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Preparation for the next major incident: are we ready? Comparing major trauma centres and other hospitals
  1. Jamie A Mawhinney1,
  2. Henry W Roscoe2,
  3. George A J Stannard3,
  4. Sophie R Tillman3,
  5. Nick Freemantle4,
  6. Thomas D Cosker5
  1. 1Department of Plastic Surgery, Salisbury District Hospital, Salisbury, UK
  2. 2Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3Medical Sciences Division, University of Oxford, Oxford, UK
  4. 4University College London Institute of Clinical Trials and Methodology, London, UK
  5. 5Department of Orthopaedics, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Dr Jamie A Mawhinney, Department of Plastic Surgery, Salisbury District Hospital, Salisbury SP2 8BJ, Wiltshire, UK; jamiemawhinney12{at}gmail.com

Abstract

Objectives A major incident is any emergency requiring special arrangements by the emergency services. All hospitals are required by law to keep a major incident plan (MIP) detailing the response to such events. In 2006 and 2019, we assessed the preparedness and knowledge of key individuals in hospitals across England and found a substantial gap in responding to the MIP. In this report, we compare responses from doctors at major trauma centres (MTCs) and other hospitals (non-MTCs).

Methods We identified trusts in England that received over 30 000 patients through the ED in the fourth quarter of 2016/2017. We contacted the on-call anaesthetic, emergency, general surgery and trauma and orthopaedic registrar at each location and asked three questions assessing their confidence in using their hospital’s MIP: (1) Have you read your hospital’s MIP? (2) Do you know where you can access your hospital’s MIP guidelines? (3) Do you know what role you would play if an MIP came into effect while you are on call?

We compared data from MTCs and non-MTCs using multinomial mixed proportional odds models.

Results There was a modest difference between responses from individuals at MTCs and non-MTCs for question 2 (OR=2.43, CI=1.03 to 5.73, p=0.04) but no evidence of a difference between question 1 (OR=1.41, CI=0.55 to 3.63, p=0.47) and question 3 (OR=1.78, CI=0.86 to 3.69, p=0.12). Emergency medicine and anaesthetic registrars showed significantly higher preparedness and knowledge across all domains. No evidence of a systematic difference in specialty response by MTC or otherwise was identified.

Conclusions Confidence in using MIPs among specialty registrars in England remains low. Doctors at MTCs tended to be better prepared and more knowledgeable, but this effect was only marginally significant. We make several recommendations to improve education on major incidents.

  • emergency care systems
  • major incident
  • planning
  • guidelines
  • education
  • disaster planning and response

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data collected are in the form of questionnaire responses anonymised of participant details. These are available through the lead author of the study. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data collected are in the form of questionnaire responses anonymised of participant details. These are available through the lead author of the study. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Handling editor Kirsty Challen

  • Presented at Presented in abstract form at the London Trauma Conference 2019; 12/12/2019.

  • Contributors JAM planned the study, collected data for the study, collated data and wrote the manuscript. HWR planned the study, collected data for the study and reviewed the manuscript. GAJS and SRT collected data for the study and reviewed the manuscript. NF performed all statistical analyses and reviewed the manuscript. TDC designed the study, oversaw the running of the study and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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