Next 48 hours are critical in battle to save lives

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Up to 20 people remained in intensive care yesterday - out of 80 kept in hospital. Doctors said the death toll was likely to rise.

Victims with severe burns and breathing problems face the most difficult time. Medical staff will be working to maintain their fluid and oxygen levels but it will not be clear for another day or two which of them is likely to survive.

John Heyworth, a consultant in Accident and Emergency Medicine at Southampton Hospital, said: "The care of burns victims has developed enormously over the past decade. The first 72 hours are crucial. Some in intensive care will die but others will recover. Often it takes 24 to 48 hours at least to get an idea of how severe their injuries are. They face a stormy time."

Doctors expressed quiet pride at the way in which the NHS's major incident plan had worked. Within minutes of the explosions, mobile medical teams were dispatched across the capital to treat victims at the scene and hospitals cleared beds and summoned staff to receive them.

Dr Laurence Buckman, a GP from north London, described arriving at the British Medical Association's headquarters in Tavistock Square, minutes after the No 30 bus had been blasted, spattering blood up the walls.

"It was eerily quiet, everything stopped, not even the birds were tweeting. Casualties from the bus were carried into the BMA's courtyard on tabletops and doors. There were nine or 10 altogether - two died as we tried to save them."

"When I arrived, someone told me to deal with a woman who had chest and pelvic injuries. She was bleeding from her hip. With a colleague, we resuscitated her, sat her up and got her talking so she could tell us where it hurt."

"We had a sudden fear she was going to die and we considered doing a thoracotamy - opening the chest - but the last one I did was 20 years ago and I didn't want to risk it. It was raining and treating a patient lying on a tabletop was not the moment to practise the procedure."

The woman was in shock, which causes a sudden fall in blood pressure because the blood vessels dilate, aggravated by loss of blood from external and internal injuries. It can be fatal unless intravenous fluids - a saline drip - are administered to the patient immediately.

"A passer-by acted as a human drip stand [holding the bag of fluid] and a chef from the hotel next door held her hand. We stabilised her and she went to hospital. In a situation like that, you need IV fluids by the gallon. We almost ran out but then a policeman turned up with an armful in the nick of time. He was like Santa Claus - I have no idea where he got them from."

There were at least two doctors tending each of the patients in the courtyard, with more seeing to the walking wounded in the hotel next door. An expert in emergency medicine, Dr Peter Holden, who had also been attending a meeting at the BMA, initially took command until the emergency services arrived minutes later.

Dr Buckman said: "For some of those patients, it was an amazing lucky break. It is very rare for victims of a major incident to have two doctors tending them within seconds. The faster you can get them stabilised, the more chance they have. From organised chaos at first, it came very quickly under control. One minute, we were slightly nervous knowing what we had to do but having nothing to do it with. The next minute when the mobile medical teams arrived it was, 'Right this is what we're doing and this is how we are going to do it.' All the emergency services came together like a jigsaw," he said.

But he added: "Specialists in emergency medicine say if you think it went well, you are being complacent."

Of the 700 injured in the four blasts, 300 were taken to hospital by ambulance, and doctors performed operations well into the night.

Most of those injured in the bus blast were taken to University College Hospital, where 23 patients remained in hospital yesterday, five in intensive care. Twelve of the patients among the 61 treated at the hospital were foreign nationals.

A spokeswoman for the hospital said: "The hospital is now getting back to normal. We are still operating on some of the casualties but we have also resumed operations on our normal elective [routine] patients." Professor Jim Ryan, a senior consultant in accident and emergency, said: "Most of the operations are on limbs. You have penetrating wounds, indented stone, debris, glass or metal.

"There is also head injury management, and lung inhalation, and injuries to the chest.

"Our plans for dealing with such a situation have gone better than we could possibly have dreamt.

"We were not overwhelmed by the situation, and the staff have been wonderful."

There were 19 victims still being treated yesterday at the Royal London Hospital, which is one mile from Liverpool Street Station, with seven in intensive care. The hospital received 208 patients from two of the incidents. Eight were critically injured, and six people were operated on, the hospital said.

Great Ormond Street Hospital was still treating four adults injured in the bombings, two of whom were described as in a "serious" condition, by a hospital spokesman yesterday.

A total of 11 people were being treated at St Mary's Hospital, Paddington, a spokesman said, two of which were in a critical condition. Guy's and St Thomas' NHS Foundation Trust received 20 patients, three of them critically injured.

The Royal Free Hospital in Hampstead, north London, said 13 patients were admitted and all were in a stable condition although one person was serious but stable. It had treated 61 patients from the bomb attacks.

The Chelsea and Westminster Hospital confirmed that three patients had been transferred to its specialist burns unit from St Mary's Hospital, bringing the total to four. Chelsea and Westminster is the specialist burns unit for central London. Two further patients were due to be transferred later, a spokesman confirmed yesterday.

'The prognosis for those in intensive care is pretty good'

Alastair Wilson, clinical director of the accident and emergency department at the Royal London Hospital, was quick to praise his staff who bore the brunt of the casualties from the Aldgate blast.

"We had 31 doctors and paramedics we could parachute by air ambulance into the various sites of the explosions so we had a network already working remarkably well.

"Everything went better than anyone could have expected," he added. "We could have done with more ambulances but in incidents like this it is always the case.

He said that his department had coped well with the bomb victims and that his department could have taken five or six times the number of victims brought in.

"The injuries we have seen are typical blast injuries - there are several who have suffered amputations and more with burns and airway problems.

"Of the people in hospital at the moment, we still have seven in a critical condition. The prognosis for those in intensive care is going pretty well. There are one or two that I am concerned about, but the longer we go from the base time the better they will do," he said.

He added that the number of victims that were being treated last night was 19, with seven in intensive care.

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