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Introduction
In November 2013 and again in December 2014, two major incidents were declared at Glasgow Royal Infirmary (GRI). The first was in response to the Clutha bar tragedy, 1 in which a helicopter crashed into a crowded pub on a busy Friday night, and the second, when a bin lorry lost control while travelling towards George Square, 2 as hundreds of people went about their Christmas shopping. Both locations are within 1.5 miles of GRI and were attended by the emergency services and augmented by the Emergency Medical Retrieval Service, who expertly managed both scenes and facilitated safe and timely transfer to GRI and other receiving hospitals.
GRI is an inner city tertiary referral centre with 900 beds and has an ED, which sees in excess of 85 000 attendances per year. Subsequent to both events, reviews were conducted at health board, hospital and departmental level. In addition, GRI has a well-established trauma group, made up of specialties involved in the management of major trauma, which meets to enhance the co-operation between teams. Our hospital updates our major incident planning regularly due to the large number of international events such as the Commonwealth Games.
Significant learning has been gained from these unfortunate events and a number of changes have been implemented in relation to major incident planning as well as to the processes in place for trauma care more generally. Following each of the incidents action points were generated from our trauma team meetings, formal major incident debrief and our ED's own internal review. The recommendations from these processes have been refined into the 10 key lessons presented in this paper and have been implemented within our ED. These lessons provide insight into challenges of providing care during major incidents and the strategies we have developed to enhance provision. Given the rarity of mass casualty events, we felt it important to share 10 lessons we have learnt.
Lots of little teams make one big team
Many EDs will be familiar with using tabards (or similar) to identify various team members during trauma resuscitations. 3 Following the first major incident, the ED took possession of several sets of tabards, each set in a varying colour. During the second incident, the different colours were especially useful...