Treatment
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Major Incident Practice: Treatment of Casualties
Speaker: Dr. Jeremy Field, Hospital Doctor and Former Army Medical Officer
Introduction
I have extensive experience in both pre-hospital and hospital environments, including multiple deployments in high- and low-intensity conflict zones. My focus today is on major incident practice, specifically the treatment of casualties.
Before diving into treatment, it’s important to recap the SCATTER-U process:
- Safety: Self, Scene, Survivors
- Five Cs: Confirm, Clear, Cordon, Control, Check
- Command & Control: Command, Control, Communications, Coordination
- Communication: Use the mnemonic METHANE to structure information transfer
- Assessment: Conduct a scene assessment and update METHANE reports as required
The broader response process includes:
- Triage
- Treatment
- Transport
- Exploitation of specialist knowledge to determine risk
- Recovery
Today, the focus is on treatment, covering:
- Where treatment takes place
- What treatment is undertaken
- Who provides treatment
Where Treatment Takes Place
Treatment can occur at:
- The scene
- Casualty Clearing Points (CCP)
- Hospitals
- In transit (limited scope, e.g., ambulances or helicopters)
At the Scene
Care may be provided by:
- Survivors or bystanders with first aid training
- Emergency services (police, fire, ambulance)
- Military medical personnel in certain contexts
Key points:
- Emergency services must first secure the scene before treating casualties
- Medical management teams establish the organisational structure, including duty allocation and geographic layout, before triage teams are deployed
Casualty Clearing Point
- Casualties requiring assistance, such as stretcher-bound patients, are brought here
- Triage Sort is performed to prioritise treatment
Hospitals
- Definitive care is provided here with full resources for advanced interventions
In Transit
- Civilian ambulances and helicopters have limited space; major interventions are rare
- Military helicopters may allow more advanced treatment during evacuation
- Patients should be stabilised and packaged for safe transport
What Treatment is Provided
Treatment follows the CABDE paradigm:
- C: Catastrophic haemorrhage
- A: Airway
- B: Breathing
- D: Circulation
- E: Neurological Disability and Environment/Exposure
Principles:
- Provide minimum necessary intervention to allow transfer to the next care stage
- The priority of treatment aligns with the casualty’s triage category
- Immediate life-saving interventions may occur during triage (e.g., stopping severe haemorrhage)
Types of Survivors and Casualties
- Uninjured: Sent to a Survivor Reception Centre
- Injured but able to walk (P3): Retriared using Triage Sort
- Unable to walk (P1/P2): Sent to Casualty Clearing Point for prioritised care
- Trapped casualties: Require assessment before extraction; triage sort identifies needed resources
Who Provides Treatment
- Bystanders/Survivors: Basic first aid
- Emergency services: Prioritise scene management but can provide life-saving care
- Ambulance Service: Primary responsibility at the scene; includes technicians, paramedics, and critical care practitioners
- Additional support: Doctors, nurses, and military medical personnel bring advanced capabilities
General Principle: The same CABDE approach is applied at all levels. Complexity of interventions increases further from the scene. Each stage aims to stabilise patients for safe transfer to the next care point.
Summary
- Major incident care is structured and prioritised according to the SCATTER-U process
- Scene safety and organisational control take precedence over immediate treatment
- Triage and minimal interventions ensure rapid evacuation and access to definitive care
- CABDE principles guide treatment across all environments
- The goal is to stabilise casualties efficiently, maximising survival and minimising delays
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