Psychosocial aspects of major incidents: DipIMC practice questions

Question 1 · Major Incident & Triage · Hard

After a coach crash with multiple casualties, the local resilience forum asks the ambulance trust's medical adviser what the multi-agency major incident plan should contain for the psychosocial care of survivors and the affected community. Which arrangement is consistent with NICE guideline NG116 on post-traumatic stress disorder (2018)?

AA co-ordinated psychosocial plan: practical help, community support, specialist access, clear roles, 1-month screening if at high risk
BA single-session psychologically focused debriefing for every survivor within 72 hours, given by counsellors at the scene and rest centres
CNo specific psychosocial provision, with survivors referred by their own general practitioner if symptoms persist beyond three months
DUniversal PTSD screening in week one, with trauma-focused cognitive behavioural therapy (CBT) for all regardless of symptoms
EA short prophylactic benzodiazepine course, offered from the casualty clearing station to the most distressed of the survivors

Show answer

Answer: A

A co-ordinated psychosocial plan: practical help, community support, specialist access, clear roles, 1-month screening if at high risk

NICE NG116 addresses disasters at the level of the plan, not just the individual. Recommendation 1.8.1 says disaster plans should provide a fully coordinated psychosocial response, and lists what the plan should include: immediate practical help; support for the affected communities in caring for those involved; access to specialist mental health, evidence-based assessment and treatment services; and clear roles and responsibilities for all professionals involved. Recommendation 1.1.8 adds that, for people at high risk of developing PTSD after a major disaster, those coordinating the plan should think about the routine use of a validated, brief screening instrument at 1 month after the disaster. The timing matters: screening is at 1 month and targeted at those at high risk, not universal and in the first week, and trauma-focused CBT within the first month is offered to adults who have acute stress disorder or clinically important symptoms of PTSD, not to every survivor. NG116 says not to offer psychologically-focused debriefing for the prevention or treatment of PTSD, and not to offer drug treatments, including benzodiazepines, to prevent PTSD in adults, so a plan built on either contradicts the guideline. Leaving psychosocial care out of the plan ignores 1.8.1. The Oxford Handbook records that social and psychological support at a major incident is shared between social services, the voluntary aid societies and health, which is why the plan must say who does what.

Where this comes from

NICE NG116 Post-traumatic stress disorderNICE, December 2018·Disaster planning“Ensure that disaster plans provide a fully coordinated psychosocial response to the disaster.”Open at this sentence
NICE NG116 Post-traumatic stress disorderNICE, December 2018·Screening after a major disaster“a validated, brief screening instrument for PTSD at 1 month after the disaster”Open at this sentence
NICE NG116 Post-traumatic stress disorderNICE, December 2018·Psychologically-focused debriefing“Do not offer psychologically-focused debriefing for the prevention or treatment of PTSD.”Open at this sentence
NICE NG116 Post-traumatic stress disorderNICE, December 2018·Early trauma-focused interventions for adults“adults who have acute stress disorder or clinically important symptoms of PTSD”Open at this sentence
NICE NG116 Post-traumatic stress disorderNICE, December 2018·Drug treatments for adults“Do not offer drug treatments, including benzodiazepines, to prevent PTSD in adults.”Open at this sentence
Oxford Handbook of Pre-Hospital Carep. 588Ch. 10 Major incident management and triage · Table 10.4 Emergency services' responsibilities: social and psychological support“Social services/voluntary aid societies/health”

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Question 2 · Major Incident & Triage · Moderate

At a major incident a group of uninjured but shocked passengers has gathered at the edge of the outer cordon. The ambulance commander is asked who is responsible for their care and for the survivor reception centre. Which answer is correct?

AThe ambulance service, with health service staff running the survivor reception centre
BThe fire and rescue service, with fire crews running the survivor reception centre
CThe police and the local authority, with council staff and volunteers running the centre
DThe casualty clearing officer, with uninjured people registered at the clearing station
EThe receiving hospital, with emergency department staff running the reception centre

Show answer

Answer: C

The police and the local authority, with council staff and volunteers running the centre

The Oxford Handbook's Table 10.4 allocates the responsibilities at a major incident: care of the injured to the health services with police and fire, but care of uninjured survivors to the police and the local authority and social services. Among the local authority's listed roles is staffing survivor reception centres and other functions, using council employees and members of the voluntary services. The Oxford Manual of Major Incident Management likewise lists evacuation and care of uninjured survivors among the specific functions of the police. The fire service's part is rescue and specialist resources such as lighting, lifting equipment and shelter, not the care of survivors. The casualty clearing station, run by the ambulance service with the casualty clearing officer, exists for the assessment and treatment of injured casualties; apparently uninjured people are monitored at a separate location rather than processed through it or conveyed to hospital.

Where this comes from

Oxford Handbook of Pre-Hospital Care
- Ch. 10 Major incident management and triage · Table 10.4 Emergency services' responsibilities · p. 588“Care of uninjured survivors”
- Ch. 10 Major incident management and triage · Roles of the other services: the local authority · p. 590“Staffing survivor reception centres and other functions”
Oxford Manual of Major Incident Management
- Ch. 1 An Introduction to Major Incident Management · Introduction to roles and responsibilities: police service · p. 30“Specific functions include evacuation and care of uninjured survivors”
- Ch. 1 An Introduction to Major Incident Management · Introduction to roles and responsibilities: fire service · p. 30“specialist resources such as lighting and lifting equipment or shelter”
- Ch. 1 An Introduction to Major Incident Management · Casualty treatment · p. 28“Apparently uninjured victims will be monitored at a specific location.”

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Psychosocial aspects of major incidents: DipIMC practice questions

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