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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Table top exercise - Triage and transportation
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So we have got to the stage where we have set up scene command and control. We've got enough resources to man all their key points. We have laid out our casualty clearing, loading, parking. We've pushed patients... Started to push patients through the system. We started with primary triage at the scene, and we will say that we have identified on primary triage 50 casualties with a breakdown of 15 P1, 15 P2, and the remainder being P3. How does that impact you?Well, it will certainly impact on your decision-making regarding resources and where those patients are going to. Some will need specialist treatment, some will need aggressive treatment, and some will be walking out of the incident and will still need transporting to a facility.Okay. So yeah, we got what did we say? 15 P1s, 15 P2s. But there is an assumption by a lot of people that all those people will be moved by frontline A&E ambulances. Is that valid, do you think?Not really, because your P1s are going to need that, possibly even helicopter, so they may need to be uplifted into a helicopter rather than an ambulance, so they are going one way. And some of your P3s, I mean, strange as it may sound, it could be a taxi for them. They need to get to the hospital to be checked out, but they don't need a frontline vehicle, and we cannot tie a frontline vehicle up that is needed for P1s on a P3, so we have got to prioritise. We have also got to prioritise the hospitals because if we send all 15 to North Suss, for instance, North Suss will not be able to cope with 15 in one go, so we may have to contact a couple of hospitals and split them.Spread the love, a bit of Barry White.Yeah.It works well.So certainly for your P3s, if you can commandeer a coach that would be helpful to do one transport instead of several. But obviously, looking at this incident in particular, when you look at the state of the roads and whether a coach can be accommodated on-site or it needs to be somewhere else.So is there an alternative solution for Priority 3s that we might want to do. So we have talked about transportation...For discharge at the scene.Discharge at the scene. So what do we need to do that with?Doctors.Yeah. So you would need to have them assessed by a doctor. And then if possible, discharged from the scene, which will save you a transportation problem.Yes.Now the point is, I think I said earlier, primary triage figures tell you what you need to push forward into the scene, and they are actually also affecting your future decision-making aren't they? So although you probably will not put any of what we have just discussed into place until we have done the secondary triage, it is already informing you... Well, actually we have got a large number of P3s we could... Right, let's call some basics doctors forward now, so that by the time that we have evacuated the casualty clearance station, we have done the secondary triage, we have got them ready, there is doctors on the scene...To be packaged and transported or discharged from the scene.Yeah. So primary figures there are going to really dictate that we are gonna need quite a large number of resources to get them from bottom to top here. But 25 vehicles, so that is 50 paramedics, shall we call it? Yeah, although there may be a mixture of technicians and ECA's depending on the services that you come from. 50 odd patients down the bottom. Have you actually got anybody left to do the transportation?Well, that is a factor that needs to be included in the to your, while we're thinking or planning.Yeah, absolutely. So actually, you are probably gonna be utilising most of that resources, either doing primary triage and assisting with the movement of casualties from the primary triage point to the casualty clearance station, or they are being utilised in the casualty clearance station doing secondary triage treatment and packaging. So actually, there probably isn't anybody left.So we have got the vehicles, we have just got nobody to drive them 'cause they are utilised on scene.Correct, because all your initial resource is actually utilised on-site. It is not actually there for transportation, something that is often forgotten. So this is the point in time where you now need to go, "Right, I now need... " Yep.Mutual aid?Not necessarily mutual aid, but I now need transportation assets. So you are gonna have to consider what transportation assets you are gonna use. And you have mentioned some of them already. So West Midlands three air assets, if memory serves me correctly, roughly.Yeah. Currently, I think they have, haven't they? Three helicopters.Okay. Do you think might need more than that for this then, perhaps? If this was...Yeah, if there were at least 15 P1s, most probably.Okay. So we are going to need mutual aid. Mutual aid to our assets despite the fact that helicopters fly quickly are going to take time. Bearing in mind some of the ones that you want to utilise will already be engaged in jobs elsewhere. So actually, if you have not already, now is the time that you should be asking for it.Yeah.Yeah, so you have got them when the patients are ready to move. Otherwise, if they are all packaged away in the back door then you ask for them, you are adding to that patient journey time, which is unnecessary.Something else that needs to be remembered as well is flying conditions because if cloud drops in on quarries or snow hits and blizzards and low cloud, then they may not be able to fly at all. So they may be flying around you, but not actually able to come into you. And again, that's the resource that you're hoping to get that that you're now not gonna get.That's a very valid point.I guess what a lot of people forget is that everyday life elsewhere to the site of the incident is still going on, so there is still gonna be the typical demand for ambulances, different services. So yeah, you may need to look further afield to gather in from further or apart...Away which is a longer travel time. Yeah.Exactly. Yeah.Okay, yeah. So if we then move... I'll assume that we have moved those patients to the casualty clearing point. We carry out secondary triage. What would you expect to happen with the casualty figures, do you think?The numbers will change.The numbers will change. Do