Intended for healthcare professionals


Major incidents in England

BMJ 2015; 350 doi: (Published 31 March 2015) Cite this as: BMJ 2015;350:h1712
  1. Sophie Hardy, emergency medicine trainee,
  1. 1Medway Maritime Hospital, Kent, UK
  1. sophiehardy50{at}

Why aren’t we learning from them?

Reporting the results of every intervention is becoming the norm in medicine and provides an excellent basis for medical advancement and quality control. But major incidents have so far escaped this scrutiny. In England, agencies are not mandated to record or report major incidents. Reports that do exist are unstructured and unregulated, and it is difficult to derive useful information from them. Our understanding of major incidents and how best to respond to them is therefore limited.

A major incident is one that overwhelms capacity or, in the NHS’s words, “any event that cannot be managed within routine service arrangements.”1 As recent media attention on emergency departments in England has shown, routine service arrangements are easily strained. With increasing threats from global terrorism and natural disasters,2 major incidents are becoming a more familiar part of our everyday lives. A recent Dutch study examined reports from five consecutive national disasters and noted that, despite changes in protocol, legislation, organisation, and funding, the same mistakes were being made each time.3

Why is it so difficult to learn from major incidents? I was on duty in …

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