Three phases of major incident:

Triage » Treatment » Transport

Do not progress with in-depth treatment until all SIEVE triaging is complete.


  • Appropriate tabard and PPE must be worn
  • Initial treatment should consist of life-saving interventions only:
    • Open airway
    • Lateral patient position if possible
    • Control life-threatening bleeding
  • Maintain documentation
    • SMART Tags
    • PCRs
    • Incident book

  • Scene safety assessment: Do not enter/proceed into scene until deemed safe.
  • Provide METHANE to State Operations Centre (SOC)
    • Major Incident Confirmed
    • Exact Location
    • Type of Incident
    • Hazards Present
    • Access
    • Number and type of casualties
    • Emergency Services present/required
  • Assume Acting Ambulance Commander & Forward Commander Roles
  • Establish on scene liaison with other agencies
  • Maintain communications with SOC
  • Establish Ambulance Assembly Point (AAP) & Casualty Clearing Post (CCP)
  • Consider need for Mass Casualty Kits (MCKs) and/or Emergency Support Vehicles (ESV)

Report to Ambulance Commander

  • Park vehicles at AAP & leave keys in vehicle
  • Undertake the role delegated by the Ambulance Commander
  • Use equipment/consumables from ESVs & MCKs if available
  • Use radio channel designated for incident
  • Maintain incident chain of command

Obtain SITREP & establish the following:

  • Maintain incident documentation
  • Establish command & communication structure
  • Confirm setup of AAP & CCP
  • Ensure availability of hand held radios
  • Ensure safety of all ambulance personnel

Continue to:

  • Liaise with HMA Incident Controller & other agency commanders
  • Liaise with SOC & other key field staff
  • Direct Hospital Response Teams (HRTs) to Health Commander
  • Monitor adequacy of ambulance resources

Reports to Ambulance Commander.

Appointed once adequate incident resources are available.

  • May begin initial Triage SIEVE until more resources become available
  • Take responsibility for forward operational activities
  • Ensure casualty Triage SIEVE & labelling undertaken using SMART tags

Reports to Forward Commander

Designated if size of scene requires incident to be sectored for ease of management. 

  • Supervise Primary Triage Officers ensuring Triage SIEVE activities are undertaken
  • Direct walking wounded to CCP
  • Supervise necessary treatment before the CCP
  • Report ‘Triage SIEVE’ as required
  • Assist the Casualty Clearing Officer once Hot Zone/Extrication Point cleared of casualties

Officer must:

  • Obtain SMART Triage Pac; place on uniform belt
  • Triage each casualty and attach SMART Tag to CASUALTY’S RIGHT ARM
  • Only provide treatment consisting of body positioning, opening airways & stopping life-threatening bleeds
  • Maintain a written record of each casualty triaged on the back of the SMART Tag

Reports to Ambulance Commander:

  • Appoint Loading Officer
  • Supervise setting up and running of CCP
  • Appoint staff to undertake SORT Triage
  • Ensure SORT casualty log is maintained
  • Liaise with Senior Doctor & Senior Nurse if Hospital Response Teams (HRTs) present
  • Liaise with other key field staff

Reports to Casualty Clearing Officer:

  • Checks all casualties correctly SMART Tagged 
  • Maintain casualty Transport Log Sheets
  • Supervise casualty transfer from loading area to ambulance
  • Liaise with Transport Nurse if Hospital Response Teams (HRTs) present
  • Take direction from SOC or the Department of Health on casualty destinations

Transport Considerations

  • Triage priority
  • Treatment and packaging
  • Appropriate destination

Reports to Ambulance Commander:

  • Check Access/Egress routes established

Meet arriving ambulance crews and direct incoming staff to Ambulance Commander or delegated person, ensuring that arriving crews have:

  • Left keys in vehicles
  • Appropriate tabards & PPE on
  • Parked vehicles orderly & all lights turned off
  • Taken appropriate equipment into the scene


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