Major Incident Response Research Articles

Planning a large‐scale tabletop exercise to test Qatar's healthcare system readiness to respond to a major incident during the 2022 FIFA World Cup

AbstractThis article is an illustration of ‘Lessons from the Field’. The Journal of Contingencies and Crisis Management has begun to present lessons coming from professionals engaged in crisis management. ‘Lessons for the Field’ provides insights that can be useful to other professionals. Moreover, ‘Lessons from the Field’ can stimulate ideas for researchers and provide resources for educators. Hosting a mega‐sporting event such as the International Federation of Football Associations (FIFA) World Cup presents many healthcare challenges, especially when organized over a small geographical area with many international supporters potentially increasing the country's normal population by 50%. This article presents how a system‐wide tabletop simulation exercise was planned to test Qatar's healthcare system's readiness to respond to a potential major incident during the FIFA World Cup. The healthcare system‐wide tabletop exercise lasted about 4 h with participants engaging in all the various facilities as expected. It provided opportunities for everyone to put their knowledge of major incident response and mass casualty management into practice. The exercise preparation ensured it ran smoothly for all participants who quickly understood how to engage in the activity. It enabled organizers and participants to identify potential gaps in systems and processes, but also in their own ability to manage such situation.

What components of emergency preparedness exercises improve healthcare practitioners’ emergency response learning?

Emergency planning exercises are commonly used to test the capability of healthcare systems to respond to major incidents. However, limited research has examined whether these exercises improve response learning for staff and, if so, what components are vital for achieving this learning. This study assesses the impact of an exercise methodology commonly used to promote emergency preparedness in UK healthcare staff, Emergo Train System (ETS), on healthcare practitioners' perceptions of learning regarding major incident response and identifies what components facilitate these perceptions of improved learning. A mixed method design was adopted, consisting of 83 pre- and post-exercise questionnaires and 10 semi-structured interviews collected from four ETS exercises. Paired Sample t-tests were conducted to identify changes in perceptions pre- and post-exercise, and stepwise multiple regression analysis was conducted to identify what exercise components facilitated perceptions of improved learning. Thematic analysis helped to understand further why healthcare practitioners felt these factors were important for improving learning. Findings showed that healthcare practitioners’ confidence and perceptions of personal and organisational preparedness, multi-agency response and teamwork significantly improved post ETS. They believed that emergency response learning was facilitated by level of effort invested in preparatory activities prior to the exercise, exercise realism and frequency. Healthcare professionals believe that ETS exercises have the potential to improve emergency preparedness across individual, team, agency and multi-agency levels, provided that scenarios are realistic, relevant agencies and roles are involved, responders are able and motivated to invest in preparing for exercises, and exercises are run regularly.

Understanding the psychological impacts of responding to a terrorist incident

ABSTRACT Background: Responding to a mass casualty event can cause significant distress, even for highly trained medical and emergency services personnel. Objective: The purpose of the study was to understand more about first responders’ perspectives about their participation in major incident responses, specifically how and which individual and system factors contributed to their preparedness or may have enabled or hindered their response. The aim of the work was to improve preparedness and response for future incidents. Methods: This study reports a detailed analysis of qualitative interview data from frontline staff who responded to a large mass casualty terrorist incident in the UK in 2017. Data highlighted the psychological distress caused by responding to terrorist events and thus became the focus of further, detailed analysis. Results: Participants (n = 21) articulated in their own words the psychological distress experienced by many of the first responders to the event. Participants reported that they were not prepared to deal with psychological impact associated with this mass casualty terrorist incident and their role in the response, and that follow-up support was inconsistent. Multiple factors were identified as potentially increasing psychological distress. Social support provided by peers and organizational debriefs were identified as two most common support mechanisms. Organizational support was identified as inconsistent. Conclusions: This research contributes to the literature the voices of first responders to UK terrorist incidents, building on existing findings while further contributing unique contextual perspectives. This research reinforces the importance of psychosocial support for those who respond to these tragic incidents, and offers a number of recommendations for organizational preparedness for future events. Abbreviations: A&E: Accident and Emergency; EPRR: Emergency Preparedness, Resilience and Response; ERD: Emergency Response Department; HEPE: Health Emergency Preparedness Exercise; PHE: Public Health England; PHE REGG: Public Health England Research Ethics and Governance Group; MCI: Mass Casualty Incident; NHS: National Health Service

Early clinical response to a high consequence infectious disease outbreak: insights from COVID-19.

