Control measure

Mass casualty and fatality plans

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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

TRAINING SPECIFICATION

Knowledge and understanding

Control measure element	Learning outcome
Mass casualty and fatality plans	The purpose and benefits of mass casualty and fatality plans The term ‘mass casualties’ The information on which mass casualty and fatality plans are based The contents to be included within the casualty management plan The process of inclusion for the casualty management plan within the joint decision making process and briefings

NOS knowledge and understanding

You need to know and understand:
You need to know and understand: 2026
K Current, relevant legislation, policies, procedures, codes of practice and guidelines in relation to emergency response K Principles of effective response and recovery K Principles of command, control and co-ordination K Roles and responsibilities of partner organisations involved in response and recovery K Relevant emergency plans and arrangements including pre-determined procedures for involvement of other organisations K How to ensure provision of continued support for individuals affected by emergencies
Respond to emergencies as a part of a multi-agency response at the strategic (gold) level
K 1 Current, relevant legislation, policies, procedures, codes of practice and guidelines in relation to emergency response K 3 Principles of effective response and recovery K 4 Principles of command, control and co-ordination K 5 Roles and responsibilities of partner organisations involved in response and recovery K 8 Relevant emergency plans and arrangements including pre-determined procedures for involvement of other organisations K 22 How to ensure provision of continued support for individuals affected by emergencies
You need to know and understand: 2069
K Current, legislation, policies, procedures, codes of practice and guidelines in relation to emergency response K Emergency plans and arrangements K The principles of Integrated Emergency Management (IEM) K Roles and responsibilities of partner organisations involved in response and recovery at local, regional and national level
Respond to emergencies at the tactical (silver) level
K 1 Current, legislation, policies, procedures, codes of practice and guidelines in relation to emergency response K 3 Emergency plans and arrangements K 4 The principles of Integrated Emergency Management (IEM) K 13 Roles and responsibilities of partner organisations involved in response and recovery at local, regional and national level
You need to know and understand: 2102
K Current, relevant legislation, policies, procedures, codes of practice and guidelines in relation to emergency responses K Relevant emergency plans and arrangements K Principles of effective response and recovery K Principles of command, control and co-ordination and potential flexibility between levels of response K Potential impact of emergencies on individuals, communities and the environment K Roles, responsibilities and information needs of organisations involved in response K How to communicate with individuals affected by emergencies in a manner which promotes understanding K Types of facilities which may be established to meet the needs of individuals affected by emergencies
Respond to emergencies at the operational (bronze) level
K 1 Current, relevant legislation, policies, procedures, codes of practice and guidelines in relation to emergency responses K 3 Relevant emergency plans and arrangements K 4 Principles of effective response and recovery K 5 Principles of command, control and co-ordination and potential flexibility between levels of response K 6 Potential impact of emergencies on individuals, communities and the environment K 8 Roles, responsibilities and information needs of organisations involved in response K 9 How to communicate with individuals affected by emergencies in a manner which promotes understanding K 10 Types of facilities which may be established to meet the needs of individuals affected by emergencies

Practical application

Control measure element	Learning outcome
Use and/or develop mass casualty and fatality plans	Jointly agree casualty management plans with other relevant agencies, taking account of the tactical options available Communicate hazards identified in the inner cordon or hazard zone as part of the process 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 relevant personnel

Control measure element

Learning outcome

Use and/or develop mass casualty and fatality plans

Jointly agree casualty management plans with other relevant agencies, taking account of the tactical options available
Communicate hazards identified in the inner cordon or hazard zone as part of the process
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 relevant personnel

NOS performance criteria

You must be able to:
You must be able to: 2002
P Confirm that strategies take account of impacts on individuals, communities and the environment in accordance with organisational requirements P Confirm that relevant organisations have sufficient, accurate information with a suitable degree of urgency to enable effective co-ordination of response in accordance with organisational requirements P Confirm provision of continued support for individuals affected by emergencies in accordance with organisational requirements
Respond to emergencies as a part of a multi-agency response at the strategic (gold) level
P 10 Confirm that strategies take account of impacts on individuals, communities and the environment in accordance with organisational requirements P 13 Confirm that relevant organisations have sufficient, accurate information with a suitable degree of urgency to enable effective co-ordination of response in accordance with organisational requirements P 16 Confirm provision of continued support for individuals affected by emergencies in accordance with organisational requirements
You must be able to: 2046
P Formulate tactical plans which take account of available information, including any pre-determined emergency plans, and anticipated risks in accordance with organisational requirements P Anticipate future resource needs, taking account of possible escalations of emergencies in accordance with organisational requirements P Work in co-operation and communicate with other responders in accordance with organisational requirements P Liaise with relevant organisations to address long term priorities of restoring essential services and helping to facilitate the recovery of affected communities in accordance with organisational requirements P Brief and debrief individuals under your area of authority fully and in accordance with organisational requirements
Respond to emergencies at the tactical (silver) level
P 2 Formulate tactical plans which take account of available information, including any pre-determined emergency plans, and anticipated risks in accordance with organisational requirements P 8 Anticipate future resource needs, taking account of possible escalations of emergencies in accordance with organisational requirements P 9 Work in co-operation and communicate with other responders in accordance with organisational requirements P 10 Liaise with relevant organisations to address long term priorities of restoring essential services and helping to facilitate the recovery of affected communities in accordance with organisational requirements P 16 Brief and debrief individuals under your area of authority fully and in accordance with organisational requirements
You must be able to: 2086
P Make initial assessments of situations and report to other responders in accordance with established procedures P Prepare and implement initial action plans in accordance with organisational requirements P Check actions are carried out, taking into account impacts on individuals, communities and the environment in accordance with organisational requirements P Conduct on-going risk assessments and management in response to the dynamic nature of emergencies in accordance with organisational requirements P Work in co-operation and communicate effectively with other responders in accordance with organisational requirements P Liaise with relevant organisations as required for effective responses in accordance with organisational requirements P Confirm that individuals under your area of authority are fully briefed and de-briefed in accordance with organisational requirements
Respond to emergencies at the operational (bronze) level
P 1 Make initial assessments of situations and report to other responders in accordance with established procedures P 2 Prepare and implement initial action plans in accordance with organisational requirements P 3 Check actions are carried out, taking into account impacts on individuals, communities and the environment in accordance with organisational requirements P 4 Conduct on-going risk assessments and management in response to the dynamic nature of emergencies in accordance with organisational requirements P 5 Work in co-operation and communicate effectively with other responders in accordance with organisational requirements P 11 Liaise with relevant organisations as required for effective responses in accordance with organisational requirements P 14 Confirm that individuals under your area of authority are fully briefed and de-briefed in accordance with organisational requirements

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Major incidents

Control measure

Mass casualty and fatality plans

Control measure

Mass casualty and fatality plans

Control measure knowledge

Strategic actions

Tactical actions

TRAINING SPECIFICATION

Knowledge and understanding

NOS knowledge and understanding

Practical application

NOS performance criteria