link to page 24

Major Incident Plan
2008

IF A MJAOR INCIDENT HAS OCCURRED
REFER TO THE ACTION CARDS ON PAGE 25

Version Version
5
Ratified By
West Midlands Ambulance Service Executive
Board
Date Ratified
October 27th 2008
Principal Authors
Regional Head of Emergency Preparedness/
Health Emergency Planning Officer
Responsible Officer
Regional Head of Emergency Preparedness
Date for Review
September 2009
Intended Audience
General Public
Supporting Documentation
NHS West Midlands ERMA CONOPS 2008
WMAS Gold Control Plan 2008
WMAS RAMP Plan 2008
WMAS Emergency Preparedness SOPs
NHS West Midlands Mutual Aid Process (Draft 1.3)
WMAS Adverse Weather Plan

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Chief Executive’s Foreword

This revised Major Incident Plan sets out the activation, response, management and
mutual aid arrangements for West Midlands Ambulance Service (WMAS). It describes
how we, as a regional service, will operate in response to a major incident, to ensure that
we are able to meet the expectations of legislation and guidance, our partner agencies
and most importantly the needs of the public we serve.

he arrangements set out in this Regional Plan build on day-to-day arrangements, which
have been in place for a long time and are tried and tested. It outlines how new
developments will be utilised to best effect to enhance major incident response. Whilst
this document provides an overview and generic response structure, it is not exhaustive
and is supported by specific plans and arrangements related to identified risks. It is
important to stress that incident management should remain flexible to adapt responses
to uncertain and complex environments.

I am committed, with the Trust board, to seeing a culture of preparedness develop within
the Trust, which will in turn ensure that we have robust emergency response and
management system in place, capable of dealing with a range of scenarios. In order for
this to occur I need your support, ensuring that you are aware of your role, understand
the principles of command and control and ensure you are appropriately trained.

I, as the Chief Executive accept overall responsibility for major emergency planning and
have appointed and given authority to a senior and experienced manager to lead the
planning team.

However all Trust staff must be fully aware of the contents of this document and I urge
you not to wait until an emergency occurs to pick up this plan.

Anthony C Marsh
Chief Executive

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West Midlands Ambulance Service Concept of Operations (CONOPS)

This CONOPS has been developed to provide a clear set of command, control, co-ordination and
communication (C4) arrangements that will manage our Trust response to incidents and major
emergencies.

It will set out the principles upon which we will operate as a Trust to ensure we have an
appropriate, proportionate and resilient response to any incident in which we become involved:
either leading or supporting.

It is built upon the following important principles:

  Locus of command at the most appropriate level (command is determined by a need to
be involved rather than a desire to be)
  That all staff are trained and competent (i.e. that all frontline staff have undergone
mandatory major incident training which cover scene management from an ambulance
service point of view)
  Clear escalation and management mechanisms
  Well defined and understood C4 arrangements
  Proportionate and appropriate response
  Sits within the context of, and adheres to, Multi-agency response arrangements
  Each locality having robust supporting plans and infrastructure in place

And also sets out the following:

a)  Defines a local or regional incident for the Trust

b)  Sets out what it means to be in charge (take leadership/command) of WMAS response to
an incident

c)  Sets out the principles of Escalation to the next level of the WMAS response (i.e. local to
regional)

d) Risk/impact
assessment

e)  Sets out our C4 structures and principles of working within them

f)  Defines a Standard Operating Procedures for determining our “core” actions during
incidents

g)  Provides individual action cards which describe “key” actions for specific roles within WMAS
major incident arrangements

Defining Local and Regional Incidents for the Trust

A Local Incident

“An incident, which is managed within the resources of a locality”

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A Regional Incident

“Any incident, which cannot be managed within the resources of a single locality or
requires regional command to be put in place”

What It Means To Be In Charge (Take Leadership/Command) Of WMAS Response To
An Incident

1)
Formally logging “who is in charge”

2)
Determining the level of incident for WMAS (local or regional) and communicating
this to other parts of the service and partner agencies

3)
Developing the overall strategy for the incident response

4)
Undertaking a risk and impact assessment to determine “what we are dealing with”

5)
Ensuring that a central electronic policy/decision and reason log is kept which
includes individual actions

6)
Putting in place a structure for the response that identifies resources needed to
effectively manage the incident (this includes ensuring officers are also assigned to
the multi-agency structures) and ensuring lines of communication are in place and
working

7)
Communicate this structure internally within the Trust and to partners who are
dealing with the incident to ensure they know our command and control structure
and shape

8)
Ensure co-ordination of resources and assets deployed to support the management
of the incident

9)
Sign off all written briefings and media statements

10)  Maintain oversight of the incident and all elements of WMAS response with
responsibility for escalation and ensuring resources meet the requirements of the
incident

11)  Ensure that all actions undertaken protect the integrity and reputation of WMAS and
the NHS

12)  Ensure that all of the right expertise across the Trust is in place and heeded when
formulating the response to an incident (i.e., are all the right people involved?)

13)  Ensure that any requests for appropriate WMAS support by partners and
stakeholders are met

14)  Escalate the level of incident and so pass on the lead elsewhere within the Trust
(Locality to Regional command)

Principles of Escalation to the next level of WMAS response (i.e. local to regional)

The WMAS response to an incident is premised on ensuring the locus of command is as
near to the incident as possible.  The level of response (local or regional) will be defined
by where command sits and the level of resources needed to run the incident.

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In essence an incident can escalate within WMAS for two reasons
  Command
  Resources

Command

Escalation through command can be for several reasons:

  The person in charge recognises they can no longer cope
  The Chief Executive Officer (or their nominated deputy) has concerns over the
way the incident is being managed
  The incident becomes more complex and therefore the management sits at a
higher level (e.g. seriousness/scale of the incident, political or media
interest/involvement) may drive this)

Resources

The resources available cannot meet the demand of the incident response and therefore
requires escalation to bring more on line; this may be for the following reasons:

  The incident grows (magnitude, geographical spread, politically)
  The incident response needs to be sustained for a longer period of time (e.g.
influenza pandemic)
  To meet partner requirements/expectations of the WMAS response
  Scale and magnitude of the incident (mass casualties, mass decontamination)

Risk assessment – (further copy at Annex 2)

In order to determine the level of the incident, resources needed and command structure to put in
place it will be important for a risk assessment to be carried out. Risk assessments should be
dynamic and undertaken at regular intervals during an incident as they are a vital decision
support tool and assist with determining the overall strategy for managing the incident response.

This following risk assessment is designed to be quick and simple.
The SILVER and GOLD commanders should use it as soon as they are
notified: it should take no more than 10 minutes to complete and gives
additional information to the METHANE report

Question/consideration
Answer  Notes/comments
Is this a WMAS incident
Y/N

Location

Nature of incident

Number of casualties (injured,

exposed or affected)
Have any multi-agency or single
Y/N

agency groups been set up to
manage the incident?
Are the command and control
Y/N

arrangements in place for WMAS
Is there an ongoing risk?
Y/N

What is the level of public concern

High/Medium/Low
What is the level of media interest?

High/Medium/Low
Are there any cordons or control
Y/N

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measures in place?
Complexity of situation

Is there a need for specialist
Y/N

support or equipment?
Is this a malicious or deliberate act?  Y/N

WMAS Command, Control, Co-ordination and Communication Arrangements (C4)

Will determine how WMAS will configure itself to respond to incidents and set out how all staff
within the service will operate during the response to an incident. It is absolutely vital that all
staff understand the command rules and work within them to ensure we have a robust, credible
and safe response:

C4 will adhere to the well-understood GOLD, SILVER and BRONZE terminology and command
that exists within other blue light responder agencies and apply to all scenes that this service
attends

Gold – Strategic
Silver – Tactical
Bronze – Operational

The command and control (C4) hierarchy will be implemented from WMAS first attendance at a
scene. It is not intended that command and control management levels are necessarily pre-
determined by rank or seniority of the individual, but out of the necessity of the role and
functions that must be discharged

Due regard will be given to the responsibilities of officers and managers attending such an
incident, to ensure their safety and well being and these are detailed in

INDIVIDUAL ROLE SPECIFIC ACTION CARDS (ANNEX 1)

Important principles of C4 for WMAS

1.  There can only ever be one GOLD operating within the Trust at any one time: i.e. when a
locality is managing an incident and there is a need to escalate to regional level, the
command moves to region. This means that GOLD COMMAND will be at a regional level
and therefore the Locality GOLD reverts to GOLD LIAISON as Command moves with
escalation

2.  There will remain a need within the regional service to maintain and attend multi agency
locality command and control structures during the response to incidents (i.e. SCG or Police
Gold)

3.  Officers within the Trust must respect and adhere to the chain of command

4.  Officers are empowered within the C4 structures to undertake their roles in line with core
action cards

5.  Officers involved in the response to an incident (regardless of rank) must have a specific
action card and set of functions to fulfil. This ensures that officers are involved because
they have a need to be rather than a desire to be.

6.  Command structure is in place to eliminate duplication of functions and ambiguity

7.  That two way dialogue and communication is essential up and down the command chain

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WMAS C4 for a LOCAL incident
Overall Incident/Situation
WMA
MAS Internal COMMAND
ND
LINK
LINKS T
S TO MULTI-AGENCY
COM
COMMAND STRUC
RUCTURES
URES
GOLD LIAISON
Multi- Agency
Locality/ies
GOLD
Multi-Agency
SILVER
SILVER
BRONZE
Multi-agency
BRONZE
Command =
Liaison =
WMAS C4 for a REGIONAL Incident (Gold at Locality level reverts to “Liaison” with
“Command” at Regional level)
Overall Incident/Situation
WMAS Regional GOLD
“COM
CO
MA
MMAND
ND”
WMAS GOLD COMMAND
LINK
NKS TO MULTI-AGENCY
COMMAND STRUCTURES
GOLD LIAISON
Multi- Agency
Locality/ies
GOLD
scene
Multi-Agency
SILVER
SILVER
BRONZE
Multi-agency
BRONZE
Command =
Liaison =

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UK Security Status Threat Level

Terrorism threat levels are designed to give a broad indication of the likelihood of a
terrorist attack. They are based on the assessment of a range of factors including current
intelligence, recent events and what is known about terrorist intentions and capabilities.
The following categories of threat and the UK has been at Severe alert status since the
London Bombings (7th July 2005).

