Major incidents

An analysis of major freeway incidents in Houston, Texas, was conducted. The data base analyzed was provided by the Houston Police Department solo motorcycle patrol division. This division responds to all freeway lane-blocking incidents that are expected to last more than approximately 45 minutes. Over a 7-year period between 1986 and 1992, the division documented the details of 612 major freeway incidents to which it responded. From these data, it was estimated that major freeway incidents occur in Houston at a rate of 0.68 incident per 100 million vehicle-kilometers (MVK). That is equivalent to a major incident every 147 MVK. Major incidents were nearly 3.5 times as likely to occur within the interchanges (based on vehicle-kilometers driven) as between them. Of the 612 major incidents included in the data base, 498 (81.5 percent) involved trucks only (even though large truck traffic accounts for only 7.7 percent of the total vehicle-kilometers traveled on Houston freeways). Furthermore, lost or spilled loads and truck overturns account for nearly one-half of the major incidents in Houston. Information on incident severity and duration is also presented.

An analysis of major freeway incidents in Houston, Texas, was conducted. The data base analyzed was provided by the Houston Police Department solo motorcycle patrol division. This division responds to all freeway lane-blocking incidents that are expected to last more than approximately 45 minutes. Over a 7-year period between 1986 and 1992, the division documented the details of 612 major freeway incidents to which it responded. From these data, it was estimated that major freeway incidents occur in Houston at a rate of 0.68 incident per 100 million vehicle-kilometers (MVK). That is equivalent to a major incident every 147 MVK. Major incidents were nearly 3.5 times as likely to occur within the interchanges (based on vehicle-kilometers driven) as between them. Of the 612 major incidents included in the data base, 498 (81.5 percent) involved trucks only (even though large truck traffic accounts for only 7.7 percent of the total vehicle-kilometers traveled on Houston freeways). Furthermore, lost or spilled ...

Chemical incidents

Purpose: Errors and incidents may occur at any point within radiotherapy (RT). The aim of the present retrospective analysis is to evaluate the impact of a customized ARIA Visual Care Path (VCP) on quality assurance (QA) for the RT process. Materials and Methods: The ARIA VCP was implemented in June 2019. The following tasks were customized and independently verified (by independent checks from radiation oncologists, medical physics, and radiation therapists): simulation, treatment planning, treatment start verification, and treatment completion. A retrospective analysis of 105 random and unselected patients was performed, and 945 tasks were reviewed. Patients’ reports were categorized based on treatment years period: 2019–2020 (A); 2021 (B); and 2022–2023 (C). The QA metrics included data for timeliness of task completion and data for minor and major incidents. The major incidents were defined as incorrect prescriptions of RT dose, the use of different immobilization systems during RT compared to the simulation, the absence of surface-guided RT data for patients’ positioning, incorrect dosimetric QA for treatment plans, and failure to complete RT as originally planned. A sample size of approximately 100 was able to obtain an upper limit of 95% confidence interval below 5–10% in the case of zero or one major incident. Results: From June 2019 to December 2023, 5300 patients were treated in our RT department, an average of 1300 patients per year. For the purpose of this analysis, one hundred and five patients were chosen for the study and were subsequently evaluated. All RT staff achieved a 100% compliance rate in the ARIA VCP timely completion. A total of 36 patients were treated in Period A, 34 in Period B, and 35 in Period C. No major incidents were identified, demonstrating a major incident rate of 0.0% (95% CI 0.0–3.5%). A total of 26 out of 945 analyzed tasks (3.8%) were reported as minor incidents: absence of positioning photo in 32 cases, lack of patients’ photo, and absence of plan documents in 4 cases. When comparing periods, incidents were statistically less frequent in Period C. Conclusions: Although the present analysis has some limitations, its outcomes demonstrated that software for the RT workflow, which is fully integrated with both the record-and-verify and treatment planning systems, can effectively manage the patient’s care path. Implementing the ARIA VCP improved the efficiency of the RT care path workflow, reducing the risk of major and minor incidents.

