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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The Developing Incident
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We need to be able to get a grip of this very quickly. And in my experience, you don't have long. You got about six or eight minutes to grip a scene. After which, yeah, if you haven't done it by then, it's probably got away from you. And the problem with is that is is it's very much time dependent because the scene has started. People have started to help. Yeah. render aid as you would expect them to do so. But they're not really doing stuff that is an effective manner. Yeah. In order to do the most for the most. And because of the way we work as a commander, I don't not there at the beginning of the incident. I will turn up later on. And so therefore, the longer it takes to grip it, the worse it's going to become. And in my experience is like a 50/50 rule. If it takes 15 minutes to grip the scene. Yeah. Or if it's been running for 15 minutes in utter chaos and then you start to grip it, it will take 15 minutes to put it back. If it's already been running 30 minutes, it's going to take you 30 minutes to bring it to the point that you want. Yeah. If it's an hour, Yeah. that's 2 hours. Yeah. So, you can see that if we don't grip it quickly and we don't grip it early, it's going to get away from us. This means that although you as a commander may have a very clear and distinct idea about what you want and what you achieve because you're not there on the scene, you have to train your first crews to carry out a set of actions in order to do that. They need to understand and recognize that a guess what this is not the day job. I've got a problem child here. They need to realize that they are the acting ambulance commander until relieved. They need to understand safety of theirel of the scene of the survivors. And if you're dealing with a chemical or hazmat type incident, they need to understand what's called a steps one, two, three process. And we'll look at that in more detail when we look at CBR and hazmat later on in the course. You turn the corner, you look through the windscreen, your first thoughts is probably, "Oh dear. This is not the day job. This is going to be a problem child. That's important to recognize that easy because the next thing that that operator needs to do is pick up the radio and send a methane message. It may be incomplete and it may be missing. They haven't even got out of the truck or the car yet, but this is a problem that's going to need specialist response. And the quicker the cavalry is alerted and on route Yeah. the quicker it can dig them out of the poo they've just found themselves in. Yeah. So recognizing it, getting a methane out, even if it's incomplete, is an important part. The next thing is to do an assessment of the scene. It's very important for them to understand or for you to understand as a commander the purpose of the assessment of the scene, which is very simple. It's to confirm or pat out or give additional methane uh information to that first methane that was sent. After that, it's to choose a site for a casualty clearing point, choose the parking locations, and plan an ambulance circuit. And you haven't got long to do that in six to eight minutes tops. And we'll talk later on about how to speed that process up and get um to the nitty-gritty of that. If you are a twoman crew, only one of them gets out, the senior person, and goes and does the wrecky and does that assessment. Number two stays and remains in the vehicle. leaves on the blue lights or whatever other markers they may have. Uh if it's tactically sound to do so because the chances are that is when you're away, other members of your organization, other ambulances will be arriving. They need to know where to go. And the rule here is if you're first on scene and you're in command, you leave your blue lights on. Anybody else arriving behind you turns their blue lights off, which means someone like me as a commander that turns up later just needs to look down the line and go there, that one. Yeah. I go straight to it. Get the hand over takeover. Yeah. And take control of the situation. So, you can see that a lot of that is outside of your personal Yeah. ability to do it when you're already driving to the scene. So it has to be embedded as part of a protocol and process by your control room to uh enforce that process uh with your first responding crews. As a forward commander, you've got to communicate both um vertically and horizontally in order to have an effective response. And actually that first vehicle on scene process is the same for each service. The first police vehicle is going to be the forward command post until relieved by a more senior officer arriving. Fire services tend not to arrive in single units. They tend to come with a minimum number of pumps based upon the call um called a predetermined attendance, a PDA. Um and the other good thing about fire service is that in general they always come with an embedded commander. You know, that's not always the case with um police and ambulance services. As the scene becomes more compensated with more resources uh arriving, you can choose to divide your bronze area down and we call this sectorization and we name or number the sectors. Uh usually um we do sectors um A, B, C and so on. Um, it is also important that if you as an organization are going to sectorize, you talk to the other agency organizations who may also be sectorizing because you want to make sure you're sectorizing the same way. Number of times I've turned up an incident and go, "Right, we've got three sectors. Fantastic." Yeah. Brilliant. And then we got A B C from ambulance service and A B C from fire service. So only one of those sectors is actually corresponding. Yeah. So when we're talking there is confusion. So make sure if you're naming or numbering sectors that actually you've done it in conjunction with