Mass casualty incidents in Ireland - Response?

seven_eleven

So I got thinking today on the bus, what resources has the HSE, Firebrigade, Gardai (and other services) in place for a MCI?

The main reason I ask this is because outside of Dublin I realise resources are fairly limited, there might be a few ambo's on call for each county.
Take for example a coach/train/aircraft crash, 50+ casualties, even in Dublin city I dont think there would be 50 ambulances available off the bat. So presumably an on site triage tent would be erected where a large portion of the injuries could be treated. Are there available physicians, nurses, and other hospital staff available to respond and how would that be co-ordinated?

In terms of vehicles, does the HSE or FB have any MCI trucks with a wide range of equipment? The only vehicles Im aware of is a HSE mobile control unit in Kilkenny. Similarly I'm curious to know what heavy lifting and multi-purpose fire brigade trucks are located around Ireland, aside from the usual tendors and turntables etc.

I live in the South East, so gathering appropriate amounts of personnel and equipment to deal with the situation would possibly be slow.

There has been a few training scenarios that I recall over the past years such as a train de-rail exercise in Carlow, and a plane crash exercise in Waterfod.

The only major incidents I can remember actually happening in the past few years was the Cork plane crash, and that RTC in Donegal that killed 8(?) people. It makes me wonder how far ambulances were dispatched from to get to that.

I'm asking a lot of questions here but just think of this as a general discussion thread about how equipped you think ES are to deal with MCI's and what contingency plans are in place.

mr.dunkey

seven_eleven wrote: »

So I got thinking today on the bus, what resources has the HSE, Firebrigade, Gardai (and other services) in place for a MCI?

The main reason I ask this is because outside of Dublin I realise resources are fairly limited, there might be a few ambo's on call for each county.
Take for example a coach/train/aircraft crash, 50+ casualties, even in Dublin city I dont think there would be 50 ambulances available off the bat. So presumably an on site triage tent would be erected where a large portion of the injuries could be treated. Are there available physicians, nurses, and other hospital staff available to respond and how would that be co-ordinated?

In terms of vehicles, does the HSE or FB have any MCI trucks with a wide range of equipment? The only vehicles Im aware of is a HSE mobile control unit in Kilkenny. Similarly I'm curious to know what heavy lifting and multi-purpose fire brigade trucks are located around Ireland, aside from the usual tendors and turntables etc.

I live in the South East, so gathering appropriate amounts of personnel and equipment to deal with the situation would possibly be slow.

There has been a few training scenarios that I recall over the past years such as a train de-rail exercise in Carlow, and a plane crash exercise in Waterfod.

The only major incidents I can remember actually happening in the past few years was the Cork plane crash, and that RTC in Donegal that killed 8(?) people. It makes me wonder how far ambulances were dispatched from to get to that.

I'm asking a lot of questions here but just think of this as a general discussion thread about how equipped you think ES are to deal with MCI's and what contingency plans are in place.

I can give you my opinion from the ambulance service only.

Your right in thinking outside the capital we do not have as many Ambulances etc. A coach crashed 50 people on board doesn't equal 50 ambulances.If they can walk they walk from the incident,if these seem to have minor injuries,broken arm,soft tissue injuries can all go on a bus,53 seater or minibus.
dead people don't need to be transported,prob get all coast guard chopper plus air ambulance for urgent cases. Off duty staff will be called in, hospital medical/surgical teams if required may be brought to the scene.
So initially response will be slow but if METHANE is given all hands will be used.
There are trained response teams and officers trained in major incident around the country that will be on call.

seven_eleven

mr.dunkey wrote: »

I can give you my opinion from the ambulance service only.

Your right in thinking outside the capital we do not have as many Ambulances etc. A coach crashed 50 people on board doesn't equal 50 ambulances.If they can walk they walk from the incident,if these seem to have minor injuries,broken arm,soft tissue injuries can all go on a bus,53 seater or minibus.
dead people don't need to be transported,prob get all coast guard chopper plus air ambulance for urgent cases. Off duty staff will be called in, hospital medical/surgical teams if required may be brought to the scene.
So initially response will be slow but if METHANE is given all hands will be used.
There are trained response teams and officers trained in major incident around the country that will be on call.

Ah yes, I know that 50 casualties doesnt equal 50 transports I should have mentioned that. But in the worst case scenario where there are 50 or more acute patients, I presume the majority of care would take place in a field hospital until deemed appropriate to be transported.

In terms of the NAS, is there any specialist equipment aside from the usual BLS, ALS, ambo's, response cars and command units? I'm guessing the civil defense and voluntaries would be called in (in the most extreme circumstances), and possibly private ambulance?

