Consensus on Items and Quantities of Clinical Equipment Required to Deal With a Mass Casualties Big Bang Incident

A National Delphi Study

Edward A S Duncan; Keith Colver; Nadine Dougall; Kevin Swingler; John Stephenson; Purva Abhyankar


BMC Emerg Med. 2014;14(5) 

In This Article


Major short-notice or sudden impact (known as big bang[1]) incidents which result in a large number of casualties are, fortunately, rare events. However they do occur and health services must be prepared to respond appropriately. In the United Kingdom (UK), as with most developed countries, normal response ambulances will not have the capacity to carry the extra equipment which is required to care for these patients while at the incident.[2]

In order to deal with a big bang mass casualties incident, National Health Service (NHS) organizations, including ambulance services must be supported by extraordinary measures.[1] As part of their role UK NHS ambulance services maintain and deploy extra clinical equipment for big bang mass casualties emergencies;[2] and, on arrival at such an incident, establish and manage a casualty clearing station. Individuals are then triaged and receive emergency medical treatment as required before transportation to hospital. However, the London Assembly Report into the 2005 London Bombings highlights the challenges of achieving this in practice: The London Ambulance Service lacked essential supplies, such as fluids triage cards and tourniquets, at all sites.[3]

Predicting the types and quantities of clinical equipment that will be required at a mass casualties big bang event is difficult. It is necessary to consider the wide range of incidents,[1] both natural and man-made, that could cause such an event, and the resultant broad spectrum of potential clinical need:- e.g. haemorrhage, burns, respiratory disorders; fractures; effects of smoke inhalation etc. The response must also be tailored to the level of care that can be practically delivered in a pre-hospital environment. A recent systematic review highlighted the lack of evidence to inform policymakers and service providers about the types and quantities of clinical equipment required at a mass casualties big bang event.[4]

Current UK ambulance service provision of clinical equipment at big bang mass casualties incidents has developed on the basis of local clinical judgment over many years, without any central co-ordination or clear evidence-base. This has resulted in variations in stock type and quantity throughout the UK. Agreeing the types and quantities of clinical equipment required at a big bang mass casualties emergency would be advantageous. At a national level it would provide policy and strategic decision-makers with knowledge to support them in planning future service provision. More locally it may enable services to make more efficient use of their resources.

This study, therefore, aims to address the current lack of knowledge about appropriate clinical equipment for dealing with a mass casualties big bang[1] event. Specific research questions are: what are a) the most important items of clinical equipment required to treat 100 people at the scene of a big bang mass casualties event?; and b) the minimum quantities required of each item?