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 - Liaising with other services - Part 1
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Okay. So moving into second table top, we are going to look at how the scene expands, how we liaise with other services and take a closer look at the decision making process and the processes we should use to help us with that decision making process. If we now think that we are probably now 60 to 90 minutes into this particular scenario, by now, we would have expected a fair amount of resources to arrived, in particular more officers. Can we have a little think about what roles you want, particularly to support you as a commander in managing this scene? Well, certainly initially you want experienced or a person with knowledge of the site. All the capabilities the site has. You want to know what assets that you have on scene that are coming to scene both for your service and any the other service and certainly a frontline picture of what is happening at the call face. What is happening in the way of person injuries, numbers. Okay. And everything else. And are there any particular roles that you could appoint that will give you that information? A. You could have the forward teams, elements of parking, your command clearing station commander. All the ones that need to be appointed to give you clarity on what is happening at those specific stages. Okay. It is clearly really very much a joint effort between probably fire service and ambulance in order to affect the rescue element of this, with Fire probably leading on the rescue element and us supporting them where we can but being focused and ready to deliver treatment. There is probably quite a large amount of decisions to be made here about, where do we start? What do we do? Do we pick the easiest bit first? Do we pick the hardest bit first? Do we, how is the approach? Because clearly you just can not just have throw people at it and start moving... Throw rocks at it. Obviously you need a plan and that plan needs to be coordinated by the emergency services or the commanders of those in emergency services on the ground. Okay. And you need a model by which you make decisions for that plan and execute it when necessary. Okay. So decision controls when you... Okay. So yeah, so let us have a look at decision controls then. So do you want to just have a quick look and go through and think which of those decision controls might well apply in this set of circumstances? Certainly risks is a key one. Health and safety a little. So I think when you are running a scene, you gotta be thinking, why am I doing stuff? Am I doing stuff just for the sake of thing, because it makes me look busy or is the stuff I'm doing actually supporting the plan that is in place. And you will find that is very interesting because people get very distracted by stuff at scene that's actually got nothing to do with the treatment and the transportation of custodies. And to give you an example of that, I went to a counter terrorist exercise good few years back now, which was based around a hospital that had been taken over by some terrorists and unusually for ambulance services, it was a very long exercise. It was three days long and ambulance services never traditionally do exercises that long. And I arrived as part of the umpire team to be met by the onsite commander. We immediately kicked off about the fact that police were not cooperating with him. Police had locked themselves in a room and would not let them in. So they couldn't have a joint cell. He had no idea what was going on. And he was really, really irritated by it. And he had been over there, he had tried to kick the door in and get in, but they were not having any of it, etcetera... And it was disgusting. Yeah. And I said, okay, that's great, mate. Where is your casualty regulation plan? Where is your casualty clearing station going? Where is your circuit going? Where is your loading? Where is your parking? Where is your white gate? Because you've been here 24 hours now. And I would've thought you might have sorted that out by now. So focused on kicking the front door in and talking to police that he had actually forgotten what his purpose in life was and had done. Nothing. Okay. It is very easy to become distracted. So you need to stick to the decision control. So if we just run down some of those, can you see that for me, Aid or... Why are we doing this? Yeah. What do you think we think will happen? Yeah. So what are the possible outcomes of what is going to happen here? That is quite useful. In light of these considerations is the benefit proportional to the risk. It comes up a lot, doesn't it? Benefit versus risk is a big thing in everything that we do. And it is actually, yeah, rather causing some... You are probably just a risk manager really to a certain degree, you are just balancing off. Yeah. Isn't it just the... How much can you get away with... Yeah. For the amount of good you want to achieve quite a lot of the time. Do we have a common understanding and a position on? Yeah. Do we have a common understanding of risk? That's quite interesting because quite often you do not. Yeah. Because your knowledge is lacking. I remember going to a job with no casualties whatsoever. It was about two o'clock in the morning. There was a fire on a waste tip on the side of just by the Aston expressway in Birmingham. And I was a bit humpy because I thought, well, I have got me out in the morning to go to this and there are no casualties, blah, blah, blah. And I arrived. I went down to the Command's group for the JESIP huddle. It was at that point I sort of found out why I was there, because going through the middle of this way site was power lines. And apparently, I know this, black smoke interferes with power lines. It causes them to short circuit. It conducts electricity, high powered electricity, especially so. And those power lines fed the Queen Elizabeth hospital in the middle of Birmingham. Suddenly I had an understanding of the risk and why I was actually there. So it may not always be self-evident to you, but by actually joining the group, joining the discussion, you learn things and you suddenly realise, "Actually, yeah. I have got a purpose in life here". Just keep everybody in Queen Elizabeth alive. Yeah, yeah. Saturday night, busiest time for the hospital. Major