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Major incidents/CBRN Flashcards

1
Q

What acronym is used to give structure to a MI?

A

CSCATT

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2
Q

Describe the components of CSCATTT

A

Command & Control
Safety
Communications
Assessment
Triage
Treatment
Transportaion

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3
Q

Describe the Command part of CSCATT? (3)

A
  1. Ambulance Incident Commander (Tactical) will appoint:
    - Operational Commander
    - Primary Triage Officer
    - Ambulance Parking Officer
    - Loading Officer
  2. Co-locate
  3. Action cards
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4
Q

Describe the aspects of Safety in CSCATT (4)

A
  1. Safety of yourself - PPE
  2. Safety of scene - cordons/barrier tape
  3. Survivors - move to place of safety
  4. Remember STEP 123 +
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5
Q

Describe Communication in terms of CSCATTT? (3)

A
  1. METHANE
  2. Talk groups
  3. Start a log
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6
Q

Describe the Assessment aspect of CSCATTT (3)

A
  1. Jointly understand risk
  2. Carry out assessment
  3. Request resources via METHANE to EOC
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7
Q

Describe the Triage, Treatment and Transportation part of CSCATTT

A

Triage
1. TST -best to work in pairs
2. Set up casualty clearing station (with medical advisor)

Treatment
Commence extended treatment once TST completed

Transportation

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8
Q

Describe METHANE

A

MI standy/declare
Exact location
Type of incident
Hazards
Access/egress
Number of casualties/severity
Emergency services on scene/required

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9
Q

Describe the command structure within the ambulance service at a MI

A
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10
Q

What tabard does the fire incident commander wear?

A

All white with ‘Fire Incident Commander’ (sometimes red/white check top part)

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11
Q

What colour tabard does a fire operations commander wear?

A

All red

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12
Q

What colour tabard does the police incident commander wear?

A

Blue/white check top part and white bottom

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13
Q

What colour do the various agencies incident commanders tabards have in common?

A

White bottom half

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14
Q

What colour tabard is the Ambulance Incident Commander (Tactical commander)

A

Green/white check top
White bottom

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15
Q

What colour is the ambulance operational commander (and most of the other tabards for ambulance service e.g. section commanders/parking officer)

A

Green white check top
Yellow bottom

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16
Q

What colour are the Coastguard tabards for:
1. Incident commander
2. Officer in charge (operational commander)

A

Both have a yellow/block block pattern bottom and tops halves are
1. white
2. red

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17
Q

What colour are the check pattern on MI tabards for:
1. Fire
2. Police
3. Ambulance s

A
  1. Red/white
  2. Blue/white
  3. Green/white
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18
Q

What colour is the bottom part (top is normal yellow/green check) of the tabard for:
- doctors
- safety officer
- decontamination officer?
- Tactical advisor/NILO

A
  1. Red
  2. Blue
  3. Purple
  4. Green
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19
Q

Describe Ten Second Triage

A
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20
Q

Describe MITT

A
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21
Q

What is the difference between TST and MITT?

A

TST designed to be quick and used by anyone, wheres MITT generally requires healthcare staff and is longer.

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22
Q

What is POWER used for and what does it mean?

A

Safety at scene at railway

Power off - should be confirmed in person, EOC if any doubt

Off tracks unless patient appears viable

Wear PPE

Ensure EOC and ambulance commander know you are entering/leaving trackshide

Rapidly move patients off trackside and treat where is safe

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23
Q

Who are the 3 groups that need to be aware of any incident occurring on the rail network at all times?

A
  1. Network Rail Control
  2. British Transport Police (will be told by network rail)
  3. EOC
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24
Q

Following identification of an incident occuring trackside, what will Network Rail Control / EOC do initially? (3)

A
  1. Agree site identification name
  2. Agree incident number
  3. Network rail will send RIO and give ETA
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25
Q

Who should emergency services wait for ideally following an incident on the tracks?

A

Rail Incident officer (RIO)

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26
Q

When might emergency services act before RIO arrives?

A

To save life

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27
Q

How do ambulance personel request trains caution/stop/power off?

A

Via EOC to Network Rail Control

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28
Q

What do some tracks have that can lead to additional risk?

A

Third conductor energised to 650-750 V DC

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29
Q

With regards to electricity on underground, what different to overground trains?

A
  • all rails carry power
  • main ‘positive’ power rail is 420 V DC and furthest away from platform edge
  • middle rail is ‘negative’ live rail and is 200V DC
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30
Q

What are the issues with regards to overhead line equipment on the railways? (2)

A
  1. Not routinely switched off
  2. 25,000 V AC
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31
Q

How far away should we keep of overhead lines on the rail network?

A

2.75m

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32
Q

How many lanes should be shut following an RTC?

