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3 Management of a major medical incident – a multi national challenge
  1. Lt Col Jon Walker
  1. Clinical Director Roto 2A; Emergency Medicine Consultant, Defence Medical Services and Oxford University Hospitals; Pre-Hospital Care Physician, Defence Medical Services and Thames Valley Air Ambulance; Honorary Senior Clinical Lecturer in Emergency Medicine, Oxford University; Consultant Advisor (Army) Emergency Medicine


Major Medical Incidents on deployed operations are increasingly likely with the utilisation of small DHC facilities with limited clinical personnel and resources. In June 2021 a Suicide Vehicle Borne IED was detonated against a DEU callsign resulting in 13 casualties. A multinational response working from the DEU Role 1+ facility was undertaken and personnel from the DEU, UK and SWE formed ‘Flash’ teams and utilised senior clinical SMEs to deliver care to all 13 patients, 9 directly from the incident and 4 after initial treatment at FRA and CHN facilities. 6 surgical cases were performed over 15 hours along with 2 critical care transfers being undertaken. There were no fatalities and all casualties were repatriated in a stable condition to allow immediate reconstruction.

The success of this undertaking was due to the acceptance from all of ‘Right Person, Right Role’ regardless of service or nationality. Recognising operational and clinical experience, combined with a shared approach to casualty management requires an adaptable mindset in order to find the best ways to deliver casualty care.

From this incident a number of key learning points were recognised:

  • Have a plan, but be prepared to adapt it as the situation changes.

  • Early meetings and understanding of other nations capabilities is key to being able to create multi–national flash teams with the right skill compositions.

  • Have equipment, medications and blood stored together and ready to deploy at short notice.

  • Be able to adapt and utilise other nations equipment and medications.

  • Always re–review the patients and re–prioritise as required.

  • It is not over until all the patients have been evacuated and the equipment and personnel are reconditioned.

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