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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Preparation
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Hello and welcome to the next s section of a major incident practice and support preparation. So what we're going to look at today is we're going to understand the need for planning, understand the nature of equipment that we will require to deal with the incident and more importantly understand the need for training. Yeah. And I can't stress that enough. Yeah, this is train, train, train in order to be effective at dealing with the incident when it occurs. Um, so clearly we're going to look at the planning of the equipment and training required. Now to fail to plan is to plan to fail. Uh, a very oldage. Um, and a mission of planning is likely to lead to failures which is why we say that your planning guidance uh should be an allhazards approach. Now most of you uh will have different legislation that covers uh what your minimum requirement I stress that the minimum requirements of you as an organization from your country. Yeah. So in um this country it's covered by uh two big things. the Civil Contingencies Act 2004 and emergency planning guidance produced by the Department of Health along with um other home office um legislation um that requires agents to respond. So as an example, a hospital is required to do a communications exercise every 6 months, a tabletop exercise every year, and a full live exercise every 3 years as laid down in the guidance. So equipment falls into two parts really. uh equipment from your personnel in terms of personal protective equipment and the medical equipment that you're going to need to manage your patients. And we're going to look at the selection, training, and maintenance of both. part of your personal protective equipment, particularly if you're working in a prehosp environment, will be that your PPE needs to identify not only which service you come from, but what your role is uh at that instant. So whether you're the incident commander, yeah, you're the um breathing apparatus entry officer, you're an entry control officer for the ambulance service, you're the parking officer, your PPE needs to identify who you are. Similarly, actually it works exceptionally well within a hospital environment that uh when an incident occurs, tabers are also used to define heads departments and the roles of the individual people get very confused. um very very quickly and what you got to remember is that people will be working outside of their department and won't necessarily know the roles of the people within that department. So having a quick and easy method such as tabards um as part of the PPE system uh is worth considering. Uh in this country colors represent services. So red and white tends to be fire service, blue and white police, uh green and white uh medical or ambulance. People without appropriate PPE should not be allowed to enter areas of risk. And that's because actually if you do allow people to go in uh who aren't appropriately um protected then you're likely to add to the casualty load because if they become injured um you're now adding to the problem instead of taking away from the problem and that's really not the strategic objective of a commander. You know gold rule number one try not to make things any worse than they were before you arrived. So personal protective equipment needs to be looked at from a safety point of view. What is it trying to achieve? Functionality. Every time you put PPE on an operator, no matter what service organization they come from, you're going to get a degradation in function. Yeah. May not be in necessarily in the skill level, but certainly in the duration that they'll be able to carry out that skill. durability. Is the PPE fit for task? Is it comfortable? Will it fit? And does it perform the visibility functions that we've already said earlier? You're also going to need to consider um whether or not you need specialist PPE in some cases, particularly if you're dealing with uh chemical or hazmat instance. Yeah. What is the level of the risk? Yeah. What's the nature of the risk? What body areas need to be covered? And how well do you need protected? And this is interesting because actually when we talked earlier about working with other agencies, you do need to be on the same sheet. I went to a major uh incident chemical release exercise in the middle of Birmingham uh held over a weekend um a good five six years back and we had ambulance service in powered respiration u power suits. Yep. um fire service in extended duration breathing apparatus and police in um Tyveck suit with surgical mask all working in the same area. So somebody's risk assessment of what the PPE was meant to be in that area was clearly wrong because you got three different tiers there. Yeah. All working in the same environment. So need to consider the risk. Yeah. do a risk assessment and consider the right PPE um and then train your personnel in their use. Yeah. To be able to effectively manage it. You're also going to want to look at comfort. And the reason that's important is that what you'll find is if people aren't comfortable, they don't perform well. And also if you're providing that item for safety then uh you are not um fulfilling the function that it happened to be which sometimes means that as a commander you might need to rethink a situation. I think we're all familiar with the threepoint um harness uh protective helmet u that most services use etc. But my experience has been that they only wear that when you're watching them. Yeah. And when you arrive at scene, you can query quickly seeing a number large number of helmets being put on as they've actually when they've arrived at the patient or arrived at the scene, undone the strap, picked the helmet off, put it down, and then turned to the patient. Therefore, now unprotected for the environment that you were doing it. There's a couple of ways of looking