| CODE |
| http://7julyinquests.independent.gov.uk/hearing_transcripts/01022011am.htm |
| QUOTE |
| 1 February 2011 - Morning session 1 Tuesday, 1 February 2011 2 (10.00 am) 3 MR KEITH: It may be my Lady that Ms Gallagher has been 4 detained. In those circumstances, Mr Patterson has 5 kindly agreed to go first, if that meets with my Lady's 6 approval. 7 LADY JUSTICE HALLETT: Have we had any message? It's very 8 unlike Ms Gallagher. 9 MR PATTERSON: I gather ten minutes. 10 LADY JUSTICE HALLETT: Is she happy that we carry on? 11 MR PATTERSON: She invited, I think, that I should go before 12 her, my Lady. 13 LADY JUSTICE HALLETT: Thank you. 14 MR PATTERSON: I'm grateful. 15 COLONEL PETER FRANCIS MAHONEY (continued) 16 Cross-examination by MR PATTERSON 17 MR PATTERSON: Colonel Mahoney, may I begin by expressing 18 gratitude from those families whom I represent for the 19 reports that you've prepared in relation to their loved 20 ones who died; that's the Trivedi family, the Mozakka 21 family and the family of Philip Beer. 22 In fact, those three deceased in many ways cover 23 quite a spectrum of different types of casualty, don't 24 they? Because, at one extreme, we have Mrs Trivedi, 25 who, as you told us yesterday, clearly died instantly, 1 1 and you referred to the non-survivable injuries. 2 I don't go into the detail, but you may recall how close 3 she was to Jermaine Lindsay's bomb in that first 4 carriage at King's Cross. 5 A. Yes, I can picture all her injuries. 6 Q. Yes. I don't ask you anything about that case. The 7 next of the three, Behnaz Mozakka, might I just explore 8 one matter with you in relation to that, please? It's 9 your report at page 50, and I don't know if you have it 10 there, Colonel, but at section D5 you dealt with injury 11 mechanisms. 12 A. Yes. 13 Q. Again, I don't go into the details. The family have 14 read with care your conclusions. But certainly, at 15 D5.1, you refer to the effects of heat -- 16 A. Yes. 17 Q. -- and the heat damage. At 5.2, you refer to the 18 foreign objects, and you touched upon this yesterday. 19 Bone fragments that must have been blasted from one 20 lower leg area to the other lower leg area -- 21 A. Yes. 22 Q. -- and you referred to the energy that would have been 23 required to cause that. 24 Then, at D5.3, you refer to Mr Hepper's analysis and 25 how he concluded that this was indicative of her being 2 1 in close proximity to the blast because of the energy 2 required to cause those sorts of injuries to the legs in 3 particular. 4 Then just looking, please, in that paragraph, 5 I think Dr Kirkman stated that it was highly likely that 6 anyone within two metres of the device would suffer from 7 primary blast lung injury and, based on the external 8 injuries, Behnaz Mozakka was at short range to the 9 device. 10 A. Yes. 11 Q. Does it follow from that, given what we know about where 12 the body was found -- namely, in that double doorway 13 quite close to where the bomb exploded -- that there was 14 a high likelihood of blast lung injury? 15 A. Yes, I think if we take the other injuries that 16 Mrs Mozakka had as indicators of her proximity and take 17 the engineering advice and modelling advice and 18 physiology advice from my colleagues, all of that adds 19 up to saying that she was very close to the bomb and 20 that would be consistent with the -- with their 21 estimates that she would have had severe blast lung 22 injury. 23 Q. Then the conclusion at D6.1 is that: 24 "On the balance of probabilities, she was close to 25 the bomb when it exploded. She suffered non-survivable 3 1 internal blast injury and died when the bomb exploded or 2 soon afterwards." 3 A. Yes. 4 Q. The family, in particular, are keen to explore, if 5 possible, whether you can help with, if she didn't die 6 instantly, how long she might have survived before 7 dying. Is there anything that you can cite that would 8 help us explore that question? 9 A. No, I don't think there is, other than to say if you 10 take the reasoning thus far, if we can agree the 11 reasoning thus far, that she was that close, and if we 12 can agree that you had that sort of overpressure and 13 this is somebody who we do not have evidence of her 14 being alive after the explosion, our expectation, is -- 15 all I can say is, at the time of explosion, or very soon 16 afterwards, my expectation -- and I don't have definite 17 evidence for this, but my expectation, from everything 18 that comes together, is you're talking about minutes, if 19 at all. 20 But when we look at -- again, add all the injuries 21 up and add up the train of reasoning, it is highly 22 likely that she died at the time of the explosion, but 23 I cannot be more precise than that. 24 Q. So highly likely that she died instantly, but possibly 25 survived for a few minutes? 4 1 A. Yes, and I think you have other casualties within the 2 carriage that demonstrate that range of experience. 3 Q. Then turning to the third family that I represent and in 4 respect of whom you prepared a report, Philip Beer, and 5 dealing first of all, please, Colonel, with the period 6 of time that it's believed that he was still alive -- 7 A. If you give me one moment, I'm just searching out 8 Mr Beer's report. Other than that, if we could have the 9 documents displayed on the screen, that would be ideal. 10 Q. Perhaps if we look at your time-line, which is at 11 page 78 and your report is INQ11064 [INQ11064-78]. 12 A. Yes. 13 Q. I see we have the time-line there. Certainly we know in 14 particular from a passenger, Paul Mitchell, who survived 15 and who gave evidence, that Mr Mitchell was with 16 Philip Beer for quite some time and, indeed, when 17 Mr Mitchell was finally removed by paramedics, 18 Philip Beer cried out with pain when Mr Mitchell got up 19 off his leg and was removed from the carriage and, as 20 the time-line indicates, the estimate is that that was 21 at about 9.50. 22 A. Yes. 23 Q. So a little over one hour after the explosion at 8.49, 24 and then, as we can see from the time-line, the 25 paramedic who dealt with Mr Beer, Peter Taylor, the 5 1 estimate given there is 9.50. In fact, it may have been 2 slightly longer than that, because the evidence of 3 Mr Taylor was that it was at 8.45 that he started off 4 into the tunnel, that he triaged and dealt with some 5 casualties both on the track and then once he was on the 6 train, so that by the time he got up to the first 7 carriage where Philip Beer was lying, he agreed that it 8 was possibly something like 9.55. So certainly it's 9 over an hour after the explosion. 10 I think it's clear from what you said yesterday, 11 Colonel, that all these hundreds and thousands of hours 12 that you and your team spent analysing these various 13 issues, the work that you had to put in would have been 14 a lot easier if you'd had the benefit of internal 15 examinations. Is that right? 16 A. Yes, if we look at our military casualties, they have 17 internal post-mortems and the majority of them have 18 a post-mortem CT scan. So they have a complete, 19 whole-body CT scan which looks for fragments, makes sure 20 that there's no retained ordnance, but also means that 21 you have a clear record of internal injuries. 22 Q. So, for example, if an expert like yourself or a family 23 want to know about the internal injuries and whether, 24 for instance, there was this leathering effect in the 25 lungs that you spoke of yesterday, an internal 6 1 examination might answer that, X-rays might answer that. 2 Is that right? 3 A. We rely on a combination of both. 4 Q. We are denied both in this case, is that the position? 5 We don't have either? 6 A. Well, the only information that we have evidence of is 7 an external examination and the fluoroscopic examination 8 which comments on fragments but does not comment on 9 internal injury. 10 Q. So for Philip Beer, we can never say with any certainty 11 what the mechanism of death was, the precise cause of 12 death? We know obviously that the cause of death in the 13 broadest sense was the explosion, the bomb that exploded 14 caused by Jermaine Lindsay, but the precise mechanism of 15 death is something we can't ever say with certainty? 16 A. No. I mean, I think I wouldn't be -- I cannot add 17 anything more to my explanation from yesterday. If we 18 accept the reasoning of the report, blast lung is 19 a possibility. But there are other potential causes of 20 death. Do you want me to run through them? 21 Q. I'd love to go through them with you in a moment, if 22 I may. Before we do that, can we deal with the 23 puffed-out chest, because there was evidence, was there 24 not, from the paramedic, Peter Taylor, that he saw what 25 he described as a puffed-out chest -- 7 1 A. Yes. 2 Q. -- when he triaged Philip Beer? 3 I think you've considered this in your report and 4 you noticed that this wasn't something that was seen in 5 the scene photographs. 6 A. Correct. 7 Q. So they were taken when Philip Beer's body was still on 8 the train, I think it was on 8 July, and so, at that 9 stage, it wasn't visible. I think the word you used was 10 "distending" of the abdomen? 11 A. D6.2, I think, yes. 12 Q. Secondly, this was a feature that wasn't described by 13 the pathologist who conducted the post-mortem on 14 12 July. 15 A. Yes. 16 Q. So five days later. Can you help us, Colonel, can you 17 explain why a puffed-out chest might have been seen at 18 the time by a paramedic but would have been absent a day 19 later when photographs were taken and five days later 20 when the post-mortem was conducted? 21 A. I think my difficulty is it's a very vague description 22 and you can interpret it a number of ways. If we 23 interpret it to mean that Mr Beer's chest looked 24 expanded, you have a number of explanations. One 25 explanation could be that he was breathing hard because 8 1 he had difficulty breathing due to a number of potential 2 mechanisms, and what you were seeing was someone trying 3 very hard, in their position -- what people tend to do 4 when they're having difficulty breathing is prop 5 themselves up and try to expand the chest as much as 6 they can and use the accessory muscles of respiration in 7 the neck and the top of the chest. 8 Q. Not an internal injury? 9 A. An internal injury is the -- is what makes you short of 10 oxygen, and then the response of the person to that 11 shortage of oxygen is to breathe very hard. 12 So one possibility is that the description is of 13 somebody whose posture was making them breathe very 14 hard, and their chest could looked puffed out. The 15 other possibility is that you're looking at an internal 16 injury, you're looking at something within the chest 17 causing the chest to appear expanded. 18 Then, if you go down that line of reasoning, the 19 conditions that could cause the chest to look expanded 20 are an air leak, as discussed yesterday, and there are 21 reports of blast lung having that appearance in the 22 literature, but I have never seen that appearance 23 myself, so I cannot verify that from my own experience. 24 Q. What about bleeding into the chest? 25 A. Bleeding into the chest -- the chest is a rigid -- when 9 1 the chest is intact, it's a relatively rigid structure. 2 Let me rephrase that. You have a bony confine to the 3 chest, so whereas, if you've got bleeding into the 4 abdomen, which has got a soft front to it, you can see 5 distension. Generally, bleeding into the chest won't 6 cause the chest to sort of distend. You need something 7 under pressure to cause the chest to look distended, and 8 for that you're really talking about an air collection. 9 Q. So of the three possible internal injuries that you said 10 Philip Beer could have had, the puffed-out chest as 11 described by the paramedic could be evidence that he had 12 a punctured lung -- 13 A. Yes. 14 Q. -- rather than blast lung injury? 15 A. Yes, it could. 16 Q. The fact that it wasn't seen a day later and five days 17 later, is there anything unusual about that? 18 A. Again, that's into post-mortem changes and really, for 19 that, you'd want a forensic pathologist or a pathologist 20 to discuss that. 21 Q. Can I ask you, please, Colonel, about his proximity to 22 the bomb? Could we see on the screen, please, the 23 schematic diagram for carriage 1? It's INQ10283. 24 I think it's page 10 [INQ10283-10]. 25 We can see there, Colonel, that the approximate 10 1 position of the explosion is by double doors D5. 2 A. Yes. 3 Q. Can you indicate, please, where you understand that 4 Philip Beer was positioned, where he was standing at the 5 time of the explosion? 6 A. Again, as I think it says in the report, we do not have 7 confirmation of where he was standing. My 8 understanding, from the reading of the evidence, is he 9 was somewhere within that region. 10 Q. I think Patrick Barnes is cited in the report as the 11 evidence for that. 12 A. Yes. 13 Q. We can look at it, if necessary. There is a diagram 14 from Patrick Barnes that suggested that the position 15 was -- do you see seat 90 or position 90? 16 A. Yes, I do. 17 Q. So somewhere around that. Would that be the basis for 18 the assumption that it was two and a quarter metres from 19 the explosion? 20 A. I think Mr Hepper is basing that -- his view on the 21 distance from Mr Barnes' statement, yes. But we do not 22 have anything saying for definite: this is where Mr Beer 23 was placed. 24 Also, I think we had agreed that the density of 25 people within this carriage is such that it's difficult 11 1 to be precise about where people were placed. 2 Q. There was evidence given by the survivor I've mentioned 3 already -- Paul Mitchell -- that, when he got on to the 4 carriage, he ended up at about position 98. Do you see 5 that? So he would have stepped on, turned left, and 6 moved about halfway down towards the rear of the 7 carriage. 8 A. Yes. 9 Q. He said that Philip Beer was right behind him. So, if 10 that's right and Philip Beer was close to position 98, 11 clearly he was a lot further away from the explosion 12 than -- 13 A. Absolutely. 14 Q. -- you have assumed. 15 A. And I think, as I've stated all the way through, we 16 based the conclusions on the evidence that was presented 17 to us, not on subsequent transcripts, and if there is 18 evidence that places people in a very different part of 19 the carriage, then clearly you could interpret the 20 injuries differently. 21 However, Mr Beer does have other injuries which 22 could indicate proximity to the explosion. 23 Q. Absolutely. I want to ask you about those physical 24 injuries in a moment to the legs, but just dealing with 25 this: if that's right and that he was, as Mr Mitchell 12 1 says, perhaps about 4 or 5 metres away from the blast, 2 looking at your table at page 84 [INQ11064-84]of your report, the 3 blast loading, if you are less than 3 metres from the 4 seat of explosion, is very severe, but if it's above 5 3 metres from the seat of the explosion, it's 6 categorised as minor. 7 A. Yes. 8 Q. So is that right, that if Philip Beer, as Mr Mitchell 9 suggests, was something like 4 or 5 metres from the 10 explosion, it would be minor blast loading? 11 A. Well, if Mr Beer is in the position further away down 12 the carriage, yes, quite possibly he was subjected to 13 less blast loading. I do not argue that. 14 Based on the evidence that was presented to us and 15 his injuries, we would place him close in. But if 16 there's evidence putting him elsewhere, then you need to 17 look at other injury mechanisms. 18 Q. Again, looking at your tables, on page 84, the degree of 19 blast loading, when minor, is to be equated with lung 20 injury categorised as minimal, if any? 21 A. Yes. 22 Q. So less likelihood of blast lung injury? 23 A. Agreed, which would then lead you to other potential 24 causes of lung pathology. 25 Q. Absolutely. Finally, before we leave blast loading, 13 1 presumably there would be other factors that would be 2 relevant to the amount of blast waves or blast loading 3 that would be suffered by a particular casualty? There 4 would be issues such as the number of passengers between 5 the explosion and the person that you are considering? 