other agencies or organizations. Otherwise it will lead to confusion. If it's a large incident, um, Silver Commanders may well come with, um, command vehicles, which are specially made to task. Yeah. They're usually quite large, 7 and a half tonish type vehicles. Yeah. With conferencing facilios, um, facilities inside. Yeah. Video CCT surveillance. Yeah. Thermal camera cameras, all sorts of things on them. Marvelous. Um what's not so easily done is the problem is that each service also comes with its own command vehicle with all the commanders stepping into their individual vehicles. Um something to think about uh which we tried in my service is I built my new command vehicle when it came up for renewal as a multi- agency vehicle. I purposely made it larger than I needed it in order that I could incorporate other agencies and organizations in it that it had Wi-Fi that they could log on to and bring up their stuff. Yeah. Inside my computer, inside my control room so that actually we could all work together in one vehicle rather than have to keep running between vehicles to communicate. Much easing of the process has worked exceptionally well on the instance that we've used it. Uh the most important thing about the command vehicle is you need to install good tea and coffee facilities because you'll naturally get the migration of other services to you if you've got do good tea and coffee facilities. As a commander or a subordinate commander, you should not become directly involved in casualty treatment. If you do, your field of focus will narrow. Yeah, you'll lose sight of the bigger bigger picture. And when I say subordant commander, I mean those that have got functional roles. You are the parking, you are the loading, you are the triage or whatever officer role that you are carrying out. Uh expect that if you're working at a strategic level um and you are in a multi- agency gold room that you will have highlevel VIP visitors quite rapidly. Particularly nowadays, stuff goes up. Yeah. The governmental information line very very quickly and before you've even sorted yourself out, you'll have somebody from um government or DCLG Red. Yeah. Um phoning you up and saying the prime minister would like to visit. You know, the last thing you want right now, but guess what folks, you're going to have to deal with it. So, have a process for doing it well and effectively. What I will say about senior VIP, whether you are a silver commander at scene and your chief turns up or whether you're a gold commander in a strategic cell and a minister or a prime minister turns up is give them something to do. In other words, ask for three things that you can't do immediately, but they can press the buttons and release for you. Yeah. It does two things. cuz it makes them think feel good and proud that you know because they made the right decision to come here and it gets them out of your hair. Yeah. To go away and do that and implement it for you which frees you up to concentrate on the task in hand. So we're going to look here at what should scene layout be? How do we optimize the scene to effectively manage it? So first of all we have the instant and we already know that surrounding that we have the inner or bronze cordon as close as we can get it to the inner cordon without breaching it we need to establish our casualty clearing point. Now the reason for it being as close as we can get it is that the movement of casualties from the point of wounding in the scene to the casualty clearing point is often a lift and carry process. Stretchers won't run through broken rubble and wreckage and debris. Yeah. The wheels, you know, will get jammed. People will fall off stretches, etc. So often it is a pick and carry mode. Yeah. To be able to move them. That's a physical human resource which if you make the distance longer than it needs be will tire them out quickly. And also from a patient point of view, the closer it is, the quicker it is to a point of treatment to effectively manage them and do your interventions. We already said that there will be uh an outicorn and the outer corn will both have an entrance and exit as part of the process and us that entrance and exit is controlled by police. Uh they may do this in different ways. So whilst we said that we should expect to see a blue and white uh cord and tape with a PC or police conible sat on it. Yeah. Actually quite often you'll find it's a large police van that reverses up over the pavement uh to let people in and out but it's still effectively called and it's still an entry control point. It's still a place where people are booked in and out once as a service. Yeah. As an ambulance service respond to this. You go through that out cord and you'll be directed to the parking point. So I suppose the first question here is what is a parking point? What does it look like? How does it function? And a lot of that will depend upon the size of the scene and the geography of the ground as to how it will look in its simplest form. The parking point is one vehicle one behind the other all up on the left hand side of the road. Verjo curb. Yeah. Waiting to be called forward. If you got more smoes to play with, you can be a little more adventurous. You could have um them in different lines, front line A&E vehicles, stretch of PTS vehicles, specialist response vehicles. That just means you don't have to walk as the parking officer all the way down a long line to find what you want and call it forward. You can just call the next one off the front of the road. So, if you've got an empty supermarket, car park, or the motorway is closed and you can use two or three lanes out of that motorway, depending on how many lanes there are, there are options for you to consider. It needs to be effectively controlled by a parking officer. And the parking officer is very much an enforcement of the way that we're treating this to the crews that arriving. They'll all be arriving all really really adrenaline pumped thinking