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Hospital response to a major incident: initial considerations and longer term effects

C Johnson MBBS FRCA FFICM RAMC, J F Cosgrove MBBS FRCA FFICM
DOI: http://dx.doi.org/10.1093/bjaed/mkw006 329-333 First published online: 6 May 2016
  • 1I02
  • 2A02
  • 2C07
  • 3A10

Key points

  • Read your institution's major incident plan.

  • Practice the major incident plan—clinical and non-clinical staff.

  • Command, control, and communication are essential components of management.

  • Consider how your department would manage ongoing care of mass casualties.

  • Staff will require physical, social, and psychological support during and after a major incident.

All NHS providers in the UK are required by law to prepare for large-scale emergencies and major incidents.1 A health-related major incident is described as any occurrence presenting a serious threat to the health of the community. It is likely to involve disruption of services and require the implementation of special arrangements by hospitals, ambulance, and primary care trusts.2 For hospitals, this manifests itself as the major incident plan which focuses on a specific trigger e.g. the London bombings in 2005 were external major incidents that immediately created more than 700 casualties.3 Communications from ambulance control generally activate hospitals’ major incident responses. Prehospital response subsequently directs casualties to local emergency departments, although more recently NHS trusts have activated internal major incidents because of overwhelming service pressures e.g. in January 2015, a demand for in-patient beds out stripped availability at Peterborough Hospital.4 By declaring a major incident, the trust was able to cancel non-urgent elective operations and emphasize the need for local primary care trusts, social services, etc. to expedite the discharge of medically fit patients requiring non-clinical support.

With respect to (the more usual) external major incidents, the majority of hospitals have plans based on prehospital incidents that tend to deal with events in the emergency department and immediate care of severely ill or injured patients. This may only be for a 6–8 h period; however, there are the so-called consolidation and recovery phases of a major incident (Fig. 1) that can impact upon the NHS trust for …

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