6 A. Yes. 7 Q. Whether that screen, that draught screen that we know 8 the bomber was next to, whether it provided any kind of 9 shielding or barrier? 10 A. Yes. 11 Q. Whether the bomber was in some way himself shielding the 12 blast, we know that there is a biological anthropologist 13 to give evidence shortly, who states that the 14 fragmentation of Lindsay's face was such that his face 15 may have been positioned over the device? 16 A. Yes. 17 Q. So again, would that be relevant, perhaps, in reducing 18 the amount of blast wave that might be transmitted? 19 A. If we look at the complex modelling, these are all 20 factors that Dr Pope has looked to take into 21 consideration, but there's no question, if you place 22 something between an explosive and an individual and 23 something can absorb the energy, then you can deliver 24 less energy to the individual. 25 Clearly I'm not an expert in blast or blast physics, 14 1 but I look at casualties I've dealt with from vehicles 2 and dismounted casualties, it's almost stating the 3 obvious, you shelter somebody, and unless the blast has 4 found a way round that shelter, bounced off something 5 else and hurt them, as in the bunker-type situations 6 I described yesterday, then, yes, you've absorbed 7 energy. 8 Q. Turning then to the possible internal injuries, you've 9 already said that the puffed-out chest would be 10 consistent with an air leak. 11 A. Possibly, yes. 12 Q. We know that this was a casualty who was still breathing 13 and still speaking over an hour after the explosion. 14 Does that suggest perhaps less likely to be blast lung, 15 more likely to be something else? 16 A. No. The time history and the speaking is consistent 17 with somebody with blast lung, but equally, it could be 18 somebody with an air leak from a punctured lung, unless 19 you've got more detail such as how they responded to an 20 intervention or evidence of a -- physical evidence of 21 puncture. With the evidence I have, I can't be more 22 precise. 23 Q. So that doesn't help us. What about frothing to the 24 mouth? I think your report indicates that clear fluid 25 and evidence of frothing around the mouth is often to be 15 1 found with blast lung injury. 2 A. It's certainly reported, it's reported as an indication 3 of widespread damage within the lung structure, and it's 4 reported as one of the symptomatic features of blast 5 lung, but you don't always see it. 6 Q. So you don't always see it. But the help that we can 7 get from that feature is this, is it not, that the 8 paramedic, Mr Taylor, who said that he triaged him and 9 opened his airway and carried out a few tests, he 10 indicated that there was no frothing around the mouth. 11 Is that a relevant factor there for militating perhaps 12 against blast lung injury? 13 A. I don't think so. You can see it, you may not see it, 14 and in a lot of the other victims who have also got good 15 time histories for blast lung injury, it hasn't been 16 described. It certainly is described in the literature, 17 but it's not a consistent finding. 18 Q. Is it clear fluid that we see frothing sometimes, or is 19 it blood that we see frothing, or possibly both? 20 A. It can be both, can be either. 21 Q. Caused by blast lung injury? 22 A. Yes. If you've got bloodstained fluid, it indicates 23 you've got active bleeding in the lung. If you've got 24 more clear fluid, it can indicate you don't necessarily 25 have active bleeding but you do have disruption of lung 16 1 structure. 2 Q. So if there's active bleeding in the lung, that would be 3 possibly caused by blast lung and possibly resulting in 4 frothing blood? 5 A. It could, but you can have active bleeding from other 6 causes as well. 7 Q. From other causes? 8 A. Yes. 9 Q. Of the various survivors who remember talking to or 10 having dealings with Philip Beer and the various 11 descriptions about the words that he was speaking and 12 his behaviour and so forth, none of those witnesses 13 describe repeated coughing, and I think repeated 14 coughing is also described in the literature as 15 something that you sometimes get from blast lung injury. 16 Is that right? 17 A. Coughing really just indicates you've got something 18 irritating the airway. You can see it with most chest 19 injuries and, yes, you could have it, but equally, you 20 might not have it. 21 Q. So the absence of any evidence of that doesn't help us 22 either, does it? 23 A. No. 24 Q. Then finally, Colonel, could you assist, please, with 25 treatment? We've already established that, if it was 17 1 blast lung, treatment that can be given that can 2 ameliorate the difficulty is oxygen, and then, in the 3 normal way of things, the normal treatment that somebody 4 would receive would include, I think you said, 5 a ventilator? 6 A. Oxygen will initially buy you time. You're not treating 7 the blast lung with oxygen. What you're doing is you're 8 trying to make up for the fact that some of the 9 patient's or casualty's normal lung function has been 10 damaged. So oxygen is buying you time to improve oxygen 11 levels in the blood, to improve oxygen delivery to other 12 parts of the body. 13 But the effect of that will really depend on how 14 much of the lung has been damaged. So in a very severe 15 injury, you really won't see an effect. With an 16 intermediate injury you may see an effect. And then, if 17 you can get somebody with blast lung injury into 18 a hospital and give them intensive care treatment, 19 including ventilation and including other ways of 20 supporting lung function, what you're then doing is 21 trying to give the lung time to recover and heal, if 22 it's able to do so while you support other body 23 functions. 24 Q. So it depends on the severity of the blast lung -- 25 A. Yes, it does. 18 1 Q. -- if it is blast lung? 2 Going back to your tables, if the blast loading is 3 minor, as the distance might suggest, and if the lung 4 injury is minimal, if any, if the table is to be 5 followed in relation to the distance and the minor 6 likelihood of blast loading, that might also suggest, 7 therefore, a greater chance of survivability -- 8 A. Yes. 9 Q. -- if oxygen is given and appropriate treatment? 10 A. Yes, you could have people coming in with blast-related 11 chest injury who can walk in and have a very uneventful 12 time course in hospital. Equally, you can have people 13 who deteriorate very, very quickly. But it's 14 a reflection of the underlying damage to the lung. 15 Q. Then treatment, if it was one of the other internal 16 injuries that you've postulated, bleeding into the 17 chest, again that could be treated, presumably, by the 18 removal of the blood, chest drains and the like? 19 A. A chest drain is something to think of to remove either 20 blood or fluid to allow the underlying lung to expand 21 and improve oxygenation. 22 If you've got bleeding into the chest, for a lot of 23 chest injuries the bleeding is due to fairly minor blood 24 vessels being injured, if you look at blunt trauma, and 25 all you need to do is use a chest drain for that. If 19 1 you've got significant bleeding from another, a larger 2 structure in the chest, then you're going down the route 3 to look for surgical intervention. 4 Q. But chest drains are something that are used on 5 occasions by HEMS doctors and by paramedics when the 6 need arises? 7 A. More HEMS doctors. My understanding of current 8 protocols -- again, as stated yesterday, it's been 9 a year since I've been doing pre-hospital care, but the 10 protocols that we were working to was that paramedics 11 could do chest decompression but you would expect 12 a doctor to insert a chest drain. 13 Q. If it was bleeding into the chest, what's the likelihood 14 of him having survived, if he had received, to use your 15 assumption, I think it was "normal, adequate treatment" 16 was what you described yesterday? 17 A. Well, again, I can't give you any accuracy on that 18 because, again, it's supposition, we don't know -- 19 bleeding into the chest can be so many things. Bleeding 20 into the chest from a minor injury is one life pathway. 21 Bleeding into the chest from a major vascular injury is 22 another life pathway. So really, I can't offer you 23 a meaningful interpretation of that. 24 Q. So it may be that he could have survived and made a full 25 recovery, if it was bleeding into the chest? 20 1 A. No. Go back to my previous answer. It depends on what 2 the cause of a bleed into the chest is. 3 Q. Exactly. 4 A. If you had someone who is respiratory distressed from 5 bleeding into the chest, but it's not a catastrophic 6 internal injury, yes, a chest drain could release blood 7 and, yes, that is somebody who could have their 8 respiratory function improve. 9 If you are bleeding into the chest from 10 a catastrophic injury, then putting a chest drain in may 11 not alter survival. But, on the information I have, 12 I can't give you any more precise answer than that. 13 Q. So it sounds as though you can put it no higher than: 14 possibly would have survived? 15 A. Again, if you're supposing that Mr Beer had something 16 other than blast lung, and if Mr Beer had injuries that 17 would be treatable by a chest drain, then you're going 18 down one route of treatment and one route, potentially, 19 of survival. But on the information that I've got, 20 I can't quantify or qualify that for you. 21 Q. Then the third possible internal injury that you posited 22 was punctured lung. 23 A. Yes. 24 Q. Pneumothorax. 25 A. Yes. 21 1 Q. Again, treatment could have been given for that, if that 2 was the problem, by a paramedic or by a HEMS doctor? 3 A. Yes, if you've got a leak from the lung, the treatment 4 is either what's called decompression, which is using 5 a needle which has been described in some of the other 6 casualties to release pressure, or it can be a chest 7 drain which also releases pressure in the chest and 8 allows a continued air leak to be vented. 9 Q. I think in relation to one of the other casualties that 10 you looked at, Shelley Mather, there was an example 11 there of the insertion of a chest tube -- 12 A. Yes, there was. 13 Q. -- at the scene to remove the -- 14 A. Not a chest tube. There was an example of 15 a decompression with a small cannula. 16 Q. Yes. 17 A. Yes. 18 Q. So again, obviously we don't know the precise internal 19 injury, but if it was punctured lung, there was 20 treatment that could have been given and he might have 21 survived? 22 A. Possibly, if it was punctured lung. 23 LADY JUSTICE HALLETT: Can we go back to the factors you 24 took into account in coming to your conclusions on the 25 balance of probabilities? 22 1 A. Yes. 2 LADY JUSTICE HALLETT: Mr Patterson has put a large number 3 of possible factors affecting your conclusions to you, 4 but do I take it, from reading your report, those are 5 all factors that you and your colleagues very much took 6 into account in forming your conclusions? 7 A. Yes, I took in -- the team took into -- took the view 8 that, if we place Mr Beer in the area we expected him to 9 be -- close to the bomb, given his other injuries -- and 10 if we take the explosive output and the effects to be 11 those that Dr Kirkman, Mr Hepper and Dr Pope calculated, 12 under that basis we would expect Mr Beer to have -- 13 likely to have significant blast loading and have 14 a blast lung injury. 15 LADY JUSTICE HALLETT: I noted, when you were expressing 16 your conclusion yesterday, you noted his very severe 17 injuries, including the loss of his leg, the nature of 18 the burning to the injuries and the nature of the 19 fractures. They were all, in your collective 20 conclusions, likely to have meant that he was close to 21 the seat of the bomb -- 22 A. Yes. 23 LADY JUSTICE HALLETT: -- and he had also impacted against 24 a solid object? 25 A. Again, I still stand by that. I'm not contradicting 23 1 a witness or contradicting the fact that some could be 2 different, but we're reading the information in front of 3 us and we're reading the injuries in front of us, and 4 I think it's paragraph D5.4 I talk about the 5 amputations, we talk about the blunt impact to his jaw, 6 and we talk about the associated tissue loss, and just 7 based on that and -- I beg your pardon, 5.1, we talk 8 about the images demonstrating facial injury and what we 9 interpreted as facial burns and, in our experience, that 10 would place Mr Beer close to the seat of the explosion. 11 LADY JUSTICE HALLETT: Thank you. ^ Interesting that Hallett felt the need to intervene here. 12 MR PATTERSON: Could those leg injuries and those burn 13 injuries have been suffered by Mr Beer if he was further 14 down the carriage towards position 98, as the witness 15 Mr Mitchell suggests? 16 A. Again, in our experience, based on our work and based on 17 the work we did for the inquest, our experience would 18 place those injuries -- would place someone with those 19 injuries closer to the explosion. 20 Having said that, as I've said from the beginning 21 and as is stated in the reports, the characteristics of 22 these explosives have a number of -- a number of 23 characteristics which are different to the type of 24 explosives we normally deal with as stated in there, and 25 there have to be error bars in our interpretation. 24 1 But our interpretation would place Mr Beer closer to 2 the seat of the explosion. 3 Q. Is it possible that those injuries could have been 4 suffered by him if he was further along towards 5 position 98? 6 A. If you had sufficient -- again, if you had sufficient 7 temperature and sufficient blast effect, you could 8 injure somebody further away from the seat of the 9 explosion, but the implication is the explosive products 10 and the explosive force has been channelled along 11 further down the carriageway. 12 Now, to answer that categorically, what we would 13 really need to see was the injury patterns in all the 14 surrounding people and relate the injury patterns to 15 that individual to those other injury patterns, which 16 has not been part of our original instruction. 17 Q. Finally, this please, Colonel: at the top of page 52 18 your conclusions that there is insufficient evidence to 19 say for certain whether his injuries were survivable or 20 non-survivable. 21 A. Yes. 22 Q. Does it follow from that, therefore, that it is possible 23 that his injuries were such that, with earlier removal 24 from the train, and with resuscitation, if necessary, 25 and with appropriate treatment, that he might have 25 1 survived? 2 A. If we accept our reasoning that Mr Beer was close to the 3 seat of the explosion, based on the injuries that we've 4 described and our initial reasoning that we think he had 5 a high blast lung -- a high likelihood of blast lung 6 because of the overpressure, that would push you more 7 towards injury being -- survival being less likely. 8 If you think, or there's evidence, that Mr Beer had 9 a different chest injury, that would make survival 10 potentially more likely. But on the evidence that we've 11 got our -- my interpretation and the interpretation of 12 my team would place him closer to the seat of the 13 explosion than was indicated on the map. 14 But to answer it -- to answer that appropriately, 15 we'd really need to see an injury map of all the 16 injuries around him or where the position you believe he 17 may have been, and only then, by mapping all the 18 injuries and the outcomes of people, can you say, yes or 19 no, that's how the explosive products propagated. 20 I can't be more precise than that. 21 Q. You've indicated the uncertainty and so forth, but can 22 you rule out that he possibly might have survived? 23 A. I cannot rule out, as it states in -- I think where it 24 states in our conclusion, "There is insufficient 25 evidence" -- I'll read it verbatim -- "to say for 26 1 certain whether his injuries were survivable or 2 non-survivable". I don't think I can say it any more 3 precisely than that. 4 MR PATTERSON: Thank you very much. 5 A. Thank you. 6 LADY JUSTICE HALLETT: Ms Gallagher? 