Cover
Preface to the second edition
Preface to the first edition
PART 1: Introduction
1. CHAPTER 1: The epidemiology and incidence of major incidents
  1. 1.1 Introduction
  2. 1.2 Classifying major incidents
  3. 1.3 The all hazards approach and special major incidents
  4. 1.4 Natural disasters
  5. 1.5 Epidemiology of major incidents in the UK
  6. 1.6 Summary
2. CHAPTER 2: Are we ready for the next major incident?
  1. 2.1 Introduction
  2. 2.2 Hospital preparation for major incidents
  3. 2.3 National Audit Office reports
  4. 2.4 Conclusions
  5. 2.5 Summary
3. CHAPTER 3: The structured approach to the hospital response
  1. 3.1 Background
  2. 3.2 Phases of the hospital major incident response
  3. 3.3 Summary
PART 2: Preparation
1. CHAPTER 4: Planning for major incidents
  1. 4.1 Planning
  2. 4.2 In‐hospital plans
  3. 4.3 Summary
2. CHAPTER 5: Major incident equipment
  1. 5.1 Introduction
  2. 5.2 Equipment for major incident response
  3. 5.3 Staff protection
  4. 5.4 Clinical care
  5. 5.5 Communications
  6. 5.6 Summary
3. CHAPTER 6: Training
  1. 6.1 Introduction
  2. 6.2 Exercises
  3. 6.3 Summary
PART 3: Management
1. CHAPTER 7: The scaleable hierarchy concept
  1. 7.1 Rationale for a common framework for major incident plans
  2. 7.2 Hospital co‐ordination team
  3. 7.3 Scaleable hierarchies
  4. 7.4 Summary
2. CHAPTER 8: The clinical hierarchy
  1. 8.1 Introduction
  2. 8.2 Essential clinical roles
  3. 8.3 Additional clinical roles
  4. 8.4 Non‐managerial clinical roles
  5. 8.5 Summary
  6. Senior Surgeon Action Card
  7. Operating Team Action Card
3. CHAPTER 9: The nursing hierarchy
  1. 9.1 Introduction
  2. 9.2 Essential nursing roles
  3. 9.3 Additional nursing roles
  4. 9.4 Summary
  5. Senior Nurse Action Card
  6. Senior Nurse Critical Care Action Card
4. CHAPTER 10: The management hierarchy
  1. 10.1 Introduction
  2. 10.2 Essential management roles
  3. 10.3 Additional management roles
  4. Clinical operational support
  5. Management support
  6. Infrastructure support
  7. 10.4 Summary
  8. Senior Manager Action Card
  9. Press Officer Action Card
PART 4: Support
1. CHAPTER 11: Declaring a major incident and activating the plan
  1. 11.1 Declaring a major incident
  2. 11.2 Activating the plan
  3. 11.3 Summary
2. CHAPTER 12: The reception phase
  1. 12.1 Introduction
  2. 12.2 Preparation of the hospital
  3. 12.3 Clinical care
  4. 12.4 Clinical support services
  5. 12.5 Non‐clinical support services
  6. 12.6 Management services
  7. 12.7 Other services
  8. 12.8 Summary
3. CHAPTER 13: Triage
  1. 13.1 Introduction
  2. 13.2 Aims and timing
  3. 13.3 Priorities
  4. 13.4 Triage methods
  5. 13.5 Summary of triage methods
  6. 13.6 Triage and order of intervention
  7. 13.7 Triage labelling
  8. 13.8 Summary
4. CHAPTER 14: The definitive care phase
  1. 14.1 Introduction
  2. 14.2 Surgical response
  3. 14.3 Non‐surgical (medical) response
  4. 14.4 Clinical and non‐clinical support services
  5. 14.5 Summary
5. CHAPTER 15: The recovery phase
  1. 15.1 Introduction
  2. 15.2 Resolution
  3. 15.3 Reflection
  4. 15.4 Audit
  5. 15.5 Summary
PART 5: Special incidents
1. CHAPTER 16: Incidents involving hazardous chemicals
  1. 16.1 Introduction
  2. 16.2 Response
  3. 16.3 After the Incident
  4. 16.4 Summary
  5. Senior Emergency Physician Action Card
  6. Senior Nurse Emergency Department Action Card
  7. Chemical Assessment Team Action Card
2. CHAPTER 17: Incidents involving a large number of burns
  1. 17.1 Introduction
  2. 17.2 Preparation
  3. 17.3 Pre‐hospital phase
  4. 17.4 Reception phase
  5. 17.5 Recovery and support
  6. 17.6 Summary
  7. Senior Emergency Physician Action Card
  8. Burns Co‐ordinator Action Card
3. CHAPTER 18: Incidents involving large numbers of children
  1. 18.1 Introduction
  2. 18.2 Preparation
  3. 18.3 Reception phase
  4. 18.4 Definitive care
  5. 18.5 Recovery phase
  6. 18.6 Summary
  7. Senior Paediatrician Action Card
  8. Paediatric Assessment Team Action Card
Template annexe of local highlights
Glossary
Index
End User License Agreement

