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Featured researches published by Peter Shirley.


The Lancet | 2006

Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005

Christopher Aylwin; Thomas C König; Nora W Brennan; Peter Shirley; Gareth Davies; Michael Walsh; Karim Brohi

BACKGROUND The terrorist bombings in London on July 7, 2005, produced the largest mass casualty event in the UK since World War 2. The aim of this study was to analyse the prehospital and in-hospital response to the incident and identify system processes that optimise resource use and reduce critical mortality. METHODS This study was a retrospective analysis of the London-wide prehospital response and the in-hospital response of one academic trauma centre. Data for injuries, outcome, triage, patient flow, and resource use were obtained by the review of emergency services and hospital records. FINDINGS There were 775 casualties and 56 deaths, 53 at scene. 55 patients were triaged to priority dispatch and 20 patients were critically injured. Critical mortality was low at 15% and not due to poor availability of resources. Over-triage rates were reduced where advanced prehospital teams did initial scene triage. The Royal London Hospital received 194 casualties, 27 arrived as seriously injured. Maximum surge rate was 18 seriously injured patients per hour and resuscitation room capacity was reached within 15 min. 17 patients needed surgery and 264 units of blood products were used in the first 15 h, close to the hospitals routine daily blood use. INTERPRETATION Critical mortality was reduced by rapid advanced major incident management and seems unrelated to over-triage. Hospital surge capacity can be maintained by repeated effective triage and implementing a hospital-wide damage control philosophy, keeping investigations to a minimum, and transferring patients rapidly to definitive care.


Journal of the Royal Army Medical Corps | 2006

Critical Care Delivery: The Experience Of A Civilian Terrorist Attack

Peter Shirley

It has been recognised for some time that a terrorist incident was threatened in the UK and it has been noted previously in the JRAMC that the locations for terrorist atrocities are likely to be more diverse than previously experienced (1). July 7th 2005 witnessed the first terrorist suicide bombing on the UK mainland, targeting the public transport system in London. These attacks were unprecedented in both scale and intensity but they were anticipated in London. However there were clear difficulties, relating to multiple sites, their location underground and early problems with communication (2). This article highlights some of the experiences and learning points of the Intensive Care Medicine Service at the Royal London Hospital (RLH) in the wake of the July 7th bombings. The RLH was the single biggest receiver of casualties (195); seven of whom were admitted to the Intensive Care Unit. The Defence Medical Services have tri-service representation (both regular and reserve) at the RLH in Emergency Medicine and Pre-hospital Care, Surgical Services and Intensive Care Medicine.


Critical Care | 2008

Clinical review: The role of the intensive care physician in mass casualty incidents: planning, organisation, and leadership

Peter Shirley; Gerlinde Mandersloot

There is a long-standing, broad assumption that hospitals will ably receive and efficiently provide comprehensive care to victims following a mass casualty event. Unfortunately, the majority of medical major incident plans are insufficiently focused on strategies and procedures that extend beyond the pre-hospital and early-hospital phases of care. Recent events underscore two important lessons: (a) the role of intensive care specialists extends well beyond the intensive care unit during such events, and (b) non-intensive care hospital personnel must have the ability to provide basic critical care. The bombing of the London transport network, while highlighting some good practices in our major incident planning, also exposed weaknesses already described by others. Whilst this paper uses the events of the 7 July 2005 as its point of reference, the lessons learned and the changes incorporated in our planning have generic applications to mass casualty events. In the UK, the Department of Health convened an expert symposium in June 2007 to identify lessons learned from 7 July 2005 and disseminate them for the benefit of the wider medical community. The experiences of clinicians from critical care units in London made a large contribution to this process and are discussed in this paper.


Journal of the Royal Army Medical Corps | 2009

Operational Critical Care. Intensive Care and Trauma

Peter Shirley

Trauma management involves good prehospital, emergency, surgical, anaesthetic and intensive care decision-making. Optimal outcome depends on keeping abreast of the latest thinking in an ever-changing and increasingly technology-rich environment. The intensive care unit needs to represented as early as possible in the damage-control resuscitation phase. Improved trauma system care has resulted in an increasing number of multiply injured military patents surviving their initial trauma. These patients require intensive care and are at risk from sepsis and multiple organ failure. Attention to detail is important, preservation of organ function, infection control and nutrition to maintain muscle strength allowing normal metabolic function to return. Multiply injured patients often require lengthy periods of mechanical ventilation and a variety of therapeutic interventions may have to be considered during management of the disease process. As we are now seeing more survivors in the military trauma system the focus now needs to be morbidity reduction in order for these survivors to be best prepared for their rehabilitation phase of care.