CRITICAL
An attack is expected imminently
SEVERE
An attack is highly likely
SUBSTANTIAL  An attack is a strong possibility
MODERATE
An attack is possible but not likely
LOW
An attack is not likely

A move to Critical therefore is seen as a significant trigger and the following
predetermined actions will be initiated. These are over and above or complimentary to
our day to day modus operandi.

1.  All staff will be notified of the change in threat level and encouraged to remain
vigilant at all times and to report any concerns or intelligence to on-call emergency
preparedness manager (via a range of communications mechanisms including the
intranet, weekly briefing and verbal briefings from line managers)
2.  Staff to familiarise themselves with the Major Incident plan and action cards.
3. All on-call staff to confirm contact details for individual issue communication
equipment are provided to EOC and that such devices are charged and fully
functioning (Mobile telephone, BlackBerry, 3G cards, Airwave radios, pagers etc).
4.   Conduct a trust-wide communications exercise
5.  Ready (pre-activate) gold Control for the duration of the Critical status (including a
live test of the facilities)
6.  Confirm Major Incident vehicles and associated equipment are operationally ready
(including urgent maintenance if required)
7.  All operational staff with personal protective equipment (EH20’s, EPDs etc) to
ensure they are worn on their persons whilst on duty, and to ensure they are fully
functioning and have received training.
8. Station Managers are required to check that operational staff are physically
wearing EPDs and EH20s and fully conversant with their operation.
9.  Gold Commanders ensure that level of threat is covered in on-call handover
briefings for the duration of the Critical status
10. Emergency Preparedness department will liase with Police and other security
agencies and will take responsibility for briefing Chief Executive and Gold
Commanders of the Trust with any information that can be shared.
11. Specific Intelligence will only be shared with confirmed staff security cleared to SC
level.
12. Staff will be informed of any further changes to the threat level or subsequent
actions

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Major Incident Plan

1. Introduction

This Major Incident plan sets out the procedures adopted by West Midlands Ambulance
Service (WMAS). It is produced in modular form so that it is easily updated as new
sections are developed of reviewed.

The remainder of the Major Incident Plan is divided into 2 sections

1. WMAS Generic Major Incident Plan
2. WMAS Incident Specific Plans

In the initial stages of a Major Incident the ambulance service provides an essential
gateway between the NHS and other responding agencies. It is therefore imperative that
the ambulance service rapidly identifies and declares a major incident, or the potential for
a major incident. Ambulance service plans must also therefore reflect the responsibilities
to alert, mobilise and co-ordinate NHS resources acting in support of the wider NHS
response.

1.1 Objectives of the Major Incident Plan

Objectives

  Provide a coherent and resilient set of arrangements to enable WMAS to discharge its
emergency response duties
  Mitigate the impacts of a Major Incident
  Ensure duty of care to patients and staff is maintained
  Ensure integrated response both internally and externally
  Assist the return to normality of the community following an incident
  Provide a methodology for incorporating lessons identified into future arrangements

1.2 Major Incident Terminology and Triggers

A Major Incident is defined as an event whose impact cannot be handled within routine
service arrangements. It requires the implementation of special procedures by one or
more of the emergency services, the NHS or a local authority to respond to it1.

For the NHS, a Major Incident is defined as Any occurrence that presents serious threat
to the health of the community, disruption to the service or causes (or is likely to cause)
such numbers or types of casualties as to require special arrangements to be
implemented by hospitals, ambulance trusts or primary care organisations.

More specifically it requires the implementation of

  Rescue, triage, treatment and transport of large numbers of casualties
  Integrated management of the emergency service response
  Mobilisation of emergency services to cater for threat of death, injury and
homelessness

1 NHS Emergency Planning Guidance 2005

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  Mobilisation of specialist resources

1.3 Major Incident Notification Messages

The following standard accepted messages should be used by the Ambulance Service
when informing NHS partners of incidents.

Major Incident – Standby: This alerts the hospital that they may need to activate their
Major Incident Plan and to make advance preparations. As much information as possible
should be passed to the hospital. The hospital should receive an indication as the
whether they will be designated receiving or supporting for the incident.

Major Incident Declared – Activate Plan: This notifies the hospital to activate their plan.
It should be confirmed as to whether they are supporting or receiving and any details of
casualties expected.

Major Incident Cancelled: this message rescinds either of the two above messages at
any time

Major Incident – Casualty Evacuation Complete: all receiving and supporting hospitals
should be informed when the last casualty has been removed from the scene. This is not
an instruction for the hospitals to stand down, which is an internal decision.

1.4 Specific Risks within WMAS Operational Area

  16 sites with off site plans under the COMAH regulations (1999)
  Birmingham International Airport, Coventry Airport, Wolverhampton Business Airport
  Major centres of population
  Extensive road and rail transport infrastructure
  Liquid and Gas fuel pipelines
  Major Sporting and leisure and shopping venues
  Special Event plans – V Festival, Political Party Conferences
  Numerous military establishments

1.5 Ambulance Service Responsibilities

The Ambulance Service is principally geared to the immediate clinical needs of those
directly or indirectly associated with an incident and their subsequent transportation to
treatment centres.

The responsibilities of the Ambulance Service include

  The saving of life in conjunction with other emergency services
  To instigate a command structure, including the appointment of a Medical Incident
Commander as required
  To protect the health and safety of all NHS personnel on site
  To provide and coordinate on site NHS communications
  To alert receiving hospitals for the receipt of injured
  To undertake ah health service assessment of the incident

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  To instigate a triage process, using triage sieve on all patients and triage sort as
required
  To provide treatment to casualties
  To provide most appropriate types of transportation of casualties to treatment centres
  To provide clinical decontamination and direct mass decontamination, that includes
dirty side triage and limited dirty side clinical care
  To mobilise UK National Capabilities Stock as appropriate
  To maintain adequate levels of cover throughout the service area, reducing disruption
to normal workload
  To alert and coordinate the work of the Voluntary Aid Societies
  To have the facility to call on ambulance tactical advisor and other sources of
information
  Provide a nominated member of staff to maintain communications with receiving
hospitals
  Have the facility to deploy bulk oxygen supplies to meet requirements at the site

2. Initiation

It is probable that the initial alert will come from one of the emergency services, it is also
possible that such a call could come from any source and as such it may not always be
initially clear if an incident is one of Major proportions.

In addition to this ambulance service staff of all ranks must immediately inform the EOC if
they consider an incident to which they have been normally dispatched to could be a
Major Incident. This should take the form of a METHANE message to ensure accuracy,
brevity and clarity.

Clear SOPs have been developed for the use by EOC on the receipt this information.

It is recommended that the Major Incident Plan be initiated early, possibly unnecessarily,
rather than to delay doing so, which would have consequential risks to patient safety.

The Chief Executive may also activate the Major Incident Plan at any time in response to
a widespread incident either within the UK or internationally.

4. Initial Risk Assessment and First Actions at Scene

Rapid assessment of the scene is vital in the initial response to an incident in order that
the levels of resources can be appropriately mobilised.

The quality of first information passed from the scene will be crucial in determining the
speed and adequacy of the subsequent response. In addition, there should be regular
situation reports (SITREPS) provided to the EOC. The acronym METHANE is considered
to be good practice nationally and is consistent with doctrine in all other ambulance
services and those formally taught on Major Incident Medical Management and Support
(MIMMS) courses.

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M Major
Incident    Standby/Declared and Call Sign
E
Exact Location

Grid Reference, directions etc
T
Type of Incident

Rail, Chemical etc
H
Hazards

Present and potential
A
Access   Direction
of
approach/egress
N
Number of Casualties
Number, severity and type
E
Emergency Services
Present and required

The first WMAS resource on site becomes the Ambulance Incident Commander until
relived by a suitably trained member of staff as detailed in Action Card 7. The Ambulance
Incident Commander is the on site Silver who is responsible for the command and control
of the incident scene.

4.1 Ambulance Silver Command Cell

The Ambulance Silver Command Cell should be where the Ambulance Incident
command, Medical Commander, Communications and tactical advisor are collocated to
provide command and control of WMAS assets in response to the incident. This structure
should ensure clear communications links at scene with multi-agency partners, and
externally to Gold Control and designated hospitals. All decisions made and actions
taken in the Ambulance Silver Command Cell, should be logged by the Silver Loggist.

The Silver Command Cell should ensure that the following positions/roles become
operational as soon as possible.

  Ambulance Holding Area – which may fall outside of the Outer Cordon
  Casualty Clearing station
  Ambulance Parking Point
  Ambulance Loading Point – should be adjacent to the Casualty Clearing Station
  Ambulance Safety Officer
  Bronze Forward Incident Officer
  Triage Officers

This list is not exhaustive and a Bronze Commander may be allocated to any site-specific
supervisory role.

Silver Commanders and other officers may find it useful to refer to the CSCATTT
process, which encapsulates the all-hazard structured approach to major incident
management in seven key principles. The generic nature of these principles have been
shown to cross interservice boundaries at the scene. This is covered in WMAS Major
Incident and CBRN training courses in addition to MIMMS.

1.  Command and Control
2. Safety
3. Communication
4. Assessment
5. Triage
6. Treatment
7. Transport

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5. Safety

5.1 Safety triggers for Emergency Personnel (STEP123)

The following guidance should be used when the cause of an incident is unknown

ONE casualty, approach using normal procedures

TWO casualties, approach with caution and consider possible options

THREE or more casualties without obvious cause – DO NOT approach scene.
Withdraw and isolate, report SITREP to EOC as soon as possible.

