Synopsis
Use structured incident communication and current NHS triage tools to prioritise lifesaving actions, repeated assessment and organised casualty movement.
- A major incident requires special response arrangements; it is not defined by one fixed casualty number.
- Send an early M/ETHANE message and update it as facts change rather than waiting for a complete assessment.
- The NHS Ten Second Triage tool is intended for all first responders and uses observable findings without requiring measured vital signs.
Reasoning priorities
Create shared understanding and mobilise the response.
Separate confirmed facts from estimates. Give usable location and access information, current hazards, an approximate casualty distribution and resources required; revise the report when those assumptions change.
Worked reasoning
A clinical responder assesses a non-walking adult with no catastrophic bleeding. The person breathes, responds to voice, has respiratory rate 24/min and pulse 96/min. Initial responder triage was P2.
- Confirm the scene sector is safe and that the casualty is in the clinical responder’s care. Check for immediately correctable airway obstruction or bleeding while repeating the assessment.
- Apply MITT in order: there is no catastrophic bleeding, the person cannot walk, is breathing, responds to voice and is older than two years.
- Compare the measured respiratory rate with the MITT range of 12–23/min. At 24/min the casualty is P1; the later pulse of 96/min does not cancel an earlier P1 decision.
- Update the visible category and record the time and findings. Communicate the change to the treatment and evacuation lead so that it results in a revised priority, not just a changed label.
- Verify that the casualty reaches the designated priority-care area and is reassessed. Continue appropriate treatment while organising evacuation; do not assume that categorisation itself resolves the underlying injury.