Major Incident Management

Major incident management

A major incident overwhelms routine local emergency provision and requires multi‑agency, coordinated escalation. Typical causes include large transport collisions, disasters, fires/explosions, hazardous‑materials releases and mass‑casualty criminal events.

The emergency department (ED) is central to reception, triage, immediate lifesaving care, decontamination and onward disposition. Effective response depends on early recognition, simple reproducible triage, clear command and control, plain‑English communications, and protection of staff and patients (JESIP; GOV.UK).

Immediate operational checklist

• Declare the incident and send a concise situational report using the M/ETHANE format (Major incident; Exact location; Type; Hazards; Access; Number of casualties; Emergency services). Update frequently as the incident evolves (GOV.UK).
• Activate the hospital major incident plan (EPRR), establish command (Strategic/Tactical/Operational or Gold/Silver/Bronze), mobilise staff and open predetermined casualty reception and triage areas (RCEM).
• Assign clear roles, for example: senior clinician to lead triage/clinical coordination, resus lead, decontamination lead, bed/flow coordinator, security and family liaison.
• Commence rapid triage (Triage Sieve / MITT / Ten‑second triage as appropriate) using tags and tracking; start immediate lifesaving interventions (catastrophic haemorrhage control, airway, breathing) in parallel (NICE NG39; RCEM).
• If hazardous contamination is suspected, prevent entry of contaminated patients into the ED; set up decontamination and separate self‑presenter routes and ensure appropriate PPE for staff (RCEM).
• Maintain a single point of contact with ambulance control and on‑scene command and designate a...