5.2 Personal Safety

  Do not compromise your safety or that of colleagues or the public
  Don appropriate protective equipment and tabard as necessary
  Obey all cordons and safety advice
  Encourage self help for survivors with minor injuries
  Follow the instructions of the Ambulance Incident commander

6. Additional WMAS Capacity

6.1 Patient Transport Services (PTS)

In the event of a declared Major Incident the resources of PTS will assist the Emergency
and Urgent operations of WMAS in all or some of the following according to the prevailing
situation
  Participation in hospitals emergency discharge programme
  Participation in hospital to hospital transfers
  Transport at the scene for walking wounded
  Deployment to alternative treatment sites where implemented

Activation of PTS to any of the above will be decided in conjunction with the EOC Duty
manager, the Gold Commander and the PTS Manager.

6.2 Community First Responders (CFRs)

Whilst CFRs would not be tasked by the EOC to respond directly to a Major Incident,
there is a role for CFRs to provide additional cover and support to the ongoing
emergency activity unrelated to the incident to assist in making resources available for
the incident.

7. Multi-Agency Command and Control Structures and Response Arrangements

Emergency Response and Management Arrangements (ERMA) - NHS West
Midlands

ERMA provides a region-wide structure for the strategic command, control,
communication and coordination for all NHS organisations in the West Midlands is

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response to a major incident. ERMA ensures that command arrangements are robust
and can be scaled up or down in response to an incident.

WMAS Role in ERMA

As regional service provider, WMAS are in a unique position in respect of ERMA, and in
addition, form the gateway to the rest of the NHS at the scene of a major incident. In the
event that ERMA is activated, regardless of level of activation, WMAS will task an
appropriate level officer to fulfil the role of ERMA Liaison Officer who will be responsible
for ensuring the Ambulance Service perspective is considered in strategic decisions.

Multi-Agency

Large or Complex Major Incident may require the initiation of a Strategic Coordination
Group (SCG) which will require attendance and input from WMAS and is responsible for
the overall strategic multi-agency management and coordination of the incident
response. The Gold Commander is responsible for ensuring appropriate WMAS
attendance at these groups.

In some circumstances, the establishment of a Scientific and Technical Advice Cell
(STAC) may be considered. The role of this group is to provide expert advice in relation
to a range of scientific matters (including public health and environmental). It is the
responsibility of the Regional Director of Public Health (RDPH) to convene a STAC if
required. This responsibility has been devolved to the Health Protection Agency (HPA) in
the West Midlands who can be contacted via First Response.

Regional Civil Contingencies Committee (RCCC)

In exceptional circumstances, where the response to a major incident would benefit from
multi-agency coordination at a regional level, a RCCC may be convened. The role of the
RCCC is to maintain a strategic picture across the region with a focus on consequence
management, ensuring escalation of issues which cannot be resolved at local level,
guide the deployment of resources and facilitate mutual aid, and where appropriate
provide a regional spokesperson.

WMAS will be represented at RCCC by the Gold Commander or nominated deputy, by
teleconference or videoconference where circumstances demand.

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8. Triage

In situations where demand exceeds resources available it is important that treatment
priorities are established so that resources can be appropriately focused on those
patients most in need. Complete anatomical examination is too time consuming to be
used in these circumstances however, physiological methods are simple, quick and
reproducible ways of reliably identifying patients who have serious injury.

The range of Triage Categories area s follows:

(a) Immediate
First
Priority
-
  Red (P1)
(b)
Urgent Second Priority

-
  Yellow (P2)
(c)
Delayed Third Priority

-   Green (P3)
A 4th category exists for use in special circumstances (Dealing with Mass Casualties
2006)
(d)
Expectant


-
Blue (P4)

Where time allows, during transportation a Patient Report Form (PRF) should be
completed for the patient to assist the hospital Emergency Department staff.

8.1 Paediatric Triage

Separate Triage algorithms exist for paediatric casualties based on height – copies of
these algorithms are included with all triage packs on ambulances.

8.2 Casualty Labelling

WMAS has two types of casualty labelling are available on each emergency vehicle.

Triage Slap Bands

To be used for the process of Triage Sieve. These bands are single use and do not allow
for any patient information to be recorded. They are an initial prioritisation only.

Triage Cards

To be used for Triage Sort process. These uniquely numbered cards allow for patient
details e.g. brief identifying information (i.e. Male 40s) to be recorded along with details of
any drugs administered or interventions taken. This allows for the casualty to be better
tracked and provides more information for further care.

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8.3 Triage Sieve

This is a very rapid assessment of casualties. This should be undertaken at the scene of
the incident using the Slap Bands.
Y
WALKING
Priority 3 - delayed
N
N
BREATHING
Deceased
After airway
Y
opening
RESPIRATORY
< 9 – 30 >
Priority 1 -
RATE
immediate
10-29
> 2 seconds
CAPILLARY REFILL
Priority 2 - urgent
< 2 seconds

8.4 Triage Sort

This is a more anatomically based system which makes use of the Glasgow Coma Scale,
Systolic Blood Pressure and Respiratory rate. Triage Sort should be undertaken at the
Casualty Clearing Station utilising the Triage Cards. There is the opportunity to also
record basic patient details and treatments or drugs administered.

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9. Media

It should be expected that representatives of the media will arrive at the scene of a Major
Incident very quickly soon after the events. In the event of a Major Incident being
declared the EOC will notify the WMAS on call Press Officer who will coordinate
communications with media in regard to ambulance service response.

No member of WMAS staff should talk to the media without the authorisation of the Gold
Commander and the support of the Press Officer.

Should a Multi-agency press conference be convened, the Gold Commander will
nominate a spokesperson (in appropriate uniform) who will attend with the Press Officer.

If the WMAS Press Officer is required at the scene, they should proceed to an agreed
rendezvous point and liaise with colleagues from other emergency services.

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10. Staff Welfare

10.1 Welfare at Scene

Consideration should be given by the Safety Officer, Ambulance Incident Commander
and the Gold Commander for welfare arrangements to be made for staff involved in the
response to a major incident.

This could include the provision of food and water, adequate breaks and rest periods and
suitable toilet facilities.

10.2 Welfare in EOC

The EOC Duty Officer should take responsibility for ensuring EOC staff are provided with
suitable breaks recognising the increased stress levels which may arise during a major
incident. There should also be consideration given to allowing members of EOC staff to
take a few moments to contact relatives where appropriate, this should be managed by
the Duty Officer.

10.3 Welfare in Gold Control

This is covered separately in the WMAS Gold Control Plan.

11. Debriefing and Updates to the Major Incident Plan

Following a major Incident the Regional head of Emergency preparedness will be
responsible for ensuring internal debriefing is actioned, and includes all staff involved in
the response, to capture important leaning points.

Following the above, a member of the Emergency preparedness department on
cooperation with a member of staff of the divisional Management Team will participate in
any multi-agency debriefs.

All debriefs will be used to inform future planning and revision of the major incident plan.
The Major Incident plan will also be reviewed annually for relevance, context and scope.

12. Specific Arrangements

12.1 Management of the Deceased

HM Coroner is responsible for all matters concerning deceased casualties and the Police
act under the instructions if the Coroner taking temporary charge of the bodies. Such
circumstances may require the implementation of Mass Fatality Plans maintained by the
Local Authorities and addressed under separate cover.

Other than to gain access to injured casualties; those clearly deceased should NOT be
moved without Police authority in order to preserve forensic evidence.

Patients will be certified deceased by a Doctor and a record made of the time and name
of the certifying doctor. This would normally take place at one of three locations:
 At scene

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 At the Casualty Clearing Station (CCS)
 At the Receiving Hospital

Casualties found to be deceased on arrival at the receiving hospital, having been
transported by ambulance from scene, will be dealt with in compliance with extant
hospital policy. However, this should not delay the ambulance coming back in to
operation to assist the ongoing response.

As in all situations, if the deceased have to be moved or transported this should be done
with the utmost respect.

12.3 Psychosocial Staff Support

The regional Staff Advice and Liaison Service (SALS), who would be contacted by the
EOC on the declaration of a Major Incident, can provide direct support and provide
referral to specialist services and counselling.

In addition to this, information and access to further sources of help is available from
www.direct.gov.uk/helpafterincident - details of this website will be cascaded to all staff
following any Major Incident.

12.4 Hyperbaric

Where hyperbaric treatment represents the optimal clinical intervention access to these
facilities will be arranged by the EOC in contact with the national hyperbaric facilities in
the UK. Air Ambulance/Military support should be considered as appropriate transport
options in the vent of time critical hyperbaric treatment requirements

12.5 Mutual Aid Procedure

Mutual Aid arrangements are dealt with Specifically in the Mutual Aid Process.

12.6 Blast and Burn Incidents

The nature and severity of a Major Incident involving burns will initially be assessed by
the Ambulance Service, who will also map available care assets. The Ambulance
Incident Commander and Medical Incident Commander will jointly determine the
evacuation priority of casualties. Where possible, every attempt will be made to transport
patients to Emergency Departments collocated with specialised Burns Service. However,
where this is not possible, casualties will be transported to Emergency Departments for
stabilisation and specialist advice sought.

West Midlands Ambulance Service coordinates the National Burns Bed Bureau (NBBB)
which will be able to provide current burns bed availability and allow for information to be
passed to the AIC/MIC to facilitate decision making.

Transportation of burns patients will increasingly involve the use of civilian and military
Air transport resources to transfer patients to specialist centres for definitive care.

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12.7 Air Operations Unit (Air Ambulance)

Prior to the use of Air Ambulance resources at the scene of a Major Incident, the
following must occur:

  Consultation between Ambulance Incident Commander and Police Incident
Commander
  EOC Duty Manager and Air Ops will decide the role of the aircraft – i.e. transportation
of casualties or movement of medical equipment/resources or tertiary transport.
  The following criteria should be established
o  Exact Location and grid reference
o  Flying time to Scene
o  Visibility, weather conditions and potential physical hazards
o  Emergency Services present and any other aircraft
o  Proposed landing site
o Number
of
casualties

o  Designated hospitals if required
  The Air Ops unit will then confirm response or otherwise to the EOC Duty officer who
will inform the Ambulance Incident commander.

