Major Incident Planning and Support (MIP+S) Level 4
Course Content
- Course Introduction
- Personal Roles
- Ambulance Control
- Arriving on the Scene
- Triage Basics
- What is Triage
- The goal of triage
- Discriminators
- How do we triage correctly
- Initial impression
- ABCDE and triage
- Active listening
- Analgesia in triage
- Assessing pain
- Documentation and triage
- Establishing patient presentations
- Establishing patient history
- Existing medications
- NEWS2 and triage
- Triage categories
- Professional considerations
- Ten Second Triage
- Triage and MIPS
- Problems, Survivors and Casualties
- Radio Communications
- Types of radio
- Using radios
- Right and wrong way to use a radio
- Radio protocols and sending a message
- Phonetic alphabet and numbers
- Prowords in radio communications
- Call signs
- Radio Checks
- Radio check example
- Losing communications
- Broadcasting and talk groups
- Hytera PDC 550 – 4G/VHF/UHF combined
- Workplace radios
- Radio Licences
- Dual Sim Radio
- Increasing battery life
- Carrying and transporting radios
- Basic considerations when using radios
- Transmitting Techniques
- 3G and 4G radios
- METHANE Reports
- MIPS Lessons
- Course Content and introduction
- Preparation
- Command and Control
- The Developing Incident
- Treatment
- Health and Emergency Services
- Management of the Dead
- Safety
- Assessment
- Triage
- Communications
- METHANE
- Transport - part one
- Transport - part two
- CBRN Specialist Responses - part one
- CBRN Specialist Responses - part two
- Post Event Procedures
- Types of EMS
- Terminology
- Incident at a Quarry
- MIPS Location Introduction at the quarry
- Access and Egress
- Accessing Casualties
- Dealing with the media
- Dealing with the public
- Do all major incidents involve multiple casualties
- Getting further advice
- IIMARCH briefing
- Locally available assets
- Remaining calm
- Site planning
- Tabards
- Updating METHANE
- What is defined as a major incident
- Working with other services and organisations
- Effective communications
- The role of the HSE
- The importance of planning
- Aide memoirs
- Leaving the scene
- Tabletop Exercises - Quarry
- MIPS site planning table top exercise
- Table top exercise - Arrival Part 1
- Table top exercise - Arrival Part 2
- Table top exercise - Arrival Part 3
- Table top exercise - Triage and transportation
- Table top exercise - Liaising with other services - Part 1
- Table top exercise - Liaising with other services - Part 2
- Petrochemical Plant
- Tabletop Exercises - Petrochemical Plant
- Course Summary
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Communications
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Okay. So, good day ladies and gentlemen. We're going to talk about communications in this section. What we're going to look at, the objectives here are to understand the importance of good communications at the scene and beyond the scene to describe the different communication methods that can be used because there are multiple ways of communicating particularly nowadays. And whilst we're not going to teach you the principles of uh voice procedure, we are going to emphasize why voice procedure is important particularly in environments like major incidents. And I stress that one a bit because to be fair, modern communications methods even for ambulance service, police service are being treated um more and more each day like a mobile telephone rather than a proper radio. So actually even professionals voice procedure um is getting skill fade um because they're not using it on a regular basis. Why do we need to communicate? Well the problem is that uh failure in communication can lead to loss of life. Uh an example of this would be in 911 where the police failed to tell the fire service or even liaz with the fire service uh and establish their command post uh three blocks away. Um, and as you are aware, that led to the consequence of a loss of a large part of the New York Fire Department. As we've mentioned before, what we're trying to achieve with communication is this cross of communication between all the interested parties, not only the police, fire, ambulance, health, local authority, but as we've mentioned before, the um person with the problem. Yeah. very much part of that communication network. And if you're going to communicate across different agencies and organizations, you actually do need to work at your commun um your own communication because the problem is that we all have our own language. Whilst I sit here and I stand here and I talk to you in what is supposedly English, uh even in this I will be using my own professional language without even realizing it. So I speak a blend of ambulance lees and health lees. Police quite clearly speak police lees and fire speak fire lees. And the problem is that professional languages are designed absolutely purposefully to keep outsiders out. Uh that is the purpose of a professional language. Yeah. So when you're trying to cross agencies and organizations, you need to try and drop the professional language and speak as much as possible in plain English. You also have to be robust enough as a commander. is where something is said that you don't understand, you need to go, "Sorry, mate. Just clarify what that means for me." Yeah. Because you don't want to go away thinking, "I didn't really understand that." Yeah. Or have the wrong end of the stick about what the other person was saying because you misinterpreted an acronym and didn't question them on it at that particular point in time. um check and verify, clarify all the way through when you're communicating with other agencies. So in general terms, there are three