Involvement of an Ambulance Service in the Planning of a Major Incident Response Exercise

Background and Aim: Simulation facilitation should never be improvised, but be developed with specific participants’ learning objectives. In many domains where simulation is used, the stakes are usually high, either in terms of human lives or monetary value; especially when the scale of the simulation involves several hundred of participants from multiple organisations.

The exercise objectives were to: Implement and test the HMCAS Major Incident Response (MIR) plan with multiple agencies; Respond in an unfamiliar and highly secured environment; Determine the efficacy of the current MIR plan; and Identify what improvements could be made to ensure the safe and effective response of all parties involved in that particular environment.

Material and methods: The simulated major incident took 5 months of planning with regular multiagency meetings. HMCAS Training Department was responsible for the simulated patient scenario cards (Chief complaint/Vital signs upon initial assessment/Hidden information about deterioration for some of them). It involved 38 simulated patients, 80 uninjured civilians, and 32 dummies representing deceased casualties. HMCAS engaged in two half-day table top sessions with the supervisory team on duty the day of the exercise so they could apply the new MIR plan, rehearse radio communication protocols, and practise the various command roles. Such exercises require a lot of preparation to fully test various MIR aspects and included transport of casualties by ambulance and helicopter to several hospitals. The actual event unfolded over 3 hours and was followed by multi-agency and individual agency debriefing sessions.

Results and Conclusions: The objectives were achieved and provided a unique experience to: Implement the MIR plan and command structure; become familiar with a highly secured and regulated environment. From a simulation perspective, responders omitted to initiate treatment based on the moulage and casualties got out of their role during the triage process.
Staff expected to take on a command role should be explicitly briefed about expectations with regards to resource and equipment utilisation to also test on-scene secondary assessment and treatment. Other key issues identified were: on scene and radio communication, and coordination with other agencies regarding scene management; highlighting the need for more regular table top and large scale exercises.