Once the aircraft is en route Air Operations Desk will maintain communications via a
designated radio channel.

In the event that deployment of one or more aircraft the Air Operations Manager will be
informed of the deployment. If appropriate, the Air Ops Manager will attend scene to
undertake the role of Air Support Officer in the Air Ops Mobile Control vehicle.

A range of landing sites, which have been pre-surveyed, are available with the EOC.

12.8 Bulk Oxygen

This specialist equipment is intended for use in mass casualty incidents to provide
multiple patients with oxygen.  In the event of deployment MPU300 will come under
control of Equipment Officer and should be used in conjunction with the Standard
Operating Procedure

12.9 Hazardous Area Response Team / Urban Search And Rescue

HART currently provides the Trust with Paramedics trained in USAR. Operatives are
trained to work within collapsed structures and trenches, large road traffic collisions and
rescues at height. Two RRV’s and a specialist USAR support vehicle are available 24/7.

The HART team will be trained in various levels of PPE, including Extended Duration
Breathing Apparatus (EDBA), enabling them, to enter and treat, patients within, the inner
cordon or Hot Zone. The team will have a specialist forward command vehicle, as well as
reconnaissance and bulk carrying vehicles. The team will have the capability to transmit,
from the hot zone, live video and audio to the Incident Response Unit (IRU). Which in
turn can be relayed to Gold Control.


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The team is also a national asset and can be called upon, at any time and by any
ambulance service, to be utilised nationally during response a major incident. If the
HART resources are deployed they will follow their own procedures, with the HART
Team Leader working in conjunction with the Ambulance Incident Commander.

12.10 Regional Gold Control

In the event that a Major Incident requires command and control on a regional scale, this
will primarily be located at Regional Headquarters and a separate Gold Control Plan
exists detailing the precise function and operation of this facility.

12.11 Sources of Specialist advice

A range of sources of specialist information are available including:

Source of Information
Type of Information Held
TOXBASE
Clinical Toxicology Database
WISER Hazardous
Materials
Database
CAMEO
Chemical Database and information
management
ARCC
Military Aircraft Database
ERICards
Chemical Transport Database
HPA
Chemical, Biological and Radiological
information and Public health advice

12.12 CBRN

Nerve Agent Antidote Kit

Nerve Agent Antidote Kit is a twin pen Auto Injector device used for the treatment of
organophosphate poisoning by intra muscular injections. Although large stocks of Nerve
Agent Antidote Kit (Combo Pens) are carried on Major Incident Support Units, all front
line ambulances carry a pack of 10 Combo pens for use by WMAS staff displaying signs
and symptoms of nerve agent exposure. Staff should self-administer as they have been
trained and in accordance with Annex A.

In the event that Nerve Agent treatment is required for casualties, stocks of antidote kits
are stocked on Major Incident vehicles.

Electronic Personal Dosimeter (EPD)

The EPD detects and monitors radiation and alerts the wearer if they are in proximity to a
beta, gamma or X-Ray radiological source.

The EPD is provided to operational staff for personal protection and as a means of
detecting and alerting the wearer of exposure or potential exposure to a radioactive
sources. EPDs should be worn and maintained by operational staff at all times as
instructed. In the event that an EPD alarm sounds the wearer should alert EOC who have
also been advised of the actions that they should take. (Annex B)

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In the event that the UK Security Status is raised to CRITICAL, operational staff must
ensure they wear the EPD at all times and are familiar with its use (UK Security Status).

Escape Hoods (EH20)

The EH20 is a compact and portable hood which can be donned in 30 seconds and
provides protection against principal CBRN airborne threats.

The EH20 is provided to operational staff for personal protection and as a means of
escaping the hazardous area, no treatment should be carried out wearing the hood which
has an efficient operating time of 20 minutes. Staff should have easy access to the EH20
at all times which should be kept on each frontline vehicles (Ambulances/cars etc) to
ensure proximity at all times.

In circumstances where the UK Security Status is raised to CRITICAL, operational staff
must wear the EH20 on their person at all times and will be reminded of the importance
and correct use of the EH20 via direct briefing (UK Security Status)

12.13 Search and Rescue (Military Aid)

The Aeronautical Rescue Coordination Centre’s (ARCC) is a MoD facility responsible for
the national coordination and control of military and civilian SAR aviation assets,
particularly helicopters, and RAF Mountain Rescue Teams (MRTs) in response to
requests for Military Aid to the Civil Community (MACC).

It is MoD policy to render assistance whenever possible to persons, vessels or aircraft in
distress at no cost where life is at risk. Assistance from the military may also be support
to the responding organisations in addition to direct assistance to the casualty.

A clear process has been developed for access to military assistance where required,
and is included in the Adverse Weather Plan.

In addition, where the ARCC are aware of an incident, they will inform the local
emergency services for information.

12.14 Cultural and Religious Diversity

Whilst the health and safety of casualties should be the paramount consideration at the
scene of a major incident, WMAS staff should remain sensitive at all times to the
concerns and requirements of different cultural and religious groups.

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ACTION CARDS

Card Number
Action Card Role
Page
1.
Gold Commander
26
2.
EOC Duty Manager
27
3.
On Call Silver EOC
28
4.
Ambulance Incident Commander
29-30
5.
Forward Incident Officer
31
6.
First Ambulance On Scene – Driver
32
7.
First Ambulance On Scene – Attendant
33
8.
First Ambulance On Scene – Solo
34
9.
Subsequent Ambulance Crews
35
10.
Bronze  MEOC
36
11.
Casualty Clearing and Casualty Loading
37
12.
Ambulance Parking
38
13.
Safety  Officer
39
14.
Ambulance Liaison Officer
40
15.
Medical Incident Commander
41
16.
Air Operations Officer
42
17.
Primary Triage Officers
43
18.
Secondary Triage Officers
44
19.
Equipment  Officer
45
20.
Silver  Loggist
46
21.
Press  Officer
47

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ACTION CARD 1 – Gold Commander

GOLD COMMANDER

OVERALL ROLE:
To take overall command of the WMAS response, make strategic decisions in a cohesive
manner with partner agencies and ensure that decisions and actions are appropriately recorded.

LOCATION: Gold Control
CALL SIGN: Gold Commander

ACTIONS
TIME
1
Assume GOLD Command - agree this with the Chief Executive.

2
Commence Personal LOG.

3
Mobilise other Directors as required – available Directors to attend HQ.

4
Notify the Strategic Health Authority of the incident and establish a

communications pathway. Prepare to deploy personnel to the NHS Command
structures as appropriate.
5
Establish a central electronic decision/reason and tasking log.

6
Complete Risk Assessment Matrix (annex 2).

7
Consider whether Ambulance Service Regional GOLD Control needs to be set

up and action as appropriate.
8
Develop and communicate overall strategy for the Trust response

9
Confirm that command structure is in place for the Trust and communicate this

(diagram) to other agencies and internally – ensure effective operational
command of emergency and Trust resources.
10
Ensure inter-service liaison (undertake appropriate liaison with strategic

commanders in other agencies).
11
Speak to Regional Head of Communications/press officer on call.

12
Establish a framework for the overall management of the emergency.

13
Determine strategic objectives that should be recorded and subject to regular

review.
14
Rapidly formulate and implement an integrated media policy.

15
Ensure there are clear lines of communication with tactical commander(s).

16
Ensure there is longer-term resources and expertise for command resilience.

17
Ensure that any HQ staff who can assist with non-999 EOC Duties are utilised in
support of the operational effort.
18
Give consideration to the prioritisation of demands from any number of tactical
commanders.
19
Decide on what resources or expertise can be made available for tactical
commander requirements (mutual aid).
20
Plan beyond the immediate response phase from recovering from the emergency
to returning to or toward a state of normality.

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ACTION CARD 2 – EOC Duty Manager

EOC DUTY MANAGER

OVERALL ROLE:
To ensure that WMAS core response functions continue to be met during a major incident. To
work closely with the SILVER Co-ordinator in resource procurement and deployment for the
incident and to be aware of the impact it as on day-to-day operations. To be in CONTROL of
resources to the incident.

LOCATION: EOC (Locality or HQ dependent on incident)

ACTIONS
TIME
1
COMMENCE PERSONAL LOG.

1A
Allocate EOC operator to the Major Incident talk group radio position in EOC

1B
Agree with On Scene Ambulance Incident Commander a major incident talk

group
2
Confirm on call Gold (Locality Director) and On call SILVER/s have responded.

3
Activate on call Medical Pager.

4
Inform: Senior Managers

  Regional Head of Emergency Preparedness and the Emergency
Preparedness Manager on call
  Regional Head of Special Operations
  Regional Head of Communications
  Regional Head of Performance and EOC
  Capacity Manager on call
  Press Officer on call
  IT Manager on call
 Fleet Manager
5
Complete Risk assessment matrix (subsequent to METHANE) report (specific

hazards/updates).
6
Monitor the maintenance of business continuity ensuring core responsibilities

and standards within WMAS Trust are achieved – consider use of CFRs to
cover activity to free resources
7
Mobilise resources to scene based on information received.

8
Inform the most appropriate Receiving and supporting hospitals in conjunction

with Ambulance Incident Commander
9
Notify EOCs in other localities, arranging mutual support as appropriate.

10
Mobilise specialist incident support units (Control Vehicle/Air Ambulance

Command Vehicle
11
Have regard for the welfare of staff in EOC, allowing time to contact relatives

where possible and circumstances demand.
12
Activation of PODS if requested.

13
Mobilise an officer to the receiving and supporting hospitals to act as

Ambulance Liaison Officer (ALO).
14
Inform NHS Direct.

14A
Inform Airwave of expected increased usage of system for them to monitor

system capacity
15
Maintain an overview of air support capabilities, which may include Police and

Military assets in addition to HEMS/Air Ambulance.