A

Lane involved and lane either side (unless it is the outside lane ie. lane 3 just needs lane 2 + 3 shutting)

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33
Q

In relation to pre-determined response to an airport incident was is a category:
1. A
2. B
3. C

A
  1. Planes that fall into CAA category 5,6,7,8,9 + 10 e.g. large passenger aircraft
  2. CAA category 3 +4 - smaller aircraft or large passenger carrying helicopter
  3. CAA category 1 + 2 - light aircraft, gliders, small helicopterW
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34
Q

What is the difference in the initial response of the ambulance service to the different category airport incidents?

A

Category A + B send 1 x DCA + 1 x manager + 1 x HART, in addition to making NILO/tactical advisor aware

Category C HART don’t get sent automatically

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35
Q

What are the 4 categories of crowd density in the NARU guidelines?

A

V = very low density (4 persons to 4m2)
L = low density (8 persons to 4m2) (can move freely but some movement maybe limited)
M - medium density (16 persons to 4m2) - difficult to move through crowd
H = high density crowds (24 persons to 4m2), almost impossible to move through crowd

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36
Q

What are the 5 crowds types described by NARU

A
  1. Casual = not organised, will accept authority
  2. Cohesive = crowd together for specific purpose, no leadership
  3. Expressive - common purpose, loose leadership. Some mild anti-social elements, may need involvement of authorities
  4. Anti-social = some elements involved in civil disobedience and direct action.
  5. Incident = crowd reacting to, or retreating from, a dangerous situation. Panic.
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37
Q

What is at the:
1. top
2. middle
3. bottom

of hazard warning panels?

A
  1. Emergency Action Code (tells FRS/police what initial actions to take)
  2. UN number
  3. 24 hour telephone helpline
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38
Q

What are the parts of a hazard warning panel?

A
  1. Emergency Action Code (tells FRS/police what initial actions to take)
  2. UN number
  3. 24 hour telephone helpline
  4. Hazard warning diamond
  5. Company logo
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39
Q

What are the different hazard warning diamonds?

A
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40
Q

Describe the 3 zones in a CBRN incident

A
  1. Hot zone = contaminated area, HART and life saving tx only
  2. Warm zone = decontaminating area
  3. Cold zone = clean area, no PPE
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41
Q

What is the plus part of STEP 1,2,3 +? (5)

A
  1. Follow first responder CBRN flow chart
  2. Evacuate
  3. Communicate (reassure) and advise
  4. Disrobe
  5. Decontaminate (dry = default)
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42
Q

When should dry decontamination be done ideally?

A

At scene concurrently i.e. as cutting off clothes

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43
Q

How should management of suspected gas contamination be managed?

A
  1. Disrobe and place in sealed bag (can ‘off gas’ over time leading to secondary poisoning)
  2. Face upwind
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44
Q

How should liquid and solid contamination be decontaminated?

A

Disrobe and dry decontamination

If caustic then copious irrigation (can be done at hospital)

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45
Q

What is the percentage decontamination achieved at various stages?

A

Initial = 100% contaminated
Following disrobing = 10%
Following dry decon = 1 %
Following gross decontamination = 0.1%

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46
Q

When should wet decon ideally be performed and why?

A

If caustic then ideally at hospital as slower and more dangerous

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47
Q

What are the 3 parts of the National CBRN Initial Operational Response guideline?

A
  1. React
  2. Recognise
  3. Assess
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48
Q

In the National CBRN Initial Operational Response guideline, what does the ‘React’ part entail? (3)

A

Remove - themselves from area and find fresh air. If skin itchy/painful find water source

Remove - outer clothing (not overhead if possible and not if stuck to skin)

Remove - the substance from skin (decon)

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49
Q

In the National CBRN Initial Operational Response guideline, what does the ‘Recognise’ part mean? (3)

A

Evaluate the signs/symptoms of patient to identify toxidrome

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50
Q

In the National CBRN Initial Operational Response guideline, what does the ‘Assess’ part entail? (5)

A
  1. What CBRN factors are present?
  2. Where are the casualties located?
  3. Where are other people located? (keep seperate and look for evac routes)
  4. Identify unaffected routes for evacuating people
  5. Are there any secondary threats?
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51
Q

The National CBRN Initial Operational Response guidelines suggest what acronym should be used for substance assessment?

A

BADCOLDS

Behaviour
Appearance
Dissemination
Colour
Odour
Likeness
Deliberate
Symptoms

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52
Q

The National CBRN Initial Operational Response guidelines suggest what acronym should be used for casualty assessment?

A

CRESS

Consciousness
Respiration
Eyes (may be delayed)
Secreations
Skin

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53
Q

With regards to the ‘third rail’
1. What is it?
2. What is the current?
3. How common is it?
4. What must happen before you go trackside?