at this. You can be draconian about it and you go you will wear and we will rigidly enforce the wearing of PPE which in some circumstances might be exactly the right thing to do when you're any personality um votes etc. or you can sometimes rethink it. So as an example excuse me a second out baseball cap lined. Yeah. Now, it's not got a three-pole house on it. It won't protect you in a really hostile, you know, crumbling building point of view, but if you're wearing it at the scene of an RTA or RTC, then actually it will stop you bumping your head on the cab and you will be able to effectively work with the patient. So, sometimes you want to have to rethink Yeah. uh PPE and not just stick to, you know, the original formats and have different levels available. We need to think about the medical equipment that we need to do. And everyone thinks, oh, we know the answer to that because it's the same medical equipment that we always use. But my question to you is it because actually, what are we trying to achieve? We're trying to achieve doing some very basic stuff to a lot of people rather than some very advanced stuff to a small number of people. which means that both your packaging and your selection of materials may be different. So, we've all seen the helicopter medic get off with a nice big red Bergen on their back when they arrive at the scene. But in general terms, that uh Bergen or rucks sack is kitted to deal with one poly trauma patient. Yeah, maybe two at the most. and it's got lots and lots of advanced equipment in it to be able to manage that job. And if that's only for one patient, think how many rucks sacks Yeah. or Bergens you would need. Yeah. If you have multiple cases. So that means that your selection of the equipment needs to be different. Same size pack but with lots of simple stuff in it. So rather than one or two toes in it, it's got 50 toes in it. rather than two bandages. Yeah. It's got 50 in it. Um and then leave out the advanced stuff. Yeah. So that the advanced stuff goes to the right place. Yeah. For the patients to be dealt with at that level and that'll become clearer as we go on. So we also need to think about packaging. Yeah. uh they can either come in uh large plastic cases, large plastic boxes or Bergens and rucks sacks. And in general cases, we have found that Bergens and rucksacks work better. Uh mainly because they can be carried by one individual on their back, leaving their hands free to walk across um a site that is probably littered with obstructions and debris. Uh whereas carrying uh large boxes or crates across uh open ground between two people um which we've got now got one hand tied up at least will cause problems and it's less easy to move the stuff around particularly when they started to unpack the equipment. Um so think carefully about packaging size how you're going to transport your equipment and how you're going to divide it up. The other thing that's quite important is that medical equipment should be compatible. Yeah. Across services or medical responders going. So does Yeah. The leads for your patient monitor. Yeah. Fit the leads for the patient monitor in the hospital. What's the point of that then? Well, actually, if all you got to do is unplug the leads from the machine and plug it into the new machine at the hospital and then go away again, picking up a pair of leads on the way out, then actually you got a faster turnover process. You're not losing equipment. Yeah, your logistics is going to be better and also your continuity of care for the patient is going to be better as well. You're also thinking in terms of equipment about what does the commander need to support them in the field to carry out their function in the terms of stuff like mapping um in terms of tabards in terms of action cards or any other aid memoirs that they may need. Now we can give you a list and we will put a list up of the sort of things that should be found in a commander support pack but they will very much tailored to your own environment. So when you move ro or change roles you need to revisit your release or commanders rux act to change the telephone directory to change the mapping etc etc. Yeah. Um, don't forget about uh things like log books, pens, pencils. Yeah. Um, electronic logging is quite a way to go. So, we got a digital recorder. That's quite a useful tool. But if you don't check your equipment and you don't change the batteries, the first time you use it, you found the batteries have exploded inside and ruined your device, etc., you need to be prepared. So, you need to have a review process for all equipment. They do unannounced inspections of health care providers throughout the country. And on this occasion, they went to a UK ambulance service and they were walking around uh one of the ambulance stations. And um they thought it was all over when the inspector spotted against the back wall a large truck with the words major incident on the side. And he only spotted because it actually was so dirty that the green mold in it had almost made it the same color as the wall. So, it was well camouflaged against the wall. And he turned to the station manager and said, "Um, let's get the keys to the major incident truck, shall we?" Problem one, couldn't find the keys for the major instrument truck weren't where they're supposed to be. After some time, the keys were found. Jumped into the cab, couldn't start the engine because the batteries were flat. Um, got a mechanic out to jump start the vehicle. Uh when they jump started the vehicle, the blue light system fused. The inspector went, "Never mind. We'll look in the back then, shall we?" They walked around the back of the truck, went to unlock the truck, found they couldn't because the key had been snapped off in the padlock. Yeah. And nobody had reported it, and the key hadn't been placed, and the lock hadn't been placed. Pair of bolt clubers was found from the fire station next door. The lock was cut off. The back went up. Several rats