For most readers, the term ‘major incident’ is likely to be associated with mandatory annual training or updates rather than a part of day-to-day life—unless of course you work in a Hazardous Area Response Team (HART) or the Emergency Preparedness, Resilience and Response (EPRR) department.
For most ambulance staff, it's not something we spend our days thinking about. A major incident is something no one wants but we are all expected and required to be prepared for. However, major incidents do, unfortunately, occur and when they happen, we are bound to respond in a professional and organised manner.
Many of us will have a bookshelf at home dedicated to our clinical texts and for subjects like ECGs, trauma, anatomy and physiology; we may well have a number of key books. Given the rarity of major incidents, how likely is it that we all keep a book devoted to this subject? And unless we were part of the aforementioned HART or EPRR staff, it is not likely that we would need more than one.
Therefore, if we are to have one book on the subject, it needs to be authoritative, comprehensive, well presented and well written. This is where the Oxford Manual of Major Incident Management delivers.
It is authoritative. Firstly, it is an Oxford University Press offering; famous for handbooks that fill the pockets of junior doctors across the country. Secondly, it is authored by Paul Hunt, a consultant and senior lecturer in emergency medicine, and Ian Greaves, a consultant and professor of emergency medicine, who will be familiar to many for his excellent books on pre-hospital and paramedic subjects.
It is comprehensive. At 450 pages, it is packed full of information that is clear and, more importantly, relevant. It not only makes an excellent reference source for those of us who are employed on the frontline, but it also serves the function of being a well-rounded and commanding text for those who are actively involved in major incident management.
It is well presented. In true Oxford style, it comes in a handy size with a quality feel, sporting the infamously indestructible cover to survive wards and crew rooms everywhere. The book is made up of 15 chapters; the first four deal with the background of major incident management, its frameworks, and the roles and responsibilities of various agencies. These are followed by a dedicated chapter on medical management of the scene and casualties. Remaining chapters cover special incidents, including: chemical; biological; radiological/nuclear; and explosive/ballistic, before finishing with chapters on hospital response, incident recovery, psychological aspects and the media.
It is well written. With these two authors this is pretty much guaranteed and, with the added advantage that they know their audience, it has the bonus of being perfectly targeted. Before we even get to the introduction, we are provided with a 9-page glossary of abbreviations—so I think they have them covered!
This level of detail is reflected throughout the book and increases the further into each chapter you go; meaning those using it for reference can easily locate what they need.
The chapters on background and framework give us the obligatory definitions for major incidents. The book goes on to explain classification, nomenclature and basic principles—ensuring a level of understanding from the start. A theme throughout the text is multidisciplinary teamwork, providing a clear overview of how this fits into each situation. Every possible agency is mentioned but, remembering that this is written for clinicians, it also gives an in-depth explanation of the structure and responsibilities of the other key services such as police, fire and military. For example, providing visual references to rank markings.
Returning to the clinical role in major incident management, Chapter 5 provides finer detail of medical management. The rest of the book's subjects are clearly found using the familiar Oxford layout of headings and sub-headings. There is excellent use of schematics, diagrams, decision trees and flowcharts; all of which are well presented and visually easy to follow. I believe this makes the book even more appealing given we have all ‘grown up’ with this type of aide-mémoire throughout our careers.
The two chapters on special incidents and communications initially seemed like strange inclusions—the first item in special incidents is animal health. However, it became obvious how useful this knowledge is for those involved in planning and preparedness. The rest of the chapter deals with rail, maritime, flooding and air incidents, providing the basic prerequisite knowledge. Also, having read the communications chapter, it was clear that I had so far been overlooking the similarities and differences in systems used across agencies, as well as their varying resilience measures. It closes with a useful section on illustrations and symbols used in drawing site maps for major incidents.
The third quarter of the book is dedicated to the specific types of incidents, namely chemical, biological, radiological/nuclear and explosive/ballistic. Each of these is covered in great depth. By their nature, these subjects can be complex, scientific and confusing—the authors themselves admit to having suffered an amount of ‘acronym blindness’. Thankfully, though, they have managed to distil some clear, concise and unambiguous guidance. All of which is written in a logical sequence to, again, allow the reader to go as deep as they choose.
The final quarter is, by and large, aimed at those involved in the hospital setting or in ‘planning and managing’. It deals with guidance on explicit hospital response, incident recovery and business continuity, finishing off with instructions on how to engage with the media, which is an integral part of managing and containing a major incident.
Chapter 14 was of particular interest. It deals with the psychological aspects of major incidents and I was pleased to see a section in there directly aimed at the psychological wellbeing of emergency personnel. This, I feel, shows significant insight from the authors. It also offers excellent practical advice on psychological first aid, which is something I had not seen anywhere before.
There are also three appendices. The first two cover ‘other resources’ in the form of reading and websites and the third, which is particularly helpful, covers religious and cultural issues, giving succinct advice on their beliefs around medical treatment, observances and death and dying.
The book is finished off with the expected high quality index which has always been a strong point of the Oxford books.
Overall I found this to be an excellent reference book and brilliant all-round resource for its subject. It manages to balance covering in-depth details while allowing the more casual reader a fair chance at taking away the knowledge they need in bite-size chunks. The presentation is clear and easy to follow, as are the diagrams it makes good use of throughout.
If I had to find a criticism, and I struggle in doing so, it would be the lack of just one more appendix that perhaps had a set of ‘page-per-role’ instructions or flow chart for ‘actions in the event’. Admittedly, these can be found throughout the book but the addition of them in one section may well prove useful.
In summary, if you were going to dedicate an inch of space on that bookshelf of yours to just one ‘major incident’ book—I would recommend it be this one.