causes for poor communications. The first of these is lack of information. That is a common thing uh at a scene of an incident because you often arrive and know little about what's going on and sometimes the information you have is in fact not even correct or right. Um so do not be surprised whether what you thought you were dealing with changes in something completely different. As an example of this um at the 77 bombings in London um for the first 45 minutes uh it was thought that the cause of the incident was um exploding electrical substations therefore a power surge problem on the underground whereas in fact it actually turned out to be a terrorist attack with bombs. Yeah. So even the type of incident can sometimes be confused. Um now information is important because for a commander information leads to something else. It leads to something called situational awareness which is uh understanding of what is going on, what the problems are and how you're going to solve it. Sometimes if you're missing just one small piece of information, your perception or concept of what is going on can be completely 180 degrees out. Um there's an old story about a United States um warship on exercise in uh NATO war uh waters in Europe. And um the captain is making his way towards the bridge and he's making his way towards the bridge. Uh he can hear one of his radio operators going um uh you will move 15° to the north to avoid a collision over. And to which the response comes back uh we're not moving anything, mate. And the captain strides into the radio room. He picks up the microphone off the radio operator and says, "Son, this is the captain of the USS Montana. He says, "You will move 15° apart or I will take actions to prevent um damage to this ship." And the voice comes back and says, "This is a lighthouse m it's your choice." Yeah. So his perception about what he was dealing with, which he assumed was another vessel failing Yeah. to understand um all the rules of the sea etc. was completely flawed and therefore he became in the terminology I quite often use and we find ourselves doing this as commanders the commander trying to move the lighthouse. Yeah. Because you haven't got the right information. Yeah. You haven't checked and verified it. So clarity Yeah. on information. It is also worthwhile checking the reliability of the source of information when it comes into you um because quite often um it is entirely flawed and I have seen on occasions this caused some really big problems. Um about uh 18 months ago, I was um on call and uh a job came in that said that there was a uh what looked like a body or an injured person at the top of a crane in a cabin in the middle of uh Birmingham. Now, it was a weekend and the building site wasn't actually running and we were also thinking to ourselves, you know, you got to have really good eyesight to see right up into the gantry of the cabin on the crane to know that there's somebody out there and it's failing light. Yeah. Um, you know, I doubt that this is actually true. and they said, "No, no, the we're we're we're assured that the the witness is absolutely rival. The the witness is an offduty police officer." So, we get there and we um get to the bottom of the crane and the first thing that strikes me is that the hatches are all locked and padlocked. So, somebody is up there. Somebody's come down afterwards and padlocked all the hatches all the way down to the bottom. So, rescue operation undertakes. We cut all the padlocks. We have to get paramedics up there with kit bags hanging behind them because they can't wear them because the gantry up the crane is too narrow to climb. We get out to the top and the thing that has been reported as a body or people being injured is in fact the escape shootute. Yeah. Which is full of uh bottles of used urine that the crane operator had clearly decided he couldn't bother to go all the way down to the bottom of the toilet when he needed a pee, etc. a 3 and 1/2 hour operation. Yeah. Because the information we were given was flawed and was not checked and verified. Uh so the second of these is lack of confirmation. And in order to confirm information, you really need to work at it. First of all, there's a lot of similar sounding words and phrases out there. There's different ways of spelling things that actually appear to be the same. Um, and some of the things I can think of, particularly when you're working with radio, um, I remember once thinking, my god, I've got a chemical job on because the voice that came across the radio saying, I have dirty casualties. I say again, I have dirty casualties. And I thought, oh, Christ, right, get the decontamination units out, etc., etc. What the individual was trying to say badly was I have 30 figures 30 casualties. So checking and verifying the information confirming the source is uh an exceptionally important part of that process. also whether people don't do it intentionally but people try and be helpful at situations like this and often they tell you their assumptions about what's going on which is sometimes not based on any fact whatsoever. So when people tell you stuff you need to actually dig into it and go right so how do you know that what's the detail behind that to find out the veracity of the information that they are telling you so confirmation confirmation confirmation um uh I used to have a boss boss that used to use a phrase all the time going have you checked and verified that mate yeah in terms of the information coming in when we were dealing with jobs and it taught me a lot of in the terms of this is something you need to do on a really regular basis and play exceptionally close