As a helicopter-based service, it is not unusual for the PHR team to be first on scene. In fact, it is highly likely that the PHR physician will be the first doctor on scene. In this situation, the doctor becomes the Medical Incident Commander (MIC) and the paramedic becomes Ambulance Incident Commander (AIC). The team should have tabards labelled MIC and AIC for this purpose. The first teams of the other emergency services (Fire & Rescue and Police) to arrive will likewise become the respective incident commanders. This nucleus of four constitutes the initial tactical or silver command for the incident and they must remain in contact throughout the incident. As time progresses, it may be appropriate for the initial tactical commanders to be replaced by more experienced personnel.

Another advantage of arriving by air is the opportunity to assess the scene from above. This could prove invaluable and, if possible, you should try to draw a sketch or take digital stills of the scene.

In the stress of arriving at such a scene, the golden rule is information and you need to pass on what you see to the coordinator in a lucid and cogent fashion. Never assume that someone else has already done this. The team leader should radio or telephone the coordinator (or simply the emergency services standard number) and state that he is declaring a major incident. The call-taker will instantly be able to focus on the situation and should be ready thereafter to receive an information summary. The mnemonic ‘METHANE’ is an excellent technique for remembering the initial approach to major incidents (see box on next page).