they're going to see loads of patients straight away etc etc etc. It's actually quite a unusual experience to be sent to a major incident as a crew. You don't get to see it that often etc. So they don't know what to expect. There are processes that need to be done simple things and it will vary from different agencies and organizations but as example for me my crews it's stay in the vehicle when you are told to leave the vehicle and go and do something leave the keys in the vehicle. There is some risk attached to that, but in the scheme of things, the risk is minimal when we're responding to a scene because if they're away or they go away on another vehicle or etc. and they've got the keys in their pocket, that vehicle can now not be utilized, not be moved, etc., etc. So, yeah, I tend to go for a leave the keys in the vehicle. Do not, whatever you try, and I've seen it done and it's very amusing to watch, have them take the keys to the vehicle to the parking officer. cuz no matter how much he thinks he's got it under control and maybe even got a nice little pegboard to hand them on, you'll end up with just bunches and bunches of keys and not being able to control. So, it's far simpler. Leave them in a vehicle. Yeah. uh if you have drug safes, yeah, then actually we apply the same rule in a major in again there is some risk attached to that but on the terms of risk versus benefit for dealing with an incident, it's far better that way than then running around trying to look for drug keys and stuff like that. Uh that process is also written into our major instant plan signed off by the board so that there is no ambiguity about the fact that that is actually a trust policy. Yeah. And not something that was made up at the day of the race. In other words, it's been risk assessed. It's been signed off. So, what's going to happen to those vehicles arriving at the parking point in the first stage? So, let's just have a look at the first, shall we say, four or five vehicles arriving at scene. So, item one, we've already discussed. Stay in the vehicle. Do what we want when we tell you to do it. Nice easy that one. Leave the vehicle. Report to the forward commander. You're here to assist in the movement or primary triage of casualties to a casualty clearing point. Leave the vehicle where it is. Go to the casualty clearing point. Report to the casualty clearing station officer. You're here to assist with the treatment and packaging of casualties for evacuation. Take your vehicle, move it down the line to the loading officer. You'll be met by the loading officer. The loading officer will give you a casualty or casualties, will brief you on those casualties using probably an atmiss handover and tell you where you're going to take those casualties to. That's something you need to bear in mind with crews because they're used to being autonomous in terms of they make the decision on where people go, etc., etc., but they're now under a command and control process. actually you need to be told cuz otherwise uh as happened on Utoya Island. Yeah. Um picked up the um casualties from the island um took the ferry across drove off the ferry drove to the nearest hospital which was like about 3 milesi down the road took all the casualties and nobody took the patients onwards into Stockholm. They just wanted to get rid of the casualties and get back again. therefore overwhelmed uh the local health economy and actually complicated that in considerably by doing so. So you have to make sure you got good commander control of that. Having loaded the casualty, knowing which hospital you're taking to it, having had the handover, knowing what priority they are, you drive out on the circuit. Yeah. Off to the hospital, do an atmiss hospital. Um sorry, an atmiss handover. uh at the hospital, get back in your vehicle, come back into the parking point where this time round you might get to do something completely different. So, it's a continuing both an internal circuit and an external circuit when dropping off. In some cases, as mentioned earlier, yeah, you may find that uh people returning from the hospital are bringing logistics resupply back to the scene, in which case that's part of the parking officer's job to be able to um establish that and make sure it's passed off onto the um logistics officer who's in charge of it. Sometimes you won't be able to establish a circuit with a separate in and out. Sometimes geographic scenes are quite tight and you may have to have a one-way system where you reverse vehicles down, get them loaded, pull them out, etc. One at a time. All needs to be controlled by the parking officer. Does it not seem to you that the parking officer is a very overloaded chap actually? So do not be surprised depending upon the size of the scene if you're going to need a parking officer and an assistant parking officer and assistant assistant parking officer to provide command support to the parking officer to allow them to carry out their task. Now you won't find that in any action cards anywhere. Yeah. But what you'll find is from experience that sometimes you will have to make up roles. Yeah. In order to get a task done and fulfilled. In this country, we did an exercise uh which was involved a multi-terrorist attack um in a football stadium and um I was um umpiring the exercise and my job was to umpire the silver tactical commander at the scene and they were tryinging something new where we were working with fire service who were doing basically um casualty treatment and extraction. And we knew from experience that they were going to be problematic because actually they're a very can do get on with it type organization and in any time of operational or command vacuum. They will take the initiative and just do it. Well, that may not necessarily be what you want them to do. and they're working for another organization even though you theoretically have control of them. And what I was impressed by was that the civil commander realized