A
  1. Live rail that provides power to the trains via a conductor placed alongside the rail
  2. 750 DC
  3. 30% of rail network
  4. Must be isolated
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54
Q

Overhead cables powering trains:
1. what is voltage?
2. how big is the arc?
3. must they be switched off before you enter the track?

A
  1. 25,000 V
  2. 2.75 - 3.0m
  3. Usually not because they power large areas of the network
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55
Q

In rail incidents what is:
1. RIO
2. TOLO
3. SIO
4. RCM

A
  1. Rail Incident Officer - network rail on site ‘tactical’ commander
  2. Train Operating Liaison Officer - represents train company
  3. Station Incident Officer - Represents interest of the train station facility owner
  4. Route Control Manager - Network Rail ‘off-site’ tactical incident commander, located within control
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56
Q

What does 3 blasts of a whistle mean?

A

Immediately evacuate the area

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57
Q

What do the following light colours used by FRS/USaR mean?
1. Red
2. Green
3. Orange
4. White
5. Blue

A
  1. Hazard
  2. Safe route
  3. area of interest
  4. illumination
  5. structural monitoring equipment
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58
Q

Describe:
1. Surface water flooding
2. River flooding
3. Groundwater flooding
4. Coastal flooding
5. Canal flooding

A
  1. Heavy rain overwhelms drainage system
  2. Prolonged/heavy rain causes water to overflow onto neighbouring flood plains
  3. Due to the water table rising up to the surface, during prolonged wet periods
  4. Stormy weather and low pressure out to sea combine with high tides to breach sea defences
  5. Level of water in the canal too high and overtops - rare
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59
Q

What is the neutral plane with regards to fire, and what influences it (3)?

A

Boundary between heat gases, smoke and the cooler air.

Depends on:
1. ventilation
2. height of ceiling
3. layout + size of container fire is in

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60
Q

In fires, what affect does a lower neutral plane have on the risk of flashover?

A

Increases risk

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61
Q

What are common fire gases? (5)

A
  1. Carbon monoxide
  2. Nitrogen dioxide
  3. Carbon dioxide
  4. Hydrogen cyanide
  5. Ammonia
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62
Q

Describe the 5 stages of a fire?

A
  1. Incipient - small, smoke still slows visibly in room. Emission of heat is low, can easily be extinguished
  2. Growth - defined layer of smoke above fire, room temperature increases.
  3. Flashover - near simultaneous ignition of most of the directly exposed combustible materials in the enclosed area
  4. Fully developed - Energy at greatest (700-1200 degrees C). Black and dense smoke, blackened windows. Backdraft results from sudden introduction of air
  5. Decay - Flame starts to lose fuel/oxygen. Limiting fire to one compartment will limit the fuel available.
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63
Q

What is are the steps for water rescue for first responders? (4)

A
  1. Reach - branch/oar/towel to pull patient to safety. If not available lie on dock and grab hand and pull
  2. Throw - flotation aid
  3. Row - row to patient and use paddle to pull victim to stern
  4. Go - if no life saving training should not swim, go for help
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64
Q

Describe the FRS decision making tool for water rescue?

A
  1. 30-60-90 clock
  2. Multi agency meeting every 30 mins
  3. Water >6 degrees and submerged unlikely to survive 30 mins
  4. Water < 6 degrees and submerged unlikely to survive after 60mins
  5. Consider extending to90 mins for a child
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65
Q

How often should a secondary triage officer carry of MITTS on the CCS?

A

At least every 15 mins

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66
Q

What is the Tactical Communications Officer and what colour is their tabard?

A
  • Advise on best use of communications
  • technical experts
  • useful for multi-agency comms
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67
Q

What colour tabards to the Strategic Advisor, Tactical Advisor and NILo wear?

A

Green and white check top

Green bottom

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68
Q

What colour tabard is an Ambulance Entry Control Officer?

A

Green and yellow check all over

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69
Q

What colour tabard is:
1. Loggist
2. Any support role e.g press officer

A
  1. Green and white check top with orange bottom
  2. All orange
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70
Q

What can be done to help police with forensics in an MI? (7)

A
  1. If treating multiple patients change gloves
  2. If patient is suspect then if possible looked after by separate clinical team
  3. Record injuries/take photos
  4. Avoid cuts through existing cuts/tears to fabrics
  5. Don’t clean patients shoes etc of blood
  6. Avoid putting multiple blood stained clothes in one bag
  7. If handling knife use gloves and handle area that isn’t usually used (e.g. not handle)
  8. Bullets from patient can go into a plastic bag, otherwise dont touch as could be live - inform police
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71
Q

In TST what age of child should be managed as P1?

