We have had several major incidents recently, and there are two main
issues; crowding of the emergency department with people milling about
and communication. These are difficult to reconcile.
The ED Consultant cannot keep an overview of the department to deploy
resources properly and triage all the incoming. I prefer to delegate the
triage to the SpR and run the trauma teams or medical teams to expedite
patient removal. The point about medical major emergencies is well made;
think of a norovirus or salmonella outbreak in a hotel, which we have had.
We actually dealt with it by deploying docs to the hotel, and only
admitted two or three. Remember; a major incident is (unless CBRN or
explo) actually only your normal day's work all arriving together. People
still have injuries, people are still upset.
The control room must be somewhere near physically, and have good comms
with the ED. Ours is in the labs, a floor above the ED. People can then
come down and liaise. Apart from that, and people treating patients,
there must be a rigid bar preventing access of anyone else, staff or
relatives, coming into the ED.
Your system sounds reasonable, with the proviso that there must be a
comms link to the ED, preferably runners and telephone.
> *From:* Brendan Conway <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Sat, 8 Dec 2007 08:55:45 +0000
>
> I've just been asked to look over the new Major Incident Plan for
> my hospital. We're a 400 bed DGH just outside Dartford and are the
> nearest hospital for Bluewater shopping centre (largest in Europe),
> the Dartford bridge and tunnel and the new crosschannel railway
> station at Ebbsfleet.
>
> The new plan deviates from the Hospital MIMMS manual in several
> respects:
> 1. the Senior Surgeon, senior orthopedic dr, on call anaesthetist
> report on arrival for briefing to the medical controller in control
> room rather than to the senior emergency physician in the emergency
> room. These senior doctors report to the medical controller rather
> than to anyone in the emergency dept.The medical controller is the
> consultant physician on call.
> 2. The chain of command within the emergency department is not
> clear. The senior surgeon/physician/medic do not report to the
> senior emergency physician but liaise with each other. The second
> consultant physician is repsonsible for coordinating medical
> response and contacts the Consultant Anaesthetist in A&E for a
> briefing.
>
> Although I have not been responsible for drawing up new major
> incident plans before, I am doubtful about the wisdom of this
> system. I would be grateful for comments.
>
> Brendan Conway
> Consultant in Emergency Medicine
> Darenth Valley Hospital
>
/Rowley./
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