came out. They had clearly been using it as a home for a while. uh all the equipment inside was out of date, moldy and deteriorating. So clearly no audit and process check in that uh in order for it to be effective. Yeah. That's not a situation you want to find yourselves in. Yeah. So do have good audit processes to check and people remember the stuff like the drugs. It's sort of drilled into medics. You know, we'll have a process make sure the adrenaline is in date and all that. So, but people forget about things like personal support packs or major equipment vehicles that don't actually carry medicine and treatment protocols. Don't forget things like money. When you get called to a scene of a major incident, you have no idea where you're going to end up. In some cases, you can end up in foreign countries. Yeah. People have had to jump on a helicopter. Yeah. To escort a patient and find they've been landed in Ireland or another country. Yeah. And the helicopter's now taken off and gone home and left them behind because they escorted the patient in, etc., etc. In every words, you'll get hungry. Yeah. Have some form of emergency rations or the ability to get some food. Yeah. Or liquid to keep yourself hydrated. Um, you have no longer how you're going to be there. Torches um are very useful. Think about the type of light you want to use. Everyone goes with a straightforward hand torch, but actually the jobs we do require our hands to be pretty used pretty much most of the time. Even as a commander, I'm standing there with a notebook in one hand and a pen in the other. Yeah, unless I'm going to hold the torch in my mouth. Yeah, I might be wanting to think about a head torch rather than a hand torch. have the correct identification available because if people don't recognize you and you haven't got any identification to say yes I am the uh aniththetist from the local hospital and I happen to be passing by I can help you out then you're not going to get in and you're not going to be effective resupply resupply needs to be thought from the outset it's why uh we have large trucks full of equipment ready to roll that has been audited and checked on a regular basis Yeah. Yeah. In the event of an incident because actually most frontline vehicles Yeah. much like the helicopter emergency have enough um kit on board to deal with one maybe two patients. So you're going to run out of equipment very quickly which means you need to think about how that process is going to work. Not only in terms of what equipment do you need, how is it going to get there, how is it going to be resupplied to the people that are working there and what the entire process is. It's quite interesting to know that most UK ambulance services do have large equipment vehicles and when inspectors come around they look at them and they go they are very good. Ask some in-depth questions right so who's going to drive it to scene and where are they going to come from mate because they actually don't have dedicated drivers and quite a lot of the plans have not considered how the vehicle is going to get to scene. So actually that does need to be part of your process as well. Equally, yeah. Equipment that may have to come out from hospitals. Yeah. So, vehicles that go into hospitals taking patients should come back. Yeah. With resupply. Yeah. For the front line for the next patients. Again, that needs to be part of your processes. You should be leaning towards the fact that guess what? You're going to need a logistics officer and probably more than one to manage this. Not something that's often thought about when people are think, "Oh, I need uh doctors to look after patients. I need paramedics. cuz I need to come on. But actually, who's taking care of the logistics? How it's going to work? More important on this resupply is going to be the recovery afterwards. Yeah. Equipment is going to end up everywhere. It's got to be found, repatriated back to its original place, checked, verified, ready for the next time. Yeah, that's a longunning process after the event has occurred. We've already talked about uh major incident equipment being checked and serviced on a regular basis. uh so I won't re label that person point and we'll move on to training and in terms of that we're looking at training of personnel training um your medical responders from individual organizations training the health service as a whole to work cooperatively together and then finally having a combined response of all emergency uh services to respond and this training can take the form of um different levels depending on what objectives you're wishing to achieve. It may be something as simple as a paper exercise. You want to know whether people understand triage? Well, you can do that by a simple straightforward triage paper. Yeah. And assessing the results. If people you want to understand how people understand the principles of what is to be involved rather than the application of those principles, then tabletop exercises are quite often a good way to be able to demonstrate that skill set. If you want to understand how those uh principles are put into practices, then sometimes practical exercises without casualties is the way to go. So you're focusing on the function and the command support items and the processes rather than dealing with the patients. And then finally, a practical exercise with casualties where you'll put both the treatment protocols and the management and command protocols all together. And it should be done that as a tiered approach. Yeah. From the bottom upwards. In other words, you start with the principles of major incident management. Embed those in your personnel. You look at the skill sets that required. If they need to use a radio, then you need to train them to use a radio. The correct radio, the same radio they're going to be using on the day of the race. Triage. Do they understand the triage systems that you're going to be using? Yeah. and are they good at adearing to them