trauma centre. My job is to make sure that doesn't go under. So it is only by following the joint decision making model, going around and discussing with others that you will learn stuff, that suddenly actually that does impact me. That is important to me; did not think it was before, but now I can clearly see that it is. Okay? So common understanding, yeah. Clearly, Fire Service are understanding, I didn't know. As an individual, a lot of what we do is based on experience. What we have seen before. Does it fit... As human beings, that's a very natural thing. Does this fit something that I already dealt with before and based on my experience and my knowledge, how am I going to manage it? So that is certainly worth taking into consideration. All of that happens very spontaneously in those command groups with the other services. That is a lot of information, yes? So apart from all the things that Aid's mentioned so far, what might you want to support you in a command group where clearly you are not going to probably have the time to do it yourself? Scribe. A scribe, a loggist. Logistics are invaluable, particularly when it comes to, "When did you know information?", because that constantly changes. And when you come to inquiry afterwards you will find out how valuable that is. And by liaising with other services, by extracting and making sure that you are all on the same page about what the strategic objectives are at this incident and that you are all signed up to and you agree with them, that very much helps that process. You are trying to avoid it devolving into a bonfire about who thinks they are in charge, etcetera, etcetera, etcetera because actually, the reality is that nobody is. Whilst you will say, "Well, the police have primacy over all, etcetera, etcetera", the reality is that leadership phases throughout the incident. When we first turn up, there are hazards and therefore quite clearly Fire and Rescue services are probably leading at that point in time. Then we need to deal with the casualties and that's probably us. Then it is the scene of the crime, so it's the police. Then we are on to the recovery stage, so that's Local authority. So actually leadership from services transitions. Unfortunately, it's not a clear line in the sand that says, "At this point here, Fire Service stops and Ambulance service starts". It's more murkier when it spreads over, yeah, but you can see the transitional process. A lot of times we are waiting to go in and do our bit because we can not get the access, or we do not have the expertise to effect the rescue. So, you have had your big JESIP meeting. We have decided that we are going to work from left to right across the landfill. What is that happened there? We know what we are going to do. We know how it's going to... We know what we are going to do. Yeah. Yeah. So would you say the situation has changed? Yes. Okay. So if the situation has changed what would we need to do? A modified METHANE? Modified METHANE, alright. Because we need to let other people know that the situation has changed and that it has moved on. And that is the point. If the situation has changed you need to do a METHANE. Even if it was only five minutes since the last one, if it has changed you need to update and pass it back. That also helps with your loggist because it date stamps everything that is recorded. Yes. So if you have not got a loggist at that point and you do an updated METHANE and feed it back, then you have got a loggist actually, you are doing... Yeah. A sorta virtual loggist that is recording it in terms of the airwave transmission. I would look to you for that, Aid, that is right, isn't it? In terms of most... All the incident control groups are recorded. So that is useful to know. So I assume those recordings would then also be used for enquiries. Oh, absolutely. Anything that you write on, speak on, will be utilized by the inquiry afterwards. Every single scrap of paper or electronic. Any text messages you sent. Be very careful about using your own personal mobile phone at the scene of an incident because you may lose it otherwise afterwards. Because if you... "Did you send something in, Did you speak to somebody or text somebody on your own phone?" "Yes, mate." "Oh, thanks very much. We'll have that. That's part of the evidence, thank you very much." Then you have lost your phone. Not a happy way of doing business. Okay. You are always thinking about, "When is the end of this?" That you are preparing for when the end happens, that the inquiry starts. At the bare minimum, the inquiry is going to be not the professionals so much but the media. "Did they do the right thing? Why did it take so long to... " And so the notes and the logging that you make in conjunction with the other services. And that is the thing to try and show is that actually, we made all these decisions together. It was not me on my own. That was us all agreeing to that. We all signed up to it. Our collective knowledge and expertise as commanders said that this was the right answer. You can only do that by being in the command group, by co-locating together, by following those JESIP principles.
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Table top exercise - Triage and transportation
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Table top exercise - Liaising with other services - Part 2
So moving into the second tabletop, we are going to look at how the scene expands, how we liaise with other services and take a closer look at the decision making process and the processes we should use to help us with that decision making process. If we now think that we are probably now 60 to 90 minutes into this particular scenario, by now, we would have expected a fair amount of resources to arrive, in particular more officers. Can we have a little think about what roles you want, particularly to support you as a commander in managing this scene?
Well, certainly initially you want to be experienced or a person with knowledge of the site. All the capabilities the site has. You want to know what assets that you have on the scene that are coming to the scene both for your service and any the other service and certainly a frontline picture of what is happening at the call face. What is happening in the way of personal injuries, numbers?
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