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Dealing with a major incident: DCT experience of dental patient care after the Manchester bombing

Blog Author Laura Timms, Emily Higgins, and Catherine Moshkun

Blog Date 01/06/2018

Working as dental core trainees (DCT) at the Manchester Royal Infirmary and Royal Manchester’s children hospital, the three of us were on-call the night of the Manchester Arena terror attack, and worked in the days following the disaster. 

With colleagues, we recently published a paper in the BDJ about the treatment of patients after the attack, and some clinical case studies.

Personally, we all found the events challenging and emotional, and no previous training could prepare us to witness the devastating and life changing injuries to such a large number of patients. In spite of this, the skills of all staff involved, and the commitment from those working under such extreme, heart-breaking conditions, was truly amazing to watch and have a small role in. 

This blog sets out some of our thoughts on what we did, and what we learnt from the experience.

Responding the aftermath: key DCT tasks

The willingness of staff to help, and how everyone pulled together was remarkable. As was the response by other patients, many of whom left the emergency department if their injury was not life threatening, without complaint, realising the situation was unprecedented. 

As DCTs responding to the aftermath, our tasks included:

  • assisting senior colleagues in theatre
  • assessment of cases, and escalation to seniors
  • liaising with other teams and senior staff
  • attending polytrauma and planning meetings 
  • receiving and prioritising referrals for maxillo-facial injuries
  • arranging pre-theatre paperwork and tests
  • providing information for senior staff on location and status of patients 

Maxillo-facial injuries suffered

As the majority of patients suffered polytrauma, the need for team-work and coordination was paramount.  

Specialties treating the patients with maxillofacial injuries were the emergency department staff, critical care staff, anaesthetic teams, general surgery, orthopeadics, opthalmology, neurosurgery, ENT and many more. 

Patients’ presented with a number of maxillo-facial injuries including: 

  • dento-alveolar trauma; avulsions, fractured teeth, luxations, dento-alveolar fractures
  • soft-tissue injuries
  • Injuries and foreign bodies to the eye 
  • penetrating wounds into deep structures
  • mandible, maxillary, orbital and nasal fractures 
  • foreign bodies in hard and soft tissue 

Working under pressure: key skills for DCTs

While this was a truly unique situation, many of the skills carried out are relevant to the wider role as a DCT. 

The work listed above will be familiar to most DCTs working across the country. 

Pertinent to this situation were prioritising patients, which was especially challenging over-night where staff numbers are always lower in the maxillo-facial team, but continued on into the day shift, with more patients being referred after being stabilised, after primary and secondary surveys, and more life threatening-treatments had been carried out.

Even under normal circumstances, DCT can be a highly-pressurised environment and being able to work calmly and effectively is key. Our training helped us to keep our heads and prioritise, treating patients as efficiently as we could.

Team-working and within and across teams was also critical, this was particularly difficult as all teams were under enormous pressure, so communication skills and being able to give clear histories and referrals, as well as prioritising the information needed was important. 

DCT: the importance of reflection

Another lesson learned from the experience was the importance of reflection. 

While this can be easy to overlook, it is important in situations such as this to learn from any good practice and also how to improve, but importantly in this here to reflect on the difficult events encountered and try to be aware of how this has affected you. 

Support from family, friends and colleagues was useful and invaluable at this stage. 

As a DCT it is likely you will be encountering distressing and upsetting situations, due to the scope of work involved, for example with oncology patients. The ability to cope with, this and learn how to be resilient are important attributes for a DCT.

Overall, we learnt how important it is to work well together and with other colleagues, to try achieve the best outcome for our patients. 
 
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Laura Timms, Emily Higgins, and Catherine Moshkun
Dental Core Trainees