Learning from Major Incidents

Major Incidents

In this month’s EMJ, David Lowe, Jonathan Millar and colleagues from Glasgow Royal Infirmary (GRI) and the University of Glasgow share their experience gained from the tragic events that unfolded in their city in 2013 and 2014. The first –  where a police helicopter crashed into the Clutha Vaults pub due to a fuel management issue – led to ten deaths and several seriously injured, while the second caused 6 deaths and 15 injured when the driver of a bin lorry crashed after blacking out at the wheel. Many of those injured were taken to GRI, and in the aftermath of these incidents, lessons were learnt and action points generated. Ten key lessons are included in the article, and with many major incidents occurring throughout Europe and the rest of the world in recent months, it’s sadly all too possible that you may have to declare one in your department in the near future. Reading about and learning from the experience of others can help you to refine your own disaster management plans.

Whilst some of the points may have already entered your mind, such as early allocation of roles, and having an effective command and control structure to co-ordinate resources both in the ED and in the rest of the hospital, there are some less obvious, but equally key points for learning. In a smaller hospital, particularly if you have a major trauma unit nearby, trauma may be a rare sighting, and on activation of the trauma team the response may be slow with some members unclear of their responsibilities. The Glasgow team recommend a low threshold for activation of the trauma team, as this will not only help members to become more familiar with the process and each other, but also raises awareness of trauma care in the hospital.

Another change involves drug preparation. It was found that in a major incident, multiple patients may need an RSI, analgesia, sedation, or other key medication such as tranexamic acid. This can lead to several doctors or nurses all trying to access the same medications at one time. They have implemented a protocol that on activation of the major incident plan, designated staff will draw up a number of drugs bundles which can then be accessed quickly by the trauma teams, without a fight at the drugs cupboard or the fridge.

The article has a number of other fantastic learning points and is well worth a read. If you have access, you can also read the reply by Sophie Hardy which explores the difficulties with sharing major incident experience, and a link to the website majorincidentreporting.net which is a global initiative to aid this. On the same subject, if you haven’t already read the paper (published in the Lancet in November 2015) by Martin Hirsch, Pierre Carli and colleagues on the response to the multisite terrorist attacks in Paris, then please do. You can also see Youri Yordanov, one of the authors of the paper, give one of the keynote lectures at this year’s RCEM Scientific Conference in Bournemouth in September, where he will be speaking on the lessons learnt from Paris.