List of Tables

Chapter 01
1. Table 1.1 Size classification of major incidents
2. Table 1.2 Natural disasters
Chapter 02
1. Table 2.1 Major incident planning in Britain (1996): a survey of 224 British hospitals with 24/7 emergency departments
Chapter 04
1. Table 4.1 Key area selection
2. Table 4.2 Examples of areas where planning for changes to the hospital infrastructure may be needed
Chapter 05
1. Table 5.1 Examples of resupply picklist for disposable equipment needs per 50 minor cases
2. Table 5.2 Examples of resupply picklist for disposable equipment needs per 25 major cases
Chapter 06
1. Table 6.1 Examples of relevant in‐hospital training courses
Chapter 11
1. Table 11.1 Examples of staff identification methods
Chapter 12
1. Table 12.1 Responsibilities during hospital preparation
Chapter 13
1. Table 13.1 Major incident triage categories
2. Table 13.2 The triage sort (Triage Revised Trauma Score)
3. Table 13.3 Triage Revised Trauma Score and priority
4. Table 13.4 Predicted survival for triage categories
5. Table 13.5 Summary of triage methods
Chapter 16
1. Table 16.1 Significant chemical incidents
Chapter 17
1. Table 17.1 Examples of major incidents known to have involved a significant number of burn casualties
2. Table 17.2 Burns services in the UK and Ireland
3. Table 17.3 Specific equipment for burns major incidents
4. Table 17.4 Burns triage
Chapter 18
1. Table 18.1 Major incidents known to have involved significant numbers of children
2. Table 18.2 Example of resupply picklist for disposable equipment needs per ten children
3. Table 18.3 Normal values for children for respiratory rate (RR), heart rate (HR) and blood pressure (BP)

List of Illustrations

Chapter 01
1. Figure 1.1 Box plot of total number of casualties by type of incident, 1968–96
2. Figure 1.2 Box plot of casualty admissions by type
Chapter 03
1. Figure 3.1 Hospital co‐ordination team
Chapter 06
1. Figure 6.1 Building blocks of major incident education
Chapter 07
1. Figure 7.1 Hospital co‐ordination team
Chapter 08
1. Figure 8.1a The clinical hierarchy: medical support services
2. Figure 8.1b The clinical hierarchy: clinical services
3. Figure 8.2a and b The clinical hierarchy: local highlights
Chapter 09
1. Figure 9.1 The nursing hierarchy (ODP, operating department practitioner)
2. Figure 9.2 The nursing hierarchy: local highlights
Chapter 10
1. Figure 10.1a The management hierarchy: clinical operational support
2. Figure 10.1b The management hierarchy: management support
3. Figure 10.1c The management hierarchy: infrastructure support
4. Figure 10.2a, b and c The management hierarchy: local highlights
Chapter 11
1. Figure 11.1 Example hospital call‐in list
Chapter 12
1. Figure 12.1 Schematic diagram to show the take‐over of adjacent areas for a major incident response
Chapter 13
1. Figure 13.1 The triage sieve
2. Figure 13.2 Triage Revised Trauma Score and priority
3. Figure 13.3 Cruciform label system
Chapter 16
1. Figure 16.1 Triage sift
2. Figure 16.2 Modified triage sieve
3. Figure 16.3 Dirty to clean circuit
Chapter 17
1. Figure 17.1 Direct transfer for burns algorithm
Chapter 18
1. Figure 18.1a and b Paediatric triage tape. (a)