from the outset because this was going to be the first time this had been tried that it was going to be a problem. And one of the first officers that arrived at scene after he'd sorted out park and he said, "Right, mate, you you're going to be the fire leaison officer. Take a radio, embed yourself with them. I will speak to you when I want the fire to move." Yeah. and what I want them to do. So I will have direct control over them. Whereas otherwise he would have had to gone to the fire tactical commander who talk to the fire bronze officer who talk down to the team. It would be a long chain of communication. You can see it there. There leads the way of trouble. Yeah. But he recognized it was going to be a problem from the outset and he invented a role that had never been thought of before. So sometimes you will have to improvise command roles in order to get the job done. That's just one example of having it done. When we talk about the roles at scene, uh we'll talk about the sort of commander, communications officer, the safety officer, they all carry out different functions. And if you look at this chart, even though it's a very limited chart, you'll see there's something like about 10 12 different command roles on this. The problem is at the beginning, yeah, we don't necessarily have all those personnel available to be able to effectively do that. So if you've got limited resources, you may have to do without certain things in the initial stages and decide how important your equipment officer is to you at that particular point in time. Do you need it now or can it wait? Yeah. How important is your safety officer now? Do you need it now or can it wait? You may find if you're a tactical commander that actually you're running both the bronze and the silver area simultaneously because you haven't got somebody to take over the forward commander role. You may in certain circumstances have to combine roles. Yeah. In order to manage it. So you might be you are the silver commander, but guess what? You're carrying out the communications officer's role at the same time until you find someone that can take that role off you. What's important here is that you will always need the roles carried out whether they're combined or you do them individually. Smaller instance, it's very easy to combine roles. Larger instance, less so. And you need to think about how you fill those roles. My first appointment is a parking officer because my experience tells me that if I don't grip parking from the outset, it'll be chaos very, very rapidly. anyone's been to a scene within about 3 or 4 minutes there are vehicles everywhere if they're not controlled. Yeah. And nobody can get in and nobody can get out. And you might go, "Well, isn't that a police responsibility?" And I would put my hand on my heart and go, "Yeah, I absolutely agree, mate." But they've got other tasks in hand. Yeah. They're not focusing on it. And from my point of view, I need to get patients out. So whether it's my job or not, I'm going to make sure that happens. Um, first crew on scene, it's what number two on that vehicle does. it becomes the parking officer until relieved. Just because it has the word officer next to it doesn't mean to say that that job has to be carried out by officer. Just somebody that's got enough nouns, yeah, or intelligence on them to be able to carry out that task until released by somebody properly. So, where are you going to establish your casualty clearing point? We've already said that it's going to be as closely in accordant as you can possibly get it in order to save your human resources and in order to deliver treatment uh quickly and rapidly. But it also needs to be on hard standing. It also needs to be close to the circuit so that vehicles can get to it. So sometimes it's a compromise. Bear in mind there is a difference between a casualty clearing point which is the patch on the ground that you say it is at that particular point in time which is basically where primary triage carries out or gets carried out. Casualty clearing station is a more formal structure. It usually has bays. Yeah. Um with stretches in it and doctors and nurses and actually the problem with those is that they take time to erect in the first place because they're not already there. And secondly, as soon as you put a stuff where casualties can be collected together with medics, you introduce a delay in the evacuation process because bless them, medics want to do too much to patients. Yeah. And actually, it's why they need to be included in the training because they need to understand that actually less is more in this case. You need to do just enough to get them to the next level of care. shelter, not only from the elements, but also from social media and media view. Nothing worse than having um you know, close-up photographs of your patients not being treated at that particular point in time in the press, etc., etc. So shelter is both an organizational reputation issue as well as a protection issue for your patients and in some cases even um sheltering your staff. Yeah. Uh I don't know about you but uh certainly in the services I've worked in with military or ambulance and having worked also with fire and police we tend to develop a rather black and macabb sense of humor. It's part of the coping mechanism, part of how we deal with things. And very interesting, this was taken into consideration by a commander in Scotland when a helicopter came down on top of a pub called the Clu Vaults incident. And um right opposite was a large international hotel for which the local press and the international press had gained access, brought out rooms with the balconies overlooking the scene, etc., etc. And the commander's biggest problem was not the them looking overlooking the scene, but them overlooking his staff when they were in the rest area. Because you can see that well whilst you have to look after the welfare of your staff, people standing around doing nothing when it