Title Page
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Report Number
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Completed on
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Prepared by
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Location
Incident Details
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Incident date
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Time of call to me
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Initial call from
- Ambulance crew
- Ambulance Team Leader
- EOC North Shift Officer
- EOC South Shift Officer
- Fire Control Room
- HART Team Leader
- Neighbouring Ambulance Trust
- Police Control Room
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Callsign
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Ambulance Trust
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Request for HART assistance
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Assistance Granted
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Rationale for decision
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Identify Control Room
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URN
Incident & Risk
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Incident Number
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Incident Type
- Adverse weather
- Agricultural
- Aircraft Incident
- Building Collapse
- COMAH Site
- Commercial
- Cyber attack
- DICE
- Domestic
- Explosion
- Fire
- Firearms
- Flooding
- Hazmat
- Hospital
- Hostage
- IDL
- Industrial
- Inland water
- Internal Trust Incident
- IT Failure
- Major Incident Declared
- Major Incident Standby
- Maritime
- Marauding Attack
- Mental Health
- Military Site
- NHS establishment
- Other NHS Trust Major Incident
- Partner Agency Major Incident
- Person at depth
- Person at height
- Person(s) Trapped
- Police Operation
- Prison Incident
- Public Disorder
- Radiological
- Rail
- Request for Mutual Aid
- RTC
- Suspect Package
- Upturned vessel
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Is a Trust requesting Mutual Aid from SCAS?
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Mutual Aid requested from
- EEAST
- IOW
- LAS
- SECAM
- SWAST
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Has SCAS declared a Major Incident or Standby?
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Have hospitals been informed?
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Hospitals informed
- Basingstoke
- Frimley
- Milton Keynes
- Oxford
- Portsmouth
- Royal Berkshire
- Southampton
- Stoke Mandeville
- St Mary's
- Winchester
- Wexham Park
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Trust declaring Major Incident
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Police Force
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Risks actual or potential
- Adverse Weather
- Asbestos - possible or probable
- Ballistic threat
- Chemicals - known
- Cold
- Collapsed structure
- Difficult Access
- Dust
- Electrical Cables
- Explosive threat
- Fire
- Flooding
- Gas
- Heat
- MMMF
- Moving Traffic
- Munitions
- Noise
- Poor visibility
- Radiation
- Rising Tide
- Smoke
- Unknown Cargo
- Unknown chemicals
- Unstable terrain
- Unstable Vehicle
- Water
- Wind
Casualty Details
Casually Information
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Are the number of casualties known?
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Adult Casualties
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Child Casualties
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Dead
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Are there any burns casualties?
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Burns casualties
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Are there trapped casualties?
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Trapped casualties
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Are there any contaminated casualties?
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Number of contaminated casualties
Triage Information
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Are the Triage categories known?
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Adult P1
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Adult P2
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Adult P3
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Adult Dead
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Child P1
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Child P2
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Child P3
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Child Dead
Resources
Resource Information
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Any resources on scene?
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What resources are on scene
- AIT
- AITV
- BASICS
- Co Responder
- Community Responder
- DMA
- ECRU
- Event Medical Resources
- HART
- HART Training Team
- HEMS
- ISV
- Loggist
- MCV
- NILO
- Officer
- Operational Commander
- Private Provider
- RRV
- Specialist Paramedic
- SORT
- Tactical Advisor
- Tactical Commander
- Team Leader
- VAS
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Number of RRVs on scene
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
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Number of DMAs on scene
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
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What Resources have been sent?
- AIT
- AITV
- BASICS
- Co Responder
- Community Responder
- DMA
- ECRU
- Event Medical Resources
- HART
- HART Training Team
- HEMS
- ISV
- Loggist
- MCV
- NILO
- Officer
- Operational Commander
- Private Provider
- RRV
- Specialist Paramedic
- SORT
- Tactical Advisor
- Tactical Commander
- Team Leader
- VAS
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Number of Team Leaders sent
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
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Number of HEMS Aircraft sent
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
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Number of RRVs sent
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
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Number of DMAs sent
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
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Have Mutual Aid resources been requested by SCAS?
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Mutual Aid Resources Requested
- AIT Staff
- DMA
- HART
- HEMS
- NILO
- SORT Staff
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Mutual Aid requested from
- EEAST
- IOW
- LAS
- SECAM
- SWAST
Liaison
Partner Agencies
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Are there partner agencies on scene?
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What agencies are on scene?
- Coastguard
- Environmental Agency
- Fire
- Fire Appliances
- FRS DIM
- FRS Hazmat
- FRS NILO
- FRS Tech Rescue
- FRS USAR
- FRS Water Rescue
- Highways Agency
- Local Authority
- Military
- NTRG
- On site specialist responders
- Police
- Police Firearms
- Police FSU
- Police Negotiator
- Police Public Order
- RIO
- RNLI
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Number of Fire Appliances
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
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Which partner agencies are attending
- Coastguard
- Environmental Agency
- Fire
- Fire Appliances
- FRS DIM
- FRS Hazmat
- FRS NILO
- FRS Tech Rescue
- FRS USAR
- FRS Water Rescue
- Highways Agency
- Local Authority
- Military
- NTRG
- On site specialist responders
- Police
- Police Firearms
- Police FSU
- Police Negotiator
- Police Public Order
- RIO
- RNLI
Liaison Advice and Intelligence
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Liaised with and advice from
- Ambulance Strategic Commander
- Ambulance Tactical Commander
- Ambulance Media
- Attending ambulance crew
- EOC Shift Officer
- HART Team Leader
- On Call 2nd Tactical Advisor
- On scene commander
- Other Trust EOC
- Other Trust NILO
- Hospital Contact
- Fire Control Room
- FRS DIM
- Fire Incident Commander
- FRS NILO
- CBRN Centre
- Police Control Room
- Police CBRN Tac Ad
- Police Incident Commander
- Police Tactical Commander
- TFC
- PHE
- RPA
- Local Authority EPO
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Trust
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NILO name
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Information taken from documents
- Ambulance Service Plan
- Chemdata
- Emergency Response Guide ERG
- Event Plan
- Multiagency Plan
- PHE Document
- NHS Guide
- Site Plan
- SOP
- WISER
Advice Offered
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Advice given to
- Ambulance Strategic Commander
- Ambulance Tactical Commander
- Ambulance Media
- Attending ambulance crew
- EOC Shift Officer
- HART Team Leader
- On Call 2nd Tactical Advisor
- On scene commander
- Other Trust EOC
- Other Trust NILO
- Hospital Contact
- Fire Control Room
- FRS DIM
- Fire Incident Commander
- FRS NILO
- CBRN Centre
- Police Control Room
- Police CBRN Tac Ad
- Police Incident Commander
- Police Tactical Commander
- TFC
- PHE
- RPA
- Local Authority EPO
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Advice given on
- Command Protocol
- Cordon distance
- Decontamination Procedures
- Existing Plan Followed
- HART Capability
- Hazmat Advice
- Hospital Treatment Required
- Incident Response Plan
- Mitigation of Risk
- Monitor Patient
- No Advice Required
- No Treatment Required
- Partner Agency Capability
- PHE Advice Given
- Possible Risks
- PPE
- Remove outer clothing
- RPE
- Site Plan Followed
- Specialist Ambulance Capability
- Treatment Regime
- Wait For FRS
- Wait for HART
- Wait for Police
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Enter narrative
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Photo
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Signature