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ACTION CARD 3 – On Call Silver EOC

ON CALL SILVER EOC

OVERALL ROLE:
To act in a co-ordination role between the commander at scene, duty SILVER CONTROL and
GOLD Commander. To ensure messages and requests are effectively channelled and
resources are managed with due regard to day to day work.
CALL SIGN: Silver EOC

LOCATION: EOC (Locality or HQ dependent on incident)

ACTIONS
TIME
1
Commence personal log

2
Report to Ambulance EOC and establish communications with the Ambulance

Incident Officer (i.e Ambulance Incident Commander on Major incident talk group
allocated by EOC silver)
3
Ensure Ambulance EOC has carried out the primary control action as per the

appropriate Action Card
4
Maintain ongoing liaison with the EOC Duty Manager (SILVER CONTROL) with

particular regard to the activation of mutual aid
5
Ensure communications are established to receiving hospitals/supporting

hospitals. Confirm contact with Hospital Liaison Officers
6
Establish contact with WMAS GOLD Commander AND MAINTAIN LIAISON

DURING THE INCIDENT
7
Establish contact with Ambulance Incident Commander (scene) and maintain

robust contact throughout incident
8
Monitor the maintenance of business continuity ensuring core responsibilities and

standards within WMAS Trust are achieved
9
Monitor duty times of personnel

10
Following “stand down” from Ambulance Incident Officer, implement reversal to

normal working
11
Prepare a report for Regional Head of Emergency Preparedness, Chief Executive

and Chief Operating Officer

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ACTION CARD 4 –Ambulance Incident Commander

AMBULANCE INCIDENT COMMANDER

Page 1  of  2

OVERALL ROLE:
Maintains overall responsibility for all activity of ambulance personnel at the scene in conjunction
with a Medical Incident Commander and has responsibility for effective use of clinical resources
at the scene.

ROLE FILLED BY: On Call Silver Operations
LOCATION: Scene (or near to scene)
CALL SIGN: Silver Commander

NB: In the event of escalation to a multi-point incident each scene will be treated as a
separate incident, each with it’s own Ambulance Incident commander coordinated
through Gold Control.
ACTIONS
TIME
1
Don the appropriate high visibility jacket marked ‘SILVER COMMANDER’

and helmet and change personal radio to major incident talk group as
directed by EOC Silver.
2
Receive briefing from Acting Incident Officer

3
Management of the scene can be achieved by following the process below

(CSCATTT)
Command and Control
Safety
Communication
Assessment
Triage
Treatment
Transport
Recovery
4
Establish Ambulance Silver Command Cell to include:

  Ambulance Incident Commander
  Medical Incident Commander (See Action Card – Medical Incident
Commander)
  Silver Loggist (see Action Card – Silver Loggist)
  Silver Communications Officer (See Action Card – MEOC)
5
Ensure regular and continued liaison with other Emergency Services

6
Using action cards designate appropriate staff into the following roles
ensuring communications are established via the appropriate major incident
talk groups:
a.  Primary Triage Officers
b.  Secondary triage Officers
c.  Forward Incident Officer(s)
d.  Casualty Clearing and Loading Officers
e.  Ambulance Parking Officer
f.  Equipment Officer
g.  Ambulance Decontamination (if required)
h.  Ambulance Dirty Store (if required)

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ACTION CARD 4 –Ambulance Incident Commander

7
Deploy other WMAS personnel, VAS, and other NHS staff to their best use

8
If suspected or confirmed CBRN incident Complete Tactical CBRN

Assessment (SOP EP 04) and report assessment to EOC.
9
Establish if additional medical support is required and report to EOC

10
Confirm that radio communications between Ambulance EOC, MEOC,

Ambulance Silver Command Cell and Receiving Hospital(s) are established.
Maintain regular communication with Ambulance Points to ensure continued
staff, equipment and vehicle availability. This will be achieved by allocating
Bronze and Silver talk groups, in discussion with the EOC Silver
11
Pass any requests for additional resources or mutual aid to Gold

Commander.
12
Liaise with the Police regarding the receiving and supporting hospitals being
used
13
Liaise with Police for the removal of uninjured persons, if necessary.

14
Decide if any specialist equipment (example lighting) is required.

15
Have due regard for the safety and welfare of staff at all times.

16
Notify the EOC “Major Incident – Last Casualty Evacuated” and “Major

Incident – Stand Down” instructions as and when necessary.
17
Provide a report and attend any debrief as instructed.

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ACTION CARD 5 – Forward Incident Officer

FORWARD INCIDENT OFFICER

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene

LOCATION: Scene
CALL SIGN: Bronze Commander

N.B. There may be more than one Forward Incident Officer required if an incident is zoned
operating under the direction of the Ambulance Incident Officer (Silver Commander) to directly
manage clinical resources within the site or sector.

ACTIONS
TIME
1
Don high visibility jacket and helmet. change personal radio to bronze talk
group as directed by Ambulance Incident Commander
2
In liaison, with the Ambulance Incident Commander, directly manage and
coordinate medical activities at the incident or specific site or sector providing
updates to the AIC as required.
3
Direct Ambulance personnel as needed/consider use of specialised units.

4
Liaise with the Medical Incident Officer (MIO) and assist in the directing of
medical teams as needed. Ensure Ambulance Incident Commander is aware
of such teams on site.
5
Liaise, where required, with the MIO to monitor and manage initial triage.

6
Provide flexible managerial control of the forward area.

7
Monitor the working environment for safe working practices.

8
In liaison with the Ambulance Incident Commander, ensure:

  That appropriate access/egress exists
  The setting up of a Casualty Clearing Station
  The setting up of an Ambulance Loading Point
  The setting up of an Ambulance Parking Point
  The setting up of a Forward Triage
  Casualty Decontamination Area (as required).
9
Maintain liaison with other Emergency Service Representatives.

10
Inform the Ambulance Incident Commander when casualty evacuation is
complete in sector of responsibility.
11
In liaison with the AIC, allocate staff as required to meet the ongoing needs of
the incident.

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ACTION CARD 6 – First Ambulance On Scene - Driver

FIRST AMBULANCE ON SCENE - Driver

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Usual Call Sign

ACTIONS
TIME
1
Park as near to the scene as safety permits.

2
Ensure vehicle keys remain with the vehicle.

3
High visibility jacket and helmet are to be worn at all times.

4
Leave roof beacons on. The first ambulance on scene will remain the
Ambulance Silver Command Cell. Point within easy reach of Police/Fire Control
Units, until relieved.
5
Provide Ambulance EOC with an initial visual report and confirm the attendance
of other emergency services.
6
Do not leave your vehicle and, where possible, maintain a communications link
between your attendant and Ambulance EOC.
7
Provide a report and attend any debrief as instructed.

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ACTION CARD 7 – First Ambulance On Scene - Attendant

FIRST AMBULANCE ON SCENE - Attendant

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Usual Call Sign
! DO NOT STOP TO TREAT !
Do not become involved directly in the rescue or treatment of casualties
The attendant of the first ambulance on scene assumes the role of Ambulance Incident
commander until relieved by a suitably trained officer.

ACTIONS
TIME
1
Safety jacket and helmet are to be worn at all times.

2
Carry out reconnaissance of incident and report back to Ambulance EOC the
following METHANE format message:

Type of incident and declare a Major Incident to the EOC
Exact location and any directions to the site
Type of incident
Hazards present
Access / egress including holding and parking points
Number of casualties and early estimates of ambulances required including
numbers trapped
Special Equipment and medical teams are on scene
Location of Ambulance Parking Point
3
In liaison with other emergency services, set up the following:

  Access and egress to site
  Ambulance Parking Point
  Casualty Clearing Station
4
Provide briefing to Ambulance Incident commander

5
Following handover to Ambulance Incident Commander, then undertake duties
as directed
6
Provide a report and attend any debrief as instructed.

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ACTION CARD 8 – First Ambulance On Scene - Solo

FIRST AMBULANCE ON SCENE - Solo

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Usual Call Sign
! DO NOT STOP TO TREAT !
Do not become involved directly in the rescue or treatment of casualties
THIS ROLE ASSUMES AMBULANCE INCIDENT COMMANDER UNTIL RELIVED

ACTIONS
TIME
1
Safety jacket and helmet are to be worn at all times.

2
Carry out reconnaissance of incident and report back to Ambulance EOC the
following METHANE format message:

Type of incident and declare a Major Incident to the EOC
Exact location and any directions to the site
Type of incident
Hazards present
Access / egress including holding and parking points
Number of casualties and early estimates of ambulances required including
numbers trapped
Special Equipment and medical teams are on scene
Location of Ambulance Parking Point
3
In liaison with other emergency services, arrange for the following structures to
be set up:
  Site Access and Egress
  Ambulance Parking Point
  Casualty Clearing Station
4
Provide briefing to Ambulance Incident Commander on arrival

5
Following handover to Ambulance Incident Commander, then undertake duties
as directed
6
Provide a report and attend any debrief as instructed.

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ACTION CARD 9 – Subsequent Ambulance Crews

SUBSEQUENT AMBULANCE CREWS

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Usual Call Sign

ACTIONS
TIME
1
Proceed as instructed (normally to Ambulance Control Point).

Note: Responders may be directed to the Casualty Clearing station area.
2
Report arrival to Ambulance Control Point on the Emergency Reserve Channel
(ERC)
Ensure you are given or ask for this information.
3
Don high visibility jacket and helmet.

4
SWITCH OFF ALL BLUE BEACONS with the exception of the vehicle being
used temporarily as an Ambulance Control Point which may be superseded by
the MEOC which will display a green and white chequered flag/beacon.
5
Driver to remain with vehicle at Parking Point until otherwise instructed.

6
Attendant to remain with vehicle until otherwise instructed, vehicle keys to be
available at all times.
7
All radio messages to be passed to Ambulance Control Point on the designated
major incident talk group as directed.
8
Undertake casualty management and movement as directed when called forward
to the casualty treatment station where you are required to undertake triage of
patients you are called forward to manage.
ENSURE YOU HAVE A TRIAGE PACK AND APPROPRIATE LABELS.
9
On leaving scene, advise the Ambulance Control Point of your:

Departure and destination.
Casualty numbers and makeup – male-female ratio and age spread.
10
Further radio communication should now be with Ambulance Control.

