Disasters: An overview

Since the 7th July, the Civil Contingencies Act 2004 has now come into force. Emergency services are required to have plans in place to respond to a range of major incidents. The role of prehospital physicians has been recognised for sometime and was highlighted during the inquiry by Hidden QC into the 1988 Clapham rail disaster. The response from all of the emergency and voluntary services was extraordinary on the day. The three post 7/7 reports have made several recommendations, the main recommendations focusing on communications and the management of uninjured survivors and relatives. Previous experience of "one-under" incidents has shown that a single casualty trapped under a train can take up to 90 min to be safety extricated. The management of over 700 casualties with a 50% conveyance rate to hospital at four complex incident sites within the documented timeframe was a significant achievement, but it is important not to be complacent. The doctrinal framework that can be applied to a major incident response is complex from Governmental Department and multiagency guidance down to individual training, operating procedures, and contingency plans, this is summarised in Fig. 9.3.