looks like people need time and attention is going to be an organizational reputation issue. And people collected at a welfare area where there's tea and bickies and stuff Yeah. tend to start getting into conversations. Yeah. and humor that may not be deemed appropriate by the world's press when photographed from a distance. So actually his first thing was to erect a shelter between the hotel and the staff welfare officer so the cameras couldn't see into the staff welfare officer area which I thought was quite bright and innovative of him. So we now got a situation where we've got a bronze in accord established. We may have sectorized uh into different sectors. The problem with sectorization is that it's manpower intensive. Every time you sectorize, you'll need a command new commander for each sector, maybe a new radio frequency, plus the people that are going to work with them. You will need to deal with survivors. So, you'll need some form of survivor reception either in the silver area or just outside the silver area. Uh if you're using existing structures as a casualty clearing point or casualty clearing station um you will need those and clearly access to them which is why the parking um is going to be important. Need to also think about vehicles other than ambulances which will include air assets. And if you got a major incident everyone thinks about a helicopter landing site but what you don't realize with a major incident you get multiple airframes arriving. You're going to need a helicopter landing field. Yeah. not just a helicopter landing site. Yeah. Uh it's a big job. Uh and all that needs to be controlled and you'll need a joint tactical air officer uh to coordinate and do that as part of the process cuz often the airframes will be coming to you on mutual aid rather than being ones that you would normally control. The media will be on to you. 30 seconds to tweet in my organization from the minute the um 999 call hits our control room. 30 seconds later it's on Twitter somewhere and that generates interest from both the public and the professional media and you as a commander are going to need to deal with that and the old habit of no comic mate yeah I'm busy isn't going to work in today's society. um which means to say there may be another um command role or subordinate command role that needs to be formed as a media liaison officer to be able to effectively the more you can divvy up your job yeah the easier your life will become dependent upon the resources you've got you're going to need to work together to solve this is not just an ambulance service healthcare problem yeah particularly in the instance we're talking about there will be um risks and hazards so fire service involved. It potentially be a scene of crime. So, police will be involved. There will be other agency organizations and there are lists of them that come out of the road come out of the woodwork when you have an incident that you've never even heard of. Uh um all turning up, all wanting their piece of the pie. Um god forbid you have a terrorist incident that produces more agencies and organizations um than you can shake a stick at to be perfectly honest. And you got to work with them all. And so we have these principles of joint working and they are five main stays of collocation which means colllocate your commanders at each level i.e. bronze, silver, gold together as soon as possible because the quicker they're together the quicker they can start exchanging information. The quicker you can all get a situational awareness of what's going on. People think that happens naturally and it doesn't. You have to make it happen because people in the initial stages are a very very focused on what their own agency or organization wants and needs to achieve etc etc. And also what people don't realize is they assume that you've got the same information as they have. But that's because people tell the information to the people they think that need it. So, as an ambulance service or a person wearing a red cross on my arm or whatever the case may, people will tell me about patients. Fire service, well, they'll tell them about things that might go bang or on fire or smoke and stuff like that. And police, well, they deal with community impact. So, they'll say the perpetrators went that way or they had a gun or whatever the case may be. So because people tell you that information, that information come down your service. Yeah. Down your chain of command from your control room. You can be missing 23 of the information. So the idea of colllocating as quickly as possible is hello mate, how's it going? With a fire service is finding out, oh yeah, by the way, there is a petrol tanker on the front end of that that's going to be causing us a hazard and we can't get to that yet. uh which if I hadn't bothered communicating I would perhaps have been sending people into triage and treat in that area which is large threat and risk to my service and organization. Yeah. So you need to communicate in a 360 manner. You also need to communicate using plain English. We'll talk a little bit about this but we're going to talk a lot about this when we come to the communication lecture. The problem with services is we all have our own language. Not only do we have our own language, but we have our own acronyms or biograms or triagrams, etc., etc. The bigger problem is they don't match up. Yeah, cuz I am an ambulance person. An ALP to me is an ambulance loading point. You turn to fire, actually it's an aerial ladder platform. Completely different thing. So I'm giving a briefing going right we are now want to move the patients to the ALP fire service are scratching their head and go why does it want to take them to my pump I don't get that yeah so if you don't use professional language when you're dealing in a multi- agency environment you just say it in a proper plain English or plain language type of way then you won't get those confusions EMS is another one for me it's