A review of the management of a major incident involving predominantly paediatric casualties.

On 27 September 1993 a double-decker bus full of secondary school children was involved in a collision with a lorry. A total of 58 people were injured, including two fatalities. All except two of the casualties were children. Forty-two casualties, including all of the seriously injured, were taken to the Accident & Emergency Department at York District Hospital. Fifteen casualties were admitted, the majority with closed head injuries. Most of the injuries were of a minor nature, predominantly soft-tissue damage and superficial lacerations. This paper reviews these injuries and the implementation of the hospital major accident (MAJAX) plan. It identifies specific problems encountered with this incident. It also describes the measures taken retrospectively to upgrade the MAJAX plan. It highlights the difficulties encountered by medical staff called to the incident who were unfamiliar with managing injuries and describes retrospective attempts to improve the awareness of trauma management skills.