THE MAJOR INCIDENT PLAN

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THE MAJOR INCIDENT PLAN

• ANAESTHETIC DEPARTMENT
• SMUHT
• 2004

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CONTENT

• Definitions
• Assumptions
• Regional command structure
• Hospital command structure
• Where anaesthetists fit in
• What should happen when a major incident is
  declared

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DEFINITION

• A major incident for the Health Service is
  an occurrence involving casualties, the number,
  severity, type or location of which would
  overwhelm resources unless extra resources are
  called in

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MAJOR INCIDENT STANDBY

• something has come to the attention of emergency
  services which might generate casualties.
  Switchboard and one or two key people are
  informed.
• eg bomb warning
• warning light in cockpit of plane approaching
  airport
• gas leak in local factory
• SMUHT has 2 3 of these per week

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MAJOR INCIDENT DECLARED

• An event has occurred generating casualties of
  sufficient numbers and/or severity to necessitate
  extra resources to deal with them
• eg a bomb has exploded
• a plane has crash landed
• toxic gas is affecting local residents
• There are casualties coming here
• The major incident plan is activated

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MAJOR INCIDENT REHEARSAL

• Part or all of the major incident plan is being
  rehearsed
• This could be-
• Emergency services only
• Emergency services and the emergency department
  (ED)
• Individual hospital departments
• All hospital departments
• And might involve-
• Live casualties
• Tactical exercise only (paper / tabletop etc)
• Call in procedure only
• As the nearest hospital to an international
  airport we have an obligation
• to run regular major incident rehearsals

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MAJOR INCIDENT STAND DOWN

• There are either no more casualties coming here,
  or the incident has not generated enough
  casualties to warrant major incident status
• There is no longer any need for extra resources
  and the hospital can return to normal working

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ASSUMPTIONS

• Mass casualties
• Out of hours
• Infrastructure is intact
• Water
• Electricity
• Roads
• Communications
• Emergency services

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COMMAND STRUCTURE

• Gold - Strategic
• Silver - Tactical
• Bronze Operational
• Analogous to system emergency services and
  military use

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COMMAND STRUCTURE

• Gold Strategic command
• highest level of command
• in an area remote from the site
• regional or National level
• involves local council, emergency services etc
• communicates with other regions, government,
  military and silver commanders

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COMMAND STRUCTURE

• Silver Tactical command
• overall control of its own bronze areas
• one at incident site, one in each hospital
• Will be near the site and able to see it, but
  take no part in direct casualty care
• communicates with gold, other silver commanders
  and its own bronze commanders

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COMMAND STRUCTURE

• Bronze Operational
• several on scene and within each hospital
• deal directly with casualties
• each has commander
• Bronze commanders gather information and
  communicate needs and events to silver commander
• Bronze commanders do not take part in casualty
  care

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Diagram scene and hospital
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WHAT ACTUALLY HAPPENSA. TO CASUALTIES

• Triage (resp rate cap refill or pulse) on scene
  into-
• P1 Immediate life threatening injury need
  intervention within 1 hour
• P2 Potential life threatening injury need
  intervention within 4 hours
• P3 All walking wounded
• (P4)
• DEAD
• Immediate life saving intervention and retriage
  (SBP, resp rate and GCS) in Casualty clearing
  station on scene
• Transfer to hospitals in rotation according to
  need
• Of those coming to SMUHT (including those
  arriving independently), further triage at ED
  entrance
• Coded notes, wristband and belongings bag
  assigned to all casualties
• 6. P1 and P2 taken into ED, P3 taken to Fracture
  clinic

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WHAT ACTUALLY HAPPENSB. TO HOSPITAL