obvious it's emergency medical services. Local authority think it's environmental management systems. Yeah. Which is the dustman. Yeah. So when I say I need more EMS assets. Yeah. Local authority is wondering why I want more dustmen. These things are happen. These come from experience. Speak plain English. Don't get into those rabbit holes. You'll need to coordinate your response. You'll need to decide upon the priorities that are there. What are we looking to achieve? Yeah. How are we looking to achieve it? What are the timelines that we're going to do? What are the problems? Sharing the information gives us a joint understanding of the risk. Yeah. When we got joint understanding of risk, it means we can work together to solve them. I might know as an example what the signs and symptoms of chlorine poisoning are. But it's the farman that's going to tell me about parts per million and at what point I'm going to need respiratory protection, etc., etc., thereby sharing and working that together. We have a joint understanding the risk. we have a common approach to actually dealing with it. That gives us all a shared situational awareness of what's going on which we have to communicate to each other and our own organizations using a sitrep and that sitrep in this item is called methane and we'll talk about the detail of methane and that critical message structure when we come to the communications lecture. Some services now have pre-desated instant commanders as part of the process at both uh operational and tactical level. Uh they may also have command vehicles. Um as we already said, command vehicles themselves need to colllocate as close as possible to aid that coordination process. Usually they come with their own lights. In an ambulance service point of view, the command vehicle has a green flashing light on a mask at the top. So when that vehicle pulls in, the mask goes up and the green light comes on. The first ambulance on scene that was the temporary command post. Blue light goes off because command has transferred from bronze to silver. And here is where command now is. So there's a hand over takeover process process for the vehicle. So we understand where we are. We follow the scatter or CSCAT process and in most cases for command roles you can write the action cards in advance and if you look at your source materials which you will have compare clinical guidelines for operations with the national amance resilience unit action cards written by completely different organizations one being the military the other being the ambulance service and a civilian role and look at things like scene commander and scene layout and see how similar they are. There's virtually no difference apart from perhaps in some cases terminology. Yeah. So that means that tasks and roles can be predefined in action cards as part of your preparation phase. I'd also say that you need to do an afteraction review. Yeah. To see whether your SOPs and your action cards are up to date or need tweaking and adjusting as part of that process. Predominantly as the silver commander, you're look very much looking after the safety uh and welfare of your own personnel. Although you may delegate the role to a safety officer. The po point to remember about delegation is you can delegate the task but you can't delegate the responsibility. Yeah. So if they get it wrong, it's still your fault as the commander. Okay. So make sure you pick your people appropriately for task. Communication is the probably the big problem for a silver commander in the middle because you've got communication going everywhere. It's going forward down to your own troops in the bronze area and to your bronze commander. It's going backwards up to your gold control or your gold commanders winging that you've got too much resources and needs them back for the day job etc. And it's going sideways uh the other two organizations to ensure you have yeah good situation awareness. It's a very compressed task which is why you can see the more people that you can surround yourself with. Yeah. To help break that down into different chunks, the easier your life becomes. Don't try and do it all yourself unless you actually have to. Your big job is here is the continual assessment. I said there was assessment of the scene, but it's a continual assessment process on a battle rhythm that will be set by you depending on the urgency of the situation. And you need to think about things. Do you need more additional treatment personnel? Do you need additional transport? Do you need mutual aid? Yeah. Is there other types of equipment that you need? Are we meeting our objectives? Are we achieving what we expect to be able to achieving? Big point to bear in mind. You know, if you're sat there 4 and a half later and you're still 4 and a half hours later and you still got patience on the ground, something's gone wrong. Yeah. Because you should be aiming to clear scenes quickly and rapidly. Yeah. Means your people are doing too much on scene. Yeah. And we're not focusing on getting patients to the right place at the right time. What's brilliant about being a medical commander is your mission never changes. We only ever really have three things to do. We need to charge, we need to treat, and we need to transport. Yeah. So keep TTT in mind and ask yourself, are we doing that? Are we achieving that? Yeah. Oversight all the time. Get into the detail. Check and verify the information. Yeah. That's coming up. You'll be surprised at how many people will tell you stuff that is totally not true. They're not doing it to lie to you or to you know they're doing it because they think or made an assumption. So check whether information coming to you has been assumed or you know clearly there's a lot more under command and control we talk about. We'll talk a bit more about that under safety and we'll talk a bit more about that under communications as well and even in some of the um other lectures such as treatment etc.