7 MS GALLAGHER: My Lady, if I could just apologise to 8 yourselves and the Inquest team, and to you, for the 9 delay in my arrival, not baby-related, despite my 10 obvious condition. In fact, asthma-related. So I'm 11 very grateful to Mr Patterson for going first. 12 LADY JUSTICE HALLETT: No apology necessary, Ms Gallagher. 13 Questions by MS GALLAGHER 14 MS GALLAGHER: Thank you. 15 Colonel, could I just commence by asking you about 16 some general issues, and then I'm going to turn to some 17 specific questions about two individual deceased, 18 Miriam Hyman and Michael or "Stan" Brewster. 19 So first of all, in relation to the general issues, 20 Colonel, in respect of the individual deceased, your 21 task, as set out in each individual report, 22 paragraphs 2.1 and 2.2, was to address the following 23 questions. 24 First, whether or not the 18 deceased you were asked 25 to look at did or did not, on the balance of 27 1 probabilities, receive injuries that were survivable, 2 and then, in particular, you were given these two 3 questions: firstly, on the balance of probabilities, 4 what internal injuries did they have; and then, 5 secondly, on the basis of that, those internal injuries, 6 plus observable external injuries, what were the 7 prospects of this particular deceased surviving at all? 8 A. Yes. 9 Q. Applying those tests to the 18 people, in summary, from 10 the reports and from your evidence yesterday, of those 11 18 individuals you were asked to assess, you've 12 concluded that 15 were non-survivable or "survival was 13 unlikely", to use the phrase that you used in the 14 Carrie Taylor report, but you've made clear yesterday 15 that overall group of 15 includes both more obvious or 16 clear-cut cases and also some more difficult, complex or 17 even borderline cases. 18 A. Yes. 19 Q. In relation to the other three people, you simply 20 couldn't reach a conclusion. You've said in the report 21 for Samantha Badham and Philip Beer "insufficient 22 evidence". 23 A. Yes. 24 Q. And Shelley Mather it's "I can't say"? 25 A. Yes. 28 1 Q. So in relation to the 15 on which conclusions have been 2 reached, Colonel, albeit on the balance of probabilities 3 and subject to many caveats, could I just summarise the 4 different categories of material which were presented to 5 you, so the raw data that you were given and the 6 evidential difficulties that they presented? 7 Firstly, there's the post-mortems. As you've said 8 on a number of occasions, they were external only, not 9 internal, and also there were delays of a number of days 10 before they were performed -- 11 A. Yes. 12 Q. -- which undermines to a certain extent references made 13 to external appearance. 14 A. It undermines references made to external appearance 15 from photographs taken during the post-mortem process. 16 Photographs taken closer to the -- on the scene or 17 closer to the time the bombs were detonated, a number of 18 those have much clearer appearance. 19 Q. Yes, I was going to come on to those. So the 20 post-mortem photographs, as you've said, interpreting 21 how injuries appear in photographs is obviously 22 difficult in any event, but there's additional 23 difficulties with the post-mortem photographs. That was 24 the second category I was going to refer to. The third 25 one is the scene photographs. As you've said, they were 29 1 taken closer in time to the explosions than the 2 post-mortem photographs, but there were particular 3 difficulties in using them as interpretative aids also, 4 weren't there? 5 A. There's always difficulties just from looking at 6 a photograph. There has to be, because you're relying 7 on the way the photograph's taken and what is evident to 8 you. 9 Q. Of course, and with those scene photographs, well, 10 firstly, they're not taken from all angles -- 11 understandably, because they weren't taken for the 12 purpose that you've now used them -- but isn't it also 13 right that they were taken, in many instances, after the 14 bodies had been moved or rearranged? 15 A. Yes, as stated in the reports. 16 Q. Also, the bodies are generally clothed, unless their 17 clothing has been blown off or removed by emergency 18 services personnel. So again, that makes it difficult 19 as an interpretative aid to possible internal injuries, 20 external indications of internal injuries? 21 A. Yes, and the only way to do that is to take into account 22 the pathologist's view in the external report, 23 interpretation of the external post-mortem photographs, 24 and you've a highlight of the difficulties with that, 25 and dovetail that with the scene photographs. 30 1 Q. Certainly. The fourth category, then, you've referred 2 yesterday, in answer to questions from my learned friend 3 Mr Keith, to there not being full X-rays, so fluoroscopy 4 only, the more limited form. Is this of particular 5 relevance in relation to blast lung? 6 A. Yes. 7 Q. Because, is it right that chest radiography is 8 considered a necessary diagnostic evaluation for blast 9 lung and often there's a characteristic butterfly 10 pattern? Is that right? 11 A. There's no question that chest radiography is enormously 12 helpful when you're diagnosing blast lung. If you were 13 treating someone or looking after somebody after an 14 explosion and they were short of breath or complaining 15 of difficulty breathing, blast lung would have to be one 16 of the things that you consider. 17 But for a clear diagnosis, it is very helpful -- not 18 essential, but very helpful -- to have either CT images 19 or X-ray images, and that clearly has made our 20 interpretation very complicated. 21 Q. The fifth category of material, then, the raw data that 22 you were provided with was the witness statements. 23 A. Yes. 24 Q. We've heard reference to some of the difficulties, most 25 notably the fact that the witnesses, when they gave oral 31 1 evidence, often clarified or changed their position, and 2 we know that you had information from the Inquest team 3 in relation to Aldgate and Edgware Road before embarking 4 upon phase 2, so you knew about the oral evidence there. 5 But you were, of course, even in those instances, 6 heavily reliant on their summary of the oral evidence? 7 A. We were reliant on the time-line as presented in our 8 reports. 9 Q. In relation to King's Cross and Tavistock Square, we 10 know you received some updates -- reference has been 11 made to Christian Small and Garri Hollness -- but you 12 didn't have the full time-lines in relation to them. 13 A. Yes. 14 Q. There's a number of further difficulties with the 15 witness statements and, indeed, with the oral evidence 16 which haven't been referred to. 17 Obviously, with oral evidence, there's the passage 18 of time. We've witnesses recalling events five years 19 ago. Many of the witnesses we've heard from over the 20 past four months have been distressed or confused, where 21 they've blurred their memories of what occurred with 22 subsequent extensive press coverage, so quite often 23 they've come to believe that someone they were dealing 24 with must have been a particular person they've seen in 25 photographs and, in fact, the evidence shows that must 32 1 be wrong. 2 There are also conflicts in the witness evidence. 3 Very difficult for you to work on that when you haven't 4 heard from the witnesses and, necessarily, that would be 5 an imprecise science. 6 Also, Colonel, many witnesses only gave their 7 original written statements in 2006, so many months 8 after the bombings and, in fact, with some witnesses, 9 they only gave their original statements much more 10 recently when contact was made with them by the Inquest 11 team. 12 So even the written statements aren't 13 contemporaneous, many of them are many months after. 14 A. No question. It's a complex task and it is not the way 15 you would choose to give a cause of death on an 16 individual. 17 Q. Of course. Also, as well, in relation to three of the 18 scenes, there's the conditions, because, as we've heard 19 in evidence, there was a lack of light, poor light on 20 the Tube trains, plainly less of an issue in relation to 21 Tavistock Square. So in addition to confusion, passage 22 of time and so on, there's also just the fact that many 23 witnesses are describing things which they were seeing 24 in the half-light in these tremendously difficult 25 circumstances. 33 1 The sixth category of raw data which you were given 2 essentially came from the Metropolitan Police Service, 3 so it was the scene reports and the seating plans, but 4 of course, they were based in large part on the written 5 witness evidence which we've just discussed. 6 Just to give an example of some of those 7 difficulties, could we have [INQ10282-8] on screen, which 8 is a document you've seen before? It's from 9 Edgware Road. It's referred to in your report. 10 I represent the family of "Stan" or Mike Brewster 11 who's at number 14. You can see interposed between him 12 and the bomber is number 13, a gentleman called 13 Danny Biddle, who, in fact, survived, despite, according 14 to this analysis, being closer. 15 From the witness evidence in relation to 16 Edgware Road, Colonel, the accuracy of that graph is in 17 doubt for a number of reasons. 18 Firstly, a number of witnesses didn't recall seeing 19 the area of these doors, D3, D4, so crowded. We heard 20 some evidence which would suggest that Laura Webb and 21 Jonathan Downey, who were 8 and 9 on this graph, in fact 22 were much further along towards doors D1 and D2, so they 23 perhaps weren't thrown as far by the blast as this graph 24 would suggest, because we know they end up at the other 25 end of the train. Some of the evidence suggested they, 34 1 in fact, had been further along, in any event. 2 Also, there's a suggestion -- 3 MR KEITH: I'm very sorry to rise to my feet. For my part, Not as sorry as we are. Gallagher was on a roll 4 and it may be the witness's part as well, I would be 5 greatly assisted if we knew whether or not the Colonel's 6 conclusions in relation to Mr Brewster are being 7 challenged, because that will then put these questions 8 about the reliability of his evidence into some sort of 9 context. 10 MS GALLAGHER: Yes, we do have a challenge, both on behalf 11 of Miriam Hyman and Stan Brewster. 12 A. Then give me a scene photograph, ma'am. 13 LADY JUSTICE HALLETT: Sorry? 14 A. If you want to challenge it, I need the scene 15 photographs and I'll take you through exactly what our 16 conclusions are, and I mean a clinical scene photograph. 17 LADY JUSTICE HALLETT: You mean showing the bodies in situ? 18 A. If you want me to explain why we've come to the 19 conclusions that we have, that's what I need to do. 20 MS GALLAGHER: My Lady, for present purposes, I'm just using 21 this as an example in relation to some difficulties with 22 graphs. I would need to speak to the family, who are in 23 court, about that. I plainly have instructions to put 24 certain matters. 25 Could I conclude with the general questions and the 35 1 questions in relation to Miriam Hyman before taking 2 instructions in relation to Michael Brewster? Thank 3 you. 4 LADY JUSTICE HALLETT: I also think people need to give some 5 thought as to, if I allow the photographs to be shown in 6 court, are they to be shown in the annexes and are they 7 to be then, as it were, published? 8 MS GALLAGHER: Absolutely. My Lady, Michael Brewster's 9 sister is in court with her husband. The remainder of 10 the family, whom I represent, aren't in court. 11 I clearly would need their instructions too. But I can 12 certainly deal with the general matters and then also 13 deal with the Miriam Hyman issues and then take 14 instructions. 15 LADY JUSTICE HALLETT: For various and important reasons, 16 the Colonel can't return after today. 17 A. No. 18 MS GALLAGHER: Is the photograph available in court? Do you 19 have the photograph you're referring to in court? 20 A. No, it's held by the Inquest team. But if you're asking 21 me to explain why we've interpreted clinical injuries 22 the way we have, then I can talk you through the 23 pictures of the bodies on the scene and explain why 24 we've interpreted the way we have. 25 I've already explained in great detail, as you've 36 1 just set out, the limitations of the evidence with which 2 we've been presented. If you wish to challenge our 3 conclusions, then I wish to defend our conclusions and, 4 to do that, I will require clinical photographs. 5 MS GALLAGHER: My Lady, the witness did say yesterday, when 6 asked about the number of variables, that if you shifted 7 a variable -- in fact, he specifically said in relation 8 to Michael Brewster that, if he was wrong on 9 positioning, if the team were incorrect on positioning, 10 that could change their conclusion. It's clearly 11 central. 12 I think there is an issue regarding how it's going 13 to be managed, particularly in the light of the fact 14 that the witness can't have available in court this 15 morning the material referred to. 16 A. There's no question, as I've said all the way through, 17 if you move somebody and, therefore, alter the blast 18 loading, then you have somebody who is more or less 19 likely to have primary blast injury. But remember, 20 the -- our interpretation is not just based on the scene 21 photographs. It's also based on interpretation of the 22 other injuries that we're seeing. 23 We have no vested interest in placing someone in one 24 place or another. 25 Q. Of course, and one of the things I was going to refer 37 1 you to is the fact that in your report, in two places -- 2 it's both pages 51 and 54, so in appendices D and E -- 3 A. Who are we speaking about now, is this Mr Brewster or -- 4 Q. In relation to Mr Brewster. I wasn't going to come to 5 this yet, but I think it would be sensible to mention 6 it. 7 LADY JUSTICE HALLETT: Sorry to interrupt, Ms Gallagher. 8 I'm just thinking, do you have instructions on whether 9 or not you are content for the Colonel to describe the 10 injuries? Putting to one side the photographs for 11 a moment, do you have instructions on the description -- 12 I see Mr Smith may be able to help further. 13 Mr Smith is exploring whether or not we have the 14 body maps available, which might actually -- the Colonel 15 is shaking his head. 16 MR KEITH: My Lady, as my Lady knows, body maps were 17 prepared for a number of the deceased in the eventuality 18 that we might have to refer to their injuries in more 19 detail than that contained in the reports. I've just 20 passed Mr Smith a note to see whether or not they are 21 available, not in Colonel Mahoney's possession, but on 22 the Trial Director system, so that we could refer to 23 them. 24 I think the answer is that they are available, if we 25 need to get to that stage, but as my Lady has just 38 1 pointed out, a considerable amount of detail of the 2 clinical injuries suffered by Mr Brewster is, indeed, 3 contained in the report at INQ11074. 4 There is little in that report which goes beyond, of 5 course, the injuries which appear to be identifiable 6 from the photographs. So if my learned friend's 7 instructions are based on a general challenge because of 8 the nature of the clinical injuries, could I invite her 9 perhaps, with a certain degree of circumspection, to go 10 through the injuries in the written report and, only if 11 she finds herself unable to proceed further, to invite 12 us to put on to Trial Director the body map for 13 Mr Brewster, so as to avoid any consideration of having 14 to look at the photographs in any kind of court 15 proceedings. 16 LADY JUSTICE HALLETT: It may be that all that is subject to 17 the final proviso that the Colonel is still going to 18 say, "I can only explain it by use of the photographs". 19 But, Ms Gallagher, is that a way forward, to see if we 20 can go down that path? 21 MS GALLAGHER: I think certainly let's take it as far as we 22 can go. The witness, the Colonel, can say at any time 23 if it's simply impossible to answer the question. 24 I've got instructions from the family in court, 25 my Lady. They've no objection to there being graphic 39 1 descriptions or, indeed, to even a photograph being used 2 in court. They wouldn't be content with it being used 3 in the annex. They plainly wouldn't be content with it 4 being any more public and, also, they'd like the 5 opportunity, if it is being used, for them to leave 6 court, if they wish to, as it may be too distressing. 