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Developed and maintained by the NFCC

Control measure

Mass casualty and fatality plans

Control measure knowledge

Dealing with a mass casualty incident requires the planning, co-operation and response of numerous partner agencies. These incidents have the potential to rapidly overwhelm services and careful pre-planning and a co-ordinated response has been shown to provide the best outcome for casualties.

Mass casualty plans are designed as an effective response to major incidents where conventional sudden impact events, or an emergency which results in mass casualties occur simultaneously in multiple locations. Plans are normally activated by the ambulance service of where the incident occurs. Conventional incidents are defined as those that cause traumatic injuries (involving burns, fractures, bleeding etc.) and/or fatalities and do not contain any CBRN (e) elements. See National Operational Guidance: Hazardous Materials – Exposure of the public to hazardous materials.

The number of casualties which determines the term ‘mass’, will depend on the geographical makeup of the area where the incident occurs and the number of casualties that local resources can normally deal with.

Because of the dynamics of a major incident, the activation of mass casualty plans will need to be based on the nature and severity of the trauma suffered, the ratio of ambulance and medical resources available and the accessibility and appropriateness of clinical expertise and resources available within the critical timeframe to reduce mortality from injury. It is therefore difficult to map options against fixed casualty thresholds; the options implemented will vary from one scenario to the next but should be based on pre-agreed emergency preparedness arrangements which outline agreed multi agency actions and responsibilities in responding to mass casualty incidents.

The level of fire and rescue services participation in the implementation of any mass casualty plan will need to be agreed based on the nature and hazards present at an incident and any specialist resources that may be required. See control measures Multi-agency communication and Multi-agency co-ordination

Once a mass casualty incident has been declared it may be necessary for all relevant response organisations to activate their own major incident plans (if they have not already done so). They should then establish a strategic coordinating group to identify the requirements necessary to maintain or increase, if necessary, the capability of the essential emergency services to sustain safe levels of service.

The casualty management plan must be discussed with partner agencies, ensuring that all on-scene commanders are aware of the contents. The plan should include:

  • Tactical options to be conducted (treat and leave or treat and extricate)
  • Composition of the teams delivering casualty care
  • Initial locations for casualty collection points (CCP) and casualty clearing stations (CCS)
  • The casualty management plan must be included as part of the joint decision making process and briefings, prior to staff being deployed into the warm zone, ensuring that all staff are aware of the tactics and procedures to be followed.

See Control Measure - Hazardous Materials Risk Assessment.

Strategic actions

Fire and rescue services should:
  • Identify fire and rescue service roles, resources and assets required to support any mass casualty or mass fatality plans

  • Ensure that staff are suitably trained in the tactical options used as part of a casualty or fatality management plan

Tactical actions

Tactical incident commanders should:
  • Jointly agree a casualty management plan, taking account of the tactical options available

  • Communicate hazards identified in the inner cordon or hazard zone

  • Support other on-scene commanders with the nomination of casualty collection point (CCP) and casualty clearing station (CCS) locations

  • Communicate the casualty management plan to other personnel

All personnel should:
  • Carry out the tactical options included in the jointly-agreed casualty management plan