Early clinical response to a high consequence infectious disease outbreak: insights from COVID-19.

Mass casualty incidents-are you ready? A major incident planning template for diagnostic radiology.

Mass casualty incidents (MCIs) create a large number of casualties in a short period of time. Diagnostic radiology plays an important role in major incident responses but is often underrepresented during major incident planning (MIP) and simulation. Surveys suggest radiologists are unfamiliar with their role during an MCI. We aimed to identify key topics for radiology MIP, familiarize radiologists with their role during an MCI and identify areas for future research. The terms "radiology" and "mass casualty incident" were entered into the advanced search builder on PubMed. Abstracts from this primary search were reviewed and papers selected for inclusion. Additional studies of interest were identified upon review of reference sections of relevant articles and from the related article tab on PubMed. MCI and trauma guidelines were reviewed. Key factors that caused issues during prior MCIs were identified including staff alert mechanisms, patient identification strategies, patient tracking, scan ordering and result communication. Limitations of local imaging resources and capacity should be identified and inform plans for the utilization of diagnostic radiology in the MCI setting. Simulation can help identify areas for improvement and familiarize staff with their roles. Further development of reliable MCI alert technology and patient identification strategies are needed as well as prospective validation of trauma CT selection criteria to identify patients who will benefit most from CT. Radiology should take part in MIP to address key issues encountered during prior MCIs and in MCI simulation to optimize major incident response.

Major incident response: how each tragedy informs future nursing care

Major incident response: how each tragedy informs future nursing care

Changes in NHS Major Incident management and their relevance to the Defence Medical Services

High-profile Major Incidents in the UK civilian setting in the last few years have appropriately raised awareness of the principles and frameworks involved in the design of reliable response systems....

EHAC medical working group best practice advice on the role of air rescue and pre hospital critical care at major incidents

BackgroundHelicopter EMS (HEMS) teams may perform a variety of clinical, managerial and transport functions during major incident management. Despite national and international variations in HEMS systems, the rapid delivery of HEMS personnel with advanced skills in major incident management and clinical scene leadership has been crucial to the delivery of an effective medical response at previous incidents. This document outlines the Best Practice Advice of the European HEMS and Air Ambulance Committee (EHAC) Medical Working Group on how HEMS and Pre Hospital Critical Care teams may maximise the positive impact of their resources in the event of Major Incidents.MethodsNarrative literature review and expert consensus.ResultsTo ensure a safe, coordinated and effective response, HEMS teams require suitable, proportionate and up to date major incident plans that are integrated into the major incident plans of other regional emergency and healthcare services. Role specific protocols, training and equipment should be adapted to the expected HEMS role in the major incident plan and likely regional threats. System and incident factors will influence HEMS utilisation during the major incident response and can include patient and staff transfer, equipment resupply, aerial assessment, search and rescue, clinical leadership and advanced care. During the recovery phase of a major incident there is a need to ensure restoration of conventional service and address the welfare of involved HEMS personnel. Standardised reporting of major incidents is strongly recommended for clinical governance, legal and research reasons.ConclusionsThe rapid delivery of HEMS personnel with advanced skills in Major Incident management and clinical scene leadership is crucial to the delivery of an effective medical response at Major Incidents.

Virtual training environments for major incident response planning in UK gas infrastructure

PurposeThis paper aims to evaluate a virtual training environment for testing UK gas pipeline emergency response plans.Design/methodology/approachInterviews, observations and desk research were used to identify current methods for testing plans. A virtual training environment was developed and evaluated with industry experts by using participatory design techniques. Key themes relating to both the current methods for testing plans and for a virtual training environment were identified using thematic analysis.FindingsImproved training performance, remote participation and evidence of decision testing are benefits a virtual training environment can bring to current practice. It is suggested that a virtual training environment can enhance, rather than replace, the current process of testing emergency response plans.Research limitations/implicationsAnalysis of the virtual training environment being used to test plans in a live context would give further ecological validity to the findings. A study of the prototype used to test plans for incidents involving sectors outside the gas industry would further validate the findings.Originality/valueThe application of a virtual training environment to facilitate testing plans and the decision-making processes for major incidents involving high-pressure gas pipelines and storage sites is yet to be documented. This paper contributes to the literature by documenting the decision-making process and evaluation of a virtual training environment for testing plans in this context.

