Planning for a major incident

The roles and responsibilities of the Ambulance Service

The Ambulance Service forms part of the National Health Service (NHS) response to a Major Incident. It is principally geared to the immediate clinical needs of those directly or indirectly associated with the incident(s) and their subsequent transportation to established treatment centres.

The Ambulance Service is primarily responsible for the alerting, mobilising and coordinating at the scene all primary NHS resources necessary to deal with any incident, unless the incident is an internal health service incident.

The Ambulance Service works to ensure that it is capable of responding to major incidents of any scale in a way that delivers optimum care and assistance to the casualties that minimises the consequential disruption to healthcare services and which brings about a speedy return to normal service provision. This is done by ensuring the Ambulance Services work as part of a multi-agency response across organisational boundaries. The key responsibilities of the Ambulance Service are to:

  • Save life, in conjunction with the other emergency services
  • Establish a strategic, tactical and operational command structure.
  • Have 'on call' Ambulance Tactical Advisors with the expertise to provide advice on matters relating to the Major Incident Plan and the appropriate response by the Trust.
  • Allocate a Safety Officer who has responsibility to protect the health and safety of ambulance and NHS personnel on site.
  • Coordinate and manage the on-site NHS response.
  • Alert other emergency services.
  • Provide a nominated member of staff to communicate with receiving hospitals, to be known as Hospital Ambulance Liaison Officer (HALO).
  • Provide on-site ambulance communications and Communications Officers.
  • Ensure that a log of all actions and communications are kept.
  • Instigate the use of a Casualty Clearing Station (CCS) when required.
  • Instigate the use of recognised triage 'sieve' and 'sort' on all patients prior to evacuation from scene.
  • Arrange and maintain the required personnel to provide optimal levels of treatment of casualties at the site.
  • Arrange and maintain the most appropriate means of transporting the injured to the receiving hospitals.
  • Have the facility to deploy and provide sufficient bulk equipment (including oxygen) to meet the requirements at site.
  • Provide clinical decontamination of casualties that includes dirty side triage and limited Hot Zone clinical intervention.
  • Support public mass decontamination by maintaining health presence at the mass decontamination units when activated by fire and rescue services.
  • Provide post incident welfare and debriefing for its entire staff involved in the incident.
  • Ensure that supporting agencies such as Medical Emergency Response Incident Teams (MERIT), Voluntary Aid Societies (VAS) and Community Responders receive adequate welfare and debriefs.
  • To comply with Local Resilience Forum multi-agency plans for the management of mass fatalities (and Regional Mass Fatalities Plan). Ensure that ambulances are not deployed for removal of the deceased, ambulance services can only be concerned with transport of live casualties.
  • Provide a plan that has the flexibility to enable an effective response to a multi-sited incident.
  • Inform wider health partners of a major incident.
  • Warning and informing of the public.

Underpinning the response of the Ambulance Service and other partner agencies is the Civil Contingencies Act (2004) which designates the Ambulance Service as a 'Category 1 Responder', which means that NWAS is required to:

  • Cooperate and Share Information; with other responders via the Local Resilience Forum (LRF).
  • Assess Risk; Responders must ensure that they have an accurate and shared understanding of the risks they face; NWAS assesses risk both corporately and collectively at LRF level through Community Risk Registers, compiled in line with the National Risk Register and associated guidance.
  • Maintain Emergency Plans; NWAS maintains generic plans (Major Incident Response Plan) and specific plans for events or incidents by following the recognised emergency planning cycle.
  • Have in place Business Continuity Management arrangements to ensure that NWAS can continue to fulfill its core duties in the event of an emergency situation challenging normal operations.
  • Warning and Informing the Public; Responders must ensure that the public are made aware of the risks of emergencies and that the public is warned and provided with information and advice at the time of an emergency (H.M Government, 2010, p. 94).
  • Provisions of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 also require the Trust to assess risk, maintain plans, co-operate and share information with other responding agencies.
  • The Health and Safety at Work etc. Act 1974 as amended makes provision for securing the health, safety and welfare of persons at work and for protecting others against risks to health or safety.

NWAS Resilience arrangements follow the internationally recognised cycle of emergency preparedness, namely Mitigation, Preparation, Response and Recovery.


Preventing future emergencies or minimizing their effects. This includes activities which may prevent an emergency, reduce the chance of an emergency happening, or reduce the damaging effects of unavoidable emergencies.


Preparing to handle an emergency and includes plans or preparations made to save lives and to help response and rescue operations. Such preparedness activities take place before an emergency occurs.


Responding safely to an emergency includes actions taken to save lives and prevent further property damage in an emergency situation. Response is putting your preparedness plans into action and takes place during an emergency.


Recovering from an emergency includes actions taken to return to a normal or an even safer situation following an emergency. Recovery activities commence during the response phase but continue long after the emergency is over.