without thinking? Yeah, that's something that is probably more difficult to manage than you would anticipate. Yeah, in some cases you may have to decontaminate or clean patients before you can triage or treat them. Do you have the correct decontamination processes in place as a skill set? Do you have trained all your personnel or specialists amongst your personnel to be able to deal with that? tabletop exercises, practical exercises without casualties, and then finally a health service exercise followed by a multi- agency exercise with casualties. The problem we have quite often is people all keen to have exercises and they want to start at the top. Let's have a multi- agency exercise with casualties. And everybody goes in and it becomes a bit of a fog of war. Yeah. Because nobody knows what's going on because you haven't started at the baseline and worked your way up. Yeah. you're trying to start at the top and work your way down. That's never a good way or educational model. Yeah. To follow. So, Civil Contingencies uh act 2004 plans must include training and exercising schedules. Yeah. And six monthly communication tests, annual Top three-year live exercise for all agencies that are going to be involved. This is also what's not mentioned covered off and audited by NHS England in the United Kingdom on a yearly basis through something called NHS core standards where a large spreadsheet of have you got the following comes out which has to be returned up through the system. It is an opportunity to look and see how you rate. Are your plans in date? Are your exercising processes working? And people quite often go, "Well, we have exercised. We've done all that." That's great. But have your personnel changed? Because you may have exercised a year ago, but now have none of the same personnel. Yeah. Because they've changed, moved on, be promoted, etc., etc. So when I said that's the minimum stand required actually are all your current personnel up to speed and trained for a large organization that is a continual process because as soon as you get to the end you're restarting and doing it all again. So that needs to be part of that process. preparation. 90% of dealing effectively with a major instance is going to be in that preparation phase. So spend the time on it. The better prepared you are, the better you'll be able to cope. In military partners, train hard, fight easy.
This section emphasises that effective preparation is critical to successfully managing a major incident. The three key pillars are: planning, equipment, and training.
1. Planning
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“Fail to plan, plan to fail” – good preparation prevents failures.
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Planning must follow an all-hazards approach, adaptable to different incident types.
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UK requirements are set by the Civil Contingencies Act 2004 and Department of Health emergency planning guidance, requiring regular exercises:
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Communications exercise every 6 months.
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Tabletop exercise annually.
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Live exercise every 3 years.
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2. Equipment
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Falls into two categories:
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Personal Protective Equipment (PPE) – must identify role and service (e.g., incident commander, ambulance officer) and follow recognised colour codes (red/white = fire, blue/white = police, green/white = ambulance). Inappropriate or missing PPE risks adding to casualties.
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Medical Equipment – should prioritise simple, high-volume supplies (bandages, tourniquets) over advanced kit, reflecting the need to treat many patients rather than one.
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PPE considerations: safety, functionality, durability, comfort, and visibility. Risk assessments must ensure PPE standards align across agencies.
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Medical kit considerations:
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Equipment must be compatible across services (e.g., monitor leads).
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Packaged in portable rucksacks for mobility and ease of use.
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Regular audits are vital; neglected or outdated kits can critically undermine readiness.
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Logistics: resupply and recovery must be planned from the outset, requiring designated logistics officers. Hospitals and vehicles must support forward supply.
3. Training
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Training ensures personnel can use equipment correctly and work effectively across agencies.
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Approaches should be tiered:
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Paper or classroom exercises.
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Tabletop simulations.
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Practical exercises without casualties.
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Full multi-agency exercises with casualties.
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Training should cover radios, triage systems, decontamination processes, and command/coordination.
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Plans must include ongoing training schedules to accommodate staff turnover.
Key Message
90% of managing a major incident is preparation.
Through comprehensive planning, effective equipment selection/maintenance, and continuous training, organisations can respond decisively. As the military saying goes: “Train hard, fight easy.”
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