MILLTOWN CEMETERY INCIDENT 16 MARCH 1988 Paper presented to AMBEX '88 by THOMAS McKEE, Deputy Chief Ambulance Officer, Eastern Area Ambulance Service, Northern Ireland.DURING THE PAST TWENTY YEARS THE AMBULANCE SERVICE IN NORTHERN IRELAND HAS HAD TO ATTEND MANY UNUSUAL AND DANGEROUS SITU- ATIONS. Bombings suchas the Abercorn Restaurant, Bollfast, resulting in 157 casualties, McGurk’s Bar with 15-dead, Warrenpoint 1i soldiers ‘dead, the Droppin’ Well Bar and Enniskillen ‘Remembrance Day. ‘Shooting incidents, sometimes with one, and somtimes multiple dead andl injurcel ‘Punishment shootings, riots with injuries ‘caused by bricks, bottles, petrol bombs and ‘plastic bullets (baton rounds). ‘The incident | am to talk about today, ‘however, did not begin in Northern Iecland, bhut in Gibraltar, where, on the 6 March 1988 ‘three persons were shot dead. All three ‘were from West Belfast and had connections with a paramilitary organisation. At previous funerals of paramilitaries, the Royal Ulster Constabulary, (RUC) Northern Invland’s police force, had a heavy presence. AL the majority of these funerals, violence ‘had occured involving the police and, snoumners, and on occasions this had spilled ‘aver into the community. ‘On this oceasion, the RUC slated that they ‘would be adopting a low-pratile approach to the funerals. ALL three funerals were arranged lo coincide: ‘an the 16 March 1988, other television company representatives, Local, National and World Press were represented The coffins, follawed by several thousand mourners ‘At about 13.00 on the 16 March the funeral processions were moving along Belfast’s Falls Road accompanied by several thou: sand mourners. The funerals and mourners rhoved into Milltown Cemetery, to the TRA plot. Between 13.20 andl 13.25 a male person threw fragmentation gronades into te crowd. Shots were also fired. The mourners scattered, or attempted! to find protection from the attack, using, headstones. The attacker was pursued by mourners ta the M1 Motorway, which is situated to the cast of the cemetery. More shots were fired ‘The colling of the theae Gkbrakar bombers maka their way to Miltown cemetery ‘Because of the controversy surrounding the ‘killings in Gibraltar the world’s media gathered in Belfast. Besides BBC, ITV and the local UTV there were CBS, NBC and The atackor fring shots into the crowd The Ambulance Service was alerted to the incident in an unusual way. Because of the nature of the funerals and the publicity surrounding them one of our Public Rekt tions Officors was monitoring bath radioand television broadcasts. Overhearing a radio newsflash giving details of the attack and that a number of people had been injured, he immediately telephoned Ambu- lance Control to ascertain our response to the incident. His call was timed at 13.26, Based on this call, three vehicles and a Station Officer were activated, the first crew arriving four minutes later. The first radio reportindicated the magnitude of the incident and stated that the first casualties had been removed by the funeral cars and ‘Ambulance Canteol activated a further three vehicles and myself. ‘A further related incident was notified on the M1 Motorway. The information was that three persons had been shot. ‘Two vehicles and a Station Officer were activated. ‘The designated and support hospitals were alerted, the Service Liaison Doctor was called to Ambulance Control and the medi- cal and surgical take-in was switched from the designated hespital to one of the support hospitals. When Station Gfficer and vehicles arrived on the motorway, they reported that they were not required. The reported incident ‘had, in fact, been the arrest of the gunnan, who had fired more shots. Hy this time I had arrived in the cemetery ‘and, on hearing the report, redirected the Station Officer and wehictes to assist with the main incident. ‘There, land the other staff were faced with trying to operate on narrow roadways, many of which were impassable. 60,4 large crowd of confused, angry and teiise people had gathered and the only ‘control being, undertaken was by funcral stewards. established Incident Control ina turing square almost at the centre of the incident and beside the IRA plot. A holding area was also established. ‘The Divisional Officer Operationsand a Station Officer, bath of whom had been on an interviewing pancl, arrived, followed by the Mabile Control Uni Duties were allocated as follows: 1. Station Officer to mobile control, 2. Station Officer as Triage Orticer, 3. Station Officer as Loxting Officer. The Divisional Officer and four crew staff, using short- range hand-portable radios Kling tivae peoplo at the gravosido. ‘The RUC arrest the gunman whe, moments earlier, made a gun and grenade atiack on IRA funeralsfrom the Mabile Control Unit, moved into the crowd, extracting casualties ta the triage and loading arca, After a number af casual ‘igs had been removed in this manaer, it became increasingly more difficult to locate further casualties, The stalt wore thercfore ‘withdrawn to the triage/loading point, and ‘a message circulated via the stewards asking, for the locations of casualties. ‘Vehicles were moved from the holding area to the loading area as patents became available, maintaining two vehicles always in the loading area. This co-ordinated movement ensured that patients were moved quickly to the desigmated hospital. A total of 67 patients were removed to hospital using, 10 ambulances and other vehicles; 64 to the