Limiting pre-hospital care resource deployment in a simulated major incident

Background and Aim: Emergency preparedness is a key aspect of civil security. Other than “alphabet” or “of off the shelf” courses that individuals can attend for their professional development, it is important for emergency services to arrange their own training activities, customised to their own setting and with their own resources. Qatar’s national Ambulance Service (HMCAS) has recently purchased major incident vehicles and equipment and rewritten the Major Incident Response (MIR) plan. Linking with a system-wide training exercise focusing on the hospital facilities, HMCAS ceased the opportunity to simulate an explosion on a university campus to test the new MIR plan. Our aim was to do this without compromising real emergency call coverage.

Material and methods: The scheduled simulated major incident included 271 casualties with different degrees of injuries represented either as simulated patients (actors with moulaged wounds), mannequins, and paper patients with pictures. The casualties were 13 deceased, 147 green (117 paper patients, others were simulated patients), 61 yellow (simulated patients), 50 red (19 mannequins, others were simulated patients). Receiving facilities were spread throughout Qatar and had a copy of the complete set of patient cards. To save time and resources, a particular strategy was used to “virtually” transport casualties. At the exit of the campus, unit number and patient information (including treatment received) were collected by exercise control staff (ECS) and entered on a shared file to inform receiving facilities’ ECS about which patients to account for and pull out from the patient folder at the Emergency Department (ED) in the form of a paper or simulated patient, with a treatment update, at the expected time of arrival. Ambulances now available could immediately return to scene under a new call sign without ever leaving the campus. Simulated patients who were not transported, removed any bandages, collected a new patient card, went to the make-up station, and returned to the scene.


To test the system wide response, EDs received simulated patients, mannequins, and paper patients handed over by the few ambulance crews who actually remained in the same location throughout the whole exercise. In addition self-presenting patients went to specific hospital facilities according to a pre-set time schedule. All patients had a patient card with presenting condition parameters for clinicians to assess and help with the triage process. The 122 simulated patients to represent casualties were actually role played by 126 actors due to the virtual transport to receiving facilities and swap of live for paper patients or on scene simulated patients being re-enacted by their standby “double” at ED.

Results and Conclusions: Our approach allowed the saving of ambulance travel time thanks to the swapping/recycling of patients on scene and at receiving facilities. 20 ambulances/0 green buses were deployed as opposed to an expected 36 ambulances/6 green buses. The exercise met the objectives of the ambulance service however some of the receiving facilities did not feel stretched enough by the volume of patients. Part of the issue is that some of paper patients loaded into the ambulances in addition to simulated patients were not reported to the ECS at the campus exit and hence never virtually arrived at any of the receiving facilities. Greater emphasis should be placed on briefing participants how to manage paper patients.