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• Improving Major Incident Preparedness
  Anand Krishna, Beenu Madhavan, Oliver R McGregor and Azazul Choudhury
  Published on: 21 November 2019

• Published on: 21 November 2019

  Improving Major Incident Preparedness

  • Anand Krishna, Medical Student King's College London
  • Other Contributors:
    • Beenu Madhavan, Consultant Anaesthetist
    • Oliver R McGregor, Medical Student
    • Azazul Choudhury, Medical Student

  Dear Editor,

  We were pleased to read the short report entitled: ‘Preparation for the next major incident: are we ready? A 12-year update’ by Mawhinney et al. (1). We were particularly interested to read the recommendations of the authors for improving knowledge of major incident protocol, as we have recently completed a Quality Improvement (QI) initiative at a central London hospital Emergency Department (ED), aiming to improve knowledge and awareness of major incident protocols.

  We note that in your paper you assessed only doctors at registrar level. While we recognise the value of this approach, we adopted a slightly different methodology, by evaluating a single department but across staff groups; the importance of nurses, porters and security staff would be vital in transitioning to a major incident state.

  We reviewed a trust Emergency Preparedness, Resilience and Response (EPRR) report that demonstrated, although the trust was broadly compliant with major incident guidelines, there was a suggestion training and awareness amongst staff could be improved.

  We conducted a driver analysis to determine possible factors causing low levels of awareness of major incidents and methods of protocol access. This allowed us to optimise our understanding and target our interventions. Following this analysis we conducted baseline data collection and implemented two interventions: a poster campaign directing staff to both hard copies of the major incident...

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  Dear Editor,

  We were pleased to read the short report entitled: ‘Preparation for the next major incident: are we ready? A 12-year update’ by Mawhinney et al. (1). We were particularly interested to read the recommendations of the authors for improving knowledge of major incident protocol, as we have recently completed a Quality Improvement (QI) initiative at a central London hospital Emergency Department (ED), aiming to improve knowledge and awareness of major incident protocols.

  We note that in your paper you assessed only doctors at registrar level. While we recognise the value of this approach, we adopted a slightly different methodology, by evaluating a single department but across staff groups; the importance of nurses, porters and security staff would be vital in transitioning to a major incident state.

  We reviewed a trust Emergency Preparedness, Resilience and Response (EPRR) report that demonstrated, although the trust was broadly compliant with major incident guidelines, there was a suggestion training and awareness amongst staff could be improved.

  We conducted a driver analysis to determine possible factors causing low levels of awareness of major incidents and methods of protocol access. This allowed us to optimise our understanding and target our interventions. Following this analysis we conducted baseline data collection and implemented two interventions: a poster campaign directing staff to both hard copies of the major incident protocol as well as intranet based guidance; and a series of handover presentations.

  From baseline to final collection, more staff in the ED were able to correctly define a major incident (58% to 94%); understand the role of major incident protocol (58% to 100%) as well as correctly locate the protocol quickly (63% to 100%). These interventions demonstrate how simple QI initiatives can significantly improve awareness, knowledge and understanding, for negligible cost.

  As part of additional data we collected, we surveyed staff attitudes towards the importance of understanding major incident protocol as well as the number who had received formal training in major incidents. Only 67% had received formal training, and the format of this was variable. Some training was delivered at trust induction, some had attended simulation and disaster management courses.

  We strongly endorse your recommendations to improve knowledge of major incident protocol, especially through the use of simulation and induction action cards as well as using virtual reality and other technology. Our cost effective interventions, and targeting of all stakeholders in the department would help to improve basic understanding of the need for and the role of the MIP, and would encourage staff to improve major incident protocol knowledge and event preparedness.

  Reference: Mawhinney JA, Roscoe HW, Stannard GAJ, et al Preparation for the next major incident: are we ready? A 12-year update. Emergency Medicine Journal Published Online First: 12 August 2019

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  Conflict of Interest:
  None declared.

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