A

<2 yrs / not walking

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72
Q

If a patient is walking but clearly has significant ie. catastrophic injury, how should they be triaged?

A

Sit down and make P1

73
Q

Who takes overall responsibility of the risk assessment and safety of staff/attendees at events?

A

The organisers

74
Q

When organising a large event who is it mandatory to consult and who is advised?

A

Mandatory: Local authority and local emergency services

Advised: Safety Advisory Groups (SAGs)

75
Q

What is a Safety Advisory Group (SAG)?

A

These are groups of multi-agency representatives for events. They have no legal power and are just there to give expert advice and guidance

76
Q

How is a venue capacity calculated?

A

Conisder p factors (physical condition of the venue) and s factors (quality of safety management).

77
Q

How many people can exit a 1.2m wide exit in 1 minute on:
1. Steps
2. Flat exit

78
Q

What colour stripes fire extinguishers indicates the following, what fires should they and should they not be used on?
1. 2 white stripes
2. Blue stripe
3. Single white stripe
4. Single black stripe

A
  1. Water
    - wood/paper/textile/solid material fires
    - not liquid/electrical or metal fires
  2. Powder
    - liquid and electrical fires
    - not metal
  3. Foam
    - liquid fires
    - not electrical or metal
  4. Carbon dioxide
    - liquid and electrical fires
    - not metal fires
79
Q

Re: fire alarms at events (Purple Guide):
1. maximum distance from person to alarm at all times
2. height off ground
3. how often should they be checked?

A
  1. 45m
  2. 1.4m off ground
  3. at least weekly
80
Q

When organising an event and planning FRS (purple top):

  1. How big does the road need to be
  2. How much load should it be able to take
  3. How far from this road can the event be
A
  1. 3.7m wide and high
  2. 12.5 tonnes
  3. 50m
81
Q

What are the five parts of a MI?

A
  1. Emergency Services Response
  2. Incident Management
  3. Crisis Management
  4. Business continuity
  5. Recovery
82
Q

What are the five tiers of event medical resource as set out by the Purple Guide?

A

Tier 1: <500 ppl
Low risk event (no drugs/alcohol)

= 1-2 responders and a defib

Tier 2: 500-2000 ppl
Social EtOH, < 24 hrs

= 2-4 responders, a defib and a paramedic crewed ambulance.

Tier 3: 2000-5000 ppl
ETOH likey and recreational drug use. Moderate injury risk. Hospital admissions likely to occur as a result. >24 hours

= 4 first responders, a defib, 2 paramedics, 2 nurses, a doctor crewed ambulance

Tier 4: 5000-10000 ppl

Etoh likely and recreational drug ise. Hospital admissions likely. Event lasting 2-3 days

= 6 first responders, a defib, 2 paramedics, 2 nurses, paramedic crewed ambulances and a doctor on site as clinical lead.

Tier 5:
Complex events with >10,000 people

= 8 first responders, a defib, 3 nurses, at least 2 paramedic crewed ambulances and a doctor on site as clinical lead PLUS control staff

83
Q

What is the minimum level of training for responders at a registered event?

A

FREC (First Responder Emergency Care) level 3

84
Q

What are the 4 types of ionising radiation and their characteristics?

A

Alpha- heavy and highly charged and interact strongly with atoms. Can only travel short distances and cannot penetrate human skin. Hazardous only when ingested, injected or absorbed through a wound.

-

Beta- charged but less interaction than alpha therefore travel further and penetrate more. Including through skin, clothes and standard PPE. Can cause skin injury with prolonged exposure. Hazardous to internal organs only when inhaled, ingested or absorbed through wounds

-

Gamma and X-rays- uncharged and do not interact with atoms therefore can travel meters in air. Easily penetrate human body and cause organ damage. Attenuated by lead or concrete shielding.

-

Neutrons- uncharged, travel far and penetrate everything (except water). Highly damaging but only likely to be present in nuclear detonation or accident.

85
Q

What are the 2 types of hazard caused by radiation? (JRCALC)

A
  1. Radiation -radiation travels through air to body but patient does not become ‘radioactive.’
  2. Contamination (not XR) - radioactive dust/liquid/gas attaches to clothes/body and continues to emit radiationh
86
Q

What is sealed vs unsealed radioactive substances?

A

Sealed contained in solid material (usually metal) and can emit radiation but will not lead to contamination

Unsealed = powders/liquid/gas and can be released into enviroment and cause contamination

87
Q

What does JRCALC recommend with regards to radiation and:
1. P1
2. P2 +3

A
  1. Don’t delay life saving tx (risk to healthcare staff is low), manage and then remove clothes and leave on scene until they can be dealt with safely
    - dress open wounds
  2. Decontaminate as much as possible on scene. If not able wrap in sheet or blanket before conveying
88
Q

Who can respond to radiation emergencies in ambulance service with correct PPE?

