CHAPTER 1
Introduction

Learning outcomes

After reading this chapter you will be able to:

• Describe what defines a major incident
• Discuss the classifications of a major incident

1.1 What is a major incident?

In health service terms a major incident can be defined as any incident where the location, number, severity or type of live casualties requires extraordinary resources. The number of casualties alone does not determine a major incident for the health services. Thirty minor injuries that self-evacuate from the scene may be managed effectively by one hospital without the requirement for additional pre-hospital or hospital resources. The same number of severely injured casualties will almost certainly require extraordinary resources. Certain medical resources may be very scarce (for example, intensive care beds) or regionalised (for example, burns surgery), and small incidents with relatively few casualties can therefore require early involvement of regional or national resources. Where there are large numbers of dead with few or no survivors, there is often no major incident for the health services. An incident in a remote or difficult to access location may also demand greater resources to effect the rescue of casualties.

Factors that influence the declaration of a major incident for the health service

• Number of casualties
• Severity of injury
• Numbers of medical responders
• Access to medical resources
• Location (urban vs rural)

In a similar vein, a major incident for one emergency service may not be a major incident for all other services. Where fire or chemical spillage is the predominant issue, without risk to life, a major incident response will be required from the fire and rescue service without the same level of response from other services. Where public disorder is the predominant problem, the principal response will be from the police. The following examples illustrate this point:

On 2 September 1666 a fire started in a baker's shop on Pudding Lane; it lasted 4 days and left 80% of London's buildings in ruins. A disaster on such a scale is hard to imagine and would certainly overwhelm the resources of the modern fire and rescue service. In fact, only a handful of people died in this, the Great Fire of London.

On 27 March 1977 a KLM (Royal Dutch Airlines) Boeing 747 collided with a PanAM Boeing 747 aircraft during take-off in fog. All passengers and members of the crew died (total 583). This is the worst aviation disaster in history but had very little impact on the health response as all the casualties were dead.

In January 1975 a large petrol tanker hit the Tasman Bridge, a major transport structure linking the suburbs of Hobart, Tasmania. Thirteen people died, no one was left injured.

In April 1990 the passenger ferry M/S Scandinavian Star caught fire on the Swedish west coast. Most passengers were asleep and smoke inhalation caused the death of 158 people. The surviving passengers were mostly uninjured.

A health service major incident is influenced by:

1. Number of live casualties.
2. Severity of injuries.
3. Access to medical resources (ITU beds, burns beds).
4. Incident location (remote vs urban).

Local highlights: Major incident definitions

A major incident requiring extraordinary resources occurred three or four times per year in the UK (with a range from 0 to 11 incidents per annum) in the 30 years from 1966 to 1996. Although there is a particular emphasis on terrorist-related incidents in the west over the last two decades, it must be remembered that non-terrorist-related incidents continue to occur and are frequently associated with greater morbidity and mortality.

1.2 Classification of major incidents

It is convenient to classify major incidents in three ways:

1. Natural or man-made.
2. Simple or compound.
3. Compensated or uncompensated.

Natural incidents

A natural major incident is the result of a natural event such as an earthquake, flood, fire, volcano, tsunami, drought, famine or pestilence (Table 1.1). To some extent, the natural disaster will be self-propagating: following a flood or earthquake those left homeless and starving will be vulnerable to the diseases associated with squalor.

Table 1.1 Natural incidents (number of injured not accurately known)

Man-made incidents

The range of man-made incidents is huge, but certain patterns are clear. A major incident can occur whenever large numbers of people gather together to travel, to work or for leisure. In some circumstances, the incident will be the result of deliberate terrorist activity.

Transport incidents

These are the commonest type of man-made major incidents. All forms of bulk transport of people are associated with a serious list of incidents (Table 1.2). The worst ever road traffic accident occurred in the Salang tunnel in Afghanistan in 1982 when a petrol tanker exploded. Such was the degree of destruction that only an estimate could be made of the number of dead of between 1100 and 2700.

Table 1.2 Transport incidents