Table 2

The system's response to bombing: strengths and weaknesses

Strengths in system's response

Weaknesses in system's response

Clinical staff going to Omagh to help initial response

External communications poor and no back-up with ACCOLC during telephone blackout

Distribution of victims between four hospitals for initial care

No direct communication between ambulance and hospitals

Triggering of the MIP at the RGHT without waiting for absolute proof that it was required

Delayed realization of the use of ambulance control to relay communication between TCH and the RGHT

Utilization of day-shift staff and night-shift staff at the RGHT and having replacements for later in the incident response

Internal communication reliant on overloaded internal telephone system and face-to-face meetings

Public Relations staff tasked with ensuring good quality, timely information for relatives

Little communication between hospitals regarding victims' identity and status (for families with victims in more than one hospital)

Appropriate triage of small number of patients for tertiary care to regional center

Advantages of helicopter negated by lack of previous experience and no helipad at regional center

Availability of all trauma-related specialties on one site at the RGHT

GICU busy initially, discharging and transferring patients to vacate beds. Too few beds in system for a larger incident

Single portal of entry to the RGHT to avoid missed injury and direct admission to surgical wards

Patient identity mistaken due to early acceptance of spurious information

System for tracking patients in regional centre not used by surgical teams for follow-up

ACCOLC = access overload control for cellular radio telephones; GICU, general intensive care unit; MIP, major incident plan; RGHT, Royal Group Hospitals Trust; TCH, Tyrone County Hospital.

Lavery and Horan Critical Care 2005 9:401   doi:10.1186/cc3502