EMed

CUH Major Incident plan - Emergency Department

Background

A major emergency is any occurrence which causes a threat to the health of the community, disruption of essential services, causes, or, is likely to cause, such a number of casualties, or damage to property, or to the environment, as to require special arrangements by the Garda Síochána, the Southern Health Board, and the Local Authorities.

Hospital Alert Procedure by day 09:00 - 17:00 hours

The plan will be initiated by a call to the Emergency Department from Garda Divisional Head Quarters or ambulance HQ. The Emergency Department Clinical Nurse Manager / Nurse in charge should note:

  1. Time of call
  2. Name of caller
  3. The exact location of the incident
  4. The type of incident e.g., (road / rail / air)
  5. The hazards that are present and anticipated, (chemical etc)
  6. An estimation of the number and severity of casualties
  7. The emergency services already present, and those immediately required

then:

  1. Contact and confirm details with ambulance control
  2. Confirm call with Anglesea Street Garda Station by direct line
  3. Alert Medical Director, Emergency Department
  4. Activate the Hospital Major Emergency Plan, as set out in Action cards No. 8. 9, 10, 11. 12, 13, and 1

Hospital Staff to be alerted by ED (Action Cards)

  1. Hospital switchboard
  2. Medical Director Emergency Dept
  3. Mobile medical team (Anaesthetic registrar/SHO, Surgical SHO, ED nurses x 2)
  4. Emergency Department consultants, registrars, off duty ED doctors
  5. Clinical nurse manager OPD
  6. Director of Nursing
  7. ED service and Business managers
  8. ED clerical staff
  9. Off duty ED nursing staff

Hospital Mobile Medical Team

  • The Emergency Department Registrar will be the Site Medical Officer
  • The SMO, with one ED nurse, will be conveyed from the ED to the scene of the incident by the CUH security transport
  • This team will assemble at the Emergency Department
  • Army transport will convey the team to the incident site
  • Medical emergency packs will be collected at the ED

Composition of Mobile Medical Team

Anaesthetic Registrar

Surgical SHO

Three ED nurses

Hospital alert system by night 17:00 - 09:00

Telephonists on duty in the early stages must be available for incoming calls from Gardaí, Army etc. until additional telephonists are available and radio contact made with the scene of the accident.

Notification of Major Incident will be identical to that of daytime.

Clinical Nurse Manager / Night superintendent
Establish precise information regarding the incident and follow the procedure as set out for daytime.

Telephonist on duty will then alert nominated staff

ED Clinical nurse specialist / night sisters

  1. Alert one ward on each floor, including Paediatric and Psychiatry Units
  2. Alert Consultant Staff and Nurse Service Managers using direct dial telephone
  3. Alert Radiology Department Nursing Staff
  4. Alert Supporting Hospitals
  5. Alert Junior Medical staff who are off duty and are not sleeping in staff residence. Begin with Registrars - use mobile phones for direct access, or the direct dialling telephone in the office of the Service Managers

Site medical officer

The Site Medical Officer is designated by the Medical Co-ordinating Officer at the designated Hospital.

He/she is the most senior doctor at the scene and will have the following role.

  1. Maintain close liaison with the Site Ambulance Officer to co-ordinate the appropriate dispatch of casualties to hospital
  2. Direct triage of casualties at the scene
  3. Direct and oversee treatment at the scene
  4. Deploy doctors and nurses to other points of the incident area, in close liaison with the Controllers of Operations
  5. Record all casualty triage, and communicate the details to the Medical Co-ordinating Officer

The Site Medical Officer should not become involved with treating individual casualties.

Casualty Identification

In the early stages of any incident staff and resources will be fully deployed in caring for live casualties.

The Site Medical Officer will also arrange certification and labelling of the dead.

The Gardaí will inform and consult with the Coroner for the area.

The Gardaí will be responsible for the storage and security of dead bodies at the accident site Temporary Mortuary

Initially, post mortem accommodation may be located at Cork University Hospital.

Casualty labelling system

Labelling at Incident Site: Where conditions and numbers warrant it, the Site Incident Medical Officer and any other doctors will label casualties at the scene of the incident available.

The purpose of labelling is:

  • To avoid casualties being re-examined at the scene
  • To indicate to the Ambulance Service priorities for conveyance to hospital
  • To record any treatment or drugs given to casualties at the scene
  • To record details of fatalities

The following labels are carried in the Mobile Control Vehicle.

Label Response Priority
RED Immediate 1st priority
YELLOW Urgent 2nd priority
GREEN Delayed 3rd priority
WHITE Dead  

Casualty documentation at Emergency Department Triage

  1. Outline: To cope with an influx of casualties and with the possibility of problems in the initial acquisition of personal details a major emergency system of documentation will be invoked using designated MRN s
  2. Procedure: At the CUH triage location a numbered wrist bracelet bearing the hospital MRN (Medical Registration Number) will be put on each casualty, a set of E.D documents and a personal property / clothing bag, all bearing the same number will be provided for each casualty. The triage receptionist will attempt to ascertain additional details but this process will not be to the detriment of the clinical assessment by the Triage Officer and the onward movement of the casualty to the treatment area. The notes, property and any X-ray films. must remain with the patient at all times
  3. Supplementary Identification Detail: It will be accepted as expedient that the unique casualty number will suffice for all identification procedures, pending the acquisition of further personal detail. At successive stages in the process of treatment, staff will check the state of completion of the personal details and attempt to fill in any gaps, reporting all information gained to the Hospital Control Centre
  4. The MRN will be used on all documentation and particularly on specimens and request forms for blood transfusion and diagnostic procedures. The MRN must be used on forms and specimens as if it were a name and entered in the appropriate space. It is essential that the gender of the casualty is indicated on all request forms for blood transfusion. Stick on labels pink indicating female and blue indicating male will assist in this
  5. Routine Emergency Dept. Attendance: During the time the Hospital Major Emergency Plan is in operation, all casualties received at the hospital whether from the emergency site or not will use the same documentation procedure
  6. If possible the triage receptionist will annotate the casualty checklist with an indication of any routine admission so that normal documentation procedures can be implemented post-emergency
  7. A garda documentation team will be deployed to the CUH to collate all relevant detail in respect of casualties, which will be required by the Garda Casualty Information Service - located in the School of Nursing classroom 1

Stand down

The decision to stand down will be taken by the Hospital Control Centre in consultation with the accident site officer.

Press information

A press Information centre will be set up by Hospital Management in the main Auditorium. Casualty information at the hospital will be collated by the communications staff in the boardroom, which will be passed on to the media and Central Casualty Bureau, manned by the Gardaí.

Foreign language interpreters

A list of available interpretation services is available via switchboard

Content by Mr. Sean Cotter 24/05/2011, Prof. Stephen Cusack, Dr Íomhar O' Sullivan. Reviewed by Dr ÍOS 09/03/2009. Last Review Dr ÍOS 21/10/22.