Brown Bear – A Major Incident Exercise

As part of our recent Clinical Governance Day, EMRTS ran a Major Incident exercise across the Wales Air Ambulance Charity bases in Caernarfon, Welshpool and Dafen. A Major Incident is when something happens that needs special resources to deal with it, over and above what would normally be available. People come in from home, extra equipment required, and special plans are implemented.

EMRTS will have a part to play in any serious incident in Wales, supporting the core work carried out by our colleagues in the Welsh Ambulance Service. As part of our Major Incident exercise, we were grateful to have input and guidance from senior ambulance officers who are experts in the field of Major Incident planning: Patrick Rees and Nick Bell. They and their colleagues ensured that the day was a success, and made sure that we all improved our ability to respond should the worst happen.

We also had help and support from members of hospital MERIT (Medical Emergency Response and Intervention Teams), who would leave the hospital to attend the scene of an incident to provide treatment to urgent patients on the spot. With them were representatives from BASICS and the NHS Wales Courier Service.

A challenge in running an incident like this is making it ‘real’, but also keeping things under control so that plans can be tested and learning can take place. Things need to be simulated and imagined. To do this we used a ‘tabletop’ format. Weird though it sounds for something so significant, this is a bit like a board game. We used cards to represent equipment, helicopters and staff. We set up dummy phone lines and dummy contact centres, put radios on test channels, had a fake hospital switchboard, and laid on the full gamut of staff, including those who would not actually be there but would be coordinating things from afar. On the scenes, to simulate patients we used a supply of Wales Air Ambulance teddy bears, with tags around them saying what was wrong, so that staff could practice making decisions around what actions were required.

It turns out that every Major Incident Exercise needs to have a name. One of the things we have to guard against is someone accidentally thinking this is real life, so naming the exercise is one of the ways that we keep training separate from real-world operations. In Wales, exercises like this have a naming convention: a colour, then an animal. In view of the Wales Air Ambulance mascot, and the fact that we are using teddy bears as simulated patients, we eventually came up with ‘Exercise Brown Bear’.

The exercise was replicated across the three bases. We also had ‘referees’, giving people answers to questions and telling them the results of their actions. Finally, we had a number of people making notes to check that we were learning what we needed to and picking up problems so we can make our plans more effective.

By the end of the day, we were all exhausted. However, it was a worthwhile experience and I personally took a lot from it.

The next bit will be equally important: taking all of the learning from the day and using it to make our Major Incident plans as good as they can possibly be.

Dr John Glen, EMRTS Caernarfon Base Lead

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