuries. I also teach the lay KMRST team members skills in immediate casualty care.

I am familiar with the Major Accident plan. Doctors and paramedics are needed to take on leadership of the medical teams. These roles have been assumed by the time I arrive. Doctors may be needed to attend at the sharp end, with passengers trapped on scene. This requires advanced skills such as the ability to anaesthetise – fortunately I know there are some A&E consultants here as well as mountain rescue doctors with advanced skills who have arrived before me in their guise as BASICs doctors. Doctors like me with ‘middle-grade’ experience in emergency care need to deal with the stretcher cases. Other medics will treat the walking wounded.

So I locate the triage centre beginning to evolve. This is the floor of an outbuilding at Bracken Hall Farm. Casualties arrive on stretchers with coloured cards around their necks stating the priority for evacuation. A few doctors, nurses and paramedics have assembled. As a stretchered man is delivered to the barn, I begin the work. Two KMRST cas carers, Jon and Pierre, come with me. We begin the drill working as a team. Airway with cervical spine, breathing with oxygen, circulation, disability. Our role is to identify and treat life-threatening injuries, and decide priority for evacuation. We also gather essential medical information and details of next of kin. The medical card must remain tied to the casualty at all times as he will journey through many stages before being delivered to hospital for definitive care. Nervously, I manage to get a line into his vein and administer some welcome pain relief.

Mountain rescue medical kit is only designed to treat two, perhaps three casualties. We start to think of the potential numbers of casualties and ask KMSRT members to start scavenging incoming ambulances for gloves, clinical waste bags, needles, syringes and medication. The outbuilding begins to feel like an organised medical facility. A paramedic is managing the flow of casualties in and out. We are aware there is some delay and casualties can only be moved three at a time by helicopters. My man will have to wait, which is unfortunate – I think he has internal bleeding as his vital signs are deteriorating. Jon and Pierre monitor him while I assess another casualty.

I am moved. She arrives with a walking wounded buddy who she has met after the crash, together on the ceiling of a carriage. I hear for the first time the now familiar description of the train hitting something and then swaying from side-to-side before careering off the banking. They tell me people were calm and helped each other. I am amazed by their composure, and the girl on the stretcher asks the names of all her rescuers. She is to be married in eight weeks. Emotion takes over and my eyes well with tears, but she is OK and I tell her she is OK and she is very happy.

More time passes. My team colleagues have moved all the casualties out and we wait in anticipation. Then the rumour begins there are no more casualties. My first thought is that there must be many dead. I remember scenes of hospitals in New York in the aftermath of 911 preparing for multiple casualties, but there were few.

I wander outside to stare at the wreckage. Passengers warm themselves round an open fire, drinking tea from polystyrene cups. I’m passed a bar of chocolate and a bottle of water. While I have been focusing on my small job, a great organisational structure has transformed this farmland. Then, good news, there are no more casualties, because the rest have only minor injuries. A fleeting hint of anti-climax rapidly gives way to overwhelming relief.

I spend a couple more hours at the scene searching neighbouring fields for any survivors who may have wandered off and become lost. At 3am Paul and I drive home. We eat cold Madras and drink warm rosé, then drift-off for well-earned sleep.