Systematic reporting to improve the emergency medical response to major incidents: a pilot study

BackgroundMajor incidents affect us globally, and are occurring with increasing frequency. There is still no evidence-based standard regarding the best medical emergency response to major incidents. Currently, reports on major incidents are non-standardised and variable in quality. This pilot study examines the first systematic reports from a consensus-based, freely accessible database, aiming to identify how descriptive analysis of reports submitted to this database can be used to improve the major incident response.MethodsMajorincidentreporting.net is a website collecting reports on major incidents using a standardised template. Data from these reports were analysed to compare the emergency response to each incident.ResultsData from eight reports showed that effective triage by experienced individuals and the use of volunteers for transport were notable successes of the major incident response. Inadequate resources, lack of a common triage system, confusion over command and control and failure of communication were reported failures. The following trends were identified: Fires had the slowest times for several aspects of the response and the only three countries to have a single dialling number for all three emergency services had faster response times. Helicopter Emergency Medical services (HEMS) were used for transport and treatment in rural locations and for triage and treatment in urban locations. In two incidents, a major incident was declared before the arrival of the first Emergency Medical Services (EMS) personnel.ConclusionThis study shows that we can obtain relevant data from major incidents by using systematic reporting. Though the sample size from this pilot study is not large enough to draw any specific conclusions it illustrates the potential for future analyses. Identified lessons could be used to improve the emergency medical response to major incidents.

Developing the Fourth Evaluation Dimension: A Protocol for Evaluation of Video From the Patient's Perspective During Major Incident Exercises.

Presently used evaluation techniques rely on 3 traditional dimensions: reports from observers, registration system data, and observational cameras. Some of these techniques are observer-dependent and are not reproducible for a second review. This proof-of-concept study aimed to test the feasibility of extending evaluation to a fourth dimension, the patient's perspective. Footage was obtained during a large, full-scale hospital trauma drill. Two mock victims were equipped with point-of-view cameras filming from the patient's head. Based on the Major Incident Hospital's first experience during the drill, a protocol was developed for a prospective, standardized method to evaluate a hospital's major incident response from the patient's perspective. The protocol was then tested in a second drill for its feasibility. New insights were gained after review of the footage. The traditional observer missed some of the evaluation points, which were seen on the point-of-view cameras. The information gained from the patient's perspective proved to be implementable into the designed protocol. Use of point-of-view camera recordings from a mock patient's perspective is a valuable addition to traditional evaluation of trauma drills and trauma care. Protocols should be designed to optimize and objectify judgement of such footage. (Disaster Med Public Health Preparedness. 2017;11:594-599).

Hamad Medical Corporation (HMC) ambulance service major incident response guide

Background: Qatar Hamad Medical Corporation Ambulance Service (HMCAS) major incident response guide is intended to address techniques in field operations that must be utilized in the event of a major incident. This guide standardizes operations during major incidents, regardless of what caused the incident, number of patients, severity of the injuries or the complexity of the incident. Methods: This plan was tested and implemented across the ambulance service and Hamad International Airport (HIA) in collaboration with other agencies such as police, civil defense and HIA safety department through a full-day training program. Different training methods such as workshops, lectures and simulated exercises was conducted using different scenarios. Results: This system was implemented for five real major incidents during 2014–2015 in Qatar. The average time for all units to be on scene was 20 minutes. The total units needed by this system were 33 units, approximately according to the predetermined attendance sheet (PDA). These units include all on-scene structure of command according to the HMCAS major incident response guide. The average time to transport the victims from the scene to the hospitals was 10 minutes or less. Three communication channels were established during the whole process. Conclusion: The designed system is suitable for up to 100 patients in pre-hospital emergency care in case of a major incident. The system would need to be tested and evaluated regularly to ensure compliancy and understanding from all staff in HMCAS to ensure that they are ready at all times in the event of a major incident.

