Introduction: In 1996, Carley and Mackway-Jones examined British hospital readiness for a major incident. In the light of recent terrorist events in London, we revisited the issue and conducted a telephone survey of relevant parties to investigate whether the situation has changed almost 10 years on.

Material and methods: Middle grades in anaesthesia, accident and emergency medicine, general surgery, and trauma and orthopaedics were telephoned in trauma units across the UK and asked questions a proforma. Major incidents co-ordinators for each of the units were contacted, and their planning readiness, training oportunities, and recent rehearsals were assessed through a second proforma.

Results: A total of 179 middle grades were contacted in 34 different units throughout the UK, 144 responses were obtained. 47% had not read any of their hospitals major incident plans. Only 54% felt comfortable in the knowledge of their specific role in a major incident. Major incident co-ordinators were contacted at all 34 hospitals, and 50% responded. Rehearsal of major incident plans varied widely between hospitals with 82% of hospitals having practised within the last 5 years but only 35% planning for the next 12 months. Through real or rehearsed major incidents 95% of co-ordinators said errors were identified in their major incident plans. Limitations to improvement included: lack of funding, designated full time major incident planning co-ordinator, and lack of technology. There was no significant difference between units in London and those in other regions.

Discussion: Preparedness for major incidents in the UK remains poor despite 10 years since this was last assessed. Effective major incident plans require forethought, organisation, briefing of relevant staff and regular rehearsal.