Edition History
Blackwell Publishing (1e, 2005)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Advanced Life Support Group (ALSG) to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

Registered Office(s)
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial Office
9600 Garsington Road, Oxford, OX4 2DQ, UK

For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.

Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.

Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

A catalogue record for this book is available from the Library of Congress and the British Library.

ISBN: 9781119501015

Cover images: courtesy of Advanced Life Support Group
Cover design by Wiley

Preface to the second edition

The preparation and response to major incidents continues to present challenges to emergency planners across the globe. Since we originally produced the HMIMMS course in 2005 health services have continued to respond to a broad range of events that reinforce the need to have a structured and consistent approach to the preparation, response and recovery phases of an incident response. This consistency in response is increasingly apparent in the pre‐hospital phase, but there is still room for progress in the management of the hospital phase.

The HMIMMS course has trained over 7000 candidates, has over 300 recognised instructors and is delivered in 11 countries.

The second edition seeks to build on new knowledge and to further expand the international perspective. There are many changes through the text, but perhaps the most obvious is the change from collapsible hierarchies to scaleable hierarchies. This change is intuitive and reflects the development of the response to a major incident. Similarly, we have expanded the content on recovery and business continuity, weaving this into the text to reflect its importance. These, like many of the changes, were instigated through feedback from candidates and trainees.

We hope that this second edition will help further the organisation of major incident responses around the world.

K. Mackway‐Jones
S. Carley

Manchester, 2019

Preface to the first edition

It is now nearly ten years since the Advanced Life Support Group published its first book on Major Incident response. That book (Major Incident Medical Management and Support: The practical approach at the scene) and its accompanying course, affectionately known as MIMMS, are now established around the world as best practice guides. The CSCATTT approach to incidents has become a standard like ABC.

For some of us, however, the focus on the first phase of the response (the pre‐hospital phase), while a good place to start, did not solve all our problems. Our practice was more likely to be delivering care within the hospital environment, and a course dedicated to this seemed badly needed.

This book has been written with the aim of promulgating the disciplines and lessons of MIMMS to the hospital provider. We hope that the multi‐professional team needed for a successful response can use this text and its accompanying course (to be known as Hospital MIMMS) as successfully as their pre‐hospital colleagues have used MIMMS. Certainly our pilot courses have suggested that the package does fill an unmet need. We hope that those of you that read it and train with us agree.

K. Mackway‐Jones
S. Carley

Contact details and further information

ALSG: www.alsg.org

For details on ALSG courses visit the website or contact:
Advanced Life Support Group
ALSG Centre for Training and Development
29–31 Ellesmere Street
Swinton, Manchester
M27 0LA
Tel: +44 (0)161 794 1999
Fax: +44 (0)161 794 9111
Email: enquiries@alsg.org

Clinicians practising in tropical and under‐resourced health care systems are advised to read International Maternal and Child Health Care – A practical manual for hospitals worldwide (www.mcai.org.uk) which gives details of additional relevant illnesses not included in this text.

Updates

The material contained within this book is updated on a 5‐yearly cycle. However, practice may change in the interim period. We will post any changes on the ALSG website, so we advise that you visit the website regularly to check for updates (www.alsg.org). The website will provide you with a new page to download.

References

All references are available on the ALSG website www.alsg.org

On‐line feedback

It is important to ALSG that the contact with our providers continues after a course is completed. We now contact everyone 6 months after their course has taken place asking for on‐line feedback on the course. This information is then used whenever the course is updated to ensure that the course provides optimum training to its participants.