7 LADY JUSTICE HALLETT: Let's see how we go, Ms Gallagher. 8 MS GALLAGHER: Certainly. 9 MR WATSON: If at any stage anybody really feels the 10 photograph is necessary, we'll give the family, 11 obviously, warning. 12 MS GALLAGHER: Certainly. 13 LADY JUSTICE HALLETT: But they are now prepared for graphic 14 description and any other family who are likely to be 15 affected. That's in relation to the Brewster family? 16 MS GALLAGHER: Yes. 17 LADY JUSTICE HALLETT: What about Ms Hyman's family? 18 MS GALLAGHER: Ms Hyman, there's no need to explore. The 19 issues which I'm exploring with Ms Hyman are not of this 20 nature. 21 LADY JUSTICE HALLETT: Thank you. Right. 22 MS GALLAGHER: Colonel, this is a rather unfortunate example 23 because I was just giving it as an example of the 24 difficulties that faced your team and, in fact, the next 25 point which I was going to make, not specifically in 40 1 relation to Mr Brewster, but just as an example, is 2 that, although that graph shows that both Mr Biddle and 3 Mr Brewster had a glass partition between them and the 4 bomber, in fact in your report you refer specifically to 5 there being very limited evidence of fragment injuries 6 and to him being in direct line of sight of the bomber, 7 so suggestive of there being no shielding, and that's at 8 both pages 51 and 54 of your Michael Brewster-specific 9 report. 10 A. Your scene map is showing where the bomber is sitting. 11 That's not where the bomb is detonated, is it? 12 Q. Yes. That's, of course, right. Which means that whatever Mr Biddle observed, it wasn't someone detonating the bomb 13 A. So I'm not sure of the argument. 14 Q. Yes, well, this isn't -- 15 A. Can I have the scene map? 16 Q. I'm simply referring to the Edgware Road graph as an 17 indication of some of the difficulties, because the 18 Metropolitan Police had to put that together based on 19 written witness evidence. 20 When we had oral evidence from the witnesses, it 21 became apparent that there were inaccuracies in the 22 graph. You've heard questions yesterday from some 23 people relating to other such diagrams, so I was simply 24 referring to it as one of the difficulties which faced 25 your team, in addition to the other difficulties which |
| CODE |
| http://7julyinquests.independent.gov.uk/hearing_transcripts/01022011am.htm |
| QUOTE |
| 41 1 you've spoken about already. 2 A. Sure, no question, but if you look at -- my 3 understanding -- and, please, other people who are in 4 the court who can correct me -- is, although in seat 10 5 you've got Mr Khan sitting, who's the bomber, the 6 indication of the seat of the explosion actually sits 7 between figures 9, 14 and 13. That's the circle on the 8 map. Is that correct? 9 Q. Yes, Colonel, it's probably best just to leave this for 10 the moment. The simple point just is: there are 11 difficulties with these materials which you've received. 12 In part, here, at least, there's a bomb crater, so it 13 gives you some more indication of where the actual bomb 14 itself may have been. 15 But plainly, with these materials, the 16 Metropolitan Police were relying on written witness 17 evidence. You've then received it. It's a secondary 18 analysis of written witness evidence. We've both 19 discussed and accepted the difficulties with that 20 witness evidence, and then, in oral evidence, certainly 21 inaccuracies have come to light. But that's simply the 22 point I was making. 23 A. As stated all the way through and as stated clearly in 24 the report, there are large possibilities for error in 25 a lot of the report because of the uncertainty in the 42 1 information that we've been presented with. 2 We have, however, based this on what I would regard 3 as the most appropriate and experienced expert team that 4 certainly I could put together, or the MOD could put 5 together, and we have looked in detail at clinical 6 injuries and have asked experts' interpretation of 7 injuries to try to map what they can from the evidence 8 to the state of a casualty. 9 Q. Well, Colonel, it sounds as if we agree, because what 10 I was going to put to you next simply was this: that 11 despite the incredible and very wide expertise on the 12 part of your team, the task that you were engaged in is 13 necessarily an imprecise science, particularly given the 14 imprecision and uncertainties in relation to the raw 15 data with which you were working. So you could clearly, 16 with precision, identify certain matters, but generally, 17 you're working with a very wide number of variables, 18 very complex, closed environments and where, as you've 19 said yesterday, and again today, if you shift one of 20 those variables, you can have a very different outcome? 21 A. No question at all. 22 Q. In addition -- 23 A. If you turn someone's orientation towards the bomb, you 24 may have a very different outcome. But nevertheless, 25 the injuries that people have stand. 43 1 Q. So really what we're engaged in is a very nuanced 2 discussion around your conclusions, which are based on 3 this material and these variables, Colonel. 4 In addition to the raw data received and relied 5 upon, could I just also have on screen [INQ10552-17]? 6 This is appendix A, so it's Mr Hepper, your colleague, 7 Mr Hepper. 8 A. Yes. 9 Q. It's paragraph A4.3.6. This relates to the use of 10 computational modelling to simulate the blast 11 environment, and all I was going to say, Colonel, was 12 that in itself carries its own caveats, which Mr Hepper 13 refers to here. So here he refers to the work of 14 Stuhmiller, and he says he "highlights that the 15 possibility to validate these models is limited", and 16 over the page, on page 18 [INQ10552-18]: 17 "... although the technology has progressed ... the 18 confidence and fidelity of these models is still 19 limited." 20 A. No question about it. However, you can improve the 21 fidelity, and certainly, with this particular model, 22 which is the HIP, the human injury predictor, you can 23 improve the fidelity of this model -- that's the complex 24 model -- by running it against real incidents. 25 While all my previous caveats stand about person 44 1 orientation, position, and interpretation of the 2 evidence, the model, as designed and produced by 3 Dr Pope's team at DSTL Porton Down does perform well 4 when matched against real incidents. 5 Q. There's another paragraph, also by Mr Hepper, so again 6 it's [INQ10552-19], it's paragraph A5.2.3. He refers, 7 five lines down, to the difficulties with a complex 8 blast environment, which, of course, you discussed in 9 great detail yesterday, and the possibility of high peak 10 pressures being produced in locations remote to the 11 device, which, of course, causes all sorts of other 12 complications, and just links to the multiple variables 13 which you've been referring to. 14 Then in his final sentence, he again just indicates 15 that you need to have some caveats in relation to the 16 certainty of use of modelling in these circumstances. 17 A. No question, as stated in the report and as stated at 18 each stage of the evidence. 19 Q. Colonel, one of the questions you were tasked with was, 20 on the balance of probabilities, what internal injuries 21 did the person have. 22 A. Yes. 23 Q. Colonel Russell -- it's in the individual reports at 24 paragraph A6.3. I don't need it on screen, but it's 25 page 24 of 93, if that assists, in the Mr Brewster 45 1 report. My Lady, that's INQ11074-24. Colonel, I was 2 just hoping you could put in context this comment, given 3 the question that was put to you about the internal 4 injuries. 5 What's said here is: 6 "... as the victims did not have internal 7 post-mortem examinations, injury to internal structures, 8 (eg lungs), have not been identified and cannot be 9 inferred." 10 Can you just indicate what was being said in that 11 paragraph, given that your task was essentially to infer 12 what internal injuries, such as injuries to lungs, had 13 occurred? 14 A. The appendix A is about trauma scoring, because, 15 normally, if you've got a casualty who's died and has 16 had a complete post-mortem, you can get a complete 17 inventory of their injuries. If you wanted to trauma 18 score somebody, what you would do, you'd look at 19 a number of the injuries, you'd take the three most 20 severe and it gets fed into a calculation to give you 21 a trauma score which can then be related to a likely or 22 unlikely chance of survival. This is what we'd like to 23 do. 24 We can infer from the physiology, the witness 25 statements and the injuries, that people did have 46 1 internal chest injuries because they behave in a way 2 consistent with dying either from a blast lung injury, 3 an air leak in the chest, or a bleed in the chest. 4 However, what we can't do -- which is what 5 Colonel Russell was referring to -- is assign a score to 6 that. So the score for a pneumothorax, an air leak, is 7 likely to be very different to the score for an internal 8 bleed, which in turn is different to the score for, say, 9 an amount of bruising within a lung. 10 So if we accept within the error bars that proximity 11 to an explosion is likely to cause blast lung, then we 12 can go down an interpretation of physiology, but it 13 would be meaningless to try to give -- interpret and 14 give that patient a trauma score and say "This person 15 has trauma score of X, therefore we expect their 16 survival to be Y". 17 Q. Certainly. Thank you very much, Colonel. 18 The next issue which I wanted to ask you about was 19 whether, in your area, your field, there's such a thing 20 as a control group and, to a certain extent, you touched 21 on this in answer to a question from my learned friend 22 Mr Patterson when you talked about necessarily having to 23 look at the surrounding injury pattern of other 24 individuals in order to fully inform the -- 25 A. That's not my interpretation of control group. 47 1 A control group really is one group gets therapy and one 2 group doesn't. If we mean a comparator group to say, if 3 you know where somebody is and you know about the other 4 injuries around them, and you can say with a degree of 5 certainty "This person was here, this person was here, 6 this person is here", and interpret all the injury 7 patterns, then you have circumstantial evidence to have 8 a view about that person's injuries. Is that what 9 you -- 10 Q. Yes, it's, as a nonscientist, using the phrase. The 11 simple point is this: you've obviously used the data 12 that you had and you've plotted that in relation to the 13 18 individuals? 14 A. Yes. 15 Q. Or the 18 individuals to a certain extent you obviously 16 for some reason -- for some reasons, you haven't in 17 relation to particular individuals had to do the 18 computational modelling because you had sufficient data 19 to reach a conclusion without that. But the point is 20 just this: we obviously have, in relation to other 21 individuals, who aren't included within the 18, 22 additional information. 23 So, for example, at Edgware Road, we've got detailed 24 information in relation to Danny Biddle, who is 25 estimated to be person 13 on that graph. We know he was 48 1 very close -- in very close proximity to the bomber, we 2 know he had catastrophic injuries but survived. 3 One of the questions which my families wanted to put 4 to you was: is there any mechanism for using that 5 information to test your modelling for accuracy, so to 6 feed in that information -- 7 A. No question about it. If the task was to look at the 8 entire bombing and look at all the survivors and all the 9 deceased, map all the injuries and look at the range 10 within which particular injuries occurred, then you 11 create a model with much greater fidelity and then you 12 have a better opportunity -- I use that word advisedly, 13 this is not academic curiosity -- you have a better 14 opportunity to say, given that these people, whom we 15 believe to be in this location, can be demonstrated to 16 have the following injuries, it is likely someone very 17 close to them had the same injuries. But the same 18 caveats are going to apply. 19 To interpret a survivor's injuries, you're going to 20 have more detail, you should have hospital X-rays, you 21 should have other investigations and hospital notes. 22 But the proviso is that you believe everyone is where 23 you see them to be. 24 Q. Of course, it doesn't just apply, obviously, to those 25 who ultimately survived, like Danny Biddle. It could 49 1 also apply to someone like, say, Sam Ly, my Lady, who's 2 not within the 18 but where we've got very detailed 3 consultant information and so on. 4 So again, it's simply the same point. But that 5 wasn't part of your task, Colonel, which was already 6 quite a mammoth task, and would have been even larger 7 had it included this much wider exercise? 8 A. If you want a more definitive answer on the injury 9 patterns of closed-space bombings on a London train, 10 then your task would be: look at all the deceased, look 11 at all the living and look at all the injury patterns, 12 and from that you'd have a more -- you'd have a greater 13 fidelity of your model. But that wasn't the task. 14 Q. There's just three more general issues I wanted to raise 15 with you and then I'll turn to Miriam Hyman. 16 Firstly, just a short point, it's from your phase 1 17 report, [INQ10552-14] there's no problem with this being 18 on screen, it's paragraph A4.2.2. 19 This is simply, Colonel, where reference is made to 20 the reclassification of ear injury. So is it right that 21 ear drum rupture is now tertiary? 22 A. It's regarded in the literature as both primary and 23 tertiary. There are discussions and there's uncertainty 24 about the exact mechanism, whether it's due to the blast 25 wave or whether it's due to people being thrown and the 50 1 subsequent impact on the ear drum. 2 Q. Secondly, in relation to blast lung, is it correct, 3 Colonel, that the data on the short- and long-term 4 outcomes with patients with blast lung is limited? 5 That's how it's described by the Federal Agency in the 6 US, the National Centre for Injury Prevention and 7 Control. They describe the paucity of data in the area 8 about the short- and long-term outcomes for patients. 9 Would you agree with that? 10 A. No, I wouldn't. I think our understanding of blast lung 11 is going on -- with the war in Afghanistan, is 12 increasing. I think if people survive the initial blast 13 lung injury, their outcome, their survival, all other 14 things being equal, has been seen to be better than from 15 other underlying lung injuries. 16 So -- but that can be -- that really relates to 17 people with other -- with other survivable injuries. 18 Q. Of course. Of course, I think there are some studies, 19 although they're quite old, in relation to those 20 individuals that you've referred to who survive, where 21 actually they tend to have quite limited pulmonary 22 complaints when they're followed up at a later stage? 23 A. Not at one year, they don't. Again, it's apples and 24 pears. The definition of blast lung in the literature 25 doesn't necessarily reflect what we're seeing in 51 1 closed-space explosions, what we're seeing in the 2 conflict in Afghanistan. I think our understanding of 3 blast lung is increasing all the time, so I cannot give 4 you a definitive answer on that point. 5 Q. Of course. Colonel, just one last issue. [INQ10552-8]. 6 Paragraph 6.2.5, you were taken to this yesterday by 7 Mr Coltart, the reference to internal bleeding. 8 A. Yes. 9 Q. Is that equally applicable to internal bleeding in blast 10 lung? 11 A. No. What you're implying with that internal bleeding is 12 internal bleeding that has a surgical cause and by that 13 we mean there's something like a vessel that's broken 14 and blood is leaking out or there's a hole in the liver 15 and it's amenable to surgical repair. 16 As described yesterday, the injury in blast lung is 17 very diffuse, you've got bleeding at what is 18 a microscopic level and this is not something that is 19 amenable to surgery. 