Clinical guidelines for major incidents and mass casualty events

NHS England | January 2019 | Clinical guidelines for major incidents and mass casualty events

This guidance has been developed on behalf of the NHS to establish and share best practice in the clinical management of major incidents and mass casualty events, using experience from both military and civilian practice and lessons identified after the recent incidents, and to assist clinicians in managing these patients.

Image source:

The intention is that this guidance will be regularly reviewed and re-issued as new developments based on an ever-increasing evidence base and experience emerge (Source: NHS England).

Nearly 50 per cent of sport injuries treated in A&E are in kids

University of Newcastle| November 2018 |Almost half of sport injury-related A&E attendances are children

New research indicates that children under the age of eighteen are the highest burden of sports-related injury to A&E. With 12 year-old females, and 14-year-old males being the most at risk of sustaining a sports injury. The research involved analysis of injury attendance data at two hospitals, one in Oxford and the other in Banbury, from January 2012 – March 2014. Attendances recorded totalled almost 64,000 (63,877), of these  11,676 were sport-related, with 5,533 of these in  children and young people aged 0-19.

The research conducted by researchers at the University of Newcastle and University of Oxford, found the most injurious sports activities for girls were trampolining, netball and horse riding; for boys this was rugby union, rugby league and football.


Graham Kirkwood, senior research associate at Newcastle University, said: “These figures are equivalent to 68 boys and 34 girls in every thousand attending NHS emergency departments in a year. This is a heavy burden on the NHS and on children and families from sport-related injury.”

He added: “Children need to be physically active but making organised sports as safe as possible needs to be part of any effective child obesity strategy.” (Source: University of Newcastle)

Full news release at the University of Newcastle

The full article is available to read at Journal of the Royal Society of Medicine 

To analyse and report on sports-related injuries using enhanced injury data collected by the testbed for the NHS emergency care injury data set and admissions data collected from inpatients.


Ecological study design.

Two Oxfordshire NHS England hospitals.

Emergency department attendees and inpatients aged 0–19 years with sports injuries.

Data were analysed from 1 January 2012 to 30 March 2014 by age, gender sport, injury location, injury mechanism and diagnosis including concussion/post-concussion, bone fractures and ligament damage. Admissions data were analysed from 1 January 2012 to 24 January 2015.


Children and adolescents aged 0–19 years accounted for almost half (47.4%) of sports injury-related emergency department attendances and almost one-quarter (23.5%) of sports injury-related admissions for all ages. The highest rates of attendance occurred at 14 years for boys (68.22 per 1000 person-years) and 12 years for girls (33.72 per 1000 person-years). For male 0–19-year-olds the three main sports were (in order) football (soccer), rugby union and rugby league and for females, trampoline, netball and horse-riding. The largest gender differences were in netball where injuries were predominantly in females and in wheeled motorsports where injuries were predominantly in males. Almost one-quarter of emergency department sports-related injuries recorded were fractures, the highest percentage to the upper limbs.


Public health departments in local authorities and schools should consider target sports injury prevention at children in the first four years of secondary school. For younger age groups, trampolines in the home warrant improved safety. Rugby and horse-riding should also be a focus for interventions.

Full reference: Kirkwood, G., Hughes, T. C., & Pollock, A. M. |2018 | Results on sports-related injuries in children from NHS emergency care dataset Oxfordshire pilot: an ecological study|Journal of the Royal Society of Medicine|

In the media:

BBC News Children and adolescents ‘account for half of sports A&E attendances’

Recommendations for urgent and emergency mental health care

NHS Clinical Commissioners and RI International publish recommendations for urgent and emergency mental health care | via NHSCC

Image source:

A new report, ‘Be the change: Ensuring an effective response to all in psychiatric emergency equal to medical care,’ outlines ten recommendations that if fulfilled would make urgent and emergency psychiatric health care ‘minimally adequate’, and calls on governmental agencies, policy makers and health and social services to take radical action to address inequalities and improve mental health crisis care.

The recommendations were agreed by delegates at an international summit in May 2018, hosted by NHS Clinical Commissioners and RI International. The ten recommendations, aimed at government, policymakers and those implementing health and social services, are to:

  1. End the current fragmentation of care through an integrated, systematic approach to behavioural health crisis care at the national level.
  2. Actively develop crisis service alternatives to the usual emergency measures of formal assessment and psychiatric inpatient care.
  3. Include special consideration to cater for armed forces veterans.
  4. Implement an integrated health information exchange capable technology solution to enable seamless care across organisations.
  5. Develop balanced scorecard dashboards that display real-time, meaningful data and outcome measures that support continuous quality improvement.
  6. Embed users, peers and carers should be embedded in the design and leadership of crisis systems; peer support staff should be trained and integrated in crisis service delivery.
  7. The zero-suicide aspiration should be owned by governmental agencies, policy makers and those implementing health and social services.
  8. Family and friends should be fully engaged in crisis care and inappropriate barriers created by confidentiality or privacy need to be sensitively overcome.
  9. Implement a single national three-digit crisis hub number that drives easy access in which all callers are welcome, the crisis is defined by the caller, and which is promoted via intelligent social media to get the word out to those who need it.
  10. Significant system-wide investment is needed to deliver these recommendations.

