Arrangements for on scene medical care at major incidents.

Methods and results I sent a questionnaire to 100 randomly selected accident and emergency departments. Non-responders were contacted once by telephone. The questionnaire asked the identity and training of the medical incident officer; the members, training, and experience of the mobile medical team; and whether action cards were issued. Ninety three departments returned questionnaires. Five departments were excluded from analysis because the procedures were undergoing major revision, leaving 88 for analysis. The medical incident officer was a member of an immediate care team in six hospitals, a hospital consultant in 80 hospitals, and a senior house officer in two. Twenty nine departments specified an accident and emergency consultant and eight a member of the hospital flying squad. Eight had chosen physicians, eight anaesthetists, five orthopaedic surgeons, 10 obstetricians or urologists, and 14 other specialists. Training was given through practical exercises in 16 departments, table top exercises in five, courses in 14, and local immediate care schemes in seven; 46 hospitals gave no specific training. The mobile medical team leaders included various specialties and grades (table). Only 10 teams had experience in treating patients before arrival at hospital. Four teams were trained in conjunction with the emergency services and five trained with a flying squad or immediate care scheme. In 23 cases training was not specified and 56 had no training. Action cards were issued by 66 hospitals.