The Prehospital Response

Abstract

As discussed in Chap. 1, a major incident is by definition a situation where available resources are insufficient for the immediate need of medical care. Different from the “normal accident” where an ambulance – at least within a short time – can be expected to be available for every patient who needs transport, some patients may now have to wait for transport. Evacuation may be delayed for other reasons, such as time-consuming extrication, difficulties getting access to the scene, and/or lack of rescue staff in relation to the needs. All this generates a need for additional medical functions on the scene:

• Leading and coordination of the medical work on the scene in communication with other involved organizations (rescue service, police)

• Continuous communication with the medical coordination center (the alarm center, ambulance dispatch center, or regional medical command center, depending on local organization); reporting expected need of care; and requiring resources according to needs

• Triage on the scene, i.e., deciding the order in which patients should be treated and evacuated

• Treatment on the scene because evacuation is delayed, but also because treatment may permit a lower priority for some casualties, saving ambulances for those who need to go to a hospital immediately

• Transport to hospitals with consideration of available hospital resources, which requires communication with a coordinating medical center (see above)

This means an immediate need of medical staff on the scene that (1) can lead and coordinate the work according to the above and (2) can start doing triage as a base for transport priority. Regardless of organization, these tasks are primarily done by the crew of the first ambulance on scene.

Incidents with many casualties and/or a delay in evacuation require additional medical staff for work on the scene with the tasks described above. Planning for major incidents must include preparedness for this. It is important for the medical officer in command on the scene to identify such needs at an early stage so that prehospital teams can be mobilized for this purpose and ambulance crews instead utilized for transport.