A
  1. HART (and can measure radiation)
  2. SORT can bring PPE for anyone to use
89
Q

What is the radiation dose to cause:
1. Acute Radiation Sickness
2. LD50/60 (would kill 50% population in 60 days)

A
  1. 1.0 sievert
  2. 4.5 sievert
90
Q

What is the affect on a patient of radiation at:
1. 1 sievert
2. 1-8 sievert
3. 6-20 sievert
4. > 20 sieverts

A
  1. usually mild or asymptomatic
    - N&V 48hrs
    - depressed WCC at 2-4 weeks
    - counselling if pregnant but often no foetal effects.
  2. symptoms usually 1-4 hours after exposure (N&V, fatigue)
    - Latent period 2 days- 4 weeks.
    - Then haematopoietic syndrome- BM depression, infection, bruising, bleeding. Hair loss at 2-3 weeks. LD50/60 is 4.5 sieverts without treatment.
  3. Severe GI symptoms.
    - Latent period hours-1 week. - BM depression.
    - LD100 is about 10 sieverts usually within 2 weeks.
  4. May be lucid interval but otherwise collapse, projectile vomiting, headache, LOC, burning skin.
    - Death within 2-3 days.
91
Q

What are the 2 broad sections of the Civil Contingencies Act?

A
  1. Local arrangements for civil protection
  2. Emergency Powers
92
Q

In terms of the Civil Contingencies Act what are:
1. Category 1 responders
2. Category 2 responders

A
  1. Subject to a range of statutory duties, including risk assessment, emergency planning

e.g local authority, emergency services, NHS trusts, enviroment agency and transport authority

  1. Not legally obligated to the same extent as Category 1 responders but still have an important role in emergency preparedness and response and expected to work with cat 1 responders.

e.g. utility companies, transport operators, telecommunication providers

93
Q

What are Local Resilience Forums (LRF)?

A

Category 1 and 2 responders come together to co-ordinate planning and response to emergencies.

94
Q

What are the emergency powers set out in part 2 of the civil contingencies act? (6)

A
  1. Emergency Regulations
  2. Seizure of Property
  3. Direction and Control:
    Allow officials to direct and control resources, facilities, and services
  4. Allocation of Resources
  5. Public Health Measures
    e.g quarantine, vaccinations
  6. Discretionary Powers:
95
Q

What does the CCA define as an emergency?

A

‘An event or situation that threatens or causes serious damage to human welfare, the environment or security in the UK’

96
Q

What are the 6 planning principles making up the Integrated Emergency Management?

A
  1. Anticipation (horizon scanning);
  2. Assessment (of the risks);
  3. Prevention (pre-event actions)
  4. Preparation (development of contingency plans)
  5. Response
  6. Recovery
97
Q

Who provides a link between local authorities and the military?

A

Joint (military) regional liason officers

98
Q

How should local authorities request MACA:
1. Routinely
2. Immediate need for assistance

A
  1. Defence Minister
  2. Local military commanders
99
Q

What are the following incidents:
1. Rising tide
2. Cloud on the horizon
3. Headline news

A
  1. Developing infectious disease epidemic or a capacity/staffing crisis or industrial action.
  2. Cloud on the horizon – a serious threat such as a significant chemical nuclear release
  3. Public or media alarm about an impending situation
100
Q

What does NHS England define as:
1. Critical incident
2. Major incident
3. Business continuity incident

A
  1. Localised incident where the level of disruption results in an organisation temporarily or permanently losing its ability to deliver critical services. Principally an internal escalation response to increased system pressures/disruption to services
  2. situation with a range of serious consequences that require special arrangements to be implemented by one or more emergency responder
  3. An event or occurrence that disrupts, or might
    disrupt, an organisation’s normal service delivery, to below acceptable predefined levels.
101
Q

What are the expectations of category 1 responders in relation to MI? (6)

A
  1. assess the risk of emergencies
  2. put in place emergency plans
  3. put in place business continuity management arrangements
  4. arrange communication with public re: planning and to warn if incident likely/occuring
  5. share information with other local responders to enhance coordination
  6. co-operate with other local responders to enhance coordination and efficiency
102
Q

What does NHS England EPPR set out as mandatory for Ambulance Services in relation to Tactical Medical Advisors? (4)

A
  1. Ensure their provision and that they are subject matter experts.
  2. They will be appropriately equipped and competent to give appropriate advice to the ambulance Tactical Commander and, if necessary, the ambulance Strategic Commander.
  3. Tactical Advisers can also be called on to give advice on responding to unusual incidents.
  4. May be required to attend the scene of the incident or
    emergency, a tactical coordinating group (TCG) and/ or a strategic coordinating group
    (SCG).
103
Q

What does NHS Englaned EPRR state with regards to medical teams and MI?

