Major Incident Plan Preparedness 'Worse Than 2006'

Nicky Broyd

August 13, 2019

Would you know what to do if a major incident happened on your patch? A survey reported in the Emergency Medicine Journal found half of key doctors haven’t read their hospital's major incident plan (MIP).

Lead researcher Dr Jamie Mawhinney, from the Academic Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, told Medscape News UK: "We were surprised to find that there had been no improvement in confidence since our 2006 study, especially given recent high profile emergencies such as the Grenfell Tower disaster and the London Bridge and Westminster terror attacks.

"On the contrary, our results show that middle-grade doctors are less confident in responding to the major incident plan than previously."

MIPs are put together to respond to large casualty events and are required under the Civil Contingencies Act.

Telephone Survey

To assess any knowledge gaps, the research team phoned on-call registrars in anaesthetics, emergency medicine, general surgery, trauma and orthopaedics in 74 NHS trusts in England with major emergency departments.

The research team was from Guy's and St Thomas' NHS Foundation Trust; Nuffield Orthopaedic Centre, Oxford, and the Medical Sciences Division, University of Oxford. Contact was made in the first 3 months of 2017.

Of 296 eligible doctors, 62% could be contacted and agreed to take part.

The findings were:

  • 50% had read all of their MIP or the section relating to them

  • 25% had read part of the MIP

  • 46.8% were confident that they knew where to find the plan documents, 18% didn’t know where to find the plan, the remainder were unsure

  • 36% knew what their role would be as part of the MIP – lower than in 2006

  • 27% didn’t know their role in the plan

Trauma and orthopaedics drew the biggest response rate (73%), emergency medicine was lowest (50%). However, emergency doctors were found to be the best prepared.

No assessments were made about the contents of individual plans.

Increased Workload

The survey was observational with a relatively low response rate.

Only specialist registrars, those currently most likely to lead an emergency response, were included in the study but the authors point out this may be changing as more consultants are becoming involved in 24/7 cover at major trauma centres.

Asked why things had not improved since 2006 Dr Mawhinney said: "I think it is likely that increased workload on an already stretched system has resulted in a focus on immediately urgent service-provision rather than training for potential future events, however disastrous."

The researchers wrote: "We would like to emphasise that our aim in completing this study was not to demean an already overstretched workforce but to assess how successful our approach to major incident preparation is as an organisation and what remains to be done."

Disaster Drills

Dr Mawhinney said: "In order to improve confidence amongst staff I believe it will be necessary to increase training. Specifically, we believe that all doctors should receive education on their hospital's own major incident plan at all trust inductions, as well as an abbreviated version of their own particular role."

The research team noted the use of 'action cards' issued by some hospitals to summarise key roles in an emergency and recommended they should be included in all staff induction packs.

Some doctors who'd participated in 'disaster drills' reported that they had been beneficial and it was noted that virtual reality and simulations may also be options.

Preparation for the next major incident: are we ready? A 12-year update. Emergency Medicine Journal , A 12-year update doi 10.1136/emermed-2019-208436, 12th August 2019.

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