Major incident preparedness in a post pandemic world: A survey of anaesthetists

Abstract

The COVID-19 pandemic profoundly changed anaesthetic and critical care departments across the UK and fulfilled the definition of a major incident for an extended period of time. It is regularly highlighted that individual and organisational readiness for major incident is inconsistent, as is support in the aftermath. Post-pandemic rates of anxiety and PTSD in healthcare staff have significantly increased, but we still have no embedded method of helping to prevent it. Clinical debriefing is an emerging tool with proven improved psychological outcomes for staff following an adverse event. We surveyed 354 anaesthetists of a range of grades and experiences prior to attending a webinar centred on major incident organisation, human factors and clinical debrief. While 73.8% knew where to access their hospital’s major incident plan, only 16.8% had been trained in any form of clinical debrief. Only 29% had ever received any formal training in major incident management. It seems that the occurrence of major incidents is no longer a ‘once in a career’ event. The inconsistencies in training and preparedness shown in our survey highlight opportunities for our workforce to be more agile and subsequently better supported for the future.

A major incident is ‘an incident causing casualties on a scale that is beyond the normal resources of the emergency and healthcare services’ ability to manage’. ¹ The COVID-19 pandemic profoundly changed anaesthetic and critical care departments across the UK and fulfilled this definition for an extended period of time. In the aftermath of this major incident, it seems pertinent to reflect upon our preparedness. It is regularly highlighted that individual and organisational readiness is inconsistent, as is support in the aftermath. Post-pandemic rates of anxiety and PTSD in healthcare staff have significantly increased, but we still have no embedded method of helping to prevent it. ²

We surveyed anaesthetists attending a webinar on major incident management hosted by the Association of Anaesthetists. With 354 attendees, we received 107 responses (30.6% response rate). The respondents had an average of 18 years experience in anaesthesia and comprised 58% (72/107) consultants, 18.7% (20/107) anaesthetists in training, 9.3% (10/107) SAS doctors and 4.7% (5/107) listed as other. There was a wide geographical spread of clinicians from around the UK.

73.8% (79/107) knew where to access their hospital’s major incident plan, but only 53.3% (57/107) had ever read it. Just over half (50.5%, 54/107) of respondents understood their role during a major incident. Only 29% (31/107) had ever received any formal training in major incident management.

Importantly, only 16.8% (18/107) of respondents had been formally trained in clinical debrief. Mean confidence score for leading a clinical debrief was 4.4 (1 = not confident, 10 = very confident). 38.3% (41/107) of respondents were able to identify locally available support for themselves or colleagues.

It seems that there is an opportunity to embed more formal, structured major incident teaching within local departments and national curricula. The phrase ‘major incident’ is mentioned five times in the 2021 Curriculum for a CCT in Anaesthesia. ³ No mandatory training is required prior to CCT. Our survey feedback suggests that engagement with locally arranged tabletop exercises are a recognised valuable resource for doctors in training.

Clinical debriefing is an emerging tool with proven improved psychological outcomes for staff following an adverse event. ⁴ We suggest that formal training be widespread throughout all career stages of anaesthetists and intensivists, provided by local departments, and evidenced for training portfolios and revalidation purposes.

It seems that the occurrence of major incidents is no longer a ‘once in a career’ event. The inconsistencies in training and preparedness shown in our survey highlight opportunities for our workforce to be more agile and subsequently better supported for the future.