The Hospital’s Systematic Approach For Major Incidents

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

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

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

1- Major Incidents Major incidents happen without warning “EXPECT THE UNEXPECTED”

1- Major Incidents • Simple/ Compound • Minor/ Moderate/ Severe • Compensated/ Uncompensated

1- Major Incidents Are we ready for the next Major Incident? Flexible and effective response to any Major Incident • Tools: • Major Incident Plan • Well trained staff who are familiar with their roles

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”.

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.

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.

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

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

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

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

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

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

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.

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

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

The Hospital Response

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

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!!?

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”

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 IN DOUBT, SHOUT IT OUT”

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

Reception Phase Allocation of Responsibilities Hospital Management Team

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

Reception Phase Preparation of the hospital

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

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.

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

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

Reception Phase • Transport in the Emergency Department • Surgery • ICU • Admit • Home

Definitive care phase Where might definitive care take place?

Definitive care phase

Definitive care phase • Priorities • Triage • Initial treatment/ resuscitation • Definitive management/ Surgery

Definitive care phase Which services will be required to support the clinical response?

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

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

The Recovery Phase • Resolution • Staffing rotas • Restocking equipment, drugs etc. • Ongoing surgery and other treatment • Rescheduling of cancelled activities

The Recovery Phase • Reflection • Debriefing of staff: “hot” debrief immediately after the stand down • Psychological support and counseling to the injured, survivors and relatives

The Recovery Phase • Audit • Evaluate Major Incident response • Identify the lessons to be learned. • Rewriting of the Hospital Major Incident Plan

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

The Hospital’s Systematic Approach For Major Incidents