|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
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 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
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
1 in close proximity to the blast because of the energy
2 required to cause those sorts of injuries to the legs in
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
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
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
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?
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
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
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 --
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
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
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
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
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
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
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,
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,
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
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
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
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
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
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
24 Q. So it depends on the severity of the blast lung --
25 A. Yes, it does.
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
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?
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.
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
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?
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
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.
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
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
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
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
24 First, whether or not the 18 deceased you were asked
25 to look at did or did not, on the balance of
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
23 A. Yes.
24 Q. And Shelley Mather it's "I can't say"?
25 A. Yes.
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
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
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.
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
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
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
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
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
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
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,
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
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
1 questions in relation to Miriam Hyman before taking
2 instructions in relation to Michael Brewster? Thank
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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
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
24 We can infer from the physiology, the witness
25 statements and the injuries, that people did have
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.
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
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
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
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
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
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
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
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
14 Q. I was instructed to ask you some questions in relation
15 to oxygen, but in fact, Mr Coltart addressed these
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
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
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
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
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
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
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
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
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?
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
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
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
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
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
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
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?
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
1 involuntary, that they were responsive.
2 So would that information change your view in any
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
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
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
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
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
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
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
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
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 B188.8.131.52.
24 A. Yes, that's from, I believe, Dr -- Mr Pope -- no, that's
25 the first one, isn't it?
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)."
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.
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
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
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
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
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."
1 But they do not describe someone who is no longer
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
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?
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
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
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
24 I was also concerned, given the witness
25 descriptions, I needed to know could it be something
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
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
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.
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,
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
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
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,
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
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,
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,
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
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,
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
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
1 clarify that for us, in terms of one of the chest
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
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
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.
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
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
25 Q. But are you aware, out of your experience, that
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
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,
25 A. Well, on the reports that we've got, there's only been
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
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
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?
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
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
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
25 MS SIMCOCK: Five minutes, my Lady.
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
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
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
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
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
24 Q. Yes, and just in relation to Carrie Taylor, because we
25 know she was thrown, and we know, of course, that she
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
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
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
1 that was despite maximum therapy in an intensive care
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
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
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
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.
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
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.
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
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.
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.