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ACTION CARD 10 – Bronze MEOC

BRONZE MEOC

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Bronze MEOC
A copy of the Major Incident Plan is available on the MEOC

ACTIONS
TIME
1
Don high visibility jacket and helmet.

2
An Ambulance crew will be responded to collect a Mobile Control Unit and deliver
to the scene. The Communications Officer may travel with the unit or use his/her
own vehicle.
3
In liaison with the Ambulance Incident Commander or, in their absence, set up the
unit a safe distance from the incident and near to the other emergency service
control vehicles. (Minimum distance between vehicles not less than ten metres).
4
Carry out procedures for setting up the control vehicle and implement

communication checks. Monitor major incident talk groups as designated by EOC
Silver
5
Issue hand portable radios and Action Cards as required – each person on scene
should have one or ready access to one.
6
If the Ambulance Incident Commander is not in attendance, assume that role (as
indicated by the appropriate Action Card) and inform Control of the exact location
and magnitude of incident.
7
Provide and coordinate an Ambulance/NHS communications net based on local

policy.
8
Ensure links with Ambulance EOC Silver and all other on-site Emergency Service
controls are maintained.
9
Ensure all vehicles leaving and arriving on the scene are accurately logged.

9A
Ensure departing ambulances give brief, verbal detail of patients on board and

destination
10
Provide a report and attend any debrief as instructed.

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ACTION CARD 11 – Casualty Clearing / Casualty Loading

CASUALTY CLEARING &

CASUALTY LOADING

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Casualty Clearing Station
CALL SIGN: Bronze Cas Clearing / Loading

ACTIONS
TIME
1
Don the appropriate high visibility jacket and helmet.

2
Collect a hand portable radio on major incident bronze talk group as directed by

EOC Silver from the Ambulance Control Point and set up a Casualty Clearing
Station and Ambulance Loading Point with signage once available.
3
In liaison with the Medical Incident Officer, brief medical staff on their arrival at the
incident and coordinate Triage.
4
When necessary, arrange for the siting of the Ambulance Equipment/Specialised

Unit(s) as near as possible to the Casualty Clearing Station in liaison with
PARKING OFFICER.
5
Establish Loading Point with consideration to vehicle movements, access/egress

and ground surface (seek Police assistance if appropriate).
6
In liaison with the BRONZE FORWARD INCIDENT OFFICER, Ambulance

Control Point and Ambulance Parking Officer, ensure an adequate supply of
vehicles.
7
Ensure that patient documentation is initiated, even if very limited details are

obtained.
8
Coordinate the supply of extra equipment for the casualty clearing station where

necessary.
9
Provide separate area/s for triage categories and ensure the categories are

segregated appropriately.

Red
-
Immediate First Priority
Yellow
-
Urgent Second Priority
Green
-
Delayed Third Priority
Blue
-
Expectant (P4 special circumstances)

10
Make arrangements with the Ambulance Incident Commander for the

transportation of staff and equipment in order to maintain the effective function of
the Casualty Clearing Station.
11
Specify levels of continued care required for each casualty en route to hospital,

e.g. Paramedic, Technician, Ambulance Person, and Voluntary Ambulance
Societies (VAS).
12
Provide a report and attend any debrief as instructed.

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ACTION CARD 12 – Ambulance Parking Officer

AMBULANCE PARKING OFFICER

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Bronze Parking

ACTIONS
TIME
1
Don high visibility jacket appropriately marked and helmet. Obtain a hand

portable radio from Mobile Control and /or change personal radio to Bronze talk
group as directed by Silver
2
Erect the appropriate sign – AMBULANCE PARKING POINT.

3
Inform the Ambulance Incident Commander and the Ambulance Control Point

when Parking Point is manned and operational.
4
Brief staff arriving at the incident of any special areas/hazards for consideration.

5
Ensure that all staff attending are wearing the appropriate safety clothing and

hardhat.
6
Maintain records of staff/vehicles attending:

Status of Ambulance Service arriving e.g. Paramedic, Technician
Arrival of Specialist Major Incident vehicles
Arrival of vehicles with teams of staff
Arrival of medical and nursing teams
Arrival of Doctors e.g. BASICS and GP’s
Arrival of Voluntary Ambulance Societies

Arrival of Responders
7
Log arrival of vehicles from neighbouring services.

8
Direct Ambulance Service staff and all medical staff into scene when required.

9
In liaison with the Ambulance Incident Commander, consider the provision of

refreshments to all staff including MEOC.
10
Provide a report and attend any debrief as instructed.

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ACTION CARD 13 – Safety Officer

SAFETY OFFICER

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Bronze Safety

ACTIONS
TIME
1
Don the appropriate high visibility jacket and helmet and change personal

radio to Bronze talk group as directed by Silver
2
Liaise with Safety Officers from other Services, in particular the Fire Service.

Commence a log of all Health, Safety and Welfare matters.
3
Provide tactical advice to ambulance on site command team.

4
Identify specific hazards and/or dangers and notify Forward Incident Officer

and/or Ambulance Incident Commander.
5
Monitor, in liaison with other Officers, number of staff working within the incident

boundaries and ensure all Ambulance Service personnel and hospital staff are
wearing the correct safety clothing.
6
Advise Forward Incident Officer and/or Ambulance Incident Commander of any

unforeseen hazards and dangers that may arise and of any protective measures
that can be taken, i.e. specialist clothing, decontamination.
7
Monitor all work functions, where possible, for safety and act immediately to

minimise errors.
8
Assist as required with staff briefings prior to the deployment of staff into the

scene.
9
In liaison with AMBULANCE INCIDENT COMMANDER monitor periods of duty

that staff are working and ensure that they receive adequate rest and
refreshment.
10
Identify members of staff who may be feeling the effects of stress and/or fatigue.
Take action to either relieve the stress or relieve them of their duties within the
boundaries of the incident.
11
Monitor periods of duty that staff are working and ensure they receive adequate

rest and refreshment.

N.B.

Fresh supplies of food and water brought to the scene would eliminate the risk
of potential contamination resulting from the incident.
12
In liaison with other attending Services, advise Forward Incident Officer and

Ambulance Incident Commander of the need to evacuate the scene.
13
Where required, provide Ambulance Incident Commander and Forward Incident

Officer with appropriate methods of treatment for eventualities such as
contamination.
14
Provide a report and attend any debrief as instructed.

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ACTION CARD 14 – Ambulance Liaison Officer

AMBULANCE LIAISON OFFICER

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Hospital
CALL SIGN: Bronze [Name of Hospital]

ACTIONS
TIME
1
Report to the Receiving Hospital.

2
Set up and maintain a telephone and/or radio communications link between the

receiving hospital and Ambulance Control (EOC). Change personnal radio to
Silver talk group as directed by EOC Silver
3
Don high visibility jacket

4
Liaise with the Hospital A&E Officer and Police Casualty Bureau Office.

5
Liaise with Ambulance EOC and assist with the organising of transport for nursing
and medical teams.
6
Ensure the quick turn around of ambulances bringing casualties to the hospital

and return to the incident if required.
7
Ensure release of ambulance service equipment by the hospital and arrange its

return to the incident if required.
8
Ensure maximum cooperation with the Hospital Coordinating Team in regard to

decanting of patients to secondary hospitals.
9
Maintain, so far as is reasonably practicable, a log of vehicle call signs, crew

names, fuel status, numbers of patients and equipment arriving at the hospital.
10
Liaise with Ambulance EOC with regard to the throughput of patients and any

problems that are developing or are likely to develop.
11
Under close liaison with the Ambulance Incident Commander, arrange that bulk

supplies of hospital based drugs, infusion fluids and other such items are
despatched from the Pharmacy to the location.
12
Assist with coordination of Voluntary Aid Societies at the hospital.

13
Remain at the hospital subsequent to “Major Incident Stand Down” in order to

manage continuing demands on resources for discharges/transfers.
Provide a report and attend any debrief as instructed.

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ACTION CARD 15 – Medical Incident Commander

MEDICAL INCIDENT COMMANDER

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Silver Medic

ACTIONS
TIME
1
At the time of responding inform Ambulance EOC of Identity Call Sign and mobile

telephone number. On arrival, park in safe location and ensure vehicle is
identifiable.
2
Report to the Ambulance Silver Command Cell to be briefed and collect a portable

radio on silver talk group as directed by EOC silver
3
Don helmet and high visibility jacket marked ‘MEDICAL INCIDENT

COMMANDER’
4
Confirm that the Ambulance Incident Commander has established a Causalty

Clearing Station and appropraitely resourced with additional medical staff as
required
5
Assume command of all Medical staff resources. Ensure a minimum of 1 Doctor

and 1 Nurse remain in the Casualty Clearing Station at all times.
6
Inform Police Silver Commander of receiving hospitals and supporting hospitals

being utilised.
6
General Duties:

  Liaise regularly with Ambulance Liaison Officer(s) at receiving hospitals to
ensure designated hospitals are kept informed of ongoing situation
  Ensure that a flow of patients is maintained through Casualty Clearing
Station
  Ensure, by regular assessment, that adequate resources are on site and
report any deficiencies to Equipment Officer.
7
Liaise with press officer to agree any press statements.

8
In liaison with the Ambulance Incident Commander agree ‘Stand Down’ time when

appropriate.

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ACTION CARD 16 – Air Operations Officer

AIR OPERATIONS OFFICER

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Bronze Air Ops

ACTIONS
TIME
1
Take charge and take measures to make safe the agreed temporary helicopter-

landing site.
2
Advise the Air Operations Controller of the exact location including grid

reference of the temporary helicopter-landing site.
3
Advise the Ambulance Incident Commander when the site is operational.

4
Maintain ongoing liaison with the Loading Point Officer to facilitate the transfer of
casualties designated for Air ambulance transport from the Casualty Clearing
Station to the Temporary Helicopter Landing Site.
5
Casualties will only be transferred to the Landing Site when an aircraft is on the

ground and ready to load.
6
Maintain contact with approaching and departing Air Ambulances and the Air

Operations Controller.
7
Maintain a log of casualties airlifted and confirm with MEOC including details

(sex, age etc).
8
On stand down prepare a report and attend any debrief.

