Practice ABC of Major Trauma, 4th Edition

Major Incidents

BMJ 2014; 348 doi: (Published 28 March 2014) Cite this as: BMJ 2014;348:bmj.g1144
  1. Lizle Blom1,
  2. John J. M. Black2
  1. Royal Berkshire Hospital Reading, UK
  2. John Radcliffe Hospital Oxford, UK

Embedded Image

Copyrighted Material, used by arrangement with John Wiley & Sons Limited. For personal use only, must not be reproduced or shared with third parties. Anyone wishing to reproduce this content in whole or in part, in print or in electronic format, should contact

Browse the ABC series at


  • Definition.

  • Initial response.

  • Phases of a major incident:

    • preparation

    • response

    • recovery.

The Department of Health's Strategic National Guidance to the NHS for Major Incident Emergency Planning (2005) defines a major incident as any occurrence that presents a serious threat to the health of the community, disruption to the service or causes such numbers or types of casualties as to require special arrangements to be implemented by hospitals, ambulance trusts or primary care organisations (Box 1). Varying types of casualties and medical incidents fall into this category. The type of incident will indicate the resources required. Every hospital should therefore have a major incident plan to use when normal resources are unable to cope. Whereas natural disasters account for most deaths worldwide, accidents (Figure 1) or terrorist incidents involving the transport system, such as the London bombings in 2005 (Figure 2), remain a significant risk in the United Kingdom.

Figure 1

Clapham rail disaster, London.

Figure 2

London bombing incident.

Box 1

Major incident definition

Major incidents can be:

  • Simple or compound

  • Compensated or uncompensated

  • Natural or man-made.

Most incidents are:

  • Simple (environment intact)

  • Compensated (patient load less than capacity available)

  • Man-made.


Major incidents can arise in a variety of ways.

  • Big bang: a serious transport accident, explosion or series of smaller incidents.

  • Rising tide: infectious disease epidemic or a capacity/staffing crisis.

  • Cloud on the horizon: a serious threat such as a major chemical or nuclear release developing elsewhere and needing preparatory action.

  • Headline news: public or media alarm about a personal threat.

  • Deliberate release of chemical, biological, radiological or nuclear materials (CBRN …

View Full Text

Log in

Log in through your institution


* For online subscription