A

The NHS ambulance service must have in place arrangements for the provision of medical support in the event of a mass casualty incident.

104
Q

How often should NHS funded organisations do the following in preparation for MIs?
1. Communication systems exercise
2. Table top exercise
3. Live play exercise
4. Command post exercise

A
  1. every 6 months
  2. every 12 months
  3. every 3 years
  4. every 3 years

Minimum

105
Q

Describe the NARU command structure

106
Q

Outline the JESIP principles of joint working

A
  1. Co-locate
  2. Communicate: clear, no jargon
  3. Co-ordinate: Identify the following;
    - lead organisation
    - priorities and capabilities
    - limitations
    - timing of next meeting
  4. Jointly understand risk:
    - share information on likelihood and potential impact of threat
    - agree control measures
  5. Shared situational awareness:
    - METHANE
    - Joint decision model
107
Q

What is the NARU model for human factors?

A

STOP

Situation: weather/senior officers/experience

Task: should be trained

Organisation: culture/policies/procedures

Person: individual skill/attributes/weakness

108
Q

How does NARU define:
1. Command
2. Control

A
  1. Exercise of vested authority associated with a role within an organisation to give direction to achieve defined objectives
  2. Application of authority combined with capability t manage resources to achieve defined objectives
109
Q

Describe the JESIP joint decision model (JDM)

A

VIAPOAR

  1. Gather information and intelligence
  2. Assess threats and deliver working strategies
  3. Consider powers/policies and procedures
  4. Identify options and contingencies
  5. Take action and review

Values
Information
Assessment
Powers/policies/procedures
Options
Action
Review

110
Q

How does NARU suggest developing a working strategy (6)

A
  1. Identify hazards:
    All info from all agencies should be disseminated to all 1st responders/control rooms/agencies
  2. Dynamic risk assessment
  3. Identify tasks
    Specific to each agency
  4. Apply risk control measures:
    co-ordinated approach
  5. Have and integrated multi-agency operational response plan:
    Hazards + DRA considered + agree priorities
  6. Record decisions
111
Q

What is the role of the strategic commander? (4)

A
  1. Directly represents interest of Ambulance Trust Board
  2. Must be able to perform without further authority
  3. Provide strategy for Tactical Commander
  4. Attend Strategic Co-ordinating Group (SCG)
112
Q

In an MI, how quickly should the Strategic Co-ordinating Group (SCG) meet?

A

< 2 hours and ideally face to face

113
Q

Who is the strategic advisor?

A

Will vary depend on nature of incident

114
Q

Where should the Tactical Commander be during a MI?

A

Single location:
Co-locate in person close to scene if single incident + Tactical Co-ordination Group should be attended by Tactical representative (e.g. NILO)

Multiple locations:
Attend TCG in person

115
Q

Who is the Tactical Advisor?

A
  • In depth knowledge of MI plans/special teams
  • will provide Tactical Commander with the relevant SOPs etc. during MI
116
Q

What is a NILO?

A

National Interagency Liaison Officer

Tactical Advisor but has had specific national training

117
Q

Who is the Operational Commander and where should they be during a MI?

A

Responsible officer on scene

Should co-locate at Forward Command Post (FCP)

118
Q

What does the Strategic Medical Advisor do? (3)

A
  1. Monitors overall NHS system capacity
  2. Ensures patient safety throughout wider ambulance trust is acceptable
  3. Ensures tactical has the clinic resources needed e.g. mutual aid
119
Q

What is the role of the Tactical Medical Advisor? (2)

A
  1. Casualty distribution from incident
  2. Support tactical and strategic commanders to transfer casualties to appropriate medical facilities
120
Q

What is the role of the Operational Medical Advisor?

A

Single POC if multiple advanced clinical assets deployed to a MI

121
Q

Who gives permission for HEMS teams to enter inner cordon in an MI?

A

Ambulance Commander

122
Q

Who is responsible to ensuring all medical advisors are credible and trained?

A

Excecutive Medical Officer (Chief Medical Officer) of ambulance service

123
Q

What is the difference between the following in terms of MI
1. Simple or compound
2. Compensated and uncompensated

A
  1. Simple = critical infrastructure intact
    Compound = damage to infrastructure
  2. Compensated = extraordinary capacity can deal with casualties

Uncompensated = even with extraordinary capacity unable to cope with number of casualties

124
Q

What does ‘span of command’ and ‘span of control’ mean?

