Major incident

Question 1

What is a major incident?

Answer 1

Any occurrence that presents a serious threat to the health of a community, disruption to a service or is a significant burden to the emergency services.

Question 2

How are major incidents classified?

Answer 2

Can be internal (fire, flood, electrical failure, or external.

External inc.:

1. Big bang (e.g. crash or explosion)
2. Cloud on the horizon (potential war/conflict, neighbouring nuclear disaster)
3. Rising tide (epidemic/pandemic)
4. Headline news (panic cause by news e.g. impending or new threat such as MERS)

Question 3

What is the command and control framework for major incidents?

Answer 3

1. Gold (strategic) command:
   - usually chief executive or delegated deputy
   - responsible for considering the longer term impact of the major incident e.g. financial implications, planning the recovery phase and return to normal operations
2. Silver (tactical) command:
   - Coordination of major incident response for hospital
   - staff and resources deployment
   - delegates running of individual departments to bronze command.
3. Bronze (operational) command:
   - tend to be not directly involved in clinical care
   - organise resources and staff within departments and patient flow
   - updates tactical command

Question 4

How are patients triaged?

Answer 4

P1 = emergency, high priority for immediate life-saving care ->resus
P2 = Urgent Care ->majors (treatment within 2-4 hrs) 
P3 = walking wounded ->minors (treatment 
P4 = Expectant (unsurvivable injuries) ->holding area for comfort care
P5 = dead

Question 5

What is the outline of a major incident plan?

Answer 5

Preparation of staff and resources:

1. preparation for arrival - (major incident standby, major incident declared, major incident cancelled, major incident stand down)
2. Freeing resources - cancelling elective surgery, expediting discharges (from hospital and critical areas, expansion of critical care areas into theatres, consideration of inter-hospital transfers).
3. deployment/redeployment of staff

Management of casualties:

1. Arrival of casualties - P3 and lower priority patient may arrive earlier and overwhelm the department. Triage to different locations for logistics is essential
2. Assessment of injuries - important to classify cause of injuries for risk of to staff e.g. chemical exposure.
3. Initial treatment - Damage control surgery, damage control resuscitation (avoidance of triad of death: hypothermia, acidosis and coagulopathy):
   - Identify and control haemorrhage
   - permissive hypotension
   - transfuse based on clinical findings not laboratory results
   - temperature management

Question 6

What happens after stand down?

Answer 6

1. Plans are started to resume normal operations as soon as possible. May require plans to manage backlog.
2. Secondary and tertiary surveys and further investigations of those still requiring care. #
3. Debriefing and psychological support.