The Civil Contingencies Act (2004) requires UK primary care trusts (PCTs) to plan and respond to major health incidents. We carried out a cross-sectional survey of all PCTs in the north-west region of England using a telephone interview with a structured questionnaire. We assessed: (1) staff members responsible for emergency planning; (2) risk assessment; (3) training and exercises; and (4) the planned response to a major incident. Response rate was 61% (20/33). Twelve out of 20 employed an emergency planning officer. All responding PCTs had participated in a tabletop exercise in the previous year and nine of 20 in a live exercise in the previous three years. Nine provided major incident training to new staff. Fifteen had discussed major incident preparations with their local acute trust but none could quantify the support they would be able to provide in terms of accelerated discharges. We have revealed potentially serious deficiencies in the emergency preparedness of many PCTs. PCTs are expected to play a vital role in coordinating the National Health Service (NHS) response to a major incident and these results have important implications for the ability of the NHS as a whole to effective respond to such incidents.

The exponential growth in the interconnectedness of people and devices, as well as the upward trend in cyberspace usage will continue to lead to a greater reliance on the internet. Most people’s daily activities are dependent on their ability to navigate the internet to access and manage information. There are usually real risks associated with managing or accessing information, and these risks when exploited by threat actors, often lead to cybersecurity incidents. It is a common knowledge that a major cybersecurity incident is likely to result in significant financial losses, legal liability, privacy violations, reputational damage, sensitive data compromises, as well as national security implications. Threat actors usually employ various attack techniques to cause these incidents. After we identified the major cybersecurity incident report that is consolidated by the Center for Strategic & International Studies from which we derived the data about the 803 major incidents that we analyzed, we then verified its credibility, non-partisan, global outreach and cybersecurity attack coverage by cross-referencing it with Data Breach Investigation Report (DBIR). We also through the lens of the Global Cybersecurity Index (GCI) ensured that this study is conducted within the context of cybersecurity principles. In reference to these attack techniques employed by threat actors, we conducted an exploratory investigation of 803 major cybersecurity incidents that were reported over the last decade. From a group of 244 of these major security incidents that happened and were reported between 2005 and 2021, this study reports that malware attack techniques were employed by threat actors to cause 48 percent of them and phishing attack techniques account for 19.7 percent of them. As many sources have confirmed the fact that major incidents will always happen, we highlighted the importance of readiness of organizations to conduct cybersecurity incident triage and or thorough investigation as necessary. Given the relevance of the guidelines outlined in the National Institute of Standards and Technology (NIST) incident response framework, we recommend that organizations should adopt it or similar guidelines as best as possible.

Major incidents happen infrequently and challenge the health care system by demanding more resources than are readily available. Critically injured patients need rapid treatment and swift transport to the right hospital to prevent unnecessary death and disability. Helicopter emergency medical services (HEMS) are incorporated into emergency medical systems in Norway and other countries around the world. Anecdotally, HEMS have become integrated in the immediate management of sudden-onset major incidents and case reports depict that helicopters may play a key operational role. Although the amount of research on benefits and challenges of HEMS is rapidly growing, the optimal use in major incidents remains unanswered. The main aim of this thesis is to explore the use of HEMS in sudden- onset major incidents in a systematic way from different angles. The thesis focus on optimizing HEMS role in sudden-onset major incident management by sharing experiences for policy makers to improve major incident preparedness. This is done through four studies, a systematic review, a cross-sectional study, a Delphi study and a retrospective observational study. With these studies, we found that previous research published on HEMS role in sudden-onset major incident management are mainly case reports and that little systematic research has been done. In the cross-sectional study and the retrospective observational studies, we found that HEMS participation in sudden-onset major incidents are rare in Norway. The cross-sectional study showed that HEMS personnel were experienced but only a little more than half of the crew members had attended a major incident within the previous five years. Further, the retrospective observational study showed that in a major incident, HEMS treat more patients on-scene than they transport to definite care. In this complex environment, the participation of multiple emergency services that not necessarily cooperate on a daily basis makes communication and coordination (including with HEMS) challenging. These challenges deserve focus in major incident training and planning. To provide a better knowledge base for future research, data collection from major incidents and major incident exercises should be done systematically. The template developed in the Delphi study would enable other clinicians and researchers to submit structured open access reports, to share lessons learnt, collate data and compare major incident responses. The lack of a universally accepted definition of major incidents and removal of barriers in recruiting reports to the template remain important areas for future research. To enhance the knowledge on HEMS in major incidents, it remains pivotal that the pre-hospital environment acknowledges and address these challenges.