scrutiny to it if you aren't going to make a fool of yourself as a commander sometimes. Lastly, and this is more difficult to um put your hand on, it's lack of coordination and that often happens particularly where you're working with different parts of the organization and when you're dealing with different agencies. Um, and I can best describe lack of coordination of as the stuff that falls through the cracks in the floorboards if you're not paying attention to the detail. So, as a commander, I can probably say quite nicely, right? I think we're going to need a logistic dump. Fantastic, sir. Great decision. Right, where's it going to be? Who's going to run it? What equipment's going to be there? How's it going to be issued? How's it going to be returned? All those details will need to be worked out if it's to be coordinated and function effectively rather than just make the arbitrary decision. In order to overcome this, this is why we have structured methods of communication because it reminds the individuals, it reminds the commanders of the things that they need to do. And we have different methodologies of communication. Probably the best is face to face. And the reason for that is that um up to 90% of human face-to-face communication is not actually verbal. It's non-verbal. It's in the body language. It's in the inflection that's used. It is also a two-way communication um that happens naturally even when the other people aren't speaking. So here I am talking to you today. Um but actually two-way communication is going on here because I can actually see understanding or um non-understanding or questions on your faces by the way that you express yourselves to me in your body language. And that allows me as an instructor to test and adjust my delivery. So I can change that blank look that I might be getting into some u a look of understanding and clarity. Uh the big things that we use nowadays are radios. People need to know and understand their radios um and how to maintain them and some other very simple things like changing batteries and how to change channels. I was absolutely horrified to uh uh join the ambulance service um in 2009 and found that a large number of the personnel didn't know how to change the radio on their own channel change the channel on their own radio cuz they constantly worked on one channel they never changed yeah they never had to do it etc etc and you and that included officers who had no idea how to change a channel on their radio which is an appalling situation to be in don't forget there are more simplistic things uh to do such as telephones or mobile telephones. Uh when all else fails, then you can have uh runners um which are people that will take messages from one person to another. But I would always suggest if you're using runners that you have the message written down and you get a written response. Do not allow um the runner to interpret your message verbally or interpret the response verbally because again um you will probably get some lack of clarity on the information uh being exchanged. So radio communications there's uh several requirements here. So, first of all, in modern radio communications, you've got on-site communications. That's radio communications that happen at the scene of the instant. But actually, we also need to pass information back to controls or to other vehicles that may be in transit in some cases. Um, you specialist vehicles or even air operations. Yeah. when helicopters are coming in and any uh deployed command posts or headquarters. Now in this country all the emergency services use a system called airwave which actually to be fair is just like a smart electronic telephone. Yeah. That uses a different set of masts uh from the one that your normal phone does. But the problem with that is is that as we're all using the same radio system which uses the same mass that when we all come together in a large mass all those radios put a strain on the local mass and can cause a communications overload so that we end up not being able to communicate. So some systems have embedded in them uh modes of transmission and what that means in simple terms is they do two things. They either work in what's called trunk mode operation which basically means that you press the switch on your radio. The radio sends a signal to the mast and from the mast it's retransmitted back down to another radio that will be receiving the signal. Trunk mode operation. It goes via a mast. Uh with a flick of a switch, you can switch the radio to DMO, direct mode operation, which now means that you press the button on the radio and the communication goes directly from me, yeah, to the radio that nearest me or any others we arrange without actually going through the mast. A simple walkietyalky type effect. Now each have um pros and cons. Trunk mode operation using masts means that potentially uh you can have um good off-site communication over many many miles across the whole length and breadth of the country or even internationally in some cases. Whereas uh direct mode operation means that you're probably limited to a line of sight um communications or certainly no more than about you know half a mile to a mile which is usually adequate in most cases for the scene of an incident. So if you are working with communications, you need a communications officer who's going to sort of sort out that perhaps on-site communication will be done by direct mode operation, but off-site communication will be done by trunk mode operation. Advantage of that is you can still communicate on site and you're saving the masks. Yeah. For the communication that needs to go offsite. Um these are the type