Trauma | 2005

Trauma and critical care III: chest trauma:

Peter Shirley

Patients requiring intensive care for chest trauma are often severely injured and may have suffered trauma elsewhere. The single largest cause of significant blunt chest trauma is road traffic accidents (RTAs). RTAs account for 70-80% of such injuries. Falls and acts of violence are other causative mechanisms. Blast injuries can also result in significant blunt thoracic trauma. Penetrating chest trauma comprises a broad spectrum of injuries and severity. Particular challenges occur in patients with associated polytrauma, as well as those with a combination of blunt and penetrating chest trauma. Chest injury is the most important injury in polytrauma patients with reported incidences of 45-65% and an associated mortality of up to 60%. The treatment of these patients can be prolonged and the initial injury may become of secondary importance to the effects of systemic inflammatory response syndrome, acute lung injury (ALI), nosocomial infection and intercurrent multiorgan dysfunction syndrome (MODS). Multiply-injured patients with thoracic injuries require significantly longer periods of mechanical ventilation and longer intensive care unit lengths of stay compared with nonthoracic injury trauma patients. The use of a variety of therapeutic interventions may have to be considered during management of the disease process.


Trauma | 2008

Fluids as oxygen carriers and the potential role in trauma resuscitation

Peter Shirley

Patients with major trauma present a challenge, often using large quantities of banked blood both at the time of injury and during their hospital stay. Blood transfusion is not without risk and is associated with high costs; it is immunosuppressive, rendering patients more susceptible to infection. In the western world, banked blood is fully screened and relatively safe; the same is not true in parts of the developing world, where high rates of HIV carriage make blood transfusion a risky undertaking. Additionally, blood transfusion as a vector for transmission of illnesses such as prion disease is a distinct possibility, for both the developed and developing world alike. The introduction of artificial blood substitutes would ameliorate some risk and also remove the cost of extensive blood testing. For trauma outside hospital, blood substitutes could compete directly with fluid resuscitation as donated blood is not usually available. Patients with prolonged transport times would appear to be the most obvious beneficiaries and volume expansion, along with improvement in oxygen-carrying capacity would be the ultimate goal. All clinicians confronted with the need for transfusion of homologous blood would welcome the development of a safe and reliable alternative to red blood cells in order to ensure oxygen transport to the tissues. However, even though research on red cell substitutes started more than 100 years ago, even now none of the heavily investigated compounds based on haemoglobin or perfluorocarbons has been released in Europe or the USA for routine clinical use.


The journal of the Intensive Care Society | 2005

Trauma Teams in Johannesburg and London: A Tale of Two Cities

Peter Shirley

The British Perspective Penetrating trauma and notably ballistic trauma is on the increase in the UK. According to Home Office statistics, in the twelve months to March 2003 there were 10,250 firearms offences in England and Wales (an increase of almost 40% in two years), 17% of these resulting in physical injury. The Metropolitan Police Service, in common with police forces around the country, have introduced initiatives (such as Operation Trident) to get weapons (guns and knives) off the streets of London.


Journal of the Royal Army Medical Corps | 2014

Sir Gilbert Blane: the father of naval medical science.

Peter Shirley

Gilbert Blane was born in Blanesfield in Ayrshire in 1749 and studied in both Edinburgh and Glasgow, graduating with an MD (Glasgow) in 1778. His first naval appointment was as private physician to Admiral (Lord) Rodney, sailing to the siege of Gibraltar in 1779 on HMS SANDWICH. A combination of his


Intensive Care Medicine | 2004

Intra-hospital transport of critically ill patients: minimising risk

Peter Shirley; Julian Bion


Critical Care | 2005

Effect of a single dose of etomidate on adrenal function in patients with trauma

K Price; U Allen; Gerlinde Mandersloot; Peter Shirley; D McAuley

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D McAuley

Royal London Hospital

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Julian Bion

University of Birmingham

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K Price

Royal London Hospital

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Karim Brohi

Queen Mary University of London

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