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

### Key points All NHS providers in the UK are required by law to prepare for large-scale emergencies and major incidents.1 A health-related major incident is described as any occurrence presenting a serious threat to the health of the community. It is likely to involve disruption of services and require the implementation of special arrangements by hospitals, ambulance, and primary care trusts.2 For hospitals, this manifests itself as the major incident plan which focuses on a specific trigger e.g. the London bombings in 2005 were external major incidents that immediately created more than 700 casualties.3 Communications from ambulance control generally activate hospitals’ major incident responses. Prehospital response subsequently directs casualties to local emergency departments, although more recently NHS trusts have activated internal major incidents because of overwhelming service pressures e.g. in January 2015, a demand for in-patient beds out stripped availability at Peterborough Hospital.4 By declaring a major incident, the trust was able to cancel non-urgent elective operations and emphasize the need for local primary care trusts, social services, etc. to expedite the discharge of medically fit patients requiring non-clinical support. With respect to (the more usual) external major incidents, the majority of hospitals have plans based on prehospital incidents that tend to deal with events in the emergency department and immediate care of severely ill or injured patients. This may only be for a 6–8 h period; however, there are the so-called consolidation and recovery phases of a major incident (Fig. 1) that can impact upon the NHS trust for …

Online optimization of casualty processing in major incident response: An experimental analysis

When designing an optimization model for use in mass casualty incident (MCI) response, the dynamic and uncertain nature of the problem environment poses a significant challenge. Many key problem parameters, such as the number of casualties to be processed, will typically change as the response operation progresses. Other parameters, such as the time required to complete key response tasks, must be estimated and are therefore prone to errors. In this work we extend a multi-objective combinatorial optimization model for MCI response to improve performance in dynamic and uncertain environments. The model is developed to allow for use in real time, with continuous communication between the optimization model and problem environment. A simulation of this problem environment is described, allowing for a series of computational experiments evaluating how model utility is influenced by a range of key dynamic or uncertain problem and model characteristics. It is demonstrated that the move to an online system mitigates against poor communication speed, while errors in the estimation of task duration parameters are shown to significantly reduce model utility.

Improving Agent-Based Simulation of Major Incident Response in the United Kingdom through Conceptual and Operational Validation

The aim of this paper is to report on how the credibility of an agent-based model (ABM) of the United Kingdom emergency services' response to major incidents has been improved through a process of conceptual validation, and how the ABM's software implementation has been improved through a process of operational validation. Validating the authors' ABM and its implementation contributes towards the long term goal of agent-based modelling and simulation being accepted by emergency planning officers as a means of performing emergency exercises thus playing a useful role in emergency preparedness. Both conceptual and operational validation led to the identification of potential improvements, which when implemented resulted in the authors' ABM software simulating the response to major incidents in the UK more realistically than was possible previously.

Digital horizons: technology enabled real-time management of major incident and risk responses

Exploration, development and production in the oil and gas industry pose major operational risks. The pressure on the industry to manage its assets safely and sustainably, minimising environmental and human impacts, has never been greater. Major incidents or disruptions, if managed poorly, can cause severe reputational damage and directly affect top line growth for years, if not decades. The emergence of the FLNG model for offshore production is likely to expose a new set of operational resilience challenges for the industry as it introduces new parameters into already complex upstream supply chains, often in remote, environmentally sensitive and/or dangerous locations. Operational resilience in this sector has traditionally relied heavily on scenario-based planning—identifying a set of possible eventualities, ranking them according to impact and likelihood and putting in place contingency plans for each. In a challenging financial environment where many projects are becoming marginal and struggling to secure the finance required to develop assets, the prohibitive levels of investment required has tended to mean that only the most critical production and operational systems and processes are designed for resilience. Despite this, the emergence of more flexible planning approaches and, in particular, more pervasive digital technologies that allow the operating assets at the periphery to communicate and share information in real time with central planning or resourcing functions, are beginning to change the way these challenges are thought about.

Virtual-world hospital simulation for real-world disaster response: Design and validation of a virtual reality simulator for mass casualty incident management.

Mass casualty incidents are unfortunately becoming more common. The coordination of mass casualty incident response is highly complex. Currently available options for training, however, are limited by either lack of realism or prohibitive expense and by a lack of assessment tools. Virtual worlds represent a potentially cost-effective, immersive, and easily accessible platform for training and assessment. The aim of this study was to assess feasibility of a novel virtual-worlds-based system for assessment and training in major incident response. Clinical areas were modeled within a virtual, online hospital. A major incident, incorporating virtual casualties, allowed multiple clinicians to simultaneously respond with appropriate in-world management and transfer plans within limits of the hospital's available resources. Errors, delays, and completed actions were recorded, as well as Trauma-NOnTECHnical Skills (T-NOTECHS) score. Performance was compared between novice and expert clinician groups. Twenty-one subjects participated in three simulations: pilot (n = 7), novice (n = 8), and expert groups (n = 6). The novices committed more critical events than the experts, 11 versus 3, p = 0.006; took longer to treat patients, 560 (299) seconds versus 339 (321) seconds, p = 0.026; and achieved poorer T-NOTECHS scores, 14 (2) versus 21.5 (3.7), p = 0.003, and technical skill, 2.29 (0.34) versus 3.96 (0.69), p = 0.001. One hundred percent of the subjects thought that the simulation was realistic and superior to existing training options. A virtual-worlds-based model for the training and assessment of major incident response has been designed and validated. The advantages of customizability, reproducibility, and recordability combined with the low cost of implementation suggest that this potentially represents a powerful adjunct to existing training methods and may be applicable to further areas of surgery as well.