How to use your textbook

The anytime, anywhere textbook

Wiley E‐Text

Your textbook comes with free access to a Wiley E‐Text: Powered by VitalSource version – a digital, interactive version of this textbook which you own as soon as you download it.

Your Wiley E‐Text allows you to:

Search: Save time by finding terms and topics instantly in your book, your notes, even your whole library (once you’ve downloaded more textbooks)

Note and Highlight: Colour code, highlight and make digital notes right in the text so you can find them quickly and easily

Organize: Keep books, notes and class materials organized in folders inside the application

Share: Exchange notes and highlights with friends, classmates and study groups

Upgrade: Your textbook can be transferred when you need to change or upgrade computers

Link: Link directly from the page of your interactive textbook to all of the material contained on the companion website

The Wiley E‐Text version will also allow you to copy and paste any photograph or illustration into assignments, presentations and your own notes.

To access your Wiley E‐Text:

Find the redemption code on the inside front cover of this book and carefully scratch away the top coating of the label.
Go to https://online.vitalsource.co.uk and log in or create an account. Go to Redeem and enter your redemption code to add this book to your library.
Or to download the Bookshelf application to your computer, tablet or mobile device go to www.vitalsource.com/software/bookshelf/downloads.
Open the Bookshelf application on your computer and register for an account.
Follow the registration process and enter your redemption code to download your digital book.
If you have purchased this title as an e‐book, access to your Wiley E‐Text is available with proof of purchase within 90 days. Visit http://support.wiley.com to request a redemption code via the ‘Live Chat’ or ‘Ask A Question’ tabs.

We hope you enjoy using your new textbook. Good luck with your studies!

Simon Carley	MD, FRCEM, Professor of Emergency Medicine, Manchester University NHS Foundation Trust
Brian Carlin	RCSEd, FIMC, PG Dip Med Ed, Dublin, Ireland
Pete Driscoll	BSc, MD, FRCS, FRCEM, Academic Director, Physician Associate Programme, UCLan
Stephen Groves	OBE, National Head of EPRR, NHS England
Peter T. Johnson	Advanced Practitioner Critical Care, Critical Care Outreach Lead, Royal Cornwall Hospitals NHS Trust
Celia Kendrick	BSc, RN, Dip HEP, Head of Resilience and Emergency Preparedness, North West Anglia NHS Foundation Trust
Kevin Mackway‐Jones	FRCP, FRCS, FRCEM, Consultant in Emergency Medicine, Manchester University NHS Foundation Trust, Director of Postgraduate Medicine, Manchester Metropolitan University
Andrew Ronald	FRCA, FFICM, Consultant Anaesthetist, Aberdeen Royal Infirmary, NHS Grampian
Julia Surridge	MRCPCH, Consultant Paediatric Emergency Medicine, Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust
Sue Wieteska	CEO, Advanced Life Support Group, Manchester

Simon Carley	Consultant in Emergency Medicine, Manchester Royal Infirmary, UK
Peter Driscoll	Consultant in Emergency Medicine, Hope Hospital, Manchester, UK
Peter Johnson	Advanced Practitioner in Critical Care, Royal Cornwall Hospital, UK
Celia Kendrick	Lead Nurse Emergency Department / Emergency Planning Nurse, Peterborough District Hospital, UK
Kevin Mackway‐Jones	Professor of Emergency Medicine, Consultant in Emergency Medicine, Manchester Royal Infirmary, UK
Elaine Metcalfe	Project & Development Manager, Advanced Life Support Group, Manchester, UK
Brendan Ryan	Executive Medical Director and Consultant in Emergency Medicine, South Manchester University Hospitals NHS Trust, UK
Steve Southworth	Consultant in Emergency Medicine, Stepping Hill Hospital, Stockport, UK
Polly Terry	Consultant in Emergency Medicine, Leighton Hospital, Crewe, UK
Sue Wieteska	Group Manager, Advanced Life Support Group, Manchester, UK

Major Incident Medical Management and Support

Working group

Contributors to first edition