A

Span of command: Hierarchy of command and control in each service

Span of control: Number of lines on communication one individual can realistically maintain

125
Q

What do the following refer to?
1. Operation CONSORT
2. Operation CARBON STEEPLE
3. Operation PLATO
4. Operation WAYPOINT
5. Operation CITIDEL

A
  1. Royalty/VIP under close police protection being attacked
  2. As above
  3. MTA (only police can declare)
  4. National system coordinated by Maritime and Coastguard Agency designed to provide early warning for masscal in UK waters
  5. Siege situation
126
Q

Who should have their lights on at a MI?

A

Scene commanders from each service

127
Q

What are the roles specific to the police force at a MI? (6)

A
  1. Securing a scene
  2. Investigation of incident
  3. Prevention of a crime
  4. Identification of dead on behalf of coroner
  5. Collection and distribution of casualty information
  6. Family liaison
128
Q

Re: span of control in a major incident - what is the optimum number of communication or direct reporting lines for one person to manage?

129
Q

When should a patient have a re-triage following TST? (4)

A
  1. Casualty doesn’t appear to match their triage band
  2. Condition clearly changes
  3. Healthcare professional with time re-assesses ‘silver’ and decides either P1/dead
  4. Every 15 mins (if possible)
130
Q

What does the outside of the TST bands look like?

A

White checked border

131
Q

With regards to TST what should be considered in a talking patient?

A

Are they confused - if so should be P1

132
Q

What areas of the body are considered ‘torso/back’ in regards to TST? (7)

A
  1. Neck
  2. Armpit
  3. Chest
  4. Abdomen
  5. Back
  6. Groin
  7. Buttocks
133
Q

How long should a wound that has been packed have direct pressure placed on it (TST)?

134
Q

Who decides when to switch from TST to MITT, and when is this usually?

A

Ambulance scene commander - most senior on scene

Occurs when TST completed and casualties evacuated to CCS

135
Q

What do the MITT wristbands look like

A

Block colour with no checked pattern
Space for notes

136
Q

Who is responsible for coordinating triage using MITT?

A

Secondary triage officer

137
Q

What are the 5 duty of care requirements to be considered at a MI?

A
  1. Duty of care of staff - statutory requirements under Health and Safety at Work Act 1974
  2. Duty of care to the patient - common law
  3. Article 2 Right to Life - balance of duty of care to staff and patients
  4. Dynamic risk assessment
  5. Multi-agency joint Doctrine
138
Q

What are the 3 unique roles for HM Coastguard at a MI?

A
  1. Co-ordinate UK SAR Helicopter capability
  2. Co-ordinate civil SAR in the UK Search and Rescue Region
  3. Protect maritime environment
139
Q

Outline the UK Terrorist threat levels

A

Low - attack highly unlikely
Moderate - possible but not likely
Substantial - likely
Severe - highly likely
Critical - highly likely in the near future

140
Q

What is the breakdown of P1/P2/P3 expected at a MI?

A

25/25/50 %

Higher P1s likely in MTA

141
Q

What is the recommended minimum cordon distance from an IED to use:
1. Airwave radio/phones
2. Car radio

142
Q

What is the minimum cordon distance from:
1. Unknown device
2. Smaller item IED
3. Medium item IED
4. Large item IED

A
  1. 100m
  2. 100m
  3. 200m
  4. 400m
143
Q

What is considered:
1. Smaller item IED
2. Medium item IED
3. Large item IED

A
  1. bag, briefcase, person borne
  2. suitcase, wheelie bin, car
  3. van, lorry, HGV
144
Q

In order to risk stratify suspicion items, describe the principles we should use?

A

HOT

is it Hidden?
is it Obviously suspicious?
is its presence Typical?

145
Q

Once and object has been declared suspicious what is the appropriate sequence of events?

A

4 C approach

Confirm - Confirm suspicious using the HOT principle

Clear - move to at least 100m, cordon, find something to hide behind

Communicate - inform control ensuring minimum safe distance

Control - access to cordon, keep eyewitnesses on hand for information

146
Q

What is the Guide to Safety at Sports Grounds called?

A

Green Guide

147
Q

According to the JESIP IOR for CBRN response, what should be achieve in the first 15 mins? (3)

A
  1. Evacuate
  2. Disrobe
  3. Decontaminate
148
Q

What should indicate wet decontamination over dry? (3)

A
  1. Caustic agent suspected
  2. Known biological agent
  3. Known radiological incident
149
Q

What is the dose/combination of medication in DuoDote autoinjector?

A

2.1mg atropine and 600mg pralidoxime

150
Q

When should DuoDote be given (as a minimum)?

A

At least 2 mild symptoms of NA poisoing

151
Q

What is the lower limit of weight that DuoDote safety has been established?