The report also concludes that the aim must be to provide 100% access to services to those in a behavioural health crisis and to aspire to zero suicide in healthcare settings. It calls for an approach equal to medical care to ensure an effective response to all in psychiatric emergency.

Full report: Be the change. Ensuring an effective response to all in psychiatric emergency equal to medical care. Recommendations from the first international summit on urgent and emergency behavioural healthcare

Reducing emergency admissions

The Health Foundation | August 2018 | Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions

The Health Foundation has produced a briefing which looks at Patient Activation Measures scores, which assess four levels of knowledge, skill and confidence in self-management, for over 9,000 adults with long-term conditions.


  • This briefing summarises research that explores the link between how well patients feel able to manage their long-term conditions such as asthma, diabetes and depression and their use of health care.
  • The findings show the NHS could reduce avoidable health care use and improve people’s quality of life, if they were better supported to manage their long-term conditions.
  • The briefing points to solutions and calls for national policy makers and the local NHS to take action now, including by prioritising support for self-management in the NHS long-term plan.

Read the full press release from The Health Foundation here 

The full article has been published in BMJ Quality and Safety 


Objective To quantify the association between patient self-management capability measured using the Patient Activation Measure (PAM) and healthcare utilisation across a whole health economy.

Results 12 270 PAM questionnaires were returned from 9348 patients. In the adjusted analyses, compared with the least activated group, highly activated patients (level 4) had the lowest rate of contact with a general practitioner, emergency department attendances, emergency hospital admissions  and outpatient attendances. These patients also had the lowest relative rate (compared with the least activated) of ‘did not attends’ at the general practitioner, ‘did not attends’ at hospital outpatient appointments and self-referred attendance at emergency departments for conditions classified as minor severity, a significantly shorter average length of stay for overnight elective admissions, and a lower likelihood of 30- day emergency readmission, though this did not reach ignificance.

Conclusions Self-management capability is associated with lower healthcare utilisation and less wasteful use across primary and secondary care.

Full reference:

Barker ISteventon AWilliamson R, et al| 2018| Self-management capability in patients with long-term conditions is associated with reduced healthcare utilisation across a whole health economy: cross-sectional analysis of electronic health records |

The full article is available to read from BMJ Quality & Safety 

Quick Guide: Hospital Transfer Pathway – ‘Red Bag’

NHS England | July 2018 |Quick Guide: Hospital Transfer Pathway – ‘Red Bag’  

This quick guide aims to help local health and social care systems to develop effective and efficient arrangements for Hospital Transfer Pathways (more commonly known as Sutton’s Red Bag initiative.

red bag
Image source:

Quick Guide: Hospital Transfer Pathway- ‘Red Bag’  is available here 



Case study of ‘Red Bag’ scheme

NHS England | July 2018 | How a simple red bag improved care for care home resident Patricia

NHS England have written a new case study on the ‘Red Bag initiative. The case study looks at how the scheme can benefit care home residents.  When a resident becomes unwell and is assessed as needing hospital care, care home staff pack a dedicated red bag that includes the resident’s standardised paperwork and their medication, as well as day-of-discharge clothes and other personal items.


NHS England Red Bag scheme 

NHS England and Department of Health and Social Care Quick Guide: Hospital Transfer Pathway – ‘Red Bag’

Reducing emergency admissions

This Public Accounts Committee report states that the Government must improve preventive care outside hospitals , warning that hospitals, GPs, community services and social care need to work together more effectively | House of Commons Committee of Public Accounts

The Public Accounts Committee has published Reducing emergency admissions.  The Committee finds it lamentable that nearly 1.5 million people could have avoided emergency admissions in 2016–17 if hospitals, GPs, community services and social care had worked together more effectively.  They say it is frustrating that NHS England and partners are making some progress in reducing the impact of emergency admissions for patients and hospitals when they do happen, but no impact on reducing the numbers of admissions that could have been avoided.

The report make a number of recommendations, including:

  • NHS England should identify gaps in capacity in primary and community health care and set out how it intends to fill those gaps. 
  • NHS England’s and NHS Improvement’s regional teams should assess the capacity that hospitals need in terms of beds, staff and funding to deal with emergency admissions throughout the year.
  • The Department should encourage better sharing of best practice on how the voluntary sector supports health and social care efforts to reduce emergency admissions and understand the reliance the system has on the sector.
  • NHS England and NHS Improvement should improve data they collect and that hospitals record so that by the end of 2018 care can be tracked and publicly reported.

  • Read the report summary
  • Read the report conclusions and recommendations
  • Read the full report: Reducing emergency admissions