Miracles take a little longer: the challenges of the uncompensated major incident

Abstract

The challenges of managing uncompensated major incidents (UMI) are many and complex. A concomitant loss of infrastructure is common in large-scale disasters. Significant planning, including liaison with relevant agencies on an international basis is necessary to facilitate a rapid and co-ordinated response to such events. UMIs must be managed in a structured manner in common with that utilized for smaller-scale major incidents, although some modification may be appropriate. Use of the ‘expectant’ triage category should be implemented at an early stage to prevent scarce health service resources being monopolized by patients with no possibility of survival. Many patients will be suitable for treatment at the scene without subsequent urgent referral to hospital facilities. The early involvement of military forces is vital to provide manpower, tents (for casualty clearing stations and temporary shelter), high volume transportation and forward dressing stations at the scene and at receiving hospitals. The military can also facilitate the restoration of infrastructure, including access and egress routes. The risk of uncompensated major incidents occurring is real and is not limited to natural catastrophes occurring in developing countries.