1. The Hospital’s Systematic Approach For Major IncidentsBy
Rania M Ali, M.D.
Lecturer of Anethesia & Intensive Care
Ain Shams University

2. Objectives Define a Major Incident
Describe the purpose of the Major Incident Plan
Understand the phases and build up of the hospital response

3. Objectives Define a Major Incident
Describe the purpose of the Major Incident Plan
Understand the phases and build up of the hospital response

4. 1- Major Incidents
Incident which causes so many casualties that special arrangements must be implemented.

5. “EXPECT THE UNEXPECTED”
1- Major Incidents
Major incidents happen without warning
“EXPECT THE UNEXPECTED”
A major incident could be anything from a multiple vehicle road traffic accident, rail crash to a sudden increase in flu cases

6. Minor/ Moderate/ Severe Compensated/ Uncompensated
1- Major Incidents
Simple/ Compound
Minor/ Moderate/ Severe
Compensated/ Uncompensated
It may be
necessary to declare a major incident when, for instance, additional special resources such as ICU beds,
theatre resources or burns facilities will be required, even though the total number of casualties is limited

7. 1- Major Incidents Are we ready for the next Major Incident? Tools:
Flexible and effective response to any Major Incident
Tools:
Major Incident Plan
Well trained staff who are familiar with their roles
Plan revision should be an ongoing process with updates to the plan.
Appropriate training and exercises should be organised.

8. Objectives Define a Major Incident
Describe the purpose of the Major Incident Plan
Understand the phases and build up of the hospital response

9. 2- Major Incident Plan Why have a Major Incident Plan?
The plan describes how the hospital facilities and staff will be re-organised
“IF WE FAIL TO PLAN,
THEN WE CAN PLAN
TO FAIL”.

10. 2- Major Incident Plan Why have a Major Incident Plan?
Without a proper plan the consequences would be chaotic.
How?
Systematic, high quality training
Refreshers at regular intervals
Exercises to translate theory into practice.

11. 2- Major Incident Plan Remember:
If you are reading the major incident plan because a major incident has been declared, then it is too late.

12. 2- Major Incident Plan
Which of the following would you want to include in any Major Incident plan?
Clear report to reporting structure so everyone knows who they should report to and where to

13. 2- Major Incident Plan
Which of the following would you want to include in any Major Incident plan?
Good communications

14. 2- Major Incident Plan
Which of the following would you want to include in any Major Incident plan?
Organisation of wards to cope with a sudden influx of patients

15. 2- Major Incident Plan
Which of the following would you want to include in any Major Incident plan?
Special areas set up in hospital to cater for groups such as relatives, the press & the police

16. 2- Major Incident Plan
Which of the following would you want to include in any Major Incident plan?
Clear set of actions for everyone involved so that staff know their identified role

17. 2- Major Incident Plan
Which of the following would you want to include in any Major Incident plan?
Trolleys set up with all of the additional resources such as case notes
as. All of these would be important to include. We will see how all of these play a part in the plan.

18. 2- Major Incident Plan
The Major Incident Plan should be available in all wards and departments and on the Intranet and includes the action cards.

19. 2- Major Incident Plan Action Cards
Action card should be readily accessible.
Action cards describes the duties of key personnel and departments.
It tells you who to report to
It tells you what actions to take
It provides key contact details
It is the responsibility of the head of each department to ensure both that all their staff are
familiar with the major incident plan and that they understand their own potential roles.

20. 2- Major Incident Plan Casualty labeling system
Medical Registration Number (MRN)
At the triage location
Wrist bracelet
Put on each casualty, personal property 
Used on all documentation ,
blood transfusion and
diagnostic procedures

21. Objectives Define a Major Incident
Describe the purpose of the Major Incident Plan
Understand the phases and build up of the hospital response

22. The Hospital Response The Hospital Response Pre-Hospital Phase
Reception Phase
Definitive Care Phase
Recovery Phase

23. Pre-hospital Phase Moves people from the scene to definitive care
Variable levels of treatment at scene

24. Roles for receiving hospitals
Pre-hospital Phase
Roles for receiving hospitals
To liaise with the ambulance service, other hospitals and agencies in order to manage the impact of the incident
To provide on site medical care and advice!!?

25. Pre-hospital Phase Alerting Messages “MAJOR INCIDENT – STANDBY”
“MAJOR INCIDENT CANCELLED”
“MAJOR INCIDENT DECLARED – ACTIVATE PLAN”,
“MAJOR INCIDENT – CASUALTY EVACUATION COMPLETE”
“MAJOR INCIDENT STAND DOWN”
Establish call is genuine by ringing the caller back.

26. Pre-hospital Phase By The ambulance communications centre team leader
The ER department consultant
The co-ordinating team that has been assembled in response to a MAJOR INCIDENT – STANDBY message.
If there is any doubt as to whether a major incident exists for the hospital it is best to be on the side of caution and declare it!
“IF IN DOUBT, SHOUT IT OUT”

27. Pre-hospital Phase Message record the following information
Type/ location / time of incident
Estimated number of casualties
Predominant nature of injuries
Time of message
Which other hospitals, if any, have been alerted
Name and telephone number of the person giving the information
The Telephonist will immediately confirm the message by ringing the caller back.

