MAJOR INCIDENTSMAJOR INCIDENTS

Wg Cdr David Bruce MBE MSc MBBS FIMC RCS(Ed) MRCGP AFOM DAvMed MRAeS

AKC

Wg Cdr David Bruce MBE MSc MBBS FIMC RCS(Ed) MRCGP AFOM DAvMed MRAeS

AKC

Ecuador Jun 04Ecuador Jun 04

MAJOR INCIDENTSMAJOR INCIDENTS

Definition of Major Incidents

RelevanceManagementTriage

Definition of Major Incidents

RelevanceManagementTriage

Ecuador Jun 04Ecuador Jun 04

MAJOR INCIDENTSMAJOR INCIDENTS

Your aim at any major incident should be to produce the largest number of survivors

Your aim at any major incident should be to produce the largest number of survivors

MAJOR INCIDENTSMAJOR INCIDENTS

Any incident where the number, severity or type of live casualties, or its location, requires extraordinary resources

Any incident where the number, severity or type of live casualties, or its location, requires extraordinary resources

Major IncidentsMajor Incidents

Simple

Compound

Natural

or ……..

Simple

Compound

Natural

or ……..

Man-made

Compensated

Uncompensated

Most are man-made, simple and compensated in Europe

Man-made

Compensated

Uncompensated

Most are man-made, simple and compensated in Europe

Scenes similar to this are routine events in emergency service work.

Effective scene management allows for;

• inter-service command

• safe working practices

• comprehensive scene assessments

• effective communications

• triage

• appropriate treatment

• transportation to definitive care.

Scenes similar to this are routine events in emergency service work.

Effective scene management allows for;

• inter-service command

• safe working practices

• comprehensive scene assessments

• effective communications

• triage

• appropriate treatment

• transportation to definitive care.

Routine IncidentsRoutine Incidents

TRIAGE SORTTRIAGE SORTM - Major Incident declared

E - Exact location

T - Type of incident

H - Hazards present and potential

A - Access to scene

N - Number and type of Casualties

E - Emergency services on scene

M - Major Incident declared

E - Exact location

T - Type of incident

H - Hazards present and potential

A - Access to scene

N - Number and type of Casualties

E - Emergency services on scene

Major IncidentMajor Incident

CCommand - Comando SSafety - Seguridad CCommunications - Comunicaciones AAssessment- Evaluación TTriage - Clasificación TTreatment -Tratamiento TTransport - Transporte

CCommand - Comando SSafety - Seguridad CCommunications - Comunicaciones AAssessment- Evaluación TTriage - Clasificación TTreatment -Tratamiento TTransport - Transporte

MANAGEMENTMANAGEMENT

Command, control and safetyCommand, control and safety

Command and ControlCommand and Control

Gold – strategic control, often remote

Silver – tactical, on scene comms / incident control room

Bronze – operational, functional commanders on scene and may be multiple

Gold – strategic control, often remote

Silver – tactical, on scene comms / incident control room

Bronze – operational, functional commanders on scene and may be multiple

CommunicationsCommunications

T4

T1

T2

T3

ICP

T4

T1

T2

T3

ICPTemp MortuarySRC

Casualty Clearing StationCasualty Clearing Station

T4

T1

T2

T3

ALPALPALPALP Triage Triage PointPointTriage Triage PointPoint

Body Holding Area

Equipment Store

TriageTriage

Trier ‘to sort’ Used when casualties outnumber skilled

rescuers Recognises that you will not be able to save

everyone Repeated learning in conflict

Trier ‘to sort’ Used when casualties outnumber skilled

rescuers Recognises that you will not be able to save

everyone Repeated learning in conflict

Gradings

ArmyRAF/

NATOCivilian Colour Plain

P1 T1 Immediate

P2 T2 Urgent

P3 T3 Delayed

T4 Expectant

Triage SieveT3

Delayed

T2Urgent

T1Immediate

Dead

Walking wounded?

Breathing? Open airway

Breathing rate <10 or > 30?

Pulse rate > 120

Breathing?

No

No

Yes

No

No

No

Yes

Yes

Yes

Yes

SMART Triage System

CRUCIFORM Triage System

Other Triage Systems

• Metag

• Locally produced systems

• Coloured pegs

• Balloons

TRIAGE SORTTRIAGE SORT

Triage Sort

Triage Sort

• Uses Triage Revised Trauma Score

• TRTS scores match Triage gradings

Resp Rate Systolic BP mmHg

GCS

10-29 4 >90 4 13-15 4

>29 3 76-89 3 9-12 3

6-9 2 50-75 2 6-8 2

1-5 1 1-49 1 4-5 1

0 0 Nil 0 3 0

TRTS

• TRTS 1-10 = T1

• TRTS 11 = T2

• TRTS 12 = T3

• TRTS 0 = Dead

• Survival Rates• TRTS 12 = 99.5 %• TRTS 11 = 97%• TRTS 10 = 88%• TRTS 8 = 66.5%• TRTS 6 = 63%• TRTS 4 = 33%• TRTS 1 = 25%

ANY QUESTIONSANY QUESTIONS

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