1. Major Emergency Response Libby McGugan Consultant in Emergency Medicine

2. Major Emergency  Location, number, severity or type of live casualties requires extraordinary resources  3 - 4 times per year in UK  We have a statutory duty to provide response

6. In a nutshell  SAS will inform the duty charge nurse in A&E  CN / duty A&E consultant decide on ‘standby’ vs ‘declared’  Switchboard put out call to duty staff

7. How do you know what to do?  Action cards are made up to tell staff what to do.  Do what it says on the card!

8. Major Incident Standby  Consult with your duty consultant  Go to Junior Doctor’s Mess, ground floor next to Admission Unit 2 (surgical) to collect action card  Know how to access phone numbers for off duty staff in your team

9. Example of action card  ACTION CARD 7  DUTY SURGICAL REGISTRAR  Informed by switchboard  Duties  STANDBY  1. Consult with Consultant Surgeon  2. Proceed to the Junior Doctor’s Mess and collect your Action Card  DECLARED  3. Cascade to all General Surgical Registrars and Surgical Doctors.  4. Assess General Surgical wards for patients who could be transferred or discharged  and advise the ward Nurses in Charge.  5. Advise the Hospital Control Centre (extensions 27984/27985) of staff or resource  deficiencies.  6. Proceed to A&E for tasking

10. Major Incident Declared  Cascade call out to all off duty medical staff in your team  Keep a record of who you have contacted and their response  Tell them Major Incident Declared. Report to Junior Doctor’s Mess. Bring identity badge

11. Name / GradeTimeAttend : Y / N / UC UC = unable to contact APPENDIX 1 : CASCADING CALLOUT NAME OF CASCADING STAFF MEMBER _______________ DATE ______ Tell staff 1. There is a major emergency 2. Report to Junior Doctor’s Mess (entrance opposite lab block) 3. Bring ID badge

12. Cascade call out  You need to know how to access to phone numbers of your team  External call barriers will be removed for calls  YOU ARE PIVOTAL TO NHS FIFE’S RESPONSE TO A MAJOR INCIDENT

13. Major Incident Declared  Depending on scale of incident, some staff may asked to remain on standby for next shift – coordinator will advise  Consider which patients on wards can be discharged  Clear theatres

14. Major Incident Declared  Other specialists eg O&G / paeds / maxillofacial / ENT may be contacted if required or if incident large enough to need all hands on deck

15. Site Medical Team  Team may be requested to attend scene by MIO if - scene overwhelmed, delayed egress - specific incident  Team likely to consist of - ED cons - Anaesthetic reg / cons - Orthopaedic reg / cons - Surgical reg / cons - Anaesthetic reg / cons - Orthopaedic reg / cons - Surgical reg / cons

16. Site Medical Team  Equipment / PPE stored in Major Accident Store A&E  Specialists need to be familiar with kit

17. Where to find out  Intranet  Search for MAJOR EMERGENCY

18. Any Questions? Any Questions?

19. Summary  It’s not rocket science  Need to have access to updated off duty contact numbers  Be clear about your role in cascading