Various definitions exist for what constitutes a major incident, but generally speaking, it refers to an event or situation with the potential to result in a significant number of casualties, actual casualties, considerable risks, or unique circumstances.
Major incidents are typically rare occurrences, and the likelihood of being involved in declaring one is low, nevertheless, possessing a fundamental understanding can enable quicker response in managing such incidents, potentially leading to lives being saved. The determination of a major incident often relies on individual experience and intuition rather than a strict set of rules.
Clear instances of major incidents include scenarios like explosions in densely populated buildings causing numerous casualties and entrapments, or train derailments resulting in mass casualties. Less conspicuous examples may involve potential threats from a chemical plant to a large population or a dam endangering downstream residents in a village.
It's important to note that a major incident doesn't always entail mass casualties, but rather the presence of significant risk.
In situations of uncertainty, seeking advice is advisable.
By coordinating with other experts and management, a more informed decision can be made.
What to do at the scene
Upon arrival at a major incident you must prioritise safety above all else, it is crucial to assess the situation carefully before approaching any patients, especially if there is a potential risk of chemical, biological, radiological or neurological (CBRN) or Hazardous Materials (HAZMAT) exposure.
Parking the vehicle at a safe distance allows for a comprehensive overview of the ongoing events, rather than diving into the midst of it and becoming overly focused on immediate tasks, potentially missing the bigger picture.
Furthermore, it is essential to consider the placement of a suitable Casualty Clearing Point (CCP) for initial patient treatment and care, as well as identifying appropriate loading points for patients and ambulances.
Conducting a quick reconnaissance of the area from the ambulance cab and reviewing the Mobile Data Terminal (MDT) can aid in making informed decisions, which can then be communicated to the control center.
In different scenarios, various actions can be taken accordingly, for instance, in a CBRN situation, maintaining a safe distance is crucial, and advising individuals to follow the "remove, remove, remove" protocol, which involves leaving the contaminated area, discarding contaminated clothing, and cleansing skin and hair. In cases where there are walking wounded in a non-CBRN incident, individuals with minor injuries who are able to walk can be directed to a designated collection area.
Being the first responder or first on the scene in a major incident presents challenges, as there may be a strong urge to immediately engage, however, it is more effective to initially monitor the situation from the periphery until additional support arrives.
This approach allows for better management of the overall situation, facilitates communication, and enables a more responsive reaction to any emerging threats or hazards.
Triaging patients
In situations involving a large number of casualties, a triage system will be utilized to assess and prioritize patients.
This system typically involves categorizing patients as red, amber, green – p1, p2, p3, with the addition of a category for deceased patients. The specific criteria for each category may vary depending on the region or healthcare provider.
Generally, patients requiring immediate treatment, like those with severe bleeding, will be classified as p1 or red. P2 or amber patients are those who are stable but unable to self-evacuate due to injuries, while P3 individuals have minor injuries and can walk to a designated care center.
P1 – Life-threatening injury
P2 – Unconscious but breathing
P3 – Non-life-threatening injury
METHANE in a Major Incident
The acronym METHANE is commonly employed to declare a major incident, and s ubmitting a METHANE report during such an event will trigger a series of actions that will initiate a major incident response.
If you are the first responder, you will assume responsibility for managing the situation until more qualified personnel arrive.
A well-executed METHANE report can significantly aid the initial response by preventing information discrepancies among the various responding organizations.
M – Major incident standby/declared
E – Exact location – You can use mapping software such as the mobile app "What-three-words" to give you an accurate location of the incident.
T – Type of incident – Detailing the type of incident can assist with the response required by different services, this information will dictate what resources are sent to your scene so make sure you have a "Condor Moment" and soak up the whole scene, if you do miss something though it can be added later.
H – Hazards – Identifying hazards can assist in maintaining the safety of the incoming responders/agencies and will allow them to get to the scene both quickly and safely.
A – Access and Egress – Looking at the maping software on your phone and try and identify the most ideal access and egress for the incoming emergency serives, having some knowledge of respone times will help you achieve this.
N – Number of casualties – Giving an idea of the number of casualties can help with the emergency response, use the Triage method unles you have a good unerstanding of the 9 liner method which the emergency services and the military use.
E – Emergency services present and required – Once you have triaged the casualties you will be able to work out how many ambulances you require, you will also need assistance from the Police and maybe the fire brigade.
Post Incident considerations
Following a major incident, regardless of whether it is crime-related or not, it is essential to conduct a post-incident assessment to facilitate learning.
The assessment should concentrate on deriving valuable insights and recognising effective methods that can be integrated into future assignment instructions.
Historically, evaluations have been conducted through debriefings.
Typically, these debriefings are conducted internally and concentrate on the responses of all parties involved, both internally and externally, from their respective viewpoints.
The Post incident review needs to include:
What worked
What didn't work
What we were deficient on (man power, equipment and support)
What we need to improve on for next time
future training that needs to take place
Once all considerations have been taken in to acount updates need to be made to the assignement instructions, all staff are to read acknowledge and sign them and they need to be revisted to ensure everyone is working to them.
Management plans
Assessing previouse incident is crucial for creating your incint management plan which in turn will determin what actions you are going to take in the event an incident arrises.
A detailed review of information can reveal both the positive and negative aspects of the overall response, enabling the development of a management plan for future incidents.
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