← Flooding
Mode
Single patient within a property — toggle to Multi-Patient if more than one person is involved. ⚠ Multiple patients — review the Major Incident reference.

A person trapped within a property may…

  • Present with time critical medical emergencies (i.e. difficulty in breathing, myocardial infarction, sepsis).
  • Present with an exacerbation of comorbidities and complex needs.
  • Require considered care (palliative and end of life care, bariatric, elderly, dialysis dependent renal patient).
  • Have physical and / or learning disabilities including SEND.
  • Be distressed and displaying abnormal behaviour.
  • Present with an exacerbation of mental health including substance misuse or withdrawal (drugs and alcohol).
  • Have suffered trauma.
  • Place themselves at additional risk due to their social behaviours, such as refusing to leave home.

Risk Considerations — avoid becoming a second victim

  • Prioritise personal safety — avoid becoming a second victim.
  • Do not enter or attempt to access a flooded property unless it is safe to do so and you are appropriately trained and equipped.
  • If you have access to a personal flotation device, wear it.
  • Encourage other bystanders to stay away from the water’s edge and any flood-affected areas.
  • Water can be: fast flowing, deep, cold and contaminated.
  • Be aware of the risk of entrapment or being swept off your feet, even in relatively shallow moving water.
  • Driving in floodwater is extremely dangerous — floodwater can conceal significant hazards.

National Risk Register (NRR) ⓘ

The National Risk Register (NRR) sets out the UK Government’s assessment of the most significant risks facing the United Kingdom. It provides an updated evaluation of the likelihood and potential impact of a wide range of threats and hazards that could affect the UK, its people, infrastructure, and national interests, including the risk of flooding.

Click to view the relevant risks ▸
Single patient within a flooded property — bed-bound person isolated upstairs above rising floodwater Multiple patients within a flooded property — care home residents isolated on the upper floor above floodwater
Patient survivability depends on doing the essentials well,
team coordination and clear communication.

Deployed Clinical Resource — Triage & Care in Place

A clinical resource may be deployed to a designated location to undertake patient triage, identifying those who require urgent evacuation and those who can safely remain in place with appropriate clinical support.

The resource should be capable of delivering clinical care for extended periods within a relative place of safety, even where access is restricted or the location becomes isolated by floodwater. This may include providing palliative or end-of-life care, supporting imminent births, or delivering primary healthcare within nursing or residential care settings.

Maintaining a clinical presence in this way helps ensure continuity of care, supports vulnerable patients, optimises evacuation decisions, and reduces the need for unnecessary patient movement during flooding incidents.

A

Airway

B

Breathing

C

Circulation

D

Prioritise Care

  • Seek specialist clinical advice and utilise telemedicine where available to support patient assessment and treatment decisions.
  • Consider an individualised treatment plan for patients with pre-existing conditions.
  • Provide reassurance and psychological support.
E

Prevent Further Loss of Body Heat

  • Move to an elevated warm room or position (keep out of flood water).
  • Improve thermal management — insulate the patient and provide a vapour barrier.
  • Use the Swiss Staging System to guide treatment.
  • Patients presenting with mild to moderate hypothermia may be suitable for assisted self-evacuation.
  • The absence of shivering may indicate more severe hypothermia and the need for cautious handling and supported evacuation.
Open the full Casualty Management Model Immediate Care · Optimised Care · Transition of Care
Patient survivability depends on doing essentials well · team coordination · clear communication

Decision Tools & References

Click to open — also linked from the relevant keyword above

Think — U STEP OUT

A structured prompt for deciding whether a patient within a flooded property can safely remain in place, needs support in place, or requires extrication.

U — check that the patient understands the risk posed by the flood — do they appreciate the current and evolving threat.
S — reassure the patient and offer support (are they socially isolated or supported).
T — assess if there are any immediate threats posed by the situation (i.e. the environment or clinical presentation).
E — ensure that they have capacity — are there cognitive impairments, dementia, or learning disabilities affecting their judgment.
P — make sure there are protective factors (i.e. ability to move to elevated dry floors, capable of self-rescue or sustaining themselves for a time).
O — what options are available (legal powers, safeguarding frameworks and available resources on hand).
U — is there an urgency to extricate the patient(s) — is there a safe window for extrication before conditions worsen?
T — taking action (multi-disciplinary team — Asset Type A, extrication plan, onward care, equipment).

National Risk Register (NRR) — Relevant Risks

Natural and environmental hazards include:

Open the full National Risk Register 2025 (PDF) ↗

Lexicon — Using the Correct Terminology

Precise language saves lives. Using the wrong term — for example saying “body in the water” when the person may still be viable — can lead a control room to treat the incident as a recovery in slow time and miss a life-saving opportunity.

Patient — a person(s) at an incident who receives healthcare, agnostic of whom.
Casualty — any person at the scene of an incident who is identified by responding personnel as having been injured or made unwell as a direct result of that incident.
Person — a casualty for whom there remains a reasonable possibility of life and successful resuscitation.
A body — a casualty for whom there is no reasonable expectation of life or successful resuscitation.
Immersed person — a casualty in the water with the airway (nose and mouth) above the surface and therefore able to breathe.
Submerged person — a casualty with the airway (nose and mouth) below the water surface and therefore unable to breathe.

Terminology to be confirmed against the national lexicon work (NCA / Hour-and-a-Life).

Casualty Location Marking — Victim Marking

Victim marking should be used to identify the location of known or suspected casualties (alive or deceased), particularly during incidents involving multiple casualties or where there is potential for uncertainty in casualty location following search operations. This requirement is especially relevant in flood incidents, where environments may be disordered, rapidly changing, and difficult to navigate.

Casualty Location Marking Guidance — orange V marking system: 1 mark the location, 2 add an arrow if required, 3 record confirmed casualties (L live / D deceased), 4 update during rescue, 5 location cleared; with quick reference and field example
Concept taken from the INSARAG Guidelines (2020), Manual B — Operations.

Swiss Staging Tool — Hypothermia

CategoryCategoryEstimated Core TemperatureClinical Findings
Stage 1Mild35 – 32 °C Conscious with shivering. Normal mental status, but not functioning normally and unable to care for self.
Stage 2Moderate32 – 28 °C Impaired consciousness. Abnormal mental status with shivering, or abnormal mental status without shivering, but conscious.
Stage 3Severe28 – 24 °C Unconsciousness. Vital signs (breathing, palpable carotid or femoral pulse) are present.
Stage 4DeepBelow 24 °C Vital signs are absent.
 Stage 1Stage 2Stage 3Stage 4
Clinical Findings Alert from AVPU Verbal from AVPU Painful or Unconscious from AVPU
AND
Vital Signs Present		 Unconscious from AVPU
AND
No Vital Signs