20 Q. Would it be accurate to say that, in general, managing 21 blast lung is similar to caring for pulmonary contusion, 22 would you agree with that? 23 A. I think managing blast -- all pulmonary contusion means 24 is a bruise in the chest. Pulmonary, lung; contusion, 25 bruise. So it's a bruise within the lung, and blast 52 1 lung is a form of bleeding within the chest, albeit 2 a generally more severe form, but, yes, if I was faced 3 with two adjacent patients in a critical care unit, that 4 one has blast lung, that one has been in a road accident 5 and has bruises from another cause, my management of 6 them would be very similar, at sort of 24, 48 hours 7 onwards. 8 Q. Would it standardly require judicious use of fluids? 9 A. Again, that's from the literature, and judicious use of 10 fluids, to be honest, that's -- the implication is 11 you're restricting the amount of fluid you give so you 12 don't flood the lung, but that's the same in any lung 13 injury. 14 Q. I was instructed to ask you some questions in relation 15 to oxygen, but in fact, Mr Coltart addressed these 16 yesterday. 17 A. Sure. 18 Q. So just for the families' purposes, I think that's 19 answered their questions in relation to that. 20 You did also make reference in passing yesterday, in 21 answer to some questions, to haemothorax or 22 pneumothorax. In some blast lung cases, is it right 23 that there may be clinical evidence of a suspicion of 24 haemothorax or pneumothorax and that it would warrant 25 decompression? 53 1 A. If we visit what is blast lung, blast lung is a diffuse 2 bleeding within the lung. If you look at somebody 3 caught up in an explosive environment, with all the 4 factors that encompasses, they may have been thrown. If 5 they were thrown and they hit a hard object, they could 6 have broken their ribs, their ribs could have punctured 7 the lung, that in turn could give you other causes of 8 bleeding and that would be haemothorax. 9 If you've got a fragment that's gone in and 10 punctured the lung, that in turn could give you 11 a pneumothorax. When you're faced with a person, 12 a casualty, all you're faced with is somebody who is 13 complaining that they're short of breath or looks short 14 of breath. 15 Q. Colonel, could I turn -- that's been very useful, thank 16 you. Could I turn to Miriam Hyman? 17 My Lady, the report is INQ11075. For obvious 18 reasons, any references I make I'm not going to bring on 19 screen. 20 Colonel, do you have a copy of her report to hand? 21 A. Yes, I believe I do. 22 Q. If we could just take as a starting point your 23 conclusion, which is paragraph 7.4 at page 12, and in 24 essence, Colonel, your conclusion was, on the balance of 25 probability, the combination of three things that were 54 1 most likely non- survivable: number one, the severe limb 2 injury and blood loss, although you say that would have 3 been insufficient to kill her in itself; secondly, blast 4 lung; and, thirdly, head injury. 5 Firstly, in relation to the limb injury, there's no 6 challenge on the part of the family to that conclusion 7 and they're grateful to you for it, but there is an 8 issue arising because it appears to be at odds with the 9 post-mortem. 10 Again, my Lady, I don't want to put it on screen, 11 but it's INQ1459. It's at page 5, point 2, where in the 12 post-mortem the conclusion was that she died as a result 13 of multiple injuries particularly to her lower limbs. 14 So the family are just concerned as to whether there's 15 a conflict between your conclusion in paragraph 7.4 and 16 the post-mortem. 17 A. No, I don't regard that as a conflict. Remember, we're 18 basing, and my colleagues are basing, these conclusions 19 on, when you look at the limb injuries in all these 20 patients, have we had soldiers and other people who have 21 survived similar limb injuries? 22 So while you could say, yes, you could bleed to 23 death from those limbs, equally the evidence that we 24 had, although they are very severe, we have had 25 survivors with that degree of limb injury who have 55 1 survived. 2 But when you add that to the other clinical 3 information -- and again, my understanding -- and please 4 shoot me down if I'm incorrect on this -- from reading 5 the post-mortem reports, that a number of the 6 pathologists clearly did not have access to witness 7 statements and did not have access to physiology, all 8 they had in front of them was an unfortunate victim of 9 a bombing, weren't doing internal post-mortems and so 10 were drawing conclusions as to what they saw in front of 11 them. 12 From the witness statements we would also believe 13 that Ms Hyman suffered head injury as well, which would 14 be consistent with the involuntary movements. So 15 I don't see a conflict with that. 16 Q. Of course, and, Colonel, the point you've just made 17 about the difficulties in the post-mortem is one with 18 which the family would also agree, because, of course, 19 that conclusion in the post-mortem at point 2, my Lady, 20 is followed by saying that those types of injuries to 21 her lower limbs are associated with significant vascular 22 injury which would have occasioned severe haemorrhage? 23 A. Yes. 24 Q. Whereas, in fact, from the witness evidence, from the 25 surrounding area there isn't evidence of very 56 1 significant bleeding or haemorrhage from her. The 2 bleeding seemed to be more limited. So certainly very 3 useful, the additional information which we have from 4 you, informed by more sources than just simply looking 5 at the external appearance of the body as the 6 post-mortem had to do. 7 In relation to the head injury, it's described as 8 a severe head injury in your paragraph 7.3. 9 A. Yes. 10 Q. In the post-mortem, there doesn't seem to be 11 a description of a severe head injury from external 12 examination? 13 A. No, there's a description of a laceration, I believe, 14 a parietal laceration. 15 Q. That's right. It's page 3. Do you have it to hand? 16 A. I don't have the post-mortem to hand, but I do have my 17 notes to hand. 18 Q. Yes. There's a number of references to lacerations, 19 some of which are superficial. The most serious head 20 injury described in the post-mortem by our reading is 21 point 1, a partial thickness laceration running 22 obliquely across a particular part of the scalp that was 23 3 centimetres. 24 Is it right that a partial thickness laceration 25 isn't superficial but it's not full thickness? 57 1 A. It's not full thickness, and particularly in Ms Hyman's 2 post-mortem there is not reference to an underlying 3 skull fracture. But if you look at the witness 4 statements, they describe somebody who dies very 5 quickly, is unconscious, and is making involuntary 6 movements. 7 That would lead -- that is what led us to the 8 conclusion that a severe head injury was highly likely. 9 Q. Colonel, this is the central difficulty which the family 10 have in relation to the conclusion, and it's certainly 11 no criticism. It's simply that the information that 12 you've been provided with, there's some doubts about its 13 accuracy. It's page 55, the final page of your report, 14 the appendix F, the time-line of events relating to 15 Ms Hyman. 16 We can see from that, Colonel, that you were 17 provided with information about four witnesses. 18 A. Yes. 19 Q. There's a very lengthy quote from Witness Du-Feu, 20 Michelle Du-Feu, and that describes in detail shallow 21 bleeding, blood coming out of her nose, her eyes were 22 open but she's unresponsive, very poor condition and 23 then there's a description of an attempt to treat her, 24 which is unsuccessful, and then her being dead moments 25 later. 58 1 In fact -- and of course, my Lady, this is simply 2 one hypothesis in relation to the evidence; you may, of 3 course, take a different view -- Ms Du-Feu, when she 4 gave evidence to the court, was quite confused as to who 5 this person was and ultimately didn't consider that that 6 person she was referring to was Miriam Hyman at all. It 7 appeared she was referring to somebody else. 8 The family did have doubts from the statement alone 9 of Ms Du-Feu as to whether she was referring to 10 Miriam Hyman, in any event, because the location and the 11 description was wrong in her first statement. 12 But if you were to disregard Ms Du-Feu, you're 13 obviously left with the other three witnesses, 14 Mr Featherstone, Mr Collins and Professor Dunlop, and 15 there have also been some quite significant changes in 16 relation to Mr Featherstone and Mr Collins in their oral 17 evidence. 18 In particular, you've referred in your answer, and 19 you refer in your report, to involuntary movements, but 20 both Mr Featherstone and Mr Collins in their oral 21 evidence in fact recalled something quite different, 22 which was that the movements weren't simply involuntary 23 but she was gripping their hand in response to them 24 holding her hand, they felt it was a responsive 25 movement. They did describe this happening in the first 59 1 few minutes after the blast and also they described her 2 strength diminishing. So they described her continuing 3 to grasp their hand, but they felt that her grip was 4 weakening. 5 Also, Mr Featherstone -- my Lady will recall this 6 from his oral evidence -- in fact said that his 7 statement was incorrect because, having been present 8 when an individual said that they checked her pulse and 9 believed she was dead, he was troubled by that 10 conclusion. Having left, he returns to her later. This 11 all seems to be -- it's hard to say -- it all seems to 12 be within the first ten minutes. 13 But certainly the reference in your concluding 14 paragraphs, paragraph 7.3, to a seriously injured person 15 who was unconscious, making involuntary movements, is 16 undermined to a certain extent by that evidence, and 17 also the reference to the blood coming from the nose. 18 The main reference to that, of course, was from 19 Ms Du-Feu. It is right that Mr Collins did refer in his 20 oral evidence to there being a small trickle of blood. 21 My Lady, the reference is Day 47, pages 166 and 167 for 22 that. 23 But given those changes to the information you've 24 got in the time-line, would that alter your view in 25 relation to Ms Hyman? 60 1 A. Well, I still -- I don't -- from what you've just said, 2 I don't understand what you're telling me about the 3 time-line. Are we saying that Ms Hyman did or did not 4 live more than ten minutes? 5 Q. I'm afraid we simply don't know, because the evidence is 6 that she was weakening during that initial period and 7 then an individual from the BMA building covered her 8 body with a blanket and doesn't recall taking her pulse, 9 had been told there were bodies outside, saw the torso 10 of the bomber lying in close proximity to Miriam Hyman 11 and covered them over, and I'm afraid, despite our best 12 efforts and efforts on the part of counsel for the 13 London Ambulance Service, we haven't been able to 14 ascertain whether anyone, in fact, checked her after 15 that point. 16 So the simple answer is we don't know. We've only 17 got evidence relating to that first ten-minute period. 18 We do know -- it's certainly ten minutes, because when 19 the first ambulance crew arrives on scene, her body is 20 uncovered, so we know it's some time after that, but I'm 21 afraid we don't know. The evidence we've got, though, 22 just relates to those early few minutes, and certainly 23 it suggests that she was weakening during that time. 24 There's no suggestion that she spoke at any time, but 25 there is a suggestion that her movements weren't 61 1 involuntary, that they were responsive. 2 So would that information change your view in any 3 way? 4 A. Not substantially, and again, you've still got a victim 5 who's been blown up, thrown, suffered severe injuries 6 and survives a very short period of time. 7 While clearly you're offering me, at no notice, 8 different detail on which to attempt to make 9 a conclusion, a death within that time course with the 10 injuries, from the scene photographs that I've seen and 11 the post-mortem report, I do not believe that 12 substantially changes our interpretation. 13 Q. Thank you very much. 14 In relation to Mr Brewster, my Lady, there's 15 a number of issues which don't relate to his positioning 16 at all and I can't see any difficulty in exploring those 17 at the outset, and we'll see how far we get with that. 18 LADY JUSTICE HALLETT: Certainly. And the family know -- 19 and they're happy that they should remain? 20 MS GALLAGHER: Yes, they've spoken to -- they've given 21 instructions to my solicitor. 22 So, Colonel, in relation to Mr Brewster, your 23 conclusion is at page 52, it's INQ11074, so paragraph 24 D6.2. Your conclusion is that, on the balance of 25 probability, he suffered non-survivable blast lung 62 1 injury, but also you've -- to the extent that you can -- 2 discounted the alternative hypothesis as to whether he 3 may have bled to death from his injuries being 4 untreated. 5 A. We've looked at the photographs of Mr Brewster's leg 6 injuries and the leg -- the tissue looks charred. It 7 does not look like tissue that would be bleeding. We 8 looked at the witness statements and the witnesses who 9 described putting a tie round Mr Brewster's leg, but one 10 of the witnesses does comment that they're not 11 staunching a flow of blood. 12 Based on that, we concluded there was no clear 13 evidence, there was no evidence, that Mr Brewster was 14 bleeding to death from leg injuries. But as caveated 15 all the way through, if there are different witness 16 statements, different positional data, or different 17 indications of injury, then we review conclusions, but 18 the pictures, the photographs and the reports indicate 19 those are not limb injuries that you'd expect someone to 20 bleed to death from. 21 Q. Could I just run through a number of points that you've 22 referred to just a little more fully? 23 Firstly, in relation to the charring, the 24 description in the post-mortem is of smoke blackening, 25 but you felt that, in fact, it was more than that, it 63 1 was quite substantial charring to the limbs? 2 A. That was certainly our impression, excepting the caveats 3 of interpreting the pictures. 4 Q. You've also referred to witnesses who have described 5 a lack of active bleeding and also the attempted 6 application of the tourniquet. 7 A. Yes. 8 Q. The attempted application of the tourniquet is at a very 9 late stage. 10 A. Yes. 11 Q. You will be aware that Mr Brewster was trapped in the 12 bomb crater? 13 A. Yes. 14 Q. In fact, the witnesses who refer to seeing the bleeding 15 in his legs -- to not seeing bleeding in his legs, they 16 plainly don't see that from the carriage, they see that 17 at a later stage when they've gone underneath to look at 18 him and the tourniquet is actually at the very end of 19 the process -- 20 A. Yes. 21 Q. -- which may have been up to 40 minutes. 22 So just hypothesising for a moment -- I will come to 23 the time-line in a moment, but just hypothesising for 24 a moment, in the most general terms, if that witness 25 evidence about the lack of active bleeding being seen 64 1 and about the tourniquet is at the tail-end of the 2 40-minute period, would that affect your conclusion in 3 paragraph D6.1? 4 A. We're aware that the tourniquet went on late and we're 5 aware the witnesses were in the position that they were, 6 but again, we have to rely on the information that we're 7 given. 8 If you have a witness that says, early on in the 9 injury, Mr Brewster was -- had severe bleeding from leg 10 wounds, then you've got evidence that someone has bled 11 to death. Our interpretation of the -- Mr Brewster's 12 leg wounds were that these were wounds that had been 13 subject to heat. 14 Now, there's error bars in that interpretation, but 15 if you take -- if you take our view that these were leg 16 wounds subject to heat from being close to an explosion, 17 and were not actively bleeding, then it's unlikely 18 Mr Brewster bled to death. But if you have a witness 19 that says Mr Brewster was bleeding profusely from his 20 legs, then you've got a different mechanism of injury. 