Major Incident – Rapid Grip, Command Actions & Scene Layout
Core Idea
You’ve got 6–8 minutes to “grip” the scene. If chaos runs for X minutes before control, expect ≈X minutes to recover it (e.g., 30 minutes chaotic → ~30 minutes to stabilise). Early grip prevents exponential drift.
First Crews: What must happen immediately
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Recognise “not the day job”: first crew acts as acting ambulance commander until relieved.
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Safety first: self, scene, survivors. If CBRN/HazMat, apply STEP 1–2–3.
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Send a METHANE report immediately (even incomplete) to trigger specialist response.
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Rapid scene assessment (purpose: refine METHANE, pick casualty clearing point, set parking location(s), design ambulance circuit).
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Two-person crew drill: senior dismounts to recon; second stays in vehicle, lights on if tactically sound. Rule of lights: first-on-scene keeps blues on; all subsequent units off so incoming commanders can locate ICP instantly.
Control & Multi-Agency Basics
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First unit from any service is the temporary forward command post until relieved.
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Sectorisation: only if helpful; agree sector names across services to avoid A/B/C mismatches.
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Command vehicles: co-locate; multi-agency fit-out (shared comms, workspace) helps. (Tea/coffee helps collaboration too!)
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Commanders don’t treat patients—avoid tunnel vision.
VIP/Government Visits
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Expect early VIP interest. Give them 2–3 actionable requests (resources/authorisations) so they add value and free you to command.
Scene Layout & Flow
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Inner (bronze) cordon around incident. Establish Casualty Clearing Point (CCP) as close as safely possible to reduce lift-and-carry burden and speed interventions; use hard standing and near the vehicle circuit.
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Outer cordon with controlled entry/exit (police-managed).
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Parking point:
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Simple: single file left-hand line.
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Better space: lanes by capability (Frontline, PTS, Specialist).
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Parking Officer enforces order; may need assistants.
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Crew drill: stay in vehicle until tasked; leave keys in (and drug safe keys per policy) to keep assets mobile.
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Loading Officer allocates patients, gives ATMIST handover, and directs destination—no autonomous hospital choice by crews. Maintain outbound → hospital → return → inbound circuit; returning crews may backhaul resupply to Logistics.
Adapting Roles & Resourcing
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Improvise roles if needed (e.g., Fire Liaison Officer embedded with fire teams to shorten comms chain).
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With limited staff, combine roles temporarily (e.g., Silver + Comms).
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First appointment: often Parking Officer—uncontrolled parking cripples throughput within minutes.
CCP vs. Casualty Clearing Station (CCS)
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CCP: initial ground patch for primary triage.
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CCS: structured bays with clinicians—takes time to erect and can slow evacuation; train clinical teams that in MIs “less is more”—do just enough to move.
Shelter & Reputation
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Provide shelter from weather and media for patients and staff; protect welfare areas from long-lens scrutiny to avoid reputational issues.
Air & Media
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Plan for multiple aircraft: you may need a helicopter landing field and a Joint Tactical Air Officer.
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Media arrives fast; appoint Media Liaison—“no comment” won’t fly.
Joint Working Principles (JESIP-aligned)
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Co-locate commanders (Bronze/Silver/Gold) early.
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Communicate in plain English (avoid service-specific acronyms).
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Coordinate priorities, timelines, and tasks.
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Build a Joint Understanding of Risk and Shared Situational Awareness via regular METHANE/SITREPs.
Command Handover & Doctrine
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Some services field pre-designated incident commanders and command vehicles (e.g., ambulance Silver’s green mast light indicates command location).
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Follow CSCAT/SCAT; use action cards/SOPs prepared in advance; conduct After-Action Reviews to refine them.
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Delegate tasks, not responsibility—choose role-holders wisely.
Silver Commander Focus
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Communications hub (forward, up, sideways). Build a small team to manage bandwidth.
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Continuous assessment on a set battle rhythm: Do we need more treatment, transport, mutual aid, or specialist kit? Are we meeting objectives?
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Aim to clear patients quickly; if many remain after hours, re-set tactics (TTT focus: Triage, Treat, Transport).
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Verify reports—separate assumptions from facts.
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