"We're in this together" : an exploratory study of the behaviour, preferences and perceptions of casualties during simulated major incident exercises

• Main Author: Swan, Lauren
• Format: Dissertation
• Language: English
• Published: University of Liverpool 2019
• DOI: 10.17638/03086286

This research examines public behaviours, preferences and perceptions in relation to three key issues: 1) preparing for and 2) responding to a major incident; and 3) how emergency services interact with the public during their response. These areas are of great importance for reducing risk and improving public safety but are challenging to study due to difficulties in gaining access to casualties and the unpredictable nature of major incidents. Chapter one of this thesis provides a narrative review of literature in the field, comprised of 45 research articles that discuss how casualties behave and how they are managed during major incidents, along with how prepared people are for these extreme events. Chapter two is a methodological chapter, which explains the benefits and limitations to collecting data in live exercises. This chapter details the three unique, large-scale live exercises that were used to collect data for analysis in chapters three, four and five. Data collected from these three live exercises was made into one dataset that analyses all three data chapters and comprises of 265 interviews from people playing the role of casualties and 499 surveys from people playing casualties in the live exercises. Chapter three explores the experiences of people and the types of behaviours exhibited during these exercises and why this may be. A thematic analysis of the dataset for this chapter revealed 3 superordinate themes. One superordinate theme was 'expected and experienced emotions' as people expected to feel or observe certain emotions, such as panic, but that was not observed or felt by anybody in the exercises. People also expected to observe different experiences such as chaos, but instead the environment seemed calmer meaning people at times had to alter their expectations of a major incident. It was also found that people felt the exercise was realistic and did feel negative emotions such as uncertainty but also felt more positive and appreciative towards the emergency services following their participation in the exercises. 'Expected communication' was the second superordinate theme as the type of information people expected to be told was frequently discussed. Overall more information was requested but it was felt that basic information, reassurance and clearer instructions would especially enable people to cope better and feel less unsure and uncertain. Lastly, the third superordinate theme of 'experiences and expectations from the environment' detailed how people were feeling unsettled and unfamiliar with the major incident environment especially whilst awaiting rescue. This chapter also supports the idea of casualties helping other people whilst awaiting for the first responders. Chapter four looks at casualty behaviour in relation to interacting with each other and focuses on the benefits of helping one another in major incidents. A thematic analysis of this chapter revealed 5 main themes (i) physical benefits to casualties helping each other, for example somebody could limit blood loss before the emergency services arrive (ii) psychological benefits to casualties helping each other, such as it can avoid feeling isolated (iii) benefits of helping for the recovery phase of the incident (iv) limitations reported by casualties when helping others, difficult personalities for example and (v) how to enable people to help each other, examples include providing people with adequate instructions or equipment. Chapter five uses a mixed approach, looking at both the perception (how people felt about the emergency services) and preference (how people would want the response of the emergency services to be) aspect of the research question by drawing on preand post-exercise surveys and interview data to examine people's experiences of emergency service interactions. Wilcoxon signed rank tests reveal that for 2 out of 3 exercises the level of trust and confidence people had for the Police, Ambulance and Fire and Rescue Service decreased post event, although it still remained high. A thematic analysis of this chapter supports the quantitative analysis and previous research by finding that a lack of emergency communication impacts the public perception of confidence in emergency services, and willingness to comply. The majority of themes indicate that there were a number of preferences people had that would improve the perception they hold of the emergency services; these themes were to (i) be friendly and reassuring (ii) be informative and iii) to give clear instructions. The remaining two themes of 'improving perceptions' and 'current perception', show how people believe that more live exercises could help improve the relationship between the public and the emergency services, although people still have a high amount of respect, trust and confidence for the services. Chapter six uses data collected from members of the public taking part in a survey or focus group and aims to examine what factors affect motivation to engage in preparedness action and people's preferences for receiving information on how to prepare in advance of a major incident. The 121 surveys collected and 9 focus groups (consisting of a total number of 36 participants) were analysed using a content analysis. Findings show that people have a low awareness of risk information and a mixed perception of receiving information due to beliefs that some of the information kept from them. Preferences for receiving information included receiving actionable (what can I do) information through a range of different formats to reach different people. Furthermore, from the qualitative analysis it was found that assessment of threat is a motivator that's affects people's decision to become prepared and to take preparedness action as people can be complacent if they do not believe the threat is credible. Other motivators to becoming prepared that were found include sense of community, personal responsibility and self-efficacy. Overall, whilst most of the findings are from members of the public role-playing casualties in simulated rather than real major incidents, findings extend current theories of casualty behaviour. In particular, findings support the Elaborated Social Identity Model of Collective Resilience (Drury & Reicher, 1999; Drury & Reicher, 2000)., and disprove myths that the common public response to emergencies is to panic. Findings regarding public preferences and perceptions pose implications for emergency services, providing concrete, evidence driven recommendations for how casualty communication could be improved in order to increase compliance, cooperation and public perceptions of emergency services.