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link to page 43 ACTION CARD 17 – Primary Triage Officers

PRIMARY TRIAGE OFFICERS

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Bronze Triage

ACTIONS
TIME
1
Wear tabard to identify self as TRIAGE OFFICER

2
Assign priorities and label casualties within the sector designated by

commander (bronze or silver
3
Use the TRIAGE SIEVE 2 – ADULT prioritisation

Y
Priority 3 - delayed
WALKING
N
N
Deceased
BREATHING
After airway
Y
opening
RESPIRATORY
< 9 – 30 >
Priority 1 -
RATE
immediate
10-29
> 2 seconds
CAPILLARY REFILL
Priority 2 - urgent
< 2 seconds

4
Ensure all staff undertaking triage have appropriate labels and use the

TRIAGE SIEVE
5
Use PAEDIATRIC TRIAGE TAPE – CHILD prioritisation

6
Keep a tally of the number of casualties of each priority within your sector

7
Report casualty numbers and priorities to the BRONZE Commander

8
Once Triage is complete seek further tasking from AMBULANCE INCIDENT

COMMANDER

2 Taken from Major Incident Medical Management and Support (MIMMS) model

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link to page 44 ACTION CARD 18 – Secondary Triage Officers

SECONDARY TRIAGE OFFICERS

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Casualty Clearing Station
CALL SIGN: Cas Clearing Triage

ACTIONS
TIME
1
Wear tabard to identify self as TRIAGE OFFICER.

2
Assign priorities to casualties on arrival at the Casualty Clearing Station (CCS) –

casualties should be wearing a label, but in some cases primary triage may have
been missed in which case refer to triage sieve.
3
Use the TRIAGE SORT 3to prioritise adults when time and resources allow.

4
Use PAEDIATRIC TRIAGE TAPE to prioritise children.

5
Allow senior clinicians to use judgement to adjust physiological triage priorities

based on anatomy of injury or clinical diagnosis.
6
Keep a tally of the number of casualties of each priority.

3 Taken from Major Incident Medical Management and Support (MIMMS) model

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ACTION CARD 19 – Equipment Officer

EQUIPMENT OFFICER

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: Bronze Logistic

ACTIONS
TIME
1
At the time of responding inform Ambulance EOC of Identity Call Sign and mobile
telephone number. On arrival, park in safe location and ensure vehicle is
identifiable.

2
Report to the MEOC to be briefed and receive call Airwave Radio call group.

3
Don helmet and high visibility jacket marked EQUIPMENT OFFICER.

4

Liaise with the Ambulance Incident Commander to ensure that the following has
been implemented as required.
Deployment of Bulk Major incident Equipment as begun
Designated logistics area as been identified
If HAZMAT/CBRN Incident identify Decontamination equipment dump area

5
Assume command of logistics collection area

Begin Inventory Log
Identify Rest Area for crews

6
General Duties:

  Liaise regularly.
  Dynamically check safe storage of logistics.
  Ensure, by regular assessment, that adequate resources are on site.
  Plan safe storage/disposal of used logistics
7
Liaise with regularly with

Ambulance Incident Commander
Bronze Forward
Casualty Clearing Officer
CBRN Forward Bronze Commander (if HAZMAT/CBRN Incident)

8
In liaison with the Ambulance Incident Commander  agree ‘Stand Down’ time

when appropriate.

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ACTION CARD 20 – Silver Loggist

SILVER LOGGIST

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: not required

ACTIONS
TIME
1
Report to the Ambulance Silver Command Cell

2
Liaise with the Ambulance Incident Commander to confirm what messages

require logging
3
Using WMAS Incident Log Book(s) ensure accurate and timely records are kept

with regards to:

  Telephone and radio messages
  Decisions taken by Silver Command Cell
  Multi-agency communications and information

4
Close log on stand down of incident

5
Ensure log is provided to Gold Control/Emergency Preparedness Department for

retention
6
Attend incident debrief

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ACTION CARD 21 – Press Officer

PRESS OFFICER

All staff arriving on scene should report their arrival to the EOC by radio or telephone and in
person at the Ambulance Holding Point before entering the scene
LOCATION: Scene
CALL SIGN: not required

ACTIONS
TIME
1. Start personal incident log and separate  decision / policy log and constantly

update
2. Advise the GOLD COMMANDER in relation to all media issues

3. Ensure that WMAS media input is present and appropriate within the wider

agency command and control arrangements and when needed undertake a
“talking head” role on behalf of the service.
4. Be the focal point of contact for Media enquiries within GOLD.

5. Support the smooth running of GOLD under the direction of Regional GOLD

CONTROL MANAGER
6. Provide support , advice and direction to the local and regional media networks
7. Lead on the preparation of media briefings and lines to take in liaison with the

GOLD COMMANDER
8. When appropriate and if requested deploy a press officer to the scene , other

multi-agency command groups and to Regional HQ(WMAS)
9. Assist with the preparation and dissemination of public information and advice.

10.   Ensure that the WMAS communications are running smoothly and plugged

appropriately into the wider media response.
11.   Provide access to other communication assets and resources across the

region, such as GNN, BBC Connecting in a crisis etc
12.   Work with NHS Direct to activate existing health messages and to formulate

public information for distribution through NHS Direct
13
Close Log

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Annexes

Annex A – Use of Nerve Agent Antidote Kit

Annex B – Actions on hearing an EPD Alarm

Annex C – Aide Memoir – Bulk Oxygen System

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Annex A – Use of Nerve Agent Antidote Kit

Remove Pen No 1 marked ATROPINE from the plastic holder (this will automatically
remove the safety cap)

Place the GREEN cap of the auto-injector against the upper quadrant of the thigh making
sure it is not obstructed by the contents of pockets

Press hard until the injector functions, count slowly to 10 and withdraw

Bend the needle on any hard surface and record the time of administration

Remove Pen No 2 marked PRALIDOXIME from the plastic holder (this will automatically
remove the safety cap)

Place the BLACK cap of the auto-injector against the upper quadrant of the thigh making
sure it is not obstructed by the contents of pockets

Press hard until the injector functions, count slowly to ten and withdraw

Bend the needle on any hard surface and record the time of administration. Hold both
injectors in your hand until help arrives.

If required, further COMBO Pen doses can be given to a maximum of a cumulative three.

You will now be treated as a stretcher patient in this incident.

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Annex B – Actions on hearing EPD Alarm

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Annex C – Alerting the NHS – SOP EP1



ALERTING THE NHS – SOP EP1



Task Description:
Alerting the NHS that a Major Incident has occurred, for information or action as
appropriate.

Scope:
This Alerting SOP should be used by EOC staff responsible for communicating from EOC
to other NHS Organisations in the event of a Major Incident. It does not cover actions
required when communicating with WMAS staff involved in the incident response.

Related Documentation: WMAS Major Incident Plan

- - - - STANDARD OPERATING PROCEDURE - - - -

1.  Receive and record Major Incident Standby or Declared message and
appropriate details (METHANE message)
a.  Major Incident Standby or Declared and name or call sign of caller
b.  Exact Location
c.  Type of Incident
d.  Hazards associated
e.  Access to the incident – known road blockages, relevant intersections etc
f. Number
of
casualties
estimated
g.  Emergency services required or in attendance

2.  Confirm with EOC Duty Officer the designated casualty Receiving and
Supporting hospitals

3.  Contact the designated Receiving Hospital(s)

a.  Ensure the correct Major Incident Number is used for each Trust
b.  Pass the Message Major Incident Standby or Major Incident declared –
Activate Plan and pass the METHANE information – ask for the
information to be read back for accuracy

4.  Contact the designated Supporting Hospital(s) with either the message Major
Incident Standby or Major Incident declared – Activate Plan and pass the
METHANE information

5.  Contact the appropriate PCT(s) with either the message Major Incident
Standby or Major Incident declared – Activate Plan and pass the METHANE
information.

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Annex D – Major Incident Initial Mobilisation – SOP EP2



MI INITIAL MOBILISATION – SOP EP2



Task Description: Following notification of Major Incident DECLARED this SOP should
be sued for the initial deployment of resources

Scope: As information is received back from the scene, resource requirements may vary.
This SOP is for initial use only until further information is received

Related Documentation: WMAS Major Incident Plan

- - - - STANDARD OPERATING PROCEDURE - - - -

Consider for Dispatch:

1.  Up to 6 Ambulances

2.  Nearest Officer – inform that they should fill the role of the Ambulance
Incident Commander (Action Card 4) until relieved

3.  On Call Operational Manager (Silver On Call)– inform that they will assume
the Ambulance Incident Commander role on arrival

4.  Activate Medical Pager and arrange for Medical Incident Commander (Action
Card 15) to scene

5.  Mobilisation of Ambulance Liaison Officer (Station Manager or equivilent) to
each receiving hospital

6.  Prepare for mobilisation of MEOC and Major Incident Support Vehicles
depending on information receibed from scene

Inform

1.  On Call Director (Gold On Call) of incident and to proceed to Gold Control
2.  On Call emergency Preparedness Manager
3.  Alert wider NHS as per SOP EP1 ensureing they are informed of their status
as Recieveing or Supporting
4.  On Call Press Officer
5. Voluntary Aid Societies - St John Ambulance and British Red Cross
6.  Patient Transport Service Supervisor
7.  Air Ambulance Operations Desk
8.  NHS Direct Supervisor
9.  National Blood Service
10. Health Protection Agency Emergency Planning On Call
11. SHA Director On Call

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Annex E – Tactical Assessment Checklist – SOP EP3



TACTICAL CBRN ASSESSMENT– SOP EP3

Task Description: Initial Tactical Assessment of Major Incident Scene to be used by
Ambulance Incident Commander

Scope: Assumes CBRN element until potential for this hazard is excluded

Related Documentation: WMAS Major Incident Plan

- - - - STANDARD OPERATING PROCEDURE - - - -

Scene Safety

Confirm RVP is upwind and at a safe distance (initially 100m) from closest point of
possible contamination

Confirm Initial cordon is in place

Report current weather conditions and obtain forecast for next 3 hours

Consider requiremnet for portable lighting

Substance Assessment

Liaise with Fire Service for information on substance involved -

Confirm wheather any ambulance EPD units have activated alarms

Intellegence Assessment

Liaise with Police Service regarding intelligence on

a) Accidental/Malicious
b) Substance involved (recent thefts, surveillence etc)
c)  Potential for suspects to be casualties
d)  Potential for secondary devices
e)  Potential for public disorder either internal or external to cordon

Casualty Assessment

Estimate number of numbers of casualties requiring decontamination:

P1
P3
P2
Uninjured

Potential for contaminated casualties to have left the scene?

