The British Association for Immediate Care (BASICS). Its experience in major disasters, with special reference to the role of the medical incident officer

Should New South Wales Hospital Disaster Teams Be Sent to Major Incident Sites?

“…Experience from disasters overseas has demonstrated that the efficiency of medical personnel is impaired when performing unfamiliar tasks. Personnel performing their usual duties, the ‘doctrine of daily routine’, 5 –10 are seen as the basis for efficient medical operations. For this reason the value and practicality of hospital medical teams that are not regularly involved in pre‐hospital trauma care have been questioned, 7 –12 because skills acquired in the hospital do not necessarily translate to the scene of a disaster 13 .…”

“…Personnel performing their usual duties, the ‘doctrine of daily routine’, 5 –10 are seen as the basis for efficient medical operations. For this reason the value and practicality of hospital medical teams that are not regularly involved in pre‐hospital trauma care have been questioned, 7 –12 because skills acquired in the hospital do not necessarily translate to the scene of a disaster 13 . Hospital teams often lack experience and training in the pre‐hospital environment, 8 , 14 –20 may become a liability to other emergency service personnel, 21 and may inhibit other emergency service personnel from performing their duties 8 .…”

“…Improvements in extrication techniques have resulted in an on‐site surgical presence at disasters rarely being required 7 , 8 . If field amputation is required, it may not be possible to perform an amputation with a surgeon assisted by a second doctor with anaesthetic skills, due to limitations of space.…”

Literature Review on Medical Incident Command

“…46 Abbasi et al found that incident management teams do not focus on resource shortage and ''make do with what they have available to them at the time.'' 36 The ICS organizational model may be described as hierarchical 55,59 and based on bureaucratic principles. 48 The hierarchical model has been viewed positively by response practitioners who have ''focused on the command and control value of ICS,'' and has been criticized for ''lack of focus on coordination between organizations and levels of government responding to disaster.''…”

“…When more than one hospital is involved, the distribution may be determined by an emergency service commander, 3,50,58,71,82,91,93 or by the medical commander or ambulance commander specifically. 38,55 Distribution criteria may be necessary hospital specialties or resources to meet the individual patient's needs, 50,55,93 each hospital's current bed availability or receiving capacity, 55,82,93 and ''overall impact on the EMS system.'' 93 Not all hospitals have the capability to receive patients from a mass-casualty incident.…”