of things that need to be thought of early. Nowadays also with radio communications uh emergency services have what that's called interoperability channels which basically means on the same radio I can speak to police or fire commanders or control rooms directly because we have a linked interoperability channel that we can do uh speak. This is actually often very useful uh when you're trying to clarify uh information on your way to the scene because you can talk directly to another commander from another service who is already on scene and get information uh before you arrive and that helps and aids your decision-m process. So prerequisites for radio communication knowledge of the radio. Yeah, know the working parts. know which button to press called the press to talk PTT switch. Yeah. How to change the channel. Um how to change the battery and check that the um what the battery level is. Um know your call sign. Yeah. And the call signs that you're going to need to talk to. Quite often I dispense with call signs at the scene of a major instance. And the rationale behind that is that to be perfectly honest because jobs at a scene change. Yeah. Or the person doing the job at the scene changes. If you are not keeping a breast of the changes, you will lose the call sign of that individual. So, shall we say that as an example, the loading officer this morning was Whiskey Echo 21, but this afternoon it's um Bravo Delta 52. If I've not realized that the person's changed, I would actually be calling up the wrong call sign. So, I have a tendency to dispense with call signs and use appointment titles. In other words, I ask for exactly what I want. Hello, loading. This is silver. Therefore, it doesn't matter who's on the other end. If they're carrying out the role of the loading officer, they're going to be answering you. Yeah. Because we're talking about appointment title rather than call sign. There are different types of frequencies. You probably don't need to get too involved in that, but the higher the frequency, the further the radio signal will go. Most radios nowadays are digitized. Although uh fire service still use um ground um ultra high frequency um radios on scene quite often. Their officers will use uh airway or tetra. Um, the main point for you here would be to make sure that you know and understand which radio systems are in use and how those radios work should you have to go to scene and utilize them. There are nowadays apps which aid communications very useful on your smartphones or your iPads and um some of the interoperability principles that we're talking about now um uh are embedded in those um apps. So one of the most common ones used in United Kingdom is something called the Jessip app which has not only the principles of interoperability on it. It has the be ability to uh formulate a methane message and send it to contacts in your directory. Uh so that's twofold. It allows you to formulate that methane in a written format and have a record of the time and date it was sent yeah to people in your contact. So it almost also acts as a logging app in a certain format as well. And that's important because you are required to log as a commander but you will find that you are highly compressed in time. Yeah. And your logs are likely to be quite shorthand. Yeah. If you don't utilize things like radio Yeah. or applications to aid your logging. Um, when you're using radio um to do your logging, it's important when you talk back to control to not only tell them what you've done, but why you're doing it. You need to record your rationale for the decision making as well as your decision. Cell phones are used quite a lot uh nowadays. Um, they are not a good form of communication in uh the major incident environment. First of all, as we've talked about with the radios, there is limited cell capability. Lots of cell phones in one area can swamp the communications. Um, it used to be in the old days, press um would tie up the mobile telephone network because they could afford to. They just dial a line back to the headquarters, uh, leave the phone open so they didn't lose a line. um basically keep just talking back um to their paper or their TV station over that. Nowadays that doesn't happen so much because the press have uh different methods of communications. But what does happen is the social media and the videoing yeah and loading the uh video footage of the incident up to YouTube or Twitter or whatever the case may be uh takes up the bandwidth rapidly. Yeah. for as a method of communication for yourselves as an emergency service, as a responder. Communications on cell phones is not centrally coordinated. It um will often lead to lack of situational awareness uh by a commander if people are having a conversation on a cell phone uh that's not on a radio. Um so therefore, you'll be missing out on that conversation and slowly becoming more and more less situationally aware as a commander. And I will also emphasize nowadays particularly cell phones are not a secure method of communication. They're not encrypted and certainly um nefarious press people will um be able to listen into your cell phone conversations and that may prove a problem to you at inquiry or investigation afterwards. So be aware that cell phones have a lot of disadvantages. Don't dismiss old-fashioned landline communication. It is fading, but uh it does have certain advantages between particular points. So, if you were working in an urban environment and you were set up in a shopping mall where you set your command post up in WH Smiths, uh uh but the casualty clearing station is in Boots two levels down. Well, actually there's nothing wrong with