21 Q. Of course, and there's no witnesses saying that, 22 although, of course, most witnesses were seeing him from 23 the waist up, his legs aren't seen until a later stage. 24 Just in relation to your conclusion regarding blast 25 lung, you obviously say it's likely, you don't say it's 65 1 certain, for all the reasons you've given earlier. 2 Yesterday in evidence you described how the -- you 3 described how the alveoli become filled up with blood -- 4 A. Yes. 5 Q. -- and then they're not available to perform their usual 6 function. 7 A. Yes. 8 Q. So the person is short of oxygen. 9 A. Yes. 10 Q. Putting that in layman terms, but broadly speaking. 11 The reference in the draft of the transcript was to 12 page 98, my Lady. I'll get you the reference in the 13 finalised transcript later. You did say that can be 14 manifested by the person, if they're conscious, saying 15 they've got difficulty breathing, and in observers 16 watching the fact that they're struggling for their 17 breath. 18 A. Yes. 19 Q. You then, of course, said the process can be gradual, 20 you gave this analogy to a sprained ankle. 21 A. Yes. 22 Q. Could we just, for completeness, have [INQ10552-26] on 23 screen, please? It's B4.2.1.1. 24 A. Yes, that's from, I believe, Dr -- Mr Pope -- no, that's 25 the first one, isn't it? 66 1 Q. Yes. 2 A. That's from our original one, Dr Kirkman's work. 3 Q. It's simply the final two sentences: 4 "The lungs become stiffer and breathing becomes 5 difficult resulting in hypoxia (shortage of oxygen)." 6 And: 7 "The injury may progress to a condition called acute 8 respiratory distress syndrome." 9 A. Yes. 10 Q. If we can just go down to the next paragraph: 11 "Blast lung is therefore a condition that 12 evolves ..." 13 This is like your sprained ankle analogy? 14 A. Yes. 15 Q. "... over a period of hours following blast exposure, ie 16 a casualty who may not appear 'too bad' initially may 17 become critically ill later." 18 Colonel, if the individual is suffering from blast 19 lung, in addition to difficulty breathing, is chest pain 20 an issue? 21 A. Not necessarily, no. 22 Q. You were taken to a reference yesterday -- sorry, 23 I won't go to it again, but it referred to transient 24 cessation of breathing and rapid shallow breathing. 25 A. Yes. 67 1 Q. The difficulty in relation to Mr Brewster is this: 2 there's no evidence whatsoever that he was suffering any 3 respiratory distress at any time, and if I could just 4 refer both to Mr Brewster himself and to others, the 5 family's concern is that there doesn't seem to be 6 evidence of breathing difficulties which would link to 7 this conclusion. 8 So firstly, in relation to Mr Brewster himself, 9 quite unusually amongst the 18, he was very articulate 10 and complaining and in full conversation at the outset 11 after the bombing. In fact, he was going so far as to 12 complain about pains in his legs and pains in his 13 injured hand, so he was describing how he felt at quite 14 an early stage, and there was no reference to problems 15 with his breathing at all from him. 16 But secondly, in relation to others, Mr Brewster was 17 in quite an unusual position because, while, at other 18 scenes, and indeed with other deceased at Edgware Road, 19 some witnesses remember them, some witnesses don't, as 20 you will recall, my Lady, almost all the witnesses who 21 were in the carriage recall Mr Brewster, and that's 22 simply because he was the focus of attention in the 23 carriage because of where he was placed and because of 24 the fact that he was shouting and asking to be freed. 25 So he was, to a certain extent, the focal point of the 68 1 witnesses. The vast majority of witnesses have 2 described his appearance and what he was saying and none 3 of them have referred at any time to seeing him having 4 difficulty breathing or hearing him complaining about 5 difficulty breathing. 6 So given that material, there's just a concern on 7 the part of the family that there's no evidence of him 8 having been in respiratory distress at any time or 9 having had difficulty breathing and there's no evidence 10 of him having had shallow breathing at any time, and 11 they are simply concerned, given the absence of that 12 evidence and, in fact, clear evidence of his condition 13 throughout the time from multiple witnesses, they're 14 concerned at the conclusion that blast lung must have 15 been what killed him. 16 A. I think blast lung is still a high possibility. You've 17 got somebody who, if we take the Tube map as accurate, 18 and place him in that proximity to the explosion, and if 19 we agree that he was subject to that sort -- to the sort 20 of overpressure that Dr Kirkman and Dr Pope have agreed, 21 then that is consistent with somebody getting 22 a significant primary lung injury. 23 We also -- the history describes Mr Brewster as 24 initially being very vigorous and then deteriorating. 25 In the absence of obvious bleeding, the type of things 69 1 that could kill somebody are primary blast injury, other 2 causes of internal bleeding, which we didn't see 3 anything obvious in the photographs, or other lung 4 injuries. So on the balance of probability, blast lung 5 is a possibility, a high possibility. 6 But as I said all the way through and stated in each 7 individual report, it's balance of probability. 8 Q. Of course, and, again, Colonel, you're highly reliant on 9 the information that's been provided to you. 10 You said yesterday, and you've referred to it again 11 just now -- you said yesterday in evidence that you 12 understood he was initially vigorous and trying to help 13 himself. 14 A. Yes. 15 Q. But fairly rapidly after that, his physiology 16 deteriorated, and also, in the report at page 50, it's 17 paragraph D5.1, you again say: 18 "The majority of the witnesses from the court's 19 time-line describe him initially being very active after 20 the explosion, shouting for help, but rapidly becoming 21 weaker and both his breathing and pulse deteriorating." 22 That would fit in with the time-line that you're 23 given, which describes these three phases. So phase 1, 24 actively requesting help. Phase 2, there's reference to 25 Sandip Meisuria's evidence and Anthony Pantling, when 70 1 the shouting has stopped, and phase 3, when he's 2 quieter, when Tim Coulson arrives and so on, when the 3 tourniquet is applied. 4 There's two difficulties with that in relation to 5 phase 2. The first difficulty is this: that 6 Anthony Pantling -- my Lady, it's Day 19, page 194 -- 7 Anthony Pantling said: 8 "He certainly initially was very vigorous in trying 9 to free himself, but he then appeared to be making 10 himself comfortable, reconciled to not being able to get 11 himself out." 12 So Anthony Pantling was describing, in phase 2, not 13 him rapidly deteriorating and going quiet because he was 14 rapidly deteriorating, but simply because he had become 15 reconciled to his situation. Multiple people had 16 attempted to pull him out and had failed. That's 17 a different approach to phase 2, to the indication you 18 get in the time-line. 19 A. It's a different interpretation, but equally, Pantling 20 says -- I think it's down at phase 3, there was 21 a question: 22 "Question: Did you deduce he was still conscious 23 because his eyes were open, able to see you and aware of 24 your presence? 25 "Answer: Yes." 71 1 But they do not describe someone who is no longer 2 vigorous. 3 Q. The other difficulty is the other person who's referred 4 to in phase 2 is Sandip Meisuria, and in fact, there was 5 some confusion in Sandip Meisuria's evidence as to what 6 time he was speaking of, but in fact we know -- and you 7 have this in the time-line at page 86 -- that he 8 thought, ultimately, the paramedics probably arrived 9 within 25 minutes. 10 So his estimation of timing is affected by that, 11 when, of course, the evidence seems to suggest, in fact, 12 it was some time later. 13 So there's just some difficulties with that. 14 A. So what is the question? 15 Q. The question simply is: if the presumption that he 16 fairly rapidly, or rapidly, as it's put in the report -- 17 that his physiology deteriorated rapidly, and if, in 18 fact, his physiology didn't deteriorate until some 19 30 minutes after the blast, would that alter your 20 conclusion? 21 A. That's rapid, that's rapid. That's someone who's gone 22 from being vigorous to someone who's dead. 30 minutes 23 is a rapid time period. Not as rapid as 5 or 24 10 minutes. 25 Q. Of course? 72 1 A. But it's a rapid period nonetheless. 2 Q. Colonel, the description by witnesses of him drifting 3 away, weakening pulse and fading and so on, is that 4 consistent with blast injury? 5 A. Yes. 6 Q. Despite the absence of any breathing difficulties? 7 A. It's consistent with blast injury, it could be 8 consistent with internal bleeding. Based on his 9 proximity -- on what we believe is Mr Brewster's 10 proximity to the explosion, based on the likely blast 11 loading, primary blast injury remains a high 12 probability. But equally possible, you could have other 13 internal injury. 14 Q. Of course. 15 A. We have error bars. 16 Q. That brings me, Colonel, on to a letter which is dated 17 1 December 2010. 18 I think, my Lady, because the witness isn't going to 19 have this available, it's going to have to be on screen. 20 The reference is [INQ11079-2]. It's paragraph 7. If we 21 could just centre on paragraph 7. 22 Colonel, this letter is after Edgware Road had 23 concluded, because we know the evidence for Edgware Road 24 finished on 25 November 2010, and from paragraph 7 it 25 seems that from the work on phase 2 so far issues have 73 1 been raised in relation to four particular deceased 2 where further information was required -- 3 A. Yes. 4 Q. -- or alternative expertise on a particular issue may be 5 required. 6 There's four people named there: Michael Brewster, 7 Philip Beer, Shelley Mather and Samantha Badham. Now, 8 Philip Beer, Shelley Mather and Samantha Badham, we know 9 they are the three people who are referred to at the 10 outset where you concluded you didn't have sufficient 11 evidence or you couldn't say. So of those four people, 12 the only person you reached a firm conclusion about is 13 Michael Brewster. 14 Now, is it right that the additional information 15 related to possible natural causes? 16 A. Yes, there were two things. At the stage that this 17 letter was written, our tasking letter or instruction 18 letter for phase 2, we didn't have the advance blast 19 modelling. We had what we believed was a good 20 indication of where Mr Brewster was positioned, and our 21 expectation was that he was somebody who, being that 22 close to the explosion, was likely to have had blast 23 lung. 24 I was also concerned, given the witness 25 descriptions, I needed to know could it be something 74 1 else. I've talked about potentially internal bleeding, 2 but I wanted to know was this a man who had an 3 underlying heart condition and had the stress of being 4 blown up and the associated injuries caused him to have 5 a heart attack. 6 Q. The answer from the family was there wasn't a known 7 history of cardiac problems? 8 A. The answer from the family was that, yes. 9 Q. So, Colonel, with the other three people, obviously you 10 decided, after those enquiries, that you couldn't reach 11 a conclusion. With Mr Brewster, you did. 12 A. Can you put them back up for me? 13 Q. Yes, of course. 14 A. So Philip Beer, as brought out by your learned 15 colleagues, we couldn't say for certain where Mr Beer 16 was located. 17 LADY JUSTICE HALLETT: I don't think we need to go through 18 those three again. I think Ms Gallagher is just 19 concentrating on Mr Brewster. 20 MS GALLAGHER: I don't think so either. 21 A. Okay. 22 Q. I think the point you're making, Colonel -- 23 A. In the absence of a clear location, while the other 24 individuals' injuries would suggest they were close to 25 an explosion, we could not be -- as set out, we did not 75 1 have the -- we could not give the certainty we would 2 like to give. 3 If we accept Mr Brewster's position in relation to 4 the bomb being accurate, then we have the opportunity to 5 look at blast loading. If we dispute the position of 6 Mr Brewster in relation to the bomb, then you call into 7 question the blast loading. But Mr Brewster did end up 8 in the bomb crater. 9 Q. Colonel, the concern of the family was, that given on 10 1 December you felt you didn't have sufficient 11 information to reach a firm conclusion in relation to 12 Mr Brewster and you were then told in answer to the 13 query that he had no cardiac history, what's changed 14 between then and your report? I think the answer is 15 likely to be the -- 16 A. Several hundred thousand pounds worth of blast loading 17 information, a computational model and the work of two 18 specialist teams at Porton Down, as set out in my 19 report. 20 Q. But it comes back to positioning, is the point. 21 A. Yes, it does. 22 Q. It comes back to the information about positioning. 23 My Lady, I think, without exploring positioning, 24 it's simply not going to be possible, given that all of 25 the answers ultimately come back to positioning. 76 1 I'm going to need to speak to my clients about how 2 to deal with that. It may be sensible, rather than 3 trying to deal with it in oral evidence today, 4 particularly in circumstances where Sandra Brewster, 5 Mr Brewster's wife, is at home and I haven't spoken to 6 her about the specific issue -- 7 LADY JUSTICE HALLETT: I'm afraid Ms Gallagher, I'm sorry to 8 interrupt you again, I don't think the Colonel is going 9 to be accessible. 10 MS GALLAGHER: So it simply won't be possible to explore 11 this in writing in any way? 12 A. No. 13 LADY JUSTICE HALLETT: I'm afraid he's going somewhere where 14 we can't submit questions. 15 A. You're welcome to join me. 16 MS GALLAGHER: Of course, but, my Lady, it plainly will be 17 possible for us to submit further evidence ourselves 18 relating to positioning, even if we can't test the 19 positioning evidence further. I can just see some 20 substantial difficulties both for me and for the witness 21 in attempting to test the positional evidence today, 22 particularly given the absence of a clinical photograph 23 which you've indicated would be essential for you. 24 LADY JUSTICE HALLETT: Let's see, Ms Gallagher. What 25 exactly -- before Mr Keith says something, Ms Gallagher, 77 1 what are you saying? Have you now completed the 2 questions, as far as you can go, with the Colonel? 3 MS GALLAGHER: Well, I suppose there's one final matter, 4 Colonel, which simply is this: is it right that, to 5 a certain extent, the conclusion in relation to blast 6 lung is a residual conclusion because of the fact that 7 bleeding to death has been ruled out and because of the 8 fact that natural causes have been ruled out? 9 A. I don't understand "residual conclusion". 10 MS GALLAGHER: My Lady, I'm afraid it simply all relates to 11 positioning and I think there's some substantial 12 difficulty in exploring -- 13 A. I don't understand what you mean by "residual 14 conclusion". 15 LADY JUSTICE HALLETT: Wait a minute. Let's -- Mr Keith -- 16 again, Ms Gallagher, I'm a bit concerned, you mentioned 17 further evidence, I'm not sure what you're talking 18 about. What evidence are you talking about? 19 MS GALLAGHER: Rather than evidence, my Lady, I simply was 20 referring to submissions. 21 LADY JUSTICE HALLETT: Right, submissions on the evidence 22 from the witnesses? 23 MS GALLAGHER: Yes. 24 LADY JUSTICE HALLETT: Oh, I see. 25 MS GALLAGHER: But it may be possible we can do it in 78 1 a sensible and appropriate way in writing to the Inquest 2 team. You are, of course, able to take into account 3 material we put to you in writing as well as material 4 that's put to you orally. 5 LADY JUSTICE HALLETT: Oh, indeed. 6 MS GALLAGHER: I simply can't see a way that either I or the 7 witness are going to be -- I don't think it will be 8 fruitful attempting to explore positioning today, 9 orally. 