Major Incidents: Definitions and Demands on the Health-Care System

Abstract

The incidence of situations in which available resources are insufficient for the immediate need of medical care, commonly defined as major incidents, has significantly increased during the last decades and has paralleled societal development throughout the world. The term major incidents covers a wide spectrum of events: those where the level of medical care can be maintained and all normally salvageable patients can be saved by adjusting organization and methodology to the situation (major incident level 1, alternative terminology “compensated incidents”); those where the load of casualties is so high that the level of care cannot be maintained, even by adjusting organization and methodology, but the infrastructure of the community can be maintained(major incident level 2, alternative terminology “mass-casualty incidents,” “disasters,” or “decompensated incidents”); and those situations where the level of care cannot be maintained and there is destruction of the infrastructure of the community (major incident level 3, alternative terminology “major disasters,” “complex emergencies,” or “compound incidents”). The terminology described above may vary between countries, but it is important that the terminology used is not only a theoretical construction of words but has a practical function in providing a base for decisions and performance in the response to an alert. The definitions used also must be clear and well known to all staff involved in such response. The goal of the health-care system in the response to these situations is to eliminate or reduce avoidable loss of life and health, as well as physical and psychological suffering, to the greatest extent possible. This requires accurate planning and preparedness, education, and training of all staff involved in such a response, as well as continuous methodological development and research based on the experiences from such incidents.