Claire Louise Park

Following a mass fatality incident, the assessment of survivability and preventability is essential, yet current methodologies remain inconsistent both within the UK and internationally. The 2024 UK Home Office report ‘ The Patronising Disposition of Unaccountable Power: Independent Review of Forensic Pathology’ evaluated learning from the Hillsborough disaster and the Manchester Arena bombing inquests, highlighting the urgent need for clearer, standardised processes in determining survivability and preventability. This paper critically reviews existing techniques in use to address the question of survivability and preventability and makes recommendations for a national best practice framework to improve this process for future inquiries.

Background: Triage at major incidents has traditionally relied on assessing physiology, and in the UK, this role has usually been performed by healthcare responders. However, recent major incidents have shown that this approach, particularly in the initial phases, may be inappropriate due to potential delays in the delivery of key life-saving interventions (LSIs).The Ten Second Triage (TST) tool has been developed to expedite the triage process and the delivery of key LSIs. The aim of this study was to determine the performance characteristics of the TST, including the time to deliver LSIs, in a simulated major incident setting, by both healthcare and non-healthcare responders. Methods: A prospective observational study was conducted as part of a simulated major incident exercise, incorporating a variety of trauma pathologies. Responders from all three emergency services – Police, Fire, and Ambulance - participated. Eight simulations were conducted, each involving ten responders and a team leader from the respective single service groups. The NHS Major Incident Triage Tool (MITT), the TST alone, and a combination of both were assessed. Quantitative assessments for each simulation included overall triage time, time to delivery of LSI, and accuracy of triage tool categorisation. Results: Using the TST alone, the mean overall triage time was 377 s (10.2 s per casualty). In comparison, the mean overall triage time of the MITT alone was 1500 s (40.5 s per casualty). However, when the MITT was applied following the TST, it was completed more quickly, with a mean time of 960 s (25.9 s per casualty). When the TST was used, we observed a clinically significant reduction in the time to deliver key LSIs (491 s) compared to the MITT (1377 s). Overall triage accuracy was comparable between TST (80.3%) and MITT (79.3%), and TST performance was similar between healthcare and non-healthcare responders. Conclusion: This simulation study demonstrated that the TST is a rapid and accurate early scene triage method that enables the timely delivery of key lifesaving interventions. It facilitates the administration of these LSIs faster than existing physiological triage methods. These findings support the NHS England endorsement of the TST.

Journal of Special Operations Medicine Featured Articles - Ahead of Print

Established in 2018, the Defence Endovascular Resuscitation (DefER) group recognised that resuscitative endovascular balloon occlusion of the aorta (REBOA) offered an option to improve survival in battle casualties dying from haemorrhage, particularly in remote and austere surgical settings. Following a successful jHub opportunity assessment, DefER purchased training and operational kit at pace. By 1 April 2019, the first forward surgical group undertook a bespoke endovascular training and assessment package. Results of the pilot were presented back to a jHub 4* Innovation Board, which initially awarded £500 000 to fund the project to full implementation. Med Op Cap provided a solution to establish REBOA as a core capability on to the 370 modules. REBOA catheters and arterial access kit are now available to deployed Role 2 facilities across defence as an adjunct to damage control resuscitation in specific circumstances. REBOA has, from a standing start, gained pan-Defence Medical Services (DMS) endorsement and has been integrated into deployed damage control resuscitation. To establish a new resuscitation capability across all Role 2 platforms within 15 months of inception represents implementation at pace. This agility was unlocked by empowering clinicians to develop the platform in conjunction with commercial procurement. This article describes how this innovative pathway facilitated the rapid introduction of a lifesaving haemorrhage control technique to equip DMS clinicians.

There’s a therapeutic vacuum in the “hot zone” of a terror attack. Claire Park and colleagues describe efforts in the UK and beyond to deliver expert medical care to casualties trapped at the centre of an attack

Human factors are now integrated into everyday anaesthetic practice, as a result of the work performed over a decade ago looking at anaesthetists non-technical skills (ANTS).¹ Much of this work was performed after key publications in the USA² and the UK³ highlighting that human error and system design was responsible for patient harm. Subsequent high profile cases relevant to anaesthesia^4,5 have brought to light where human factors failures have led to patient death. In 2010, the Royal College of Anaesthetists dedicated the entire Anniversary Meeting to Human Factors and published a supplement to the British Journal of Anaesthesia. Some of the human factors related to the trauma team are listed in Table 1.

Summary: A 7‐year‐old girl underwent laser ablation of tonsillar remnants. Following the procedure, which was surgically uncomplicated, the laser resistant tracheal tube used could not be removed; it was firmly lodged in the larynx, immediately below the glottic opening. This case highlights the importance of careful selection of laser resistant tracheal tubes for use in paediatric patients and challenges traditional concepts of paediatric upper airway anatomy.