Clinical guidelines for major incidents

The clinical guidelines for use in major incidents and mass casualty events have been developed following a period of multiple incidents which have presented a range of challenging clinical scenarios such as blast injury, penetrating injury and the use of chemical agents, unlike those seen in day-to-day practice.

This document allows the NHS to establish and share best practice in the clinical management of major incidents and mass casualty events, using experience from both military and civilian practice and lessons identified after the recent incidents – assisting clinicians in managing these patients.

This guidance will be regularly reviewed and re-issued as new developments based on an ever-increasing evidence base and experience emerge.

Major incident triage

As part of a review of major incident triage undertaken by the NHS England Emergency Preparedness, Resilience and Response (EPRR) Clinical Reference Group (CRG) two new triage tools have been developed; the NHS Major Incident Triage Tool (MITT) and the Ten Second Triage Tool (TST). Both tools have undergone extensive field testing across a number of scenarios with a range of responders.

NHS Major Incident Triage tool (MITT)

The MITT is to be used by all NHS responders to major incidents and is a single tool for both adult and paediatric patients that allows for rapid, reliable and reproducible triage.

MITT replaces the current triage sieve tool, triage sort tool and the paediatric triage tape.

Ten Second Triage tool (TST)

The TST is designed to be quick, simple and effective at prioritising large numbers of casualties rapidly with a focus on immediately providing lifesaving interventions (LSI). These LSI include control of severe bleeding and opening of the airway, which are known to be the key requirements to maximise patient survival in the early stages of injury. Whilst principally designed for events where casualty numbers far outweigh the availability of responders it is equally effective at any multiple patient event.

Casualty labelling following triage

This document explains the principles of labelling of patients following triage to communicate the prioritisation of large numbers of casualties.