There are seven principles for effective response to a major incident. The generic nature of these principles has been shown to cross inter-service boundaries, civilian–military boundaries, and international boundaries.

• Command

• Safety

• Communication

• Assessment

• Triage

• Treatment

• Transport

This is the “ABC” of major incident medical management. CSCA are the management parts of the response, while TTT represents the medical support that is provided.

One of the major differences between day-to-day operations and major incident response is the need for a clear command structure.

Command is exercised through the Bronze, Silver, Gold model

All staff should follow the 1–2–3 of safety:

1. Staff

2. Situation

3. Survivors

Communication failures frequently occur between scene and control centres, and within the scene itself.

Effective procedures must be in place to activate and control the incident at the scene

A rapid assessment of the situation to estimate the size and severity of the casualty load is essential.

It does not have to be completely accurate, and will be refined as the incident evolves.

Continuing assessment will relate to the hazards that arise, and the adequacy of medical resources (the right people, with the right skills and equipment to treat the casualties).

This is the sorting of casualties into priorities for treatment.

The process is dynamic (priorities may alter after treatment, or while waiting for treatment) and it must be repeated at every stage to detect change.

Simple, effective systems for triage

The aim of treatment at a major incident is to “do the most for the most”; that is, to identify and treat the salvageable.

The actual treatment delivered will reflect the skills of the providers, the severity of the injuries, and the time and resources available.

The casualty load and the availability of skills and equipment may restrict a provider’s ability to perform to best practice standards.

A key principle here is to use staff to provide the treatments that most match with those of their day-to-day practice.

Although the majority of seriously injured patients will arrive at hospital by emergency ambulance, the Emergency Department (ED) must be prepared to process patients arriving via their own or unconventional transport (e.g. bus)