Chapter 56. The major incident
An overview
Classification
• A simple major incident is one in which the infrastructure of the community in which it occurs remains intact, e.g. a train or air crash
• A compound major incident destroys or damages the infrastructure of the surrounding community
• A compensated major incident is one in which there are sufficient local resources to deal with the consequences
• An uncompensated major incident is one where the medical and other responding emergency services are destroyed or totally inadequate.
CSCATTT
CSCATT describes the priorities involved in managing a major incident.
Responsibilities of the first crew on scene
Attendant
• The attendant assumes the role of Ambulance commander until relieved by a senior ambulance officer
• He/she should undertake a rapid reconnaissance of the scene and feed back a situation report to the driver, who can then pass this to control using the METHANE mnemonic (see below)
• Suitable sites for ambulance parking point, control point and the casualty clearing station should be identified
• The Fire commander and Police commander should be identified and contacted at an early opportunity
• As ambulance commander, he/she must not become involved with the treatment of casualties.
Driver
• The driver is to stay with the vehicle at all times. He will form the communication link between the scene and ambulance control
• Park the vehicle as close to the scene as safety allows and leave the beacon switched on. The driver should then provide control with a brief report, stating the location and type of incident
• The driver must remain in contact with the attendant at all times and should not leave the vehicle until directed to do so by a senior ambulance officer.
Major incident standby/major incident declared
Exact location
Type of incident
Hazards
Access
Number of casualties
Emergency services present and required
Emergency services
• Overall control of the scene is the responsibility of the police who will control the outer cordon
• There will be a police manned incident control point through which all staff should enter and leave; all movements will be logged
• If hazards are present, the Fire service will have responsibility inside the inner cordon (the hot zone) until the danger is controlled
• Personnel entering and leaving the inner cordon must also be recorded for safety purposes
• The bronze ( operational) area lies within the inner cordon and is the area where the rescue operation is in place. There will be bronze commanders ( forward commanders) from each emergency service
• Silver ( tactical) command consists of the area within the outer cordon. The commanders from each service will be within this area, although they may move in and out of the bronze zones
• Gold ( strategic) command is removed from the scene – usually in the police HQ or local authority buildings – and is the location where the chief officers from each emergency service meet.
Silver (tactical) command
Silver command is usually handed over to more senior officers as they arrive. Commanders must not become involved in the rescue or treatment of casualties. There must be frequent documented meetings between the silver commanders from each service. The first priority is to share intelligence and establish what has happened:
• What are the main priorities for the next hour?
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