Counselling services for members of the emergency services have been frantically busy in the days following the crash.

The idea of providing counselling to members of the emergency services has only emerged in recent years.

Previously, the only outlet for medical staff, and police and fire officers was the mess hall chat, or the support of wives and families.

Stress well recognised

But post-traumatic stress disorder (PTSD) is now a well-recognised medical condition, and the 'macho' culture which prevented some from seeking help is receding.

Removing bodies has placed great strain on fire and police

The London Fire and Civil Defence Authority first offered organised counselling to officers in the wake of the 1984 fire at Kings Cross underground station, which, like this week's events, involved a large number of people trapped in an intense fire.

Now the authority runs a proactive welfare system rather than waiting for staff to realise how badly affected they have been.

A spokesman said: "Some firefighters prefer to get things off their chest around the mess table after an incident.

"But obviously there are occasions when that isn't enough. The sights that firefighters see can be horrendous, things that the man on the street can barely imagine."

Debriefing has started

Anne Willmott, the head of the Fire Brigade's counselling service, said that at least 200 fire-fighters and officers will be contacted and will be offered debriefing, information about possible reactions, and follow-up support if appropriate.

She said: "After a major incident, individuals may constantly recall images, sounds and smells. The may have nightmares, or have trouble sleeping.

We tell them these are normal reactions, however if they are still experiencing these in a month's time, that may be a signal that an individual needs more help.

The feeling of helplessness, a key component of this week's disaster, can trigger further problems", she said.

She said: "Fire-fighters want to rescue people, to do a good job - if they can't do that, it can be extremely hard."

"It's not about weakness or strength."

"Many older fire-fighters, aware of the dangers of cumulative stress, are encouraging their younger colleagues to use counselling services more often", she said.

'Pretty much inundated'

The ambulance service runs a similar counselling service, based at King's College Hospital in London - the contact number is publicised in newsletters and elsewhere.

A spokesman said the service had been "pretty much inundated" since the crash.

At St Mary's hospital, accident and emergency staff are used to seeing badly hurt people arriving following car crashes and other accidents.

The difference this week has been the sheer quantity of casualties reaching the hospital.

However, managers believe that so far, doctors and nurses are coping well.

"We have a counselling service in place," said a spokesman, "and we are having meetings to check people are alright.

"We think that people are coping remarkably well. When I spoke to members of staff yesterday they appeared to be fine."