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The psychological reactions of 50 survivors of the King's Cross fire, which hit London's underground railway system on the 18th day of November 1987, are described. Results are presented for the Impact of Event scale, the General Health Questionnaire (28-item version), the Eysenck Personality Questionnaire and a King's Cross Event Schedule. These are investigated in relation to (a) validity measures, (b) relationships between exposure and personality, and (c) spontaneous de-briefing. Two thirds of the sample had significant levels of psychological distress (meeting the "caseness" criterion on the GHQ). Both personality (neuroticism and L-scale) and degree of trauma exposure were related to subsequent reaction. Spontaneous debriefing was associated with subjective benefit. Transportation disasters present particular problems in relation to research and service delivery.

The psychological after-effects on 27 survivors of the Marchioness riverboat disaster of 20 August 1989 are described. On measures of intrusive memories and psychological difficulties these subjects are significantly higher than population norms, and somewhat higher than psychiatric in-patient populations. Personality measures taken after the disaster show that neuroticism scores are very much higher than population norms, but personality measures were not correlated with distress.

This paper describes the experiences of six people who received severe burns in the King's Cross Underground Station fire of 1987. They all developed post-traumatic stress disorder to varying levels of intensity and the problems of psychological intervention as they related to the patients' different mental defence mechanisms are outlined.

The King's Cross fire occurred at the end of the evening rush hour, on 18 November 1987. King's Cross station is within the department's health district and we felt a responsibility to respond to the psychological aftermath. The unique features of our intervention were the degree of inter agency coordination, the use of a systematic outreach and screening programme, the collection of psychotherapy outcome measures and the development of an ongoing clinic. The work represents a sustained attempt to assess the nature and prevalence of post-traumatic reactions and the most medically and economically effective form of intervention. In this paper we describe the way our team responded to the high level of psychological distress that we found, we present some preliminary results, outline two therapeutic trials, and refer to the longterm consequences for the work of our department.