• K Wong, P S Turner, A Boppana, Z Nugent, T Coltman, T D A Cosker, and S E Blagg.
• Wycombe Hospital, South Buckinghamshire NHS Trust, Queen Alexandra Road, High Wycombe, Buckinghamshire HP11 2TT, UK.
• Emerg Med J. 2006 Sep 1; 23 (9): 709-12.

BackgroundIn 1996, Carley and Mackway-Jones examined British hospital's readiness for a major incident. In the light of recent terrorist events in London, our group has re-visited the issue and conducted a telephone survey of relevant parties to investigate whether the situation has changed almost 10 years on.Materials And MethodsA proforma was devised, and registrars in anaesthesia, accident and emergency medicine, general surgery and trauma and orthopaedics were telephoned in trauma units across the UK and questioned about their readiness to respond to a major incident. Major incident co-ordinators for each of the units were contacted, and their planning, readiness, training opportunities, and recent rehearsals were assessed.ResultsA total of 179 registrars were contacted in 34 different units throughout Britain. One hundred and forty four responses were obtained. Sixty eight registrars (47%) had not read any of their hospitals major incident plan. Only 77 (54%) of the registrars questioned felt confident in the knowledge of their specific role during a major incident. Major incident co-ordinators were contacted at 34 hospitals, and 17 responses obtained. It was remarkably difficult to achieve even that level of response. Rehearsal of major incident plans varied widely between hospitals with 82% of hospitals having practised within the past five years but only 35% were planning for a rehearsal in the next twelve months. 25% of hospitals that responded did not hold any teaching on major incident planning at their introduction sessions for junior and middle grade doctors. Limitations to improvement of major incident planning included: lack of funds, lack of a designated full-time major incident co-ordinator, and lack of technology. There was no significant difference between units within London and those in other regions.DiscussionPreparedness for major incidents in the UK remains poor 10 years after Carley and Mackway-Jones examined the issue. Effective major incident plans require forethought, organisation, briefing of relevant staff and regular rehearsal. Increased resources should be provided for this at a local level and more regular rehearsals undertaken to ensure our preparedness for future major incidents.

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