designated hospital and 3 to a support hospital. Because of the type of grenade used, it was difficult to differentiate between gunshot wounds and puncture wounds caused by grenade fragments, In other cases, the fragments had caused deep open wounds. Ambulance Incident Officer. ‘Areas such as crowd control, information handling, establishing links with political representatives and handling, the media were undertaken. liv the absence of the police, such limited crowd control as there-was, was being undertaken by the funeral stewards. spake with the stewards and they started to move the people aut of the eumetery. Rumours circulated within the crowd, which could have resulted in civil disorder, Liaison with a political representative, sharing; information, or dirceting, him to where information could be obtained, enabled these rumours tn be stopped ‘There was pressure from the media for information. A number of interviews were given; a role normally carried ont by the police. However, the meslis were success fully dealt with. Ambulance Control and the Liaison Doctor had established links with the hospitals, the RUC and with myseif on site. Situation updates were continually passed between cach location. i the senior representative of the only statutory body present, I was required to accept duties in addition te those of the ‘Ono of the victims of the gun and bomb attack baing comforted by friends. Control of the incident was well established and, as the eroud started (o ave the cemetery, a vehicle was despatched to the main, and only, gate, with instructions to deal with any injured persons arriving with them. As the crowd dispersed, a further two casualties with minor injuries weretocated and moved to hospital.‘An ambulance leaving Miliown with easualtins The cemetery cleared, and at 1420 the cident was closed Asa follow-up, I moved to the designated hospital and discovered that political repre- sentatives, relatives, friends and the media had crowded into the waiting arca. The Medical Co-ordinator, Unit Administrator, Medical Records staff and the Ambulance ‘Liaison Officer were working hard to ‘establish casualty lists. ‘To add to the Ambulance Liaison Officer's problems, the routine outpatients were stil moving into and out of the hospital. 1 assisted with producing casually lists, ALO to maintain the normal flow of patients through the hospital. The ALO and I maintained a flow of information people from the casualty waiting area. “The final tally of casualties was: ADEAD All the dead on examination were found to have gunshot wounds, 4 MAJOR INJURIES Three of these patients had major shrapnel wounds ‘One with abdominal injuries One with upper One with lower All required surgery and were admitted. The fourth patient was admitted to ICU with, Cerebral Ocdemtia, The patient was venti lated andl recovered. It is believed that, inan attenapt tw escape the athick, this patient fell, hitting her head.on a gravestone. 11 SERIQUS INJURIES All LL had serious shrapnel wounds requir- if Surgery and admission, 49 MINOR INJURIES All were seen and discharged to home. Conditions ranged from shock to minor shrapnel injury. Of the unre patients who were seen in the support hospital, twe had shrapnel injuries and required admission, The third was the attacker who had multiple teruising to his head, face and both legs. These injuries were caused by the mourners who had caught him ‘before his arrest. After treatment he- was detained by police.SUMMARY OF THE PROBLEMS 1. SIZE OF CROWD ‘Witha crowd of several thousand in the coniines of the cemetery, confused, angry and tense, and moving along, the road access, vehicles had to move with caution, 2, NO POLICE INVOLVEMENT With ne police at the scene, additional roles were undertaken by the Ambulance Service. ‘Thove included assisting with crowd control, 4. NARROW ROADWAYS Within the cemetery there is ane main, wo- vehicle-wide roadway with narrow one- vchicle-wide roadways leading, from it ta turning areas. It was along one of these ‘nartow roadways that the incident took place, and therefore, access, egress and moventient became a problem. As stated, this was overcome by co-ordi- nating, vehicle movements along, the narrow road, ‘Ambulances on the narrew roadway in Mlltown Gomotary becoming an information centre and talking to the media 3, MINIMUM CONTROL Although stewards had been appointed to- assist with control of the funeral proces- sions, when the altack occurred the crowd moved in all directions, Some pursued the attacker, Others searched for relatives or friends. Some moved towards the gate and ‘others stayed in the immediate area of the attack, The stewards were recognised anly byan armband and it (ook some time before contact was made with thems. However, ‘when this did happen, their hulp was invaluable in meeting our requests. 5. UNEXPLODED DEVICES When the cemetery was clearing, a number of unexploded grenades were found. At Teast one of these Was amily a short distance from the command and control point Although there was a risk, both officers and mobile staff remained at the command and contro! point, as this had beeome the recog- nised focal point for casualty zeception and information, 6. POTENTIAL CIVIL DISTURBANCE ‘The crowd were angry and tense, and rumours had started to circulate, such as, that there were 15 dead, and that the person.