| Home | Help | Search/Archive | Feedback | Table of Contents |
|
Firstly, recognition of the outbreak may be delayed, especially when symptoms are non-specific. Although Legionella was identified promptly, the lack of a single catastrophic trigger such as an explosion (as would be usual in a "typical" major incident) and the initial difficulty in predicting the scale of the outbreak led to some confusion as to quite whether, and when, a major incident should be declared.
A further difference is the duration of the crisis, which necessitated careful planning to protect staff from overwork. This would be more pronounced if staff themselves were incapacitated, as might well occur with SARS.
Secondly, the low mortality was attributed partly to the widespread use of an early warning scoring system for the timely identification and referral to intensive care of deteriorating patients.2 We have still to explore whether this effect was due to the scoring system itself or the close involvement of intensive care staff on general wards.
Thirdly, the hospital's incident plan was simply not designed for this type of incident. Paradoxically, this seems to have been beneficial in that it gave experienced clinical and managerial staff the freedom to improvise as events demanded.
Furthermore, despite the presence of a central incident room, our data suggest a loose organisational hierarchy with employees of comparatively low status able to make decisions. These characteristics are evident in safety critical "high reliability organisations,"3 and the challenge for major incident planning is to prevent such vital human factors being stifled by protocol and prescription.
Andrew F Smith, head of research and development
Cathy Wild, researcher
Morecambe Bay Hospitals Trust, Royal Lancaster Infirmary, Lancaster LA1 4RP
John Law, professor
Department of Sociology, University of Lancaster, Lancaster LA1 4YT
References
|
| Home | Help | Search/Archive | Feedback | Table of Contents |
