Multiple Casualty Incidents

Where the number of casualties (temporary) exceeeds the capacity available of the healthcare resources (at the incident)

For example: you could be covering a running event, at the finish line medical post you may have 10 patients in quick succession who collapse, and there is only 4 responders covering the area. At this point you could argue you have a multiple casualty incident, as you have 10 collapsed patients and only 4 people to treat them.

However, this a temporary issue - you can call in additional support from surrounding medical teams, such as cycle responders, other medical posts and ambulances.

So you have a temporary incident but can cope with the resources available

Multiple casualty incidents often:

• need more resources deployed to the scene to help out

• containable in a short time

A first responder includes any member of the emergency services who is likely to be the first operational resource to be deployed to a CBRN incident.

The person is unlikely to be trained in specialist CBRN response or have specific CBRN Personal Protective Equipment (PPE). This also includes staff at Health Care premises who may be required to carry out the role of a first responder. It focuses on the multi-agency first response and the initial life-saving phase of a CBRN incident, and is intended to enable control room personnel and first responders to facilitate or undertake life-saving actions as soon as possible.

This approach also promotes close inter-agency working, which is vital in responding effectively to a CBRN incident.

Previous protocols for the response to a CBRN incident, dictated that unprotected emergency responders should withdraw from the scene and await the arrival of specialist trained and equipped assets (STEP 1,2,3). However, recent evidence has pointed to a need for a more rapid and flexible approach to a CBRN incident.

Visual Indicators

Visual Indicators Visual indicators of a CBRN event may include all or some of the following:

• Dead or distressed people, birds and animals

• Multiple individuals showing unexplained signs of skin, eye or airway irritation; nausea; vomiting; twitching; sweating; pin-point pupils; runny nose; disorientation; breathing difficulties; and convulsions

• The presence of hazardous materials or unusual materials/equipment

• Unexplained vapour or mist clouds

• Unexplained oily droplets or films on surfaces or water

• Withered plant life and vegetation

Note: Symptoms of exposure to a biological or radiological attack may not be present within the first minutes and hours of an attack occurring. Chemical releases are often, but not always accompanied by a more rapid onset of symptoms.

In the early stages of an incident, it may be difficult to establish whether a CBRN event has occurred

Mass Casualty Incidents (Significant Incidents)

Incidents that require significant medical resources to be deployed to the scene

Examples include:

• Significant transport incident

• Terrorist attack

Major Incidents

Definitions

"Emergency means an event or situation which threatens serious damage to a place in the UK" [Civil Contingenceis Act]

"An event or situation requiring a response under one or more of the emergency services major incident plans" [Cabinet Office]

"An event or situation with a range of serious consequences which requires special arrangements to be implemented by one or more emergency responder organisation" [JESIP Definition]

In health service terms, a major incident is: "an incident where the number, severity and type of live casualties requires extra ordinary resources"

The word 'live' makes a big difference -multiple dead patients would not trigger a major incident response from health (ambulance, medical and hospitals), however would from Fire or Police

No two incidents are ever the same

Major incidents can be natural or man-made

• Natural: Floods, fires, earthquakes (can be long lasting events)

• Man-made: Terrorism, transport, mass gatherings or industrial (usually self contained incidents)

Major incidents can be simple or compound in their nature

• Simple: hospitals, communications, infrastructure remain intact

• Compound: damage to transport, communications or ineffective health services

Major incidents can be compensated or uncompensated

• Compensated: where the load is less than the extra ordinary capacity (most UK incidents)

• Uncompensated: load of live casualties exceeds surge capacity (rare in the UK)

Examples

For each of the incidents below, can you categorise them as:

• Natural or Man-Made

• Simple or Compound

• Compensated or uncompensated

You can reveal the answers using the downward arrow