Major Incident / Disaster

Management
 Definition
• Major incident
= any incident where the location, number, severity
or the type of live casualties requires
Extraordinary Resources
• Large numbers of dead with few @ no
survivors– NOT major incident for health
services.
• One major incident for one services is not
necessary for all.
 Classification of Major Incident

A) Natural vs Man-made

B) Simple vs Compound

C) Compensated vs Uncompensated
(Disaster)
• Natural – earthquakes,
tsunami, flood, fire,
volcano etc
uncontrollable, huge,

• Man-made- transport
incident, industrial
incident, mass
gatherings, terrorist
attack, shooting, war.
large number of people
• Simple-
incident happen but
infrastructure remained
intact ( roads, hospital,
telephone)

• Compound
– infrastructure damaged
- road disrupted,
- ineffective health
services.
Compensated - load is
less then capacity
(demand
less, supply more)

Uncompensated
- load exceed capacity

Disaster = Catastrophe =
Uncompensated major
incidence
 Phases of major incident
• 3 phases

1) Preparation – Planning, Equipment,

Training.
2) Response – approach to the major incident
all hazards response- CoSCATTT).
3) Recovery- documentation, identification,
reporting, definitive Rx, litigation etc
 Preparation- Planning
a) Planning – Fail to plan- Plan to fail
b) What need to be planned?
- Ambulance service operational plan
- Disaster plan for each accepting hospital
- Coordination plan of resources on wider scale
(regional/ state/ national)
- planned to get the resources.
c) Plan---review----update faults
 Preparation- Equipment
• Protective equipment at scene.
• Equipment should match skill of
provider.
• Bring equipment that compliment and
not duplicate
• Familiar to use it.
 Preparation- Training
• Education
• Exercise- table top, mock drill, scene
discussion
 Response
• All hazards structure response. The ABC of
disaster response
1) Command & Control
2) Safety
3) Communication
4) Assessment
5) Triage
6) Treatment
7) Transport

Main guidance to disaster response – combine

response
 Command & Control
• Command- vertical relation.
- chief of each services

• Control- horizontal relation

- in-charge of the whole incident
- done by one service

Very important to establish this first. Set-up JSEC

(Joint Services Emergency Command Center)
 Safety

• Self – Scene – Survivor

• Self- wear protective clothing

and gear
- do not enter unless cleared/ ordered/
necessary
• Scene- make the area as safe as possible
• Survivor- the least important.
 Communication
• The most vital link in any rescue work.
• Combine effort
• Communication failure is the commonest
failing point at the scene.
• Radio net
• Quality of the 1st info and the speed it get
thru.
• What to pass over- METHANE msg.
 Assessment
• Of the scene- number and severity
• Determine the initial response
• Need not to be completely accurate but
refine as time goes
• Continue assessment
 Triage
• Sorting according to priorities of treatment.

• Dynamic- repeat at every stage

• Highest hierarchy in the medical response

 Treatment

• Do most good to the most people

• Skill of provider / Severity of injuries/ time
patient spend at scene
• Treat so that patient survive the journey.
• Treatment mostly directed towards ABC &
spine control. KIV amputation
• Proper packaging.
 Transport
• Right patient to the right place at right time
• Areas set-up to facilitate evacuation &
transport
• Decision about transport. Who?what?
How? Where?
• Method of transportation available.
Roles of ambulance services at
scene
• 1st crew action is critical and speed is crucial.
• Time is life – give max. time for hospital to
prepare
• 1st ambulance- roles as command center.
- coordinate the ambulance
response
- informed other relevant
agencies
 Aim of disaster response
• Save life
• Prevent escalation
• Relieve suffering
• Protect environment and property
• Restore normality
• Facilitate enquires
 Roles of Ambulance services

Estb. Forward
control
Set-up ambulance Triage
parking

Determine receiving Save life

hospital AMBULANCE
Prevent further
Mobilized extra help
injury

Relieve suffering
Arrange transport
Prepare casualty clearing
Communicate with station
based
 Level of medical intervention
during major incidence
• 1) Triage
• 2) Life saving first aid
• 3) Advance life support
• 4) Specialist medical help – MMT / SMT
• 5) Packaging for transport
 Scene Management
• Must have Command and Control
• Cordon – function as to control movement of
vehicle & personal in/out of scene
• Outer cordon- surround entire incident
- must be safe distance from any
hazard
• Inner cordon – not clearly marked
- not really free from danger
- strict control of movement
- control by Fire / Police
Arahan 20
 Outer cordon
Green zone

Red zone
Inner cordon
Yellow zone
Red zone
 Key Location during major
incidence
ACP/MCP
FCP APP
S
C
CASUALTY
E red CLEARING ALP
N
STATION
E

yellow

Inner cordon Outer cordon

 Tahap Pengurusan Bencana
Ciri-ciri Tahap 1 Tahap 2 Tahap 3
Kawasan Kaw kecil > 2 daerah > 2 negeri
Sifat Tidak komplek Komplek Amat komplek
Terkawal sukar dikawal Diluar kawal
Berterusan Berterusan
Impak kpd Kecil Pindah ramai Kematian:Sangat
penduduk Musnah banyak ramai
Kematian: kecil Kematian: banyak Infrastruktur musnah
ekstensif
Jejas aktiviti harian

Tahap Tidak sulit Sulit dari segi S/R Perlu kepakaran luar
Pengurusan Kepakaran biasa Perlu kepakaran negeri
Mampu sederhana
ditangani Mampu ditangani
agensi peringkat
negeri
 Summary
1) Command & Control
2) Safety
3) Communication
4) Assessment
5) Triage
6) Treatment
7) Transport

Main guidance to disaster response – combine

response
THANK YOU FOR YOUR
ATTENTION