10 LADY JUSTICE HALLETT: Does that now complete your 11 cross-examination -- your questioning of the Colonel? 12 MS GALLAGHER: Yes, and in essence, where we're left is it 13 comes down to positioning. 14 LADY JUSTICE HALLETT: Indeed. 15 MS GALLAGHER: If the positioning is accurate, the 16 conclusion stands. 17 LADY JUSTICE HALLETT: I've written that down so many times 18 I think that message has got through. 19 MS GALLAGHER: No, of course, but I'm afraid it hasn't been 20 possible to avoid the issue of positioning much as I've 21 attempted to do so. 22 LADY JUSTICE HALLETT: It's not in response to your 23 questioning, but the Colonel was saying it in response 24 to others. 25 Mr Keith, given what Ms Gallagher has just said, do 79 1 you have any comments at this stage? 2 MR KEITH: My Lady, yes, I do. The provisions of rule 40 of 3 the Coroners Rules preclude any submissions being made 4 on the facts. My Lady is not permitted, of course, to 5 receive an address on the facts, so I doubt whether my 6 learned friend in law would be permitted to address you 7 on the interpretation of Colonel Mahoney's evidence. 8 LADY JUSTICE HALLETT: No, but she could remind me of those 9 passages of the evidence that she particularly could 10 draw to my attention. That's not making submissions, 11 surely. 12 MR KEITH: My Lady, there might be a difference, we accept, 13 between a statement of the factual position as it 14 appears and an analysis of the conclusions to be drawn 15 from those facts. It is, I'm afraid, a difference that 16 we might have to explore in due course. 17 But for present purposes, the Colonel has, it seems 18 to me, given clear evidence as to conclusions reached in 19 relation to Mr Brewster and, without wishing to violate 20 the provisions of rule 40 myself, Mr Brewster was, of 21 course, in the crater, the bomb crater, as the Colonel 22 said, and there is no evidence that he was any further 23 away from the bomb than that. 24 Given that the bomb crater could only have been 25 a matter of a fraction of a metre away from the bomb, 80 1 0.55 metres in the report, there is surely no material 2 upon which it could properly be suggested that he would 3 have suffered anything other than the full 4 2.0 megapascals of overpressure, 20,000 times 5 atmospheric pressure. 6 So I really do question whether or not there is any 7 proper factual basis, given that there is no evidence 8 that Mr Brewster was anywhere else, for my learned 9 friend to pursue the point further, even if rule 40 10 permitted her to address you on the facts. 11 LADY JUSTICE HALLETT: Right. 12 MS GALLAGHER: My Lady, just to finish that. Plainly, 13 you're not able to receive an address from legal 14 representatives on the facts directly under rule 40, but 15 of course, you can receive submissions on the 16 sufficiency of factual material for reaching certain 17 legal conclusions. So we're certainly able to do that, 18 in the way that inquest lawyers do all the time, so the 19 factual issues are referred to in that way but not 20 directly and so not violating rule 40. 21 LADY JUSTICE HALLETT: It is a typical lawyer's 22 interpretation. 23 MS GALLAGHER: Yes, thank you. 24 LADY JUSTICE HALLETT: Thank you, Ms Gallagher. Does 25 anybody else have any questions for the Colonel? Yes, |
| CODE |
| http://7julyinquests.independent.gov.uk/hearing_transcripts/01022011am.htm |
| QUOTE |
| 81 1 Ms Simcock? 2 Questions by MS SIMCOCK 3 MS SIMCOCK: Colonel, may I just start with some questions 4 about your instructions, please? You confirmed in 5 relation to questions from Mr Keith -- who asked you 6 questions first of all yesterday -- that you weren't 7 asked to address the question or comment upon the 8 appropriateness or adequacy of any medical treatment. 9 A. Can I ask who you are and whom you represent? 10 Q. Yes, I represent the London Ambulance Service. My name 11 is Ms Simcock. It shouldn't really matter, though, 12 who's asking you the questions. 13 But can I confirm that at page 5 of each and every 14 report you do confirm that you discussed with Mr Smith, 15 the Solicitor for the Inquest, the parameters of that 16 instruction and that he confirmed that, insofar as you 17 considered that medical treatment caused or failed to 18 prevent death, then you should say so. Is that right? 19 A. That's correct. 20 Q. So firstly, then, you did consider -- you and your 21 team -- medical treatment to that extent in the process 22 of preparing your reports? 23 A. We considered information that we had in the witness 24 statements and we considered indications of medical 25 treatment that we could see from the photographs, such 82 1 as evidence of thoracostomy, that is an incision being 2 made into the chest to release air, or evidence of 3 needle decompression of a chest. 4 Q. Yes, but specifically with a view to considering whether 5 that medical treatment had caused or failed to prevent 6 death. Is that right? 7 A. We could only be aware of treatment if it was mentioned 8 in the witness statements and we could see evidence of 9 it in the photographs, and we could only really consider 10 that in relation to: here is somebody who's had a chest 11 decompression, is that likely or unlikely to have made 12 a difference to this outcome? 13 Q. So may I confirm that, given that there is no such 14 factual conclusion in any of the reports, you didn't, in 15 fact, consider that any medical treatment that was 16 evident caused or failed to prevent death in any of the 17 cases that you looked at? 18 A. On the information that we had, based on witness 19 statements and based on the photographs -- as I say, we 20 were not in a position to make comment on the medical 21 treatment. The only comment that's been made is the 22 comment that's been drawn out of me today in the 23 additional questioning. 24 Where we had uncertainty, as we certainly had in one 25 patient, we asked for additional expert opinion to 83 1 clarify that for us, in terms of one of the chest 2 decompressions. 3 Q. Yes, in relation to Shelley Mather. 4 A. Yes. 5 Q. So presumably, had you considered that such a conclusion 6 was open to you on the evidence that you had -- ie that 7 medical treatment did cause, contribute or failed to 8 prevent death -- you would have said so? 9 A. If we had evidence of something that somebody had done 10 in a medical capacity and could say this intervention 11 has likely hastened this individual's death, then that 12 is something we would have commented on. 13 We were not in a position to comment on the 14 application or non-application of oxygen or other 15 interventions like that, because we did not have the 16 evidence to judge that. 17 Q. Thank you. In relation to trauma scoring, just for 18 completeness, you were asked some questions about this, 19 and you and your team came to the view that you simply 20 couldn't usefully carry out any trauma scoring -- 21 A. Correct. 22 Q. -- on any of the deceased you looked at. Is that right? 23 A. Correct. 24 Q. So just to clarify and close this issue off, when 25 Colonel Russell says in his appendix A in each of the 84 1 reports that full trauma scoring cannot be applied to 2 the casualties and, later, that any results will be 3 underestimates of the total severity of injury suffered, 4 it's not that there are any results out there somewhere 5 that we don't have? 6 A. Well, we certainly haven't done trauma scoring. One of 7 the things we wanted to do originally before we were 8 presented with the information, were we to do trauma 9 scoring, which would have allowed us to make -- 10 construct a database and give a mathematical probability 11 of outcome. 12 But in deceased patients, in the absence of internal 13 post-mortem, you do not have the anatomical 14 intervention -- anatomical information to do that trauma 15 scoring. Anything is a guess. We did not feel that was 16 appropriate. 17 Q. Thank you. In relation to the information you did have, 18 fluoroscopy, first of all, you described it as a limited 19 form of X-ray, particularly looking for breaks and the 20 presence of external fragments. 21 A. Yes. 22 Q. So it's a type of imaging that is different to plain 23 X-rays with which some members of the public may be 24 familiar. Is that right? 25 A. Yes. 85 1 Q. Am I right in saying that the image is seen in real-time 2 on a monitor and the fluoroscopy images are generally 3 less detailed and of a poorer image quality than plain 4 X-rays? 5 A. I can't comment on image quality because that would 6 really depend on the nature of your X-ray machine and 7 your fluoroscopy machine, so I can't comment on that. 8 All I can comment on is that the information that we 9 have referred to fluoroscopic results which commented on 10 breaks and commented on fragments. We were not 11 presented with any hard copy of any images. 12 So we were not given images to say "Interpret this". 13 Q. Yes, of course. You'd said that it was a limited form 14 of X-ray, so one thing it is good at, though, is looking 15 for foreign bodies, fragments in a deceased body. Is 16 that right? 17 A. That's correct. 18 Q. It can show breaks, fractures, in bones. That's right? 19 A. Yes. 20 Q. But of course, it may not pick up all fractures present, 21 is that right? 22 A. Again, it depends on the operator, depends on the 23 fidelity of the machine, it depends what they're looking 24 for. 25 Q. But are you aware, out of your experience, that 86 1 fractures can be present, particularly, for example, if 2 they're small, that aren't picked up by fluoroscopy and 3 indeed may not be picked up by plain X-ray? 4 A. I'll comment on plain X-ray. You can take plain X-rays 5 and you will not necessarily see a fracture on a plain 6 X-ray. You may see that fracture, subsequently, several 7 days later, and that can be just due to the way the -- 8 the way the X-ray is taken, the process by which the 9 fracture is being remodelled. So any imaging technique 10 has limitations. 11 LADY JUSTICE HALLETT: It may depend on the expertise of the 12 person assessing the X-rays? 13 A. Yes, my Lady, yes. 14 MS SIMCOCK: Indeed. What I'm getting at really, Colonel, 15 is, simply because there may not be the presence of, for 16 example, rib fractures in the fluoroscopy report in 17 certain post-mortems or, indeed, small fractures of the 18 skull in certain post-mortems here, it does not 19 necessarily exclude their presence? 20 A. I can only interpret -- we can only interpret the report 21 that people have given. If people have commented on the 22 presence of a fracture, or the presence of a fragment, 23 we can comment on that. I cannot comment on the absence 24 of a report. 25 Q. But the absence of a report does not preclude a fracture 87 1 being present? 2 A. I don't know what those individuals examined. I don't 3 know if they tried to examined the whole body. I don't 4 know if they looked at the pelvis. I don't know if they 5 looked at the skull. 6 Q. Precisely. 7 A. I can only draw a conclusion based on the material that 8 is presented to us. So I cannot comment on additional 9 aspects of investigation. 10 Q. But even if -- let's take the skull. Even if a skull 11 was examined in a particular individual and fluoroscopy 12 concluded -- the person carrying out fluoroscopy 13 concluded "I don't see the presence of a skull 14 fracture", that in and of itself does not preclude, does 15 it, the presence of one, because of all the reasons 16 you've just described? 17 A. Any imaging is open to interpretation, which is why you 18 have hard copy in hospital and which is why more than 19 one person will review it. but Mahoney's team were not given hard copies by his own admission 20 Q. Yes, thank you. Fluoroscopy doesn't show soft tissue 21 injury. Is that right? 22 A. Correct. 23 Q. And it doesn't show -- so it wouldn't show, for example, 24 pneumothoraces? 25 A. Well, on the reports that we've got, there's only been 88 1 comment on fractures and fragments. There have not been 2 reports on chest examinations. There's been post-mortem 3 reports commenting on the presence or absence of rib 4 fractures, but no one has commented on fluoroscopy 5 appearances. 6 So again, I cannot explore this any further. 7 Q. I'm grateful. Just lastly on this topic, then, does 8 fluoroscopy have the ability to show blast lung or blast 9 bowel injury? 10 A. If I wanted to look at blast lung or blast bowel, 11 I would be looking for a plain X-ray or a CT image. 12 Q. Yes. 13 A. There is no comment throughout the examinations, that 14 we've had access to, on fluoroscopy being used to look 15 at -- trying to look at cavities. 16 Q. Yes, I'm very grateful. 17 In terms of external injury, a wound having 18 a charred or burnt appearance, you've confirmed firstly 19 suggests a close proximity to the explosion, to the 20 bomb. Is that right? 21 A. We're interpreting it as a close proximity to a heat 22 source and, under these circumstances, we're taking that 23 proximity to the heat source being the explosive. 24 Q. The implication from that being that that individual 25 would have been subject to a high blast loading. Is 89 1 that right? 2 A. That's been the interpretation that we've placed, unless 3 we've had evidence to say otherwise. 4 Q. Yes, thank you. 5 Secondly, a charred or burnt appearance of a wound 6 would suggest that there was unlikely to be uncontrolled 7 or significant bleeding or haemorrhage from those 8 wounds. Is that right? 9 A. If we can agree a wound looks charred, and we can agree 10 the tissue is burned, then it is unlikely that that 11 tissue is bleeding freely. 12 Q. Is that because the blood vessels have effectively been 13 closed off? 14 A. Coagulated, yes. 15 Q. But, of course, those external injuries don't help you 16 at all with whether or not there is the presence of 17 a significant internal injury that would have caused 18 significant internal bleeding. Is that right? 19 A. No. Again, as stated in the reports, the presence or 20 absence of internal injuries would have to be inferred 21 by people's proximity to the bomb and the witness 22 statements giving clinical signs and symptoms. 23 Q. Yes. In the reports you've referred to post-mortem 24 changes which occurred in some of the deceased bodies 25 making it difficult to interpret injuries? 90 1 A. Yes. 2 Q. Without wishing to go into any distressing detail of the 3 post-mortem changes you're referring to, can you explain 4 in any more detail the sort of difficulty in relation to 5 which particular injuries? 6 A. No, I can't, without giving distressing clinical detail, 7 which I'm prepared to do, my Lady, but -- 8 Q. No, I don't ask you to do that at all. 9 One last question -- and the same comment applies; 10 if it's distressing detail, please don't say -- was 11 there any particular issue in relation to post-mortem 12 changes in relation to any of the deceased whom you 13 concluded that there was insufficient evidence to be 14 able to say non-survivable or not, one way or the other? 15 A. My Lady, if we want to go into -- to do that, I want 16 photographs and I'll take you through the changes. 17 That's what we're talking about. 18 Again, I'm not trying to obstruct you, but really, 19 to give you an indication of our difficulties, I'd need 20 to show you the photographs. 21 Q. I just really want a confirmation whether you 22 experienced difficulties, without going into what those 23 were, with those particular deceased, the ones that 24 there was insufficient evidence? 25 A. We've experienced difficulty in interpreting a lot of 91 1 post-mortem photos, based -- because of post-mortem 2 changes. If you want me to go through individual 3 deceased to give you a clear answer, then we need to go 4 through photographs. 5 Q. I'll leave it. 6 In the reports, you give a definition of 7 a non-survivable injury as one from which long-term 8 survival is not possible, albeit it might not cause 9 instant death. You give examples in your death of full 10 body burns or some devastating head injuries. Is that 11 right? 12 A. Yes. 13 Q. Those, clearly, are just two examples you give. There 14 are clearly others. Is that right? 