Ready for a major incident: how to ensure we’re prepared for the worst

As the provider of a major trauma centre for north-west London, we treat people with multiple and critical injuries. This means we need to be ready to deal with a major incident whenever it happens – whether it’s a bomb blast or bus crash. In these circumstances, and when we’re under intense pressure, it’s vital there are plans in place to ensure we can carry on providing safe, high-quality care to all our patients. Here emergency planner, Niina Bell, explains why our emergency response is all about preparedness.

Emergency planning is about being equipped and ready so when things go wrong everybody knows what to do – not only when there’s a major incident like a train crash or terrorist event, but also if there’s a fire at one of our hospitals or a serious power cut. We have plans for each of our hospital sites which set out exactly what staff and the organisation as a whole will do in an emergency situation. Every member of staff is made familiar with these plans when they join the Trust and certain job roles have a dedicated action card outlining step-by-step what individuals need to do in an emergency.

We constantly review these plans to ensure they are robust and up to date and test them annually. Every three years we take part in a simulated ‘live’ incident where we stress-test our plans at the most practical level. These ‘live’ events are like large-scale role-play exercises based on realistic scenarios where different staff from across the Trust, alongside agencies like the police and London Ambulance Service, respond and play their role as they would in a real incident.

In March this year we took part in ‘Exercise Unified Response’. This was the biggest emergency planning exercise the UK has ever seen and we were one of 70 organisations from across Europe who participated. Emergency planners like me get extremely excited about these kinds of exercises; it’s a chance to put all our skills and experience into practice.

The scenario we tested in this exercise involved a tower block collapsing into Waterloo station in London. This affected the tunnels underneath the station and meant there were mass casualties and people trapped in underground trains. The exercise included eight real tube carriages, tons of rubble and more than 2,000 volunteers playing casualties, bystanders and worried relatives.

When it came to play our part in the exercise we managed to triage, treat and admit 'casualties’ to St Mary’s hospital within the first hour. The casualties were all actors of course and had pretend, trauma-related injuries as a result of the building collapse and an underground train collision. Injuries ranged from head traumas, internal bleeding, glass injuries caused by glass penetrating the skin, and burns. Doctors and nurses from the A&E department had to 'treat' the casualties as they would in real life, transferring patients to theatres for surgery as needed.

Our A&E teams deal with serious injuries every day, but the exercise was an opportunity for them to practice dealing with multiple, severely injured people coming to hospital on mass. It meant staff could test their skills in a high pressure scenario, getting a real feel for what it would be like – but in a safe, simulated environment.

We followed the live play by a ‘command post exercise’ where communications within and between organisations were tested using the mechanisms that would be available in a real incident, like hand-held radios. As in any major incident, we set-up two gold and silver control rooms to simulate how we’d manage our strategic (gold) and tactical (silver) response to the incident. Participants in the exercise were fed information from the scenario and had to respond. For example, they were told dozens more seriously injured casualties had just arrived at A&E and this helped to test how they would manage the influx of patients coming to hospital in the hours and days after the incident.

All sorts of staff from across our hospitals took part and responded to the live exercise, including: doctors, nurses, radiologists, porters, security staff and press officers. Staff have told me how valuable they found the exercise and how it helped them to apply their knowledge in a more meaningful way than simply reading a document. For my team in emergency planning, these kinds of exercises are absolutely the best way to identify any practical problems in our emergency response plans and to know if different parts of the plans work seamlessly together. It’s also a rare opportunity to get feedback from incident 'casualties’ - the actors - who let us know how they felt during their treatment.