STUDY OBJECTIVES: To describe the incidence and epidemiology of major incidents occurring in Britain over the past 28 years. METHODS: Major incidents were identified through a MEDLINE search, a hand...

A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.

Background/Aims There is a lack of literature on the experiences of those in tactical command during major or critical incidents in the NHS. This study explored sudden-onset incidents in NHS hospitals, seeking to understand the lived experience of individuals in tactical command roles during these incidents, the concerns that they had and how they addressed them. Methods A total of 13 staff members participated in semi-structured interviews as part of research into 10 sudden-onset critical or major incidents that took place across seven NHS hospitals. All participants had held tactical command roles during the incident. Data were transcribed and analysed using constructivist grounded theory methodology. Results Participants described a series of challenges and requirements in tactical command roles. They faced high levels of uncertainty and were expected to take on leadership roles with substantially raised levels of personal accountability, while operating with teams made up of internal and external staff. Eight key themes were identified: navigating an unfamiliar landscape; lack of preparedness; absorbing accountability; effecting cultural change; seeking reassurance; constructing a single version of the ‘truth’ challenging previous assumptions; and responsibility for the organisation. Conclusions Safety was one of the key factors directing the responses of those in tactical command during sudden-onset incidents in NHS hospitals. Individuals in these roles felt responsible for balancing the responses at operational level with the wider impact across the hospital and broader health economy. Implications for practice Training and preparedness among individuals who may assume tactical command roles during incidents should be reviewed and needs to cover more than the major incident structure and procedures within a hospital. Training and response protocols should be aligned more closely to the actual behaviours of commanders.

Hospital response to a major incident: initial considerations and longer term effects

Planning for major burns incidents in the UK using an accelerated Delphi technique

Network area-wide impacts due to major traffic incidents can be assessed using a microsimulation approach. A VISSIM microsimulation model for a motorway network has been developed and is used to quantify impacts of a major incident in terms of associated costs. The modelled results reveal that a 65% capacity reduction results in 36% more incident-induced delay when compared with the application of a 50% capacity reduction assumption for a two-hour incident clearance duration that blocked one lane of a two-lane motorway. Additionally, an incident which caused a full blockage incurred 40 times more associated impact costs when compared with a major incident which caused a one lane blockage. A 23% cost saving can be achieved by clearing one lane of a fully blocked two-hour major traffic incident after 90 minutes, while a 37% cost saving can be achieved by clearing all blockages after 90 minutes.

Background: In 1996, Carley and Mackway-Jones examined British hospital’s readiness for a major incident. In the light of recent terrorist events in London, our group has re-visited the issue and...

The decision to declare a major incident (MI) is not one to be taken lightly, but a delay in doing so may have dire consequences. The aim of this study was to ascertain what factors make specialists from a variety of professional backgrounds in the United Kingdom determine from an initial visual assessment of a scene that a MI should be declared. Participants were presented with three different scenarios, which were presented pictorially. Their responses were noted. One hundred seventy-eight professionals took part in this study. For Scenario 1 (a road traffic incident), 101 (57%) declared a MI. For a coach rollover in Scenario 2, a MI was declared by 82 (46%) people, and a MI was declared by 156 (87%) for a rail crash in Scenario 3. Forty-six participants had attended a MI previously. The results for declaring a MI in this group were: (1) Scenario 1, 25 (54%); (2) Scenario 2, 25 (54%); and (3) Scenario 3, 44 (96%). Of this group, 44 had previously had training before experiencing the MI. Those who had > or = 10 years of service in emergency services were more likely to declare a MI in Scenario 2 and 3. The main problem with the existing system is the interpretation and subjective nature of the word "major". Specialists incorporate many individual factors into using the word. Future research should focus on the development of a system tied to more objective analysis.