Sunday 18 March 2018

'I pronounced the Westminster Bridge attacker dead' - Irish surgeon Morgan McMonagle on how we would cope with a terror attack

Morgan McMonagle tells our reporter that Ireland desperately needs a comprehensive plan to deal with major traumatic events. But, he also believes, we already have all the skills to do this

Surgeon Morgan McMonagle. Photo: Tony Gavin
Surgeon Morgan McMonagle. Photo: Tony Gavin

Joy Orpen

Spare a thought for our beleaguered brethren across the water, who have endured so much tragedy this year.

Six people killed and 50 injured when a van ploughs into pedestrians on Westminster Bridge. A suicide bomber kills 22 and injures 59 people at a pop concert in Manchester. Eight people killed and 48 injured when a van mows them down on London Bridge. Up to 80 people killed and at least 70 injured in the Grenfell Tower inferno. One worshipper dies and nine others are injured outside a mosque during Ramadan.

The death toll is absolutely tragic, but it might have been much worse, if the UK hadn't had a protocol already in place for dealing with such traumatic events. And, what very few people know is that an Irishman was part of the team that put the programme together.

Morgan McMonagle, a Cavan native, is a vascular surgeon at University Hospital Waterford. However, he also wears a plethora of other illustrious medical hats and has a CV that is, given that he is still in his early 40s, simply astonishing.

A police officer holding flowers on Westminster Bridge in London
A police officer holding flowers on Westminster Bridge in London

Morgan was only 12 when he decided on a career path. "I liked adrenaline-producing excitement," he explains, "and watching M*A*S*H (a TV series about an army medical team) sparked my interest in medicine."

Having graduated with honours from UCD in 1997, he began his internship at St Vincent's University Hospital, Dublin, working 80 hours a week. The next step involved two years of intense surgical training in most of the main teaching hospitals in Dublin, including Beaumont.

One day, a seriously injured boy was brought into the emergency department. "I was a junior doctor and I had to tell the parents that their little boy was going to die," explains Morgan. "And he did, that night. Seventeen years ago, there was no system to manage major incidents like this. That's when I decided to do trauma surgery."

Consequently, his next job was as a registrar in emergency medicine at St James's Hospital. This was followed by a short stint in the Johannesburg General and Baragwanath hospitals in South Africa, where stabbings and gunshot wounds were rife.

Our adrenaline junkie then worked for CareFlight in Australia, while continuing his academic research. "We helped with search and rescue, road accidents and transferring ICU patients," says Morgan.

He has a vivid personal memory of winching an injured hiker from a canyon. "It was terrifying, hauling someone on a swinging stretcher, 200 metres up into the helicopter, with four tons of downwash from the rotors." In another incident, he performed surgery in the bush on a father and son who had been badly burned.

Emergency personnel on Westminster Bridge following the attack in March. Photo: PA
Emergency personnel on Westminster Bridge following the attack in March. Photo: PA

But even those challenges weren't enough for Morgan. "I decided it wasn't a good long-term plan," he says. All along, he had continued to study and hone his various skills. So, when he returned to the UK, he gained experience as a specialist registrar in vascular surgery at several British hospitals.

In 2009, he qualified as a consultant at the Queen Elizabeth Hospital, in Birmingham. "Vascular surgeons get extensive experience in massive bleeding and they operate on all areas of the body," explains Morgan. He went on to do a fellowship in vascular surgery at the Royal Brisbane Women's Hospital in Australia. He then consolidated his credentials even further when he worked at the Hospital of the University of Pennsylvania in the US. "It's one of the busiest trauma centres in the world," he says. "That was the first hospital to describe damage-control surgery. On a busy night, we dealt with 12 to 15 gunshot incidents. Learning from the masters was brilliant surgical training."

Having returned to Queen Elizabeth Hospital, in Birmingham, Morgan operated on, and supported, injured young soldiers who had fought in the Middle East. "A lot of severely injured patients, who 20 years ago would have died, are surviving, because there's a more efficient trauma system," explains Morgan.

"We now do what is known as 'damage-control surgery'. That means there is someone on site to do basic surgery. The injured soldiers are then 'packaged', put on a plane, and are back in England within 12 hours or so. That's when we begin to reconstruct their injuries. It's all done within a very socialist style of healthcare. It's a very different system in Ireland."

In 2007, Morgan was invited to be part of a team to evaluate the efficiency of the UK trauma system. They found it to be lacking. So the Department of Health began developing a document that would address the inherent problems. "I was part of a team that put together the definitive surgery trauma skills course," says Morgan. "I'm very proud to have been part of it."

Once the protocol for dealing with traumatic events had been agreed, four London hospitals began to roll it out.

In 2011, he was appointed as a consultant in vascular and trauma surgery at St Mary's Hospital, London, and is still an honorary consultant there. He is also director of trauma training at the Royal College of Surgeons, and runs courses, including some in Manchester.

So, when the suicide bombing took place in that city, Morgan's colleagues were already trained to deal with the emergency. Similarly, when the Westminster Bridge attack occurred, he headed the trauma team for that. "I was the one who pronounced the attacker dead," he says.

"However, in spite of the mayhem, there were good outcomes overall. When a good system is implemented in the first place, it really works well."

As far as the Grenfell Tower disaster was concerned, Morgan says they could see the inferno from the hospital. "With a tragedy like that, there is usually not a lot of surgery, as many of the patients are already dead. Sadly, the bulk of the bad stories involve children."

So how prepared is Ireland, should a major event occur here? Not ready at all, according to Morgan.

"There is no formalised plan in place and there's no formalised trauma network," he says.

But he's not altogether pessimistic at this point. "We have all the skills we could ever need right here in this country. We have some highly trained surgeons. We could make Ireland into a flagship for the rest of the world as far as trauma is concerned."

Morgan McMonagle has published three books -'Vascular and Endovascular Surgery', 'Trauma and Critical Care Surgery' and 'Trauma: Code Red'

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