Here's an interesting vehicle I found from googling around a bit: http://i.imgur.com/ytNF09H.jpg mass casualty transport.

Bang Bang

The term Multiple Casualty Incident Management (MCIM) which training and provision is Major incident Medical Management and Support (MIMMS).
There is an official document relating to the management of major incidents and MCIM entitled 'A Framework For Major Emergency Management', this can be downloaded free from the Dep't of Health & Children website. It's an excellent document well worth obtaining if you wish to learn about MCIM in Ireland.
Major incidents are also covered to some degree in the PHECC CPG's.

A major incident can be defined as an incident that relies on more than what resources are immediately available in a specific area at that time and these type of incidents happen more frequent than the general public would be aware of.

flazio

It is trained for in the Paramedic classes, Ballinasloe school have been putting up very good incidents for trainees for a few years now.

Potential-Monke

And from the Gardai point of view, there are members trained (always at least one working) in Major Emergency operations. Within 10-15 minutes, a dedicated room would be set up with resources coming out of thin air.

apc

All senior management in the Fire Service are trained in major emergency planning. Just count your lucky stars it has never happened as the chances of it working is nil.

civdef

That's a broad statement to make?

BaronVon

I would be very surprised in AGS could react sufficiently to a proper major emergency.

They could probably manage with drafting nearby units in, forsaking normal policing temporarily. But if the situation arose where they needed to call in off duty members en masse, I don't envisage them being able to get members in and transported to a scene in a required time frame.

seven_eleven

Potential-Monke wrote: »

with resources coming out of thin air.

A hint of sarcasm perhaps?

apc wrote: »

All senior management in the Fire Service are trained in major emergency planning. Just count your lucky stars it has never happened as the chances of it working is nil.

Well I have enough faith in the fire brigade to do as best as they can, I'm sure the plan would work somewhat but I dont think any plan will fully work no matter how detailed. Things always go wrong.

infacteh wrote: »

I would be very surprised in AGS could react sufficiently to a proper major emergency.

They could probably manage with drafting nearby units in, forsaking normal policing temporarily. But if the situation arose where they needed to call in off duty members en masse, I don't envisage them being able to get members in and transported to a scene in a required time frame.

Depending on the situation of course, its possible the civil defense could be called to give a hand with a large amount of their work if needed.

timmywex

infacteh wrote: »

I would be very surprised in AGS could react sufficiently to a proper major emergency.

They could probably manage with drafting nearby units in, forsaking normal policing temporarily. But if the situation arose where they needed to call in off duty members en masse, I don't envisage them being able to get members in and transported to a scene in a required time frame.

AGS are probably best equipped to deal out of the emergency services. At the scene of a major emergency AGS dont actually have much to do, securing the scene & any evidence and controlling traffic of the emergency vehicles. Obviously supporting the other services aswell.

Compare that to the ambulance service who have a lot less staff working in an area! AGS would pull members from investigations/paper work/traffic checkpoints/patrols and send to the scene

At least thats what i think, maybe a AGS member will point in a different direction though!

maglite

How have we got on Dduring the last couple Major Incidents?

Potential-Monke

seven_eleven wrote: »

A hint of sarcasm perhaps?

Yes and no. It was an attempt at getting the point across that the resources aren't there to begin with, and secondly that when others know that the most they would be doing is standing in a spot stopping traffic, then they wouldn't mind doing that as it doesn't involve any follow up!

But, depending on the size of the incident, i don't this AGS would have sufficient resources. I'd imagine the other emergency services would have less.

charlemont

I'm almost sure that each County Council have plans drawn up in conjunction with their local emergency services, I know South Tipp CC has anyway and they would include for example a planned response to a serious pile up on the M8.

kub

I am aware that perhaps the most recent major accident response was the aircraft crash at Cork Airport.
There was a huge turn out for it by all emergency services, they got huge praise for their work and planning on the day.
A lot of things though were in their favour, the incident happened at the 2nd highly populated city in the country, it happened in the morning of a working week eg Thursday ( i think at approx 11am). One of the countries largest trauma centres is only 10 mins from the airport and the actual amount of casualties was low.

Having said all that though, i would hate to think of the situation should it have been a packed 737 late on a Saturday night.

Having said all that though, i take my hat off to all concerned on the day, an excellent professional response.

irishrgr

I can say from having attended a few of these over the years that things rarely go according to any set plan and generally most agencies normal operations cannot absorb a sudden surge of casualties.

Major event planning has shifted from specific drills to a more general "all hazards" planning concept. IE be it a bus crash, plance crash, building collapse, the command and control concepts are generally the same. The tactical execution is diferent of course which is why we do training.