28. The Hospital Response The Hospital Response Pre-Hospital Phase
Reception Phase
Definitive Care Phase
Recovery Phase

29. Reception Phase Medical Co-ordinator Senior Emergency Physician
Allocation of Responsibilities
Hospital Management Team
Medical Co-ordinator
Senior Emergency Physician
Directs medical staff
Senior Nurse
Directs nurse staff
Senior Manager
Manages the Support Services
Responsibilities of Central Control are
To manage the hospital’s major incident plan according to the incident.
To determine the number and range of injuries which can be managed within the resources available in the hospital
To determine when the application of the Major Incident Plan should cease
Support Services, which includes looking after the press and relatives.

30. Dependent upon time from alert to patient arrival
Reception Phase
Preparation of the hospital
Dependent upon time from alert to patient arrival
Pre-allocation of staff and
resources speeds the
preparation time

31. Reception Phase Preparation of the hospital Clinical areas
Emergency Department
Staff reporting area
Theatres
ICU
Wards
Body holding area
Non clinical areas
Hospital Co-ordination centre
Hospital Information centre
Discharge area
Press area
Emergency blood donation
Good plans will help these areas activate quickly
maintain communications with relatives of existing patients and those from the incident, the local community, the media and VIPs
Press information: A press Information centre will be set up .Casualty information at the hospital will be collated by the communications staff, which will be passed on to the media and Central Casualty Bureau

32. Reception Phase Preparation of the hospital
A triage point is set up at the entrance
In-patients awaiting discharge are to be taken to general out-patients
Patients from ward are transferred out so that casualties from the major incident can be accommodated
Patient’s relatives are taken care of in the restaurant

33. Reception Phase Preparation of the hospital Reception areas initially
Reconfiguring emergency department
Current state and capacity of ICU and theatres
Managing current patients
Ward clearance
A triage point is set up at the entrance
In-patients awaiting discharge are to be taken to general out-patients
Patients from ward are transferred out so that casualties from the major incident can be accommodated
Patient’s relatives are taken care of in the restaurant

34. Reception Phase Is the following statement true or false?
All staff involved in
the Major Incident Plan,
must ensure that they
wear their identification badge.
Without ID you will denied access to the areas designated for the major incident. This is to prevent any unauthorised people such as members of the press from getting access to victims or staff.

35. Reception Phase Priorities of treatment in the Emergency Department
Life saving resuscitation
Clinical Assessment
Definitive management

36. Reception Phase Triage
The sorting of multiple casualties into categories by priority
“THE MOST IS DONE FOR THE MOST”
The triage category of patients
may change if their condition
improves or deteriorates
This is the sorting of multiple casualties into categories by priority to ensure that “the most is done for the
most”. The triage category of patients may change if their condition improves or deteriorates.

37. Reception Phase Transport in the Emergency Department Surgery ICU
Admit
Home

38. The Hospital Response The Hospital Response Pre-Hospital Phase
Reception Phase
Definitive Care Phase
Recovery Phase

39. Definitive care phase
Where might definitive care take place?

40. Definitive care phase Emergency Department
Most patients will be seen & discharged
Surgical cases
Co-ordinated by Senior Surgeon
Non surgical cases
Co-ordinated by Senior Physician
Ensure all patients reviewed by appropriately qualified staff

41. Definitive care phase Priorities Triage
Initial treatment/ resuscitation
Definitive management/ Surgery

42. Definitive care phase
Which services will be required to support the clinical response?
Lots – pretty much everyone

43. Definitive care phase
Which services will be required to support the clinical response?
Lots – pretty much everyone

44. Forensic medical services Evidence retention
Definitive care phase
The Dead
Body holding area
Forensic medical services
Evidence retention

45. The Hospital Response The Hospital Response Pre-Hospital Phase
Reception Phase
Definitive Care Phase
Recovery Phase

46. The Recovery Phase
The management of a Major Incident can continue long after the Stand Down.
Resolution
Reflection
Audit

47. The Recovery Phase Resolution Staffing rotas
Restocking equipment, drugs etc.
Ongoing surgery and other treatment
Rescheduling of cancelled activities
Staffing rotas: continuing demand for both routine tasks and work related to the Major Incident

48. The Recovery Phase Reflection
Debriefing of staff: “hot” debrief immediately after the stand down
Psychological support and counseling to the injured, survivors and relatives
psychological debriefing
formal operational debriefing

49. The Recovery Phase Audit Evaluate Major Incident response
Identify the lessons to be learned.
Rewriting of the Hospital Major Incident Plan
Major Incident Plan Revision, Training & Exercises
Plan revision will be an ongoing process with updates to the plan as required
Appropriate training and exercises will be organised.

50. Summary
A major incident is a significant event which causes a disruption to the service.
Plan, train and respond to any major incident considering 4 phases
Pre-hospital
Reception
Definitive Care
Recovery

51. The Hospital’s Systematic Approach For Major Incidents
Thank you
Rania M Ali, M.D.