Major Incident Planning and Support (MIP+S) Level 3
Course Content
- Course Introduction and Overview
- Personal Roles
- Ambulance Control
- Arriving on the Scene
- Triage Basics
- What is Triage
- The goal of triage
- Discriminators
- How do we triage correctly
- Initial impression
- ABCDE and triage
- Active listening
- Analgesia in triage
- Assessing pain
- Documentation and triage
- Establishing patient presentations
- Establishing patient history
- Existing medications
- NEWS2 and triage
- Triage categories
- Professional considerations
- Ten Second Triage
- Triage and MIPS
- Problems, Survivors and Casualties
- Radio Communications
- Types of radio
- Using radios
- Right and wrong way to use a radio
- Radio protocols and sending a message
- Phonetic alphabet and numbers
- Prowords in radio communications
- Call signs
- Radio Checks
- Radio check example
- Losing communications
- Broadcasting and talk groups
- Hytera PDC 550 – 4G/VHF/UHF combined
- Workplace radios
- Radio Licences
- Dual Sim Radio
- Increasing battery life
- Carrying and transporting radios
- Basic considerations when using radios
- Transmitting Techniques
- 3G and 4G radios
- METHANE Reports
- Incident at a Quarry
- MIPS Location Introduction at the quarry
- Access and Egress
- Accessing Casualties
- Dealing with the media
- Dealing with the public
- Do all major incidents involve multiple casualties
- Getting further advice
- IIMARCH briefing
- Locally available assets
- Remaining calm
- Site planning
- Tabards
- Updating METHANE
- What is defined as a major incident
- Working with other services and organisations
- Effective communications
- The role of the HSE
- The importance of planning
- Aide memoirs
- Leaving the scene
- Tabletop Exercises - Quarry
- MIPS site planning table top exercise
- Table top exercise - Arrival Part 1
- Table top exercise - Arrival Part 2
- Table top exercise - Arrival Part 3
- Table top exercise - Triage and transportation
- Table top exercise - Liaising with other services - Part 1
- Table top exercise - Liaising with other services - Part 2
- Petrochemical Plant
- Tabletop Exercises - Petrochemical Plant
- Course Summary
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Get StartedTable top exercise - Arrival Part 1
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So basically, we are going to do a tabletop exercise based around an incident that is going to happen in this quarry. The exercise will focus primarily on the initial arrival at the scene and the first part of the CS CAT acronym for the command, safety, assessment and communications. The scenario is that you have been called to the quarry, there has been a landslide in the quarry where this part of the quarry over here has collapsed down on top of a visitor's stand, which holds up to 50 visitors and dignitaries from multiple countries. In addition, two of the large earthmovers have come down with that and are at precarious angles hanging on that landslide. So on arrival at the gate, you have been presented with a map of the quarry and its route plans and they have been kind enough to supply you with an aerial photograph of the quarry site itself. So as initial responders have just arrived on scene, what do you think are the first actions that need to be carried out?Communications with the health and safety manager on the scene to get his information before we go any further.Yeah, you are absolutely right. So what you need to do is link in with whoever is going to be leading this from the company point of view and trying to make sure that you have got some continuity with that all the way through because if you keep changing people, you lose information, you lose things. So getting those key links when you come in. Anybody else you would want to be talking to apart from whoever is leading from the quarry company?Some of the other emergency services.Okay, so such as...Police, fire.Police and fire. So out of those who do you think is probably going to arrive first?It's probably going to be the fire.It's probably going to be fire. Yeah, they tend to be set up much better, they are usually within reasonably short distances. So fire is gonna be here pretty quickly. Now are there benefits that having fire on site give you as a medical responder?They have got a medical background and thus boots on the ground, so there is more... There is a few of them come with the fire trucks, so at least four...Plenty of hands.Yeah, plenty of hands.Plenty of hands, so there is certainly manpower and shifting, but there is some other things that are very useful about fire services. What does fire services deal with in general?They carry quite a lot of kit.They carry a lot of kit in order to do what?Put out fires.Extrication.Put out fires, yeah. Extrication, that is a very good point. And what else? What are they really good at? When they arrive on scene and looking at whatever incident it is...Risk assessments.Risk assessment. They are absolutely all over risk assessment, yeah, and understanding that. They are very useful to be on site when you are because, to be fair, as medical responders, we have a limited amount of knowledge on the risks that may be involved. They have got a great deal of experience, so that's one of the reasons that you want to co-locate with them at a Forward Command Point as soon as you possibly can. So having met the quarry manager, having found the lead Fire Service Officer, and the really good thing about fire service is that they come with an integral chain of command, there is always an officer leading