Command and Coordination

• All emergency services operate a bronze–silver–gold command hierarchy.
• They follow joint operating principles, using METHANE as the standard communication format.
• Effective response depends on the four C’s: command, control, coordination, and communication.

Safety and Scene Management

• Safety first for responders, the scene, and survivors.
• Use cordons and access control to prevent secondary harm and manage hazards.
• Task volunteers and bystanders carefully to support order without exposing them to risk.

Role of Health and Hospitals

• Health services uniquely use Major Incident Standby so hospitals can prepare without fully disrupting routine care.
• Hospitals must balance incident readiness with continuity of everyday operations.

Clinical Teams and Prehospital Care

• Prehospital medical input includes ambulance crews, doctors, and MERIT teams (Medical Emergency Response Incident Teams).
• Hospitals avoid sending too many staff out; expertise is needed for incoming patients.
• Prehospital clinicians often work in pairs with high initiative but must still follow established processes.

First Actions on Scene

• The first crew/commander prioritises initial assessment, not immediate treatment.
• Follow SCATTER/CSCATT: Safety, Command, Assessment, Triage, Treatment, Transport.
• Quickly identify and delegate to capable bystanders (e.g., separate injured/uninjured, find anyone with medical training, support basic crowd control).

Assessment and Resources

• Continuously assess the scene, casualty numbers, and impact on routine operations.
• Decide early on mutual aid: deploy it to the incident if rapid, or use it to backfill the “day job” if delayed.
• Set a flexible battle rhythm for reassessment (e.g., every 20 minutes initially, lengthening as stability increases).

Triage, Treatment, and Transport

• Triage is dynamic and repeated throughout the evacuation chain.
• Provide “just enough, just in time” treatment to get patients to definitive care.
• Transport is often the most complex element: plan casualty flow, vehicle/air asset use, patient packaging, and ensure accurate documentation for post-incident review.

Communications

• Build a scalable communications plan; one channel is rarely sufficient.
• Use separate radio frequencies for gold–silver–bronze to prevent information overload at higher levels.
• Maintain rigorous record-keeping; every detail may be scrutinised after the incident.

Casualty Clearing and Evacuation Control

• Appoint a lead for the casualty clearing station (CCS) to make clear, defensible prioritisation decisions for evacuation to definitive care.
• Designate a loading officer to manage patient loading and asset turnaround.
• Plan and marshal vehicle and aircraft movements (including rotor-wing), with suitable parking, landing, and egress routes.
• Implement both primary and secondary triage, supported by action cards aligned to national ambulance initial actions cards and clinical guidelines for operations.

Tip: Action cards keep leaders on-task under pressure and standardise handovers between roles.

Specialist Capabilities

• HART (Hazardous Area Response Team) covers: working at height, rope access, chemical environments (powered respirators, extended-duration BA), public disorder support, and water rescue.
• Consolidating many skills into one team increases training and audit burden; ensure funding and competency maintenance keep pace.
• Additional medical inputs may include immediate care/voluntary doctors, occupational health clinicians, off-duty qualified staff, and local military medical resources.
• In some countries, civilian services are military (e.g., France’s fire service structure) or work closely with armed forces (e.g., Estonia/Latvia) due to limited civilian capacity.

Hospital Coordination and In-Hospital Triage

• Establish a robust hospital coordination team for command, safety, and operations.
• Plan for decontamination on site if not completed pre-arrival.
• Ensure resilient communications: receive activation, recall staff, reassign departments, liaise with emergency services and the Casualty Bureau (police-led), and manage relatives on site.
• Prepare for media interest: media-train senior clinicians; coordinate messaging with communications leads.
• Conduct rapid re-triage on arrival using pathways for: immediate treatment, theatre, ICU/HDU, definitive care, and inter-hospital secondary transfers if patients arrive at non-optimal destinations.

Other Emergency Services: Roles and Interfaces

Police

• First senior officer may act as initial commander until relieved.
• Apply safety (self, scene, survivors) and METHANE communications.
• Assess community impact and advise on declaring a major incident; manage traffic and cordons.
• Provide forward (bronze) and silver command points; facilitate partner agencies’ needs.
• Document and evacuate uninjured survivors (witness handling); prevent escalation and disorder.
• Coordinate media messaging with other services; activate support agencies (e.g., mountain rescue).
• Lead on identification and documentation of the deceased.

Fire & Rescue

• Mobilise via predetermined attendance with embedded command.
• Establish forward control, manage hazards, and secure clear routes in/out.
• Provide life-saving first aid, extrication, hazard mitigation, and assistance with recovery of the deceased.
• Continuously assess how hazards affect rescue, triage, treatment, and transport.

Coastguard and Maritime

• For coastal incidents: set up forward bronze control, manage scene safety, and prevent escalation.
• Follow the same SCATT/CSCATT decision logic, adapted to maritime risks and assets.

Military and Other Agencies

• Provide specialist hazard control (e.g., explosives), logistics (food, water, shelter), and surge capability for displaced populations.
• Integrate under civil command structures with aligned objectives and shared communications.

Common Principles and Joint Messaging

• Across agencies, the principles are aligned: establish command, ensure safety, communicate clearly, assess continuously, and prioritise the greatest good.
• Maintain shared strategic aims and consistent public messages; joint press briefings by gold/silver/bronze leads reinforce unity of effort.

Key Takeaways

• Safety of responders, scene, and survivors is non-negotiable.
• A clear command structure enables effective multi-agency work.
• Hospitals face unique readiness demands, including standby preparations and in-hospital re-triage.
• First crews assess first and leverage bystanders intelligently.
• Casualty clearing, loading control, and air/ground logistics are central to a stable evacuation chain.
• Specialist teams (HART, water rescue, public order) expand safe operating envelopes—but require sustained competency management.
• Police, Fire & Rescue, Coastguard, and Military roles interlock; consistent joint media messaging is essential.
• Robust communications and meticulous documentation are as vital as clinical care.