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Annex F – Bulk Oxygen System – SOP EP4

BULK OXYGEN SYSTEM – SOP EP4

N.B.
MPU 300 Unit Oxygen delivery specification is
48 patients @ 8 Litres per min (CCS setting)
4 patients @ 8 Litres per min (150 metres distance)

Both Supply and reserve Units are adjacent and in safe
1.

operating locations

2.    Ensure both Bleed Valves, (Red) are in closed position

3.    Turn on all cylinders-Duty + standby

4.    Switch on Unit through TEST phase and mute alarm

5.    Note Pressure gauge readings on main control panel

Yellow bags on standby unit contain 6 x 10m O2 lines with 4
6.

valve distribution head and masks

Locate lines to unit using valve housing. Collar to be pushed
7.

inwards while inserting fitting, (check for lug positioning)

Patient distribution lengths can be fitted as determined by
8.

patient treatment requirements

Important
9.

Red bleed valves are released prior to changing cylinders

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Annex G – Risk Assessment Matrix

In order to determine the level of the incident, resources needed and command structure
to put in place it will be important for a risk assessment to be carried out. Risk
assessments should be dynamic and undertaken at regular intervals during an incident as
they are a vital decision support tool and assist with determining the overall strategy for
managing the incident

This risk assessment is designed to be quick and simple. The SILVER and GOLD
commanders should use it as soon as they are notified: it should take no more than
20 minutes to complete

Question/consideration
Answer Notes/comments
Is this a WMAS incident
Y/N

Location

Nature of incident

Number of casualties (injured,

exposed or affected)

Have any multi-agency or
Y/N

single agency groups been set
up to manage the incident?
Are the command and control
Y/N

arrangements in place for

WMAS

Is there an ongoing risk?
Y/N

What is the level of public

concern

High/Medium/Low

What is the level of media

interest?

High/Medium/Low

Are there any cordons or
Y/N

control measures in place?

Complexity of situation

Is there a need for specialist
Y/N

support or equipment?

Is this a malicious or
Y/N

deliberate act?

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Annex H – Key Contact Details

All contact details required for the initiation of this plan, and response to a major incident
are contained in locality EOC’s, MEOC’s and Emergency Preparedness Offices.

Numbers have been intentionally removed from this version of the plan for
anonymity

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Annex I – External Distribution List

Electronic copies of this Major Incident plan have been circulated to:

British Red Cross
East Midlands Ambulance Service
Government Office West Midlands
Great Western Ambulance Service
Hereford and Worcestershire Fire Service
Health Protection Agency
NHS West Midlands
Northwest Ambulance Service
West Midlands Lead PCT organisations
St John Ambulance
Shropshire Fire and Rescue Service
Staffordshire Fire and Rescue Service
Staffordshire Local Resilience Forum
(For onward dissemination to Category 1 and 2 responders)
Staffordshire Police
Warwickshire Fire and Rescue Service
Warwickshire Local Resilience Forum
(For onward dissemination to Category 1 and 2 responders)
Warwickshire Police
Welsh Ambulance Service
West Mercia Local Resilience Forum
(For onward dissemination to Category 1 and 2 responders)
West Mercia Police
West Midlands Fire and Rescue Service
West Midlands Local Resilience Forum
(For onward dissemination to Category 1 and 2 responders)
West Midlands Ambulance Service Internet (external website)

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Annex J - Glossary

Ambulance Control
A Senior Control Officer based at Ambulance Control, not directly involved with the controlling of
Management Officer
Ambulance Service resources, but rather having a listening brief. The role provides a valuable overview
to the Ambulance Incident Officer.
Ambulance Control Point
An emergency mobile control vehicle (MEOC), readily identifiable by a green flashing light, providing an
‘on-site’ communications facility which may be at a distance from the incident. It is to this locaiton that
all NHS/Medical resources should report. Ideally, the point should be in close proximity to the Police
and Fire Service Control vehicles, subject to radio interference constraints.
Ambulance Incident
The Officer of the Ambulance Service with the overall responsibility for the work of that Service at the
Commander
scene of a Major Incident.
Ambulance Liaison Officer
The Ambulance Officer responsible for providing mobile radio communication and/or the supervision of
Ambulance Service activity and liaison at receiving or supporting hospitals receiving casualties from a
Major Incident.
Ambulance Loading Officer
The Ambulance Officer responsible for ensuring that suitable access/egress is available to the area, for
organising patient movement in priority order with documentation and maintaining a supply of
appropriate transportation.
Ambulance Loading Point
An area, preferably a hard standing, in close proximity to the Casualty Clearing Station, where
ambulances can manoevre and load patients.
Ambulance Parking Officer
This Officer is responsible for marshalling both staff and types of vehicle arriving at the parking area
and, in liaison with the Ambulance Incident Officer, ensures the most appropriate use of such
resources.

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Ambulance Parking Point
The place designated at the scene of a Major Incident where arriving ambulances can park, thus
avoiding congestion at the entrance to the site or at the Ambulance Loading Point. These areas are
also suitable for staff briefings, procedurement of refreshments and restocking of equipment.
Ambulance Tactical Officer
An Ambulance Officer responsible for ensuring the overall safety of Ambulance/NHS personnel and
other support staff involved at the incident.
Casualty Clearing Station
A facility set up at a Major Incident by the Ambulance Service in liaison with the Medical Incident Officer
to assess, treat and triage casualties and direct their evacuation.
Casualty Clearing Station
The Ambulance Officer who, in liaison with the Medical Incident Officer, ensures an efficient patient
Officer
throughput at the Casualty Clearing Station.
Communications Officer
The Officer responsible for managing the Ambulance Control Point (Emergency Mobile Control) on-site.
On Site
A prime area of responsibility is to ensure, in liaison with the Ambulance Control, that the most
appropriate communications net is available for all medical personnel on site.
Consultant in Charge
The Consultant (usually the Consultant in charge of the A&E Department) who is nominated and
responsible for coordinating all hospital medical arrangements relating to Major Incidents.
Emergency Operations
A Control room which receives all demands for the Ambulance Service in a specified geographical
Centre
area, coordinates and allocates resources.
Emergency Services
The Ambulance, Fire, Police and Coastguard Services.
Forward Control Point
A selected area, near or at the scene, where the Incident Officer/Forward Incident Officer can direct the
operation with mobile communications. The Forward Control will also act as a focal point for the
NHS/Medical resources at the initial point of patient contact on the scene. There may be a requirement
for more than one Forward Control.
Forward Incident Officer(s)
The Officer(s) who, under the direction of the Ambulance Incident Officer, manages the

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Ambulance/Medical resources at the ‘points of patient contact’ within the site. This role is of particular
relevance in the event that the Ambulance Incident Officer, who for logistical reasons or operational
requirements, is unable to be placed at the site.
Hospital Casualty Officer
A nominated Doctor who will receive and assess all casualties as they enter the hospital and decide the
priority of treatment.
Hospital Information Centre
The Centre set up at the receiving hospital to collate data concerning casualties received, their
condition, bed status, theatres available, and to provide information to the Police Decontamination
Team, as appropriate.
Listed Hospital
Hospitals listed by Strategic Health Authority as adequately equipped to receive casualties on a 24-
hour basis and able to provide, when required, the Medical Incident Officer and a Mobile
Medical/Nursing Team.
Major Incident
For Health Services purposes, a Major Incident is one which, because of the number and severity of
live casualties it produces, or its location, requires special arrangements by the Health Service.
Medical Incident
The Medical Officer with overall responsibility for medical staff at the scene of a Major Incident. He/she
Commander
should not be a member of any mobile team.
Medical/Nursing Team
Nominated Hospital personnel that provide on-site treatment at the request of either the Medical
Incident Officer or the Ambulance Service.
Nursing Incident Officer
The Nursing Officer who coordinates nursing activities at the scene of a major incident where more
than one mobile nursing team is required and where the appointment of a Nursing Incident Officer is
considered necessary, he/she will work together with the Medical Incident Officer and should not be a
member of a mobile medical team.
Paramedic
A Qualified Ambulance Person who has obtained the Edexel (IHCD) Certificate as a Paramedic and is

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registered with the Health Professions Council (HPC) as a Registered Paramedic allowing the
practising of endotracheal intubation, intravenous infusion and cardiac care. He/she is also permitted to
administer specified drugs.
Police Casualty Bureau
A bureau established by the Police to maintain a list of casualties resulting from a Major Incident,
including casualties dealt with at the site without referral to hospital and to answer all initial enquiries
and coordinate media bulletings.
Primary Triage Officer
An Ambulance Officer or nominated Doctor at the site, organising patient removal to the Casualty
Clearing Station, using the standard system of triage.
Receiving Hospital
A hospital alerted by the Ambulance Service to receive casualties in the event of a major incident.
Secondary Triage Officer
A nominated Doctor, qualified Nurse, or Ambulance Officer who selects and assesses at the Casualty
Clearing Station the priority order in which casualties are transported to hospital or evacuated.
SORT
Special Operations Response Team.
Supporting Hospital
A hospital nominated by the ambulance service to support the receiving hospital in dealing with
casualties from a major incident.

WMAS Major Incident Plan

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Document Outline

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