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Brigadier Tim Hodgetts CBEPhD MMEd MBA CMgr FRCP FRCSEd FRCEM FIMCRCSEd FRGS FIHM FCMI
Medical Director
Defence Medical Services
Honorary Professor of Emergency Medicine
University of Birmingham
Visiting Professor School of Health Sciences
City University London
AN INTEGRATED APPROACH
TO MEDICAL DISASTER
PLANNING
CIVILIAN
MILITARY
An integrated approachOBJECTIVES
• To define a major incident
• To learn a systematic approach to the
management of a major incident
What is a
MAJOR INCIDENT?
Major IncidentDEFINITION
• Any incident where the NUMBER,
SEVERITY, or TYPE of LIVE
casualties, or by its LOCATION,
requires EXTRAORDINARY resources
Major IncidentSPECTRUM: ADULT VS PAEDIATRIC
• Major incidents involve children
San Guliana di Puglia Beslan, Ossetia
31 October 2002 01 Sep 2004
26 children killed; >100 injured 334 killed, 186 children
Major IncidentSPECTRUM: TRAUMA VS MEDICAL
• Major incidents may be‘medical’
Tokyo, March 1995
12 dead, >1000 affected
Major IncidentCLASSIFICATION
• Natural
• Man-made
natu
ral
earthquake
volcano
avalanche
flood
transport
terrorism
operations
mass gathering
industrial
ma
n-m
ad
e
Major IncidentCLASSIFICATION
• Simple
• Compound
Major IncidentCLASSIFICATION: COMPOUND
Major IncidentCLASSIFICATION: COMPOUND
Musgrave Park Hospital, Belfast, 1991
Major IncidentCLASSIFICATION
• Compensated
• Uncompensated
Major IncidentCLASSIFICATION: UNCOMPENSATED
Uncompensated
Major
Incident
=
DISASTER
Scene Priorities“ALL HAZARD” APPROACH
Systematic pre-hospital approachCSCATTT
• Command & Control
• Safety
• Communications
• Assessment
• Triage
• Treatment
• Transport
Command and Control
Command and ControlCONTROL OF MOVEMENT
Outer cordon
Inner cordon
Outer CordonPHYSICAL BARRIER
non-permissive
semi-permissive
Inner Cordon
When hazards:
Physical barrier
Fire Service or
Bomb Disposal in
CONTROL
Personnel ‘tagged’on passing through
cordon
Command and ControlTIERS OF COMMAND
Bronze
Silver
Gold
BRONZE
SILVER
GOLD
Command and ControlGOLD
Safety1—SELF
“GET OUT, STAY OUT, CALL THE FIRE SERVICE OUT”
Safety2—SCENE
Safety3—SURVIVORS
Communications
Critical Message StructureMETHANE
M Major incident STANDBY or DECLARED
E Exact location (grid reference)
T Type of incident
H Hazards, present and potential
A Access, and egress
N Number and severity of casualties
E Emergency services, present & required
METHANEPRACTICE MESSAGE: STAND BY
METHANEPRACTICE MESSAGE: DECLARED
Assessment
Triage
Treatment
<C>ABC priorities
Transport
International StandardTHE MIMMS DIASPORA