152
Q

What makes a P1 in a CBRN priority grading? (5)

A
  1. Unconscious
  2. Seizure
  3. Cyanosis
  4. Respiratory distress or arrest
  5. HR < 40bpm
153
Q

What is a P2 in CBRN incident? (5)

A
  1. Not walking
  2. Excessive secretions
  3. Confusion
  4. Wheezing
  5. Incontinence

4 Ws
Wet - secretions/incontinence
Wheezy
Whacky
not Walking

154
Q

What is a P3 in a CBRN incident? (4)

A
  1. Walking
  2. Pinpoint pupils
  3. Dimmed vision
  4. Eye pain
155
Q

What are the two main blistering (vesicant) chemical warfare agents?

A
  1. Mustards
  2. Arsenic containing Lewisite
156
Q

What is the antidote to Lewisite?

A

Dimercaprol 3mg/kg IM

157
Q

Describe the characteristics of Sulphur mustard (HD) (5)

A
  1. Reacts chemically with bleach
  2. Combustible
  3. Products of combustion toxic
  4. Vaporises at room temperature, increases in moist environment
  5. Lipophilic
158
Q

How can sulphur mustard be removed from skin?

A

Warm detergent solution

159
Q

If contaminated with liquid sulphur mustard, what should be ensured?

A

Remove within minutes and if some residual noted later also remove as it will off-gas vapour

160
Q

What are the systemic complications of sulphur mustard poisoning?

A

Crude alkylating agent which can damage DNA and result in suppression of bone marrow, sepsis and death.

161
Q

What is the smell of sulphur mustard and why is this relevant clinically?

A

Garlic or mustard

Olfactory threshold below that which toxicity occurs and therefore is an early warning to exposure

162
Q

Describe the characteristic of Chlorine gas (2)

A
  1. 2.5 x heavier than air
  2. Gas at room temperature
163
Q

What are the clinical features of chlorine gas toxicity? (4)

A
  1. Mild - mucous membrane irritation
  2. Bronchospasm
  3. Acute lung injury / ARDS
  4. Skin/eye irritation in high concentration and burns in very high
164
Q

How does chlorine gas cause damage?

A

Partially dissolves in water to form hydrochloric acie and hypochlorous acid - deposits onto mucous membranes/skin/airways.

165
Q

How should chlorine toxicity exposure be managed? (3)

A
  1. Inhalational injury - oxygen, bronchodilators
  2. Irrigate to skin PH >4.5
  3. Ocular irrigation until normal PH
166
Q

What treatment should be carried out in the hot zone of a CBRN incident? (3)

A
  1. Cat haemorrhage management
  2. Simple airway manouvres
  3. Antidotes
167
Q

Where should advanced medical care be carried out in a CBRN incident?

A

Cold zone - Casualty Clearing Station

168
Q

What is the clean dirty line in a CBRN incident?

A

Line between warm and cold zone

169
Q

How long after a major incidents are notes kept for?

A

At least 25 years

170
Q

Who has overall responsibility for the deceased at a major incident?

A

Coroner (police will on their behalf)

171
Q

When should bodies by moved in a major incident? (2)

A
  1. To access live casualty
  2. Likely to deteriorate to environmental factor e.g fire
172
Q

If you have to move a body at a major incident what must be done?

A

Make effort to record the casualty location

173
Q

Where will deceased patients taken from scene at a major incident be moved to?

A

Body holding area, usually adjacent to casualty clearing station

174
Q

If a patient dies following leaving scene where should they be taken?

A

Continue to hospital where they can be certified as dead

175
Q

What should the immediate initial treatment of nerve agent poisoning be for:
1. P1
2. P2
3. P3

A
  1. 3 autoinjectors
  2. 1 autoinjector every 15 mins
  3. Nil but will get pralidoxime IV/IO
176
Q

In addition to the 3 initial autoinjectors, what should P1 patients suffering suspected NA poisoning get?

A
  1. 5-10mg atropine IV (toxbase says 3mg)
  2. 2g IV/IO over 5 mins
  3. Re-assess for signs of toxicity every 5mins and further 5mg (3mg) IV/IO atropine as needed
177
Q

What should all patients (P1-3) with suspected NA poisoning get?

A

Proxlidoxime 2g IV/IO over 5 mins

178
Q

If a patient with suspected NA poisoning is seizing (therefore P1) what should be the sequence treatment?

A
  1. Autoinjector IM (will have 3)
  2. Benzo IV/IO every 5 mins until stops
  3. Pralodoxime
179
Q

What is the dose of paeds:
1. Atropine
2. Pralidoxime

in NA poisoning?

A
  1. 0.02mg/kg
  2. 30mg/kg

FIMC (17 decks)

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