‘who made the attack had got away, One of the politicians approached me for informa- tion, saying, he wished to stop the rumours. Information was given to him on a number of ovcasions and he was also advised to go 1o the designated hospital, as he would be recognised as someone who could ask for, and be given, relevant information. LESSONS LEARNED 1. REFINEMENTS TO THE EMERGENCY PLAN As js usual, following an incident of major proportions, the emergency plan was reviewed, Areas examined included mobi sation procedures, action by Ambulance ‘Control, the role of the Liaison Doctor and the flow of information, Lam pleased to say our plan stood up very swell to the review. In particular, the value to loading, point flow’ maintaining effective control of resources the midst of chaos, was.cantirmed beyond doubt. ‘The Liaison Doctors a telatively new concept, brought about initially by a change to the Medical Emergency Orders for Belfast International Airport. Along with our medical colleagues we apteed that th would be useful for all major emergencies. ‘This has now been proven, and a section on the Role of the Liaison Doctor is being, prepared for inclusion in the Ambulance Service Emergency Plan. 2. REVIEW OF THE ROLE OF THE AMBULANCE LIAISON OFFICER Wedbo not believe that the role of the ALO swill unclergo any major changes. However, some thought must be given to the need for the hospital to maintain its normal services whilst coping with this seale of emergency. The review will examine haw the ALO can maintain an input to both major incidents ‘and the normal functions of the hospital. 3. IMPROVEMENTS TO COMMUNICA. TIONS. ‘At the debrief of the incident, radia comma: nication was the main, Ambulance Service controlled, problems area. ‘The present system in use in Northern Inslandl operates on low-band AM, has little development potential and is about two years away from ils replacement date, The system camprises vohicle- mounted sets and single frequency 1/2 watt output hand- portables. The Mobile Control Unit has the bility of linking; the single-frequency sets to the normal operating channels. This, however, isa complicated system and resquires operators ta be weil trained in its use, Northern Ireland does nat have an ERC, as cach vehicle-mounied set earries the full range of operational frequencies, allowing, vehicles from any area (0 operate within any other area, Communication with hospitals és achiowed hy radio, which is in a fixed lacation, or by telephone. Asa result of the Milltown and other inci- dents, a number of convmunication improve- ments have boon made, suggested, or are being tested. A mumber of transportable radio cases have bboen purchased. These allow for both mains and battery operation, making them suitable for operation in a semi-permanent location. A specification for a replacement system in preparation, Hower went to the existing system, Ul ortables are being tested to give Operational, Control and Liaison Olficers freedom af anuverent away from thier vehicles or fixed locations, A radio rebroadcast system is also being tested and, if successful, will be fitted to selected vehicles. With the Liaison Doctor now included in the mobilisation, we plan to increase the FAX ncturork to allow written communication to he exchanged with hospitals, police and fire service. A request from the review grou has been made to have an ex-direetory telephone line available in Ambulance ed users to make enquir- on Doctor. Plans have also been made to increase the number of hand-portabe cellular telephones available to ambulance officersIn this context, and particularly, given the experience of Hungerford, itis encouraging to note that the cellular radio operators are currently considering how they can restrict the net to. service users in the ‘event of a future incident 4. DEALING WITH THE MEDIA ‘The media can, and indeed did, add pres- sure to an already tense situation in their at. temptsto obtain information, However, having completed a Media Skills ‘Workshop, | felt confident in talking, to the media. A number of interviews were given to both radio and press at the incident scene. Television reporters algo asked for informa- tion, but they quickly mowed to follow the action at the designated hospital. ‘The media seemed to be handled success- fully on this occasion. So much so, that during the bombing incidents.at both Balmoral Showgrounds, where a police caravan and articulated vehiele were the targets, and at Lisburn were-6 soldiers were killed, I was usod to give information and interviews, has, for so long, been a neplecied area for the Ambulance Service. My service has, now decided that all officers will attend the Media Skills Workshop, so that they ean. present the role of the Ambulance Service on, a more effective basis, from the incident scone. You will have noted from the slides and video, that not all ambulance staff on the scene were wearing, their high-visibility jackets; at least in the initial slages of the incident. Instructions hava since been issued, reinforcing the absolute need for ambulance staff to identity themselves clearly in this manner, for safety reasons |, Lam certain, be apparent to this Having said that, however, I must finish on 4 note of praise for the outstanding perform ance of the ambulance crews and alficers on the scene. Upholding a 20-year tradition, they once again provided professionalism and displayed caring attitudes in a very difficult situation which sadly cecurs all too often in Northern Ireland, ACKNOWLEDGEME! Pacemaker Press, Belfast Department of Medical Photography, Belfast City Hospital