them, which is not necessarily the case with the ambulance service where the officers may arrive quite a considerable amount of time later. Having met the site manager, so we say at the front gate, what information do you need from him?What actually has happened?Okay, so what has happened is one thing.Best access.Access. Someone give it to me in a really short word. What is happening on your radio do you think?A lot of chatter.A lot of chatter, yeah. And what is it basically saying?There is an incident going on then...Or where the incident is.Right, okay. Another word for where the incident is?Location.Exact location, yeah. So what are we looking to produce?A short METHANE message.A short METHANE message, yeah. And why is that important to get out quickly do you think?'Because it gives the base of information that all the services are going to use to decide what sort of or type of incident it is.Absolutely. So even if it is incomplete, even if there is information missing, it is really important to get the first METHANE out as quickly as possible, because if you are a first responder, you are sort of there on your own at this particular point in time. You probably found yourself in the poo, which you were not expecting. And therefore, you want the cavalry to come over the hill, the cavalry is not coming till you have sent the METHANE. Yep, so even if there is bits missing, send the METHANE as quick as possible. So what do you think the METHANE based on the limited information that we have had so far, would look like at this point in time? What areas would you be able to cover?The exact location.You can do the exact location.Type of incident.We can do the type of incident.Hazards.We can do at least some of the hazards.Other emergency services required...Yeah.If not already on scene.Yeah.Possibly number of casualties.Possibly, 'cause we were given some information about up to 50 people in the stands. So even if you cannot say, you can say that the population at risk is FIVE-ZERO. Yep. So that is a good start. Actually, to be fair, you have got a fair amount of your METHANE there, even though you have very limited information at this particular point in time. As the first crew arriving on scene, what do you then think your next move might be?We need to get a better picture of or update the information that 's already been sent.Okay.Actually a visual on scene. Look at what has actually happened.A good recce.Yeah.And what do you want to achieve by that recce? You have almost half said it already.To be able to declare a major incident. If it is there.To be able to confirm or give an expanded METHANE message back to control.[0:06:47.9] ____.That is the whole purpose of the recce, which is why, yeah, your recce should only take six to eight minutes at max because you are not really looking for a lot. You are looking to confirm everything in your first METHANE or change parts of it if necessary. Are you both going to get out of your truck and do that?No. 'Cause you are going to want somebody to stay on board the truck with communications and as a central point so anybody coming knows exactly where the first ambulance is and the best way of doing that is to leave the lights on and stay somebody with it and keep comms between the ambulance and the person on foot.Excellent. That is absolutely what we're looking for. So that basically means because you are first, irrelevant of your rank, you are currently the commander until somebody else comes along and relieves you. And therefore your vehicle is currently the command post. And that is indicated by the fact that you have got blue lights on, which means if an officer has not arrived yet, but other vehicles arrive behind you, orders the instruction that needs to be issued to them.Turn all the lights off so that you can focus on one point. Have one focal point.Correct so yeah, sometimes hard to achieve, I have to say. Yeah. Okay. But ideally, yeah. Other vehicles should turn... Also should turn their lights off so that actually we always know where the command post is.The command post is.We have said there might be hazards or risks. How do you think we are going to handle those then?Talk to someone with more knowledge about the area.Okay. So who you got in mind there?The site manager.The site manager is certainly one.The fire service?And fire service is probably the other. Okay? To get an understanding of the risk. Whilst you might not have an in-depth knowledge of the risks, what is it that we are looking to achieve as a service by understanding those risks at this early stage in the incident?Is this going to develop into something that's going to cause us a problem down the line?That is a good start, what else?To stop people going in blindly.Thank you. That is absolutely it because it is a safety issue, isn't it? So by knowing what the risks are and how big those risks are, at the bare minimum, you know what we should be able to define in conjunction with fire service is, where do we think the inner cordon is going to be? And the importance of cordon is to effect good safety measures for your staff and to stop the situation getting any worse than it already is. The golden rule as a commander, try not to make the situation any worse than it was when you arrived. Okay? Don't become a casualty yourself. Don't add to the casualty load, yeah? Because it's not helpful. It's moving the situation in the wrong direction. Okay? So if we have got to establish a cordon, this is a rather interesting aside, how do you think we might establish the inner