we think they will change for the better or for the worse?Both.I was just saying it could be both.I think you are right actually. Yeah, yeah. In general, what I would expect the P1s to become less. I would probably expect the P2s to go up a bit. And I would probably expect the P3s to go up a bit. Because actually the criteria for being a P1 on triage sieve is, you know, pulse over a 120 or resp rate over 30, which actually if you are reasonably excited at the scene of a major incident and you are injured, you would probably fulfill quite quickly, wouldn't you?To be perfectly honest. So by the time you have been properly assessed by a clinician, actually, it is likely that that grading will come down. I think threes and twos are your danger areas because threes, if you leave them too long before getting involved and getting treatment, may well be more serious than you initially thought and it will therefore deteriorate. And I think twos is the same. So if we do some revised triage figures. I think we had 15 P1s the first time around. Well, let's be reasonably generous and say we have now got 10 P1s, we have strangely still got 15 P2s and the remainder is P3s. How does that affect our decision making on some of the things we talked about on transportation already?Well, so I think the 10 P1s that you have got now, you want those to be transported as soon as you can. So...Mm-hmm.The first town which is earmarked straight away.Okay.But that is more manageable because it's only ten now.And where do you think they are going?They are going to be going to a major triage...A casualty regulation plan...To a major... I like that word. Casualty regulation plan. Fantastic. So actually having a pre-determined casualty regulation plan that says how you are going to regulate the casualties from the scene is a very useful tool. However, the problem is they are very hard to put into place because you have to get an agreement from all the NHS establishments so that is the plan that they are going to sign up to. That is not something that happens overnight and that takes, actually, years of work. I thought I would do it in 30 minutes when I left the military and got into the NHS. Took me four and a half years to actually put a casualty regulation plan into place that was accepted by everybody. So just because you have the plan, the plans are always written to what is probably the worst-case scenario. We are gonna have to use everything, folks, on this job, that is how that casualty regulation plan is written. But actually, given the numbers I have given you, would we have to invoke the whole plan?Not necessarily.So you can see there is some operational discretion there, for a commander to say, well, actually I am not gonna use all three MTCs. I am only gonna use two and I am gonna send five to each. I am going to leave the fourth one in play for daily business.Mm-hmm.I am not gonna use all, I can't remember how many TUs... I remember there was about 15 TUs, I'm going to use 15. With the numbers I've got, we are only gonna use five. I am going to spread the love between them. And then I am probably going to pick a hospital for threes. And I might be really generous and divert the day job while the whole lot goes in there. Yeah. I would not have to do it for long because the threes work shouldn't take too long to assess.Through the system and... Yeah.So there is a whole process. Just because you have a plan, does not mean that you cannot deviate from it.Just got to justify why you are deviating...Absolutely, and if you have to justify it, what do you need to do?Log it.Log it. Okay. And that is a very important point, because... If you can... You can deviate from policy and procedure as long as you record it and you have a good rationale for doing so, and that is perfectly acceptable. No plan survives contact with the enemy ever. And I can think of multiple occasions where commanders' operational discretion has been applied. So we talked about the regulation casualties, MTCs, etcetera. Is there any other transport considerations that we might want to think about? Where are casualties... It's easy to go P1s, MTCs; P2s, TUs; P3s, local emergency hospitals. But are there any other considerations that you might want to think about?Specialists?Specialists. Okay, just explain that a little bit more for me.Say for example, burns...Okay.Like major burns.Okay. Burns to burns. Yeah. Neuro to neuro. Big one, kids to kids.Yeah.Yeah. Directly. So specialist people to specialist places, the first time. Why is that important, do you think?Because they need that specialist treatment for their condition otherwise they are not...A, It is right for the patient.Yeah.Yeah. Get the patient to the right place to deal with whatever they got going on at the time. What is the more selfish bit, as a service?It frees up another space somewhere else?Well, sort of. But if I decide to take the patient to the wrong place...You have got to move them again.I have got to move them again. I have got to do a secondary transfer, and actually, I am just tying up my resources. So if you do the right place, first time, every time, then you do not have to worry about the secondary transfer. Now, there are some exceptions to the rule on that, and you have already mentioned it, Matt. So burns. You will not have enough burns beds to take burns directly to burns. So you will just have to spread the love across the major trauma centres and the trauma units initially in the first 72 hours. And then accept you've got a huge secondary transfer burden coming up in about 72 hours time to about deal with that, just the cost of doing business. If you know that at the time, then that can be factored into your future planning.
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Tabletop Discussion: Triage and Transportation at the Quarry
Overview
This video features a tabletop discussion focusing on the critical aspects of triage and transportation protocols at a quarry incident.
Key Points Covered
- Triage Procedures: Discussion on initial assessment and categorisation of casualties.
- Transportation Logistics: Planning for efficient movement of casualties to medical facilities.
- Site-Specific Challenges: Addressing unique challenges posed by quarry environments.
The discussion provides insights into preparedness and response strategies essential for managing emergencies effectively.
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