talking to the casualties clearing station by picking up the telephone, dialing them um allowing the conversation to happen the other way. The other advantage of that is it does relieve some pressure to a certain degree on your casualty clearing station staff. Working with radios is irritating annoying when you are also working with patients. Um, people tend to be patient focused. Uh, and this thing's going off and crackling and you know, was that my call sign? Was that not my call sign? I I don't know who was that for was that for me, was that not for me? Um, whereas actually if the phone rings, guess what? It's for you. Yeah. So, it does relieve that stress. You say, "Leave your agents alone. We're going to contact you by landline only." So, that can be useful in some circumstances. uh runners we've already discussed. Um in terms of uh if all else fails um again for clarity ensure you write down your questions and you get a written response. Loud haler um is actually a very useful tool uh particularly for addressing crowds and actually can be utilized as a triage device. If you're injured you can walk come to me. you have just dealt with all the P3s and done it in one go with a large volume loud halo which is a nice easy way of pulling these people out the way and then you know what's left is P1's and P2 so you can get in there and carry on with the rest of the triage. Um in circumstances like um shopping malls they often have tano as a method of communication. Um, whistles. We tend not to use whistles as an ambulance service in this country because fire service do. Short and repeated blast on a whistle is usually an evacuation signal from fire service that something's gone wrong and you need to evacuate the area rapidly. Uh, working at night, chemical light sticks, particularly in terms of um identifying triage areas in red, yellow, and green um is a very useful tool. Um you can also get uh specialist light sticks in terms of um ultraviolet light or infrared light which um can be useful for uh lighting helicopter landing sites at night. We've talked a lot so far uh and mentioned methane and in a minute we're going to look at that in a lot more detail so you understand it. Uh it is a sitrep um to pass critical information not only up and down your own chain of command but actually across services and organizations. Other critical message structures will be either missed or at missed and we'll talk about what that does. That is more a summary of clinical information on individual casualties. Usually as a commander that's too lower level detail. You're interested in big numbers. You're not interested in individual patients but certainly subordinates um who are passing individual clinical innovation will use missed or at missed uh critical message structures.
Communications at Major Incidents
Aim: Enable safe, coordinated multi-agency response by sharing accurate information on scene and beyond. Poor communication can cost lives.
Why Communication Matters
- Builds situational awareness from fragmentary, evolving information.
- Prevents deadly assumptions and “moving the lighthouse” errors—check and verify sources.
- Supports cross-agency coordination (police, fire, ambulance, health, local authority, site management, etc.).
Common Causes of Failure
- Lack of information: early reports are often wrong; keep updating.
- Lack of confirmation: clarify sound-alike words, numbers, names; challenge assumptions.
- Lack of coordination: decisions without owners, locations, timings, or logistics plans fall through the cracks.
Methods of Communication
- Face to face: richest signal (body language/inflection), best for command huddles.
- Radio: know your kit (PTT, channels, battery, scan). Use voice procedure for clarity, accuracy, brevity.
- Landlines: useful between fixed points (e.g., Command ↔ CCS); reduce radio clutter.
- Runners: only with written messages and written replies.
- Crowd/area tools: loud-hailer (e.g., “If you can walk, come to me”), tannoy systems, whistles (note: fire service evacuation signal).
- Mobiles/apps: helpful but not primary in major incidents: bandwidth congestion, poor situational visibility for commanders, security issues. JESIP-type apps can help format/log SITREPs (e.g., METHANE).
Radio Networks & Interoperability
- On-scene vs off-scene: consider Direct Mode (radio-to-radio) on scene; Trunked/Mast mode for control/remote units to protect network capacity.
- Interoperability channels: allow commanders to speak cross-service for rapid clarification en route and on scene.
Good Practice on the Air
- Use plain English; avoid service-specific jargon. Ask for clarification if you don’t understand.
- Apply RSVP: steady rhythm, slow speed (dictation pace), normal volume (avoid over-modulation), clear pitch.
- Spell clearly with the phonetic alphabet (“I spell…”). Send numbers as figures digit-by-digit.
- Pre-warn long transmissions: “Long message, over”.
- Use standard terms: Over (response needed), Out (no response), Roger (received), Acknowledge (confirm receipt/understanding).
- Request repeats: “Say again all/before/after/between <keyword>”. Correct errors with “Wrong…”.
- Prefer appointment titles on scene (“Loading, this is Silver…”) to avoid call-sign churn.
Command Responsibilities
- Ensure critical safety information is shared sideways across agencies, not just up/down your own chain.
- Designate a Communications Officer early (nets, modes, channel plan, backups).
- Log decisions and rationale via control or approved apps; time-stamp messages.
- Train regularly—voice-procedure skill-fade is real with modern “phone-like” radios.
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