15 A. Yes. 16 Q. When you refer to long-term survival, do you mean 17 survival past a few hours or days? 18 A. Yes. 19 Q. I'm very grateful. Just a few questions, then, of 20 clarification in relation to particular individuals. 21 The first is Ms Carrie Taylor. Do you have that report? 22 LADY JUSTICE HALLETT: Ms Simcock, just before we embark on 23 this, I haven't given the stenographers a break this 24 morning. 25 MS SIMCOCK: Five minutes, my Lady. 92 1 A. I will locate it. 2 Q. I'm grateful, Colonel. May I just ask you to turn to 3 page 76? I don't ask that it's up on screen. So we can 4 orientate ourselves, Colonel, this is Dr Kirkman's annex 5 and he comments on Dr Pope's conclusion that 6 Carrie Taylor suffered a peak overpressure blast loading 7 greater than 350 kilopascals. 8 I think, when you were asked questions, your 9 conclusions were, in fact, Carrie Taylor had been closer 10 to the blast than these two individuals your colleagues 11 were working on, in terms of providing this figure of 12 350 kilopascals. Is that right? 13 A. The team was asked to work on the provided body -- not 14 body maps, wrong -- on the provided carriage maps 15 indicating people's locations, and they were asked to 16 generate the pressures based on that. 17 Our interpretation of Carrie Taylor's injuries, our 18 interpretation, which were clearly disputed by Mr Taylor 19 yesterday, our interpretation would place Carrie Taylor 20 closer to the seat of the explosion and, by implication, 21 you'd expect a higher blast loading, if we've read the 22 injuries correctly and I believe we have. 23 Q. Yes. 24 LADY JUSTICE HALLETT: Ms Simcock, I'm sorry to interrupt 25 you, I think this is too important, this evidence, and 93 1 it's been a long morning for the stenographer, I think 2 we ought to take a break now, I'm sorry. 3 MS SIMCOCK: Yes, very well. 4 LADY JUSTICE HALLETT: Ten minutes. 5 (12.00 noon) 6 (A short break) 7 (12.10 pm) 8 LADY JUSTICE HALLETT: Ms Simcock? 9 MS SIMCOCK: Thank you, my Lady. Colonel, we were dealing, 10 just before the break, with blast loading in relation -- 11 specifically in relation to Carrie Taylor -- 12 A. Yes. 13 Q. -- and I was asking you about the figure that's in the 14 report, which is greater than 350 kilopascals, and 15 I think, given your other conclusions about where 16 Carrie Taylor was at the time of the explosion, your 17 view, your considered view, drawing on the expertise 18 also of your team of colleagues is that, in fact, your 19 final conclusion is that the blast loading she would 20 have been subjected to was actually much greater than 21 350 kilopascals. Do I have that right? 22 A. If our reading of Carrie Taylor's injuries is correct, 23 and it is a considered review of her injuries, our 24 reading is that would place Carrie Taylor closer to the 25 explosion than is indicated on the map. The distance 94 1 that the team calculated was based on the map, so the 2 implication would be, if she's closer to the explosion, 3 based on her injuries, then she's been subjected to 4 a higher blast load. 5 Q. Are you able to give us any further indication of the 6 sort of level of blast loading or not? 7 A. No. 8 Q. I'm grateful. 9 In relation to internal injuries, you've commented 10 that, on the photo that you saw, the scene photo of 11 Carrie Taylor, you didn't see the presence of abdominal 12 distension. Is that right? 13 A. Correct. 14 Q. Abdominal distension being present, of course, as 15 a positive sign, can indicate an internal injury and 16 bleeding, because, as you indicated previously, the 17 abdomen can become full of blood and that gives the 18 appearance. Is that right? 19 A. That's right. 20 Q. Is it possible, though, to have an internal injury that 21 does bleed significantly and still not see abdominal 22 distension present? 23 A. Yes. 24 Q. Is that because the abdomen, being a soft structure, as 25 you've previously described, there are other places 95 1 within the abdominal cavity for the blood to go? 2 A. No question. 3 Q. I'm very grateful. 4 So in relation to Carrie Taylor, given what we know 5 about your conclusions drawn from her injuries and other 6 data of her positioning, your conclusions about that, 7 and given that we know she was thrown, because of your 8 conclusions about the type of wrist fracture that she 9 sustained, it's possible, isn't it, that she did also 10 sustain an internal significant injury? 11 A. I'd say for Carrie Taylor and I'd say for a lot of the 12 other casualties it is highly likely that, if they had 13 been thrown, impacted with objects, or subject to high 14 blast loading, then they're likely to have other 15 injuries. 16 The requirement was to find -- was to make a view on 17 survivability or non-survivability. 18 Where we've got blast loading, we can have a view on 19 survivability from lung injury. Where we've got 20 objective evidence of head injury, we can make comment 21 on head injury. For most injuries other than the 22 photographs, we don't have objective evidence either 23 way. 24 Q. Yes, and just in relation to Carrie Taylor, because we 25 know she was thrown, and we know, of course, that she 96 1 had a laceration to her scalp, which certainly would 2 indicate an injury to her scalp might also be present of 3 course, an underlying head injury, in fact your report 4 concluded that that was likely. Is that right? 5 A. Quite possible, if someone's been thrown and impacted 6 with an object, and they've hit their head, underlying 7 brain injury is possible, even in the absence of an 8 obvious skull fracture. 9 Q. Yes, and we know that there is witness evidence of 10 involuntary movements and semi-consciousness of 11 Carrie Taylor from Dr Quaghebeur, whose evidence you 12 looked at -- 13 A. Yes. 14 Q. -- because it's in the time-line. We know, of course, 15 that there was bleeding from her nose. Those may also 16 be indications of an underlying head injury. Is that 17 right? 18 A. Yes, as discussed with Mr Taylor yesterday, bleeding 19 from the nose could indicate bleeding coming down from 20 a head injury, bleeding coming up from the lungs or 21 facial injury. 22 Q. Yes, and involuntary movement, in particular, whilst it 23 may be indicative of a spinal injury, is in fact 24 a positive indication of a serious head injury, isn't 25 it? 97 1 A. It can indicate a head injury, it could also indicate 2 lack of oxygen to the brain. 3 Q. Yes. 4 A. But, yes, it could indicate a head injury. 5 Q. I'm very grateful. 6 Moving on, if I may, then, finally to 7 Samantha Badham, I just had a couple of questions in 8 clarification about her case. Do you have her report? 9 A. I'm sure I do. 10 Q. I'm grateful. Colonel, you weren't, I think, asked to 11 look at all at the case of Lee Harris. Is that right? 12 A. We were not asked to look at Lee Harris at all, no. 13 Q. We know from the evidence that he and Samantha Badham 14 were together prior to the explosion. We know that they 15 were both blown out of the train carriage as a result of 16 the explosion and were found together next to each 17 other, indeed possibly intertwined with each other, on 18 the track outside the train. 19 We also know that Lee Harris suffered significant 20 internal chest injuries, bilateral lung contusions and 21 injuries to the chest wall that needed the insertion of 22 chest drains and, indeed, surgical intervention, and we 23 also know he had significant underlying head injuries 24 such that, eventually, his intracranial pressure raised 25 to levels that were simply incompatible with life, and 98 1 that was despite maximum therapy in an intensive care 2 unit. 3 Can we draw any inferences from those circumstances 4 and his injuries in assessing the likelihood and 5 seriousness of Samantha Badham's injuries? 6 A. If you can agree that somebody was in the same place 7 subject to the same forces and injured by the same 8 mechanism as you would if you're looking at a car that 9 overturned or two people who are next to each other in 10 an explosion, you can draw -- you can attempt to draw 11 a conclusion about injury patterns. 12 If we go back to one of my previous statements, to 13 get a full understanding of all the effects from these 14 bombings, you'd need to know the injuries of all the 15 deceased and all the survivors and map those 16 accordingly. 17 Yes, you can draw limited conclusions, but I can't 18 give you certain conclusions, because, when other people 19 survived being blown out of the train, I don't know what 20 either those individuals hit, I don't know which of 21 their anatomy struck a solid object. So although it is 22 likely they were subject to similar forces, without more 23 detail I couldn't give you a meaningful conclusion. 24 Q. I see. In your report on Samantha Badham at page 52, 25 you conclude that one of the likely internal injuries 99 1 she suffered was blast lung. 2 A. Yes. 3 Q. Presumably the use of the words "one of" implies that 4 there are other likely serious injuries. Is that right? 5 A. There are other potential injuries and I would say the 6 other likely injuries are: blast lung, pneumothorax, 7 haemothorax, combinations of those. Again, exactly the 8 same as the other discussions we've had on other people 9 with chest injury. 10 Q. Yes, and of course, given what we know about her 11 circumstances, being blown out of the train, is another 12 potential serious and possibly fatal injury an internal 13 head injury? 14 A. If someone has been blown out of a vehicle, be it 15 a train, and impacted on other objects, then they could 16 have a head injury, they could have a chest injury, they 17 could have a variety of injuries. But throughout -- 18 although she's described as being very unwell throughout 19 a lot of this, I believe she was talking? 20 Q. She was certainly conscious for a period of time. May 21 I come to that in a moment? May I just complete with 22 possible internal injuries? 23 Injuries to the lungs, you've already referred to 24 blast lung, haemothorax and pneumothorax I think. Blunt 25 trauma to the chest and chest wall is also a potential 100 1 injury in her case, isn't it? 2 A. Anyone being thrown out of a vehicle can have impact 3 injuries to any part of the body that impacts a solid 4 object, so, yes, certainly. If somebody's chest impacts 5 with a blunt object, quite possibly. 6 Q. You talked a little bit, Colonel, yesterday, about the 7 potential even for there to be direct impact to the 8 heart, which can affect the heart. Is that right? 9 A. Yes. 10 Q. That is a possibility in her case as well, isn't it? 11 A. If we accept that she was close to an explosion and 12 subject to significant blast loading, then you would 13 expect blast effect or blast effects to the heart are 14 a possibility. 15 Equally, if she was thrown out of the vehicle and 16 impacted on the front of her chest, then you can infer 17 injuries behind the point of impact. But unless I'm 18 offered more descriptions or unless there is more 19 clinical detail, anatomical detail, all I'm doing is 20 saying, yes, if you hit a particular part of the body 21 you can hurt the tissues underneath it. 22 Q. Yes, of course, and that detail would come from an 23 internal post-mortem? 24 A. Yes. 25 Q. Of course, we talk about all of these things in a list. 101 1 Of course, any combination of all of these together is 2 possible also, isn't it? 3 A. It certainly is, and with someone who's been subject to 4 an explosion and then ejected from a vehicle, they 5 really typify all of those mechanisms: primary blast 6 injury, and then flung, not unlike Tavistock Square. 7 Q. Of course, equally, with -- as we just discussed, with 8 Carrie Taylor, with Samantha Badham, that mechanism, as 9 you say, being close to an explosion and flung, an 10 internal abdominal injury causing significant bleeding 11 is also a possibility? 12 A. Exactly as I've said. Impact part of the body with 13 a solid object and the underlying part of the body can 14 be injured. 15 Q. The reason I'm going through the detail, Colonel, is 16 that there's some evidence, in particular in relation to 17 Samantha Badham, that she, as you say, was conscious or 18 semi-conscious for a period of time and it appears that 19 it was really a very rapid, over the course of minutes, 20 final deterioration that was very significant leading to 21 her going into respiratory and cardiac arrest once she 22 was moved. 23 I wondered whether there was any significance in 24 someone deteriorating extremely quickly once they are 25 moved from where they were in situ after the blast and 102 1 whether one can draw any inferences about their injuries 2 and the final cause of death from that? 3 A. Based on the information that I've got, I do not feel 4 I could draw that conclusion about Samantha Badham. 5 What you have to consider in the multiply injured 6 patients, speaking generically, if you moved someone 7 roughly -- I'm not saying this happened in this 8 circumstance -- and you dislodged a blood clot, then you 9 could cause internal bleeding, and that could cause 10 a deterioration. But I do not have the information to 11 make a firm statement for this lady. 12 Q. No, and of course, in someone who may well have serious 13 lung injury, either blast lung or other injury or both, 14 would -- clearly a necessary movement, she needed to be 15 evacuated from the scene, but would a necessary movement 16 also potentially alter the ventilation and perfusion 17 ratios in her lungs to precipitate a respiratory arrest? 18 A. If you move someone with a lung injury, ie move them 19 from one side to another, you do alter the dynamics of 20 the blood flow within the chest. So if they're 21 compensating and they've managed to -- say the injured 22 side was down and the good side was up and they were 23 able to ventilate the good side well, and then you turn 24 them so they're in the opposite position, yes, you could 25 alter their respiration. 103 1 But, again, I do not have enough information for 2 this lady to say if that's what happened. 3 MS SIMCOCK: I see. Thank you very much, Colonel. 4 LADY JUSTICE HALLETT: Any other questions for 5 Colonel Mahoney? 6 Those are all the questions we have for you. The 7 fact that your research and your conclusions have been 8 tested in questioning does not indicate any kind of 9 criticism of you, Colonel. It couldn't possibly. And 10 whatever conclusions I reach, there could be no 11 criticism. 12 If I may say so, this is an extraordinarily 13 impressive body of work. If I had the power to add to 14 your list of honours and awards, I would do so. We owe 15 you a huge debt of gratitude and your colleagues and, 16 I understand, the Ministry of Defence. 17 A. Yes, my Lady. 18 LADY JUSTICE HALLETT: I gather that they've been 19 significant in providing very, very large amounts of 20 resources to enable this body of work to be done. 21 A. Yes, my Lady. 22 LADY JUSTICE HALLETT: So please express my gratitude to 23 everybody concerned and I did note what you said about 24 people working holidays and Bank holidays too. That was 25 extremely dedicated of them. 104 1 When someone suggested the use of a blast expert, as 2 it was put to me, I never expected work of this 3 thoroughness and this quality. 4 So as I say, we are extremely grateful to you. 5 I know the families will be very grateful to you and to 6 your team. I hope that -- have we in any way added to 7 your body of knowledge or has it been all for the 8 purposes of this inquest? 9 A. I think, without question, my Lady, going through the 10 process and having to examine the circumstance of these 11 unfortunate victims has meant that the teams in 12 Porton Down have worked more closely together and the 13 global understanding of the explosive effects within 14 confined environments has been enhanced, and our 15 intention, the link between Porton Down and other UK 16 agencies, is our hope is that will be used to help 17 further protect the public in the future. 18 LADY JUSTICE HALLETT: I'm sure that will be a tiny crumb of 19 comfort to the families. So thank you again, Colonel. 20 It is astonishing work, thank you very much indeed. 21 A. Thank you. |
