Major Incident Medical Management and Support
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| Major Incident Medical Management and Support | |
|---|---|
| Name | Major Incident Medical Management and Support |
| Author | -- |
| Country | -- |
| Language | English |
| Subject | Emergency medicine, disaster medicine |
Major Incident Medical Management and Support Major Incident Medical Management and Support is a framework for organizing clinical, operational, and strategic responses to mass-casualty events. Drawing on doctrines used by World Health Organization, United Nations Office for the Coordination of Humanitarian Affairs, International Committee of the Red Cross, NATO, and national agencies such as National Health Service (England), Federal Emergency Management Agency, and Australian Department of Health and Aged Care, it integrates incident command, triage, transport, and hospital surge to reduce mortality and morbidity. The approach synthesizes lessons from incidents including the 9/11 attacks, 2004 Indian Ocean earthquake and tsunami, Hurricane Katrina, Tokyo sarin attack, and Sandy Hook Elementary School shooting.
Introduction
Major-incident medical systems evolved from doctrines shaped by events like the Spanish Civil War, World War II, and peacetime mass gatherings such as the Hajj. Influential organizations including World Health Organization, Médecins Sans Frontières, American College of Surgeons, International Federation of Red Cross and Red Crescent Societies, and national services such as London Ambulance Service and New York City Fire Department helped codify principles. Key operational concepts were tested during incidents associated with Manchester Arena bombing, Bataclan attack, Grenfell Tower fire, and Christchurch mosque shootings.
Definitions and Scope
The term covers preparedness, immediate clinical care, logistics, and recovery as applied to incidents like natural hazards (e.g., Kashmir earthquake 2005), technological disasters (e.g., Chernobyl disaster), chemical attacks (e.g., Tokyo sarin attack), radiological events (e.g., Fukushima Daiichi nuclear disaster), and mass violence (e.g., Orlando nightclub shooting). Frameworks reference standards from World Health Organization, International Health Regulations (2005), European Centre for Disease Prevention and Control, and professional bodies such as the Royal College of Surgeons and American College of Emergency Physicians.
Command, Control, and Coordination
Command structures adopt models used by Incident Command System, Gold–Silver–Bronze command, National Incident Management System, and multinational operations like Operation Unified Protector. Coordination involves stakeholders such as Ministry of Health (various), Local Government Association, Red Cross, United Nations Office for Disaster Risk Reduction, and auxiliary services like British Red Cross and St John Ambulance. Communications employ systems interoperable with infrastructures exemplified by TETRA, Project 25, Global Positioning System, and regional coordination centers such as Pan American Health Organization.
Triage and Clinical Management
Triage protocols derive from military practice in conflicts such as World War I and Vietnam War and civilian adaptations by bodies like American College of Surgeons and Royal College of Emergency Medicine. Common methods include systems resembling START and SALT, with clinical algorithms informed by guidelines from World Health Organization, Centers for Disease Control and Prevention, and specialty colleges including American Academy of Pediatrics and Society of Critical Care Medicine. Clinical care pathways incorporate practices from trauma centers such as Massachusetts General Hospital, Johns Hopkins Hospital, and St Thomas' Hospital for hemorrhage control, airway management, and damage control surgery.
Prehospital and Transport Operations
Prehospital response draws on models used by services such as London Ambulance Service, Los Angeles County Fire Department, and Australian Ambulance Service. Ambulance triage, responder safety, and scene management coordinate with law enforcement units like Metropolitan Police Service and New York Police Department and fire services such as Tokyo Fire Department. Air medical evacuation employs assets similar to Royal Air Force, United States Air Force, and civilian providers like Air Ambulance Service, with logistical frameworks influenced by Pan American Health Organization and multinational evacuations such as those during Haiti earthquake 2010.
Hospital Response and Surge Capacity
Hospital surge planning references examples from Massachusetts General Hospital during Boston Marathon bombing, Royal London Hospital during terrorist incidents, and international models from Cleveland Clinic and Charité – Universitätsmedizin Berlin. Strategies include activation of major incident plans, cohorting, cancellation of elective services, expansion using field hospitals such as those deployed by Médecins Sans Frontières and military medical units like USNS Comfort, and supply chain coordination with agencies like World Health Organization and United Nations Logistics Cluster.
Training, Simulation, and Preparedness
Education draws on curricula from institutions such as Harvard Medical School, King's College London, University of Toronto Faculty of Medicine, and professional courses by Royal College of Surgeons and American College of Emergency Physicians. Simulation and exercises use scenarios modeled on events like SARS outbreak, Ebola virus epidemic in West Africa (2014–2016), and complex incidents run by NATO and national civil protection agencies. Research and continuous improvement are supported by journals and societies including The Lancet, New England Journal of Medicine, Disaster Medicine and Public Health Preparedness, and International Society for Traumatic Stress Studies.