Even the largest US cites would be overwhelmed by a large event....rememeber the "wheels keep turning" as in just becuae there was aplane crash doesn't mean the rest of the calls stop...you still have the chest pains, car crashes, fights, falls etc ongoing. An influx of 50 casualties in Dublin will overwhelm the system just as much as it would in LA. Granted a bigger system has more resources to throw at an incident, but it still ends up being chaos & confusion for the first 30 or so minutes until you get a grip on what is happening and what is needed.

As a planning concept, you go with what you generally have on duty. Calling people from home is OK for relief and rotation but if they take 2 hours to get there (with kit etc) they really don't help the scene.

End of the day, most agencies plan as best they can, revise & adapt and get on with it. The drills and training are great to identify capabilities & shortfalls, agency roles & responsibilities (who is lead agency, can radiso talk to each other, etc) but it's still down to managed chaos...

punchdrunk

once the new S-92's are online with the coastguard we will be in a far better position.
I'd hazard a guess that for a major incident, one chopper from each coast of the country would be used
(leaving two on station to perform the Coastguard's primary role)

obviously the midlands based IAC air ambulance would respond too, so that would be 2x s-92's and 1x 139 responding within 15 min
all with paramedics on board and all capable of lifting multiple, worst case casualties.( for example one S-92 could lift approx. 15 walking wounded at a push)

Baldonnel I'd imagine would get another 139 in the air fairly quickly too and if the incident was truly a catastrophe i'm sure it's possible that the other two Coastguard choppers could be released too.

so going forward I'd imagine an major disaster plan will hinge on heli response.

majimbo

Interesting commentary. Given 230+ dead in a Brazil nightclub last week. (probably less of a problem). Reality - having spoken to several friends and on two occassions when I phoned Ambulance control myself (both times to be told there was a delay in geting an ambulance) it becomes apparent that many people have had delayed responses from the NAS. But we havent complained.
Remember the HIQA report of 2011 instructed a 7 minute first response for medical and trauma emergencies and allowed 19 minutes for the ambulance to arrive. Road accidents training also speaks of the Golden Hour (45min)

Unless there is radical reform the delayed responses will remain.

So first responders fire brigade and whatever ambulances are available will have to do their best and hope for walking wounded solutions.

GS generally dont get involved unless absolutely necessary

cyclops999

majimbo wrote: »

Interesting commentary. Given 230+ dead in a Brazil nightclub last week. (probably less of a problem). Reality - having spoken to several friends and on two occassions when I phoned Ambulance control myself (both times to be told there was a delay in geting an ambulance) it becomes apparent that many people have had delayed responses from the NAS. But we havent complained.
Remember the HIQA report of 2011 instructed a 7 minute first response for medical and trauma emergencies and allowed 19 minutes for the ambulance to arrive. Road accidents training also speaks of the Golden Hour (45min)

Unless there is radical reform the delayed responses will remain.

So first responders fire brigade and whatever ambulances are available will have to do their best and hope for walking wounded solutions.

GS generally dont get involved unless absolutely necessary

My fire authority will no longer refresh our EFRs & CFRs as it costs to much money.

Mister Jingles

I know its 32 years next week but I suppose the Stardust fire was one of the last major mass casualty incidents to occur in the state unless I'm leaving out an IRA bombing after that? But didn't CIE turn up with a few buses to ferry the casualty's off to the hospitals around Dublin as the fire brigade/ambo services weren't able to deal with the crises with the resources they had. Dunno if its true (especially of I wasn't even alive) but didn't the civil defense turn up ?

seven_eleven

Mister Jingles wrote: »

I know its 32 years next week but I suppose the Stardust fire was one of the last major mass casualty incidents to occur in the state unless I'm leaving out an IRA bombing after that? But didn't CIE turn up with a few buses to ferry the casualty's off to the hospitals around Dublin as the fire brigade/ambo services weren't able to deal with the crises with the resources they had. Dunno if its true (especially of I wasn't even alive) but didn't the civil defense turn up ?

According to wiki at least. I shudder to think how the ambulance service in this country was run in the 1980's.

majimbo

Apparently Dublin Fire Brigade run about 13-15 ambulances daily (increased by one when Swords part time fire station went fulltime) and that is the only increase in ambulance cover by DFB in almost 25 years despite population and increases in the greater Dublin area.

BTW Ambulances also only carry one casualty now as opposed to the older ambulances carrying two stretchers. As a result Ambulances needed to double in number to replace the potential carrying capacity at incidents but this was not done.

I don't whether HSE NAS ambulance cover has improved.

A national first response policy for fire services would surely improve attendance times for medical emergencies in rural Ireland in most cases, perhaps along the IFESA line of a national fire and ambulance service