cordon, initially?We use the whole of the quarry site itself. So people cannot get in from the sides because it's sunk. You have only got an exit... An access and an egress point. So if you block the two access and egress points off, you have got a big cordon already in place, that people cannot...Okay. So traditionally do we know what colour the inner cordon is in terms of the tape?You've got red from the fire.Yeah. So red and white tape denotes an inner cordon. Blue and white...And white tape.An outer cordon.Denotes an outer cordon.Okay.Is that set in stone? Does that always work?No. It is very interesting. If you look at some pictures from other scenes, actually the Salisbury poisonings you will remember? Yeah? There is a very nice picture of a bench which is immediately surrounded by blue and white tape and then surrounding that is red and white tape completely the wrong way around.So they have reversed it. Yeah.Yeah.But it is that way for a reason?But it is that way for a reason.Yeah.Inner cordons must have entry control, everybody going in, booked in, everybody coming out, booked out, you must know who is there from your own service at all times, which means you need to define an entry control officer. Now you said I am going to use the hold of the quarry. I think that is a really good answer initially. Why?Because it has got its own defined boundaries already.It's got natural barriers, which means they do not have to be manned. It's also quite a large area and it's probably larger than you need even at this point in time. But it is easier to shrink the inner cordon than it is to expand the inner cordon. It is always difficult to move outwards. It is very easy to move inwards. So actually defining and using the natural boundaries is probably a really good way of starting the process. So if we could using red to represent that red and white draw in where we think the inner cordon would be on this map.If it was me, I would put the barriers against the entrance and egress at this point here...Yeah.And this point here.Okay.Because the rest of it then is completely enclosed.Is naturally...Yeah.There is a little entrance there. I think.Yeah. You can't get to that though via...Oh yeah yeah yeah.You can only get to that via that, so nothing can get past that point or that point. So this is then your inner cordon.So that's an interesting point actually. Isn't it? What might you effectively have done?Well, we could have blocked off here as well and then you would have stopped anything coming.So which direction is your response coming from?This way.Okay.Yeah.And if you block this upper road here, where is the traffic going to congest?Tailbacks.Yeah.Yeah.So actually whilst you are right about it, doing that, like so, still allows flow of traffic...Yes.Around to here.Yeah.Yeah? Whilst affecting the cordon.Yeah.At the same.But you are not stopping access and egress you are just... Yeah, yeah.Yeah, not allowing them into the...Into the main zone, the danger zone.Danger area. So that's basically what the inner cordon means.Yeah, yeah.This is the danger area mate, you know?Yeah.So that is probably a better way of managing. You have got to think about your traffic flow and the fact that you may have to get a considerable number of vehicles in. So we will summarise that a bit. We have arrived on the scene. We have sent our initial METHANE. We have liaised or co-located with the other services, including the quarry. We will effectively be able to send our second METHANE and we have started to establish a cordon in conjunction with the other services. A stressed up point, because whilst quite often you will find that fire and rescue services will put a cordon up, they will put a cordon up with no thought about your access and egress. And actually, it should be a joint decision where it goes. Quite clear, they have got a lot of knowledge in terms of the risk assessment, et cetera, et cetera, to apply to that. But some pragmatism also has to come into play as well, because actually at the end of the day, we have got to extract, triage, treat and transport the casualties, which is the mission statement anyway.
Tabletop Exercise: Quarry Incident Response Plan
Scenario Overview
The tabletop exercise revolves around a simulated incident at a quarry involving a landslide. The focus will be on initial response actions and the first part of the CS CAT acronym: Command, Safety, Assessment, and Communications.
Incident Description
The scenario entails a landslide in the quarry, where a section has collapsed onto a visitor's stand accommodating up to 50 visitors and dignitaries from multiple countries. Additionally, two large earthmovers are precariously positioned on the landslide.
Initial Arrival and Actions
Upon arrival at the quarry gate, responders are provided with a map and aerial photograph of the quarry site:
- Map and Aerial Photograph: Essential resources for situational awareness and planning.
Key Actions
What are the critical first actions that responders need to undertake?
- Communicate with Health and Safety Manager: Obtain critical information and guidance from the on-site manager.
- Establish Continuity: Ensure consistent communication and leadership from the quarry company's designated lead.
It's crucial to maintain these key links to prevent information loss and maintain operational efficiency throughout the response.
Additional Communication Considerations
Are there any other individuals or stakeholders that responders should engage with initially?
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