• Emergency services ? switchboard? ED consultant,
  senior nurse, manager
• Major incident declared for SMUHT
• Switchboard ? call in key people and open phone
  lines
• All cardiac arrest bleeps activated ? ED
• Silver command set up in ED seminar room
• Theatre activity suspended
• All well patients sent home
• ED prepares to receive stretcher cases (P1 P2)
• Fracture clinic prepares to receive walking
  wounded (P3)
• A4 A6 become receiving (MAJAX) wards
• Strollers becomes Staff Tasking area for all
  called in staff
• Chest research area designated for the Press

?
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WHAT ACTUALLY HAPPENSC. TO ANAESTHETISTS

• All trainees fast bleeped to ED
• Those able to go will be given designation by
  acting BCED
• Maternity anaesthetist calls on call consultants
  first then all other anaesthetists to check
  availability. This takes just gt 1 hour
• All 4 consultants on call go straight to ED,
  liaise with BCED and wait to hear from Silver
  likely nos. severity of casualties
• Make provisional plan depending on above
  information, ICU bed availability, theatre cases
  and availability etc.
• Decide how many anaesthetists needed now and ask
  maternity anaesthetist to call them in, then
• 1st O/C consultant stays in ED and becomes Rear
  Triage Officer
• 2ndO/C consultant may stay in resus initially
  then ?theatre?Majax
• AICU goes to unit
• CICU goes to unit

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ANAESTHETIC ROLES

• We will be needed in Bronze areas-
• Emergency department
• Receiving wards
• Theatre
• Acute ICU
• Cardiac ICU
• and
• Transfers in hospital ( radiology)
• ?Transfers out of hospital
• ?On scene

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ANAESTHETIC ROLES

• REAR TRIAGE OFFICER
• Is gatekeeper for all casualties needing
  admission to the hospital deciding which
  patient goes where and in what priority
• Calls in and receives extra anaesthetists and
  gives them a place to work
• Is responsible for ensuring a debrief is
  organised
• and will therefore
• Stay in ED
• Continually receive information on ED casualty
  status
• Continually liaise with BCED and BC receiving
  areas
• Need help!

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ANAESTHETIC ROLES

• OTHER CONSULTANTS ON CALL
• Liaise with BC and other specialty consultants in
  your area to decide best way of dealing with
  casualties
• BC will need to know casualty status regularly to
  inform Silver Control
• If more anaesthetists needed, call maternity
  anaesthetist and/or contact Rear Triage Officer
  to organise this
• Extra equipment, drugs etc should be requested
  through BC
• Ensure all anaesthetists in your area know to
  communicate all casualty management and movement
  decisions to BC through you

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OTHER THINGS

• PARKING
• Consultants on call Helipad or ED visitors car
  park
• All others wherever you are directed or
  wherever you can but avoid front of hospital
• MOBILE PHONES
• May not work cell overload
• CONTAMINATION
• Responsibility of fire service should not need
  to be done in Hospital

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OTHER THINGS

• DEBRIEF
• Important
• NOT a psychological counselling session!
• Should be done on day of incident before people
  go home also at some point after the incident
• Should be run by one person
• Thank you to involved staff
• Give facts of what has happened and what is
  likely to happen next
• Be aware that some people WILL be distressed
  (including you). They should ideally not be going
  home alone and should be followed up
• The psychiatry department has very sensible
  advice leaflets

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OTHER THINGS

• THE PRESS
• Will be there before you are
• Be suspicious of anyone without SMUHT
  identification
• Be aware they have extremely sensitive
  microphones
• There is an area and press liaison officer
  designated for them and they are given regular
  updates
• If stopped by the press, politely but earnestly
  say you cannot talk to them as you are needed to
  treat casualties
• If you are to give an interview
• check your appearance
• ask what the first question will be and have an
  answer ready
• if on TV ensure your watch can be seen or stand
  with a clock behind you

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SUMMARY

• Meaning of Major Incident
• Command structure within SMUHT
• Where anaesthetists fit in
• Rear triage has key role
• All should be identifiable
• Needed in several locations
• Know who is in charge of your location
• Communicate with that person
• Know your limitations