Health complexity


The Boscastle Flood Rescue Operation: Are there lessons that can be transferred to the National Health Service?

On the 16th August 2004, the small town of Boscastle in Cornwall flooded. Heavy storms caused 6cm of rain to fall in two hours in the Boscastle area. Seven rescue helicopters were scrambled to winch people stranded on rooftops and in cars to safety. Buildings and cars were washed into the sea, and arrangements were made to evacuate up to 1,000 people. No one died in the Boscastle flood and this has been attributed to a number of reasons. Firstly, the incident occurred in daylight, at around 16:00 hours when many people were at work and the majority of people were not sleeping. Secondly, the incident was very early classified as an emergency and emergency procedures took over. The emergency team was coordinated by the police in the 'gold control' team with others from health, the military and the emergency services who normally made the strategic decisions. The 'silver team' was made up of middle managers and the 'bronze team' comprised the frontline crews - for example, the ambulance staff, the fire fighters, the police men and women, and the Royal Navy crews.

Although there are clearly different 'rules' that apply in emergency situations, we at the Health Complexity Group were interested in whether the National Health Service (and indeed Social Services) could learn lessons from the way that the Boscastle incident was managed so successfully. Are there transferable lessons? Could the NHS and Social Services raise their level of care in non-emergency situations? Are there simple rules that governed the Boscastle operation and can these rules be transferred to other situations, particularly to health and social care? This short study asks the following questions:

  1. Are emergency situations by definition, 'singularities' where all agents 'act' in the best interests of the person or population at risk, or are there transferable lessons for non-emergency situations in health and social care?
  2. What conditions, in a rapidly changing situation, were present at Boscastle, and what constraints were removed to enable a successful operation?
  3. What was the 'spectrum of power': where did the power lie, and was this designed or emergent?

The specific aims of the study are:

  • to describe the Boscastle operation from the perspective of the key 'players',
  • to identify what, if any, simple rules were in operation,
  • to extract any transferable lessons for non-emergency situations.