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Table 2 The system's response to bombing: strengths and weaknesses

From: Clinical Review: Communication and logistics in the response to the 1998 terrorist bombing in Omagh, Northern Ireland

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
  1. 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.