Evaluation of centralised and autonomous routing strategies in major incident response

Fast and efficient routing of emergency responders during the response to mass casualty incidents is a critical element of success. However, the predictability of the associated travel times can also have a significant effect on performance during the response operation. This is particularly the case when a decision support model is employed to assist in the allocation of resources and scheduling of operations, as such models typically rely on an ability to make accurate forecasts when evaluating candidate solutions. In this paper we explore how both routing efficiency and uncertainty in travel time prediction are affected by the routing strategy employed. A simulation study is presented, with results indicating that a routing strategy which allows responders to select routes autonomously, as opposed to being instructed via a central decision support program, leads to improvement in overall performance despite the associated increase in uncertainty in travel time prediction.

Implementation of a medical command and control team in Switzerland

In case of a major incident or disaster, the advance medical rescue command needs to manage several essential tasks simultaneously. These include the rapid deployment of ambulance, police, fire and evacuation services, and their coordinated activity, as well as triage and emergency medical care on site. The structure of such a medical rescue command is crucial for the successful outcome of medical evacuation at major incidents. However, little data has been published on the nature and structure of the command itself. This study presents a flexible approach to command structure, with two command heads: one emergency physician and one experienced paramedic. This approach is especially suitable for Switzerland, whose federal system allows for different structures in each canton. This article examines the development of these structures and their efficiency, adaptability and limitations with respect to major incident response in the French-speaking part of the country.

Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters

The need for and benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years. One of the advantages with such models is that all components of the chain of response can be trained simultaneously. This includes the important communication/coordination between different units, which has been reported as the most common cause of failure. Very few of the presently available simulation models have been suitable for the simultaneous training of decision-making on all levels of the response. In this study, a new simulation model, originally developed for the scientific evaluation of methodology, was adapted to and developed for the postgraduate courses in Medical Response to Major Incidents (MRMI) organized under the auspices of the European Society for Trauma and Emergency Surgery (ESTES). The aim of the present study was to describe this development process, the model it resulted in, and the evaluation of this model. The simulation model was based on casualty cards giving all information normally available for the triage and primary management of traumatized patients. The condition of the patients could be changed by the instructor according to the time passed since the time of injury and treatments performed. Priority of the casualties as well as given treatments could be indicated on the cards by movable markers, which also gave the time required for every treatment. The exercises were run with real consumption of time and resources for all measures performed. The magnetized cards were moved by the trainees through the scene, through the transport lines, and through the hospitals where all functions were trained. For every patient was given the definitive diagnosis and the times within certain treatments had to be done to avoid preventable mortality and complications, which could be related to trauma-scores. The methodology was tested in nine MRMI courses with a total of 470 participants. Based on continuous evaluations and accumulated experience, the setup of the simulation was step-wise adjusted to the present model, including also collaborating agencies such as fire and rescue services as well as the police, both on-scene and on superior command levels. The accuracy of the simulation cards for this purpose was evaluated as "very good" by 63% of the trainees and as "good" by 33%, the highest two of the six given alternatives. The participants' ranking of the extent that the course increased their competencies related to the given objectives on a 1-5 scale for prehospital staff had an average value of 4.25±0.77 and that for hospital staff had an average value of 4.25±0.72. The accuracy of the course for the training of major incident response on a 1-5 scale by prehospital staff was evaluated as 4.35±0.73 and that by hospital staff as 4.30±0.74. The simulation system tested in this study could, with adjustments based on accumulated experience and evaluations, be developed into a tool for the training of major incident response meeting the specific demands on such training based on recent experiences from major incidents and disasters. Experienced trainees in several courses evaluated the methodology to be accurate for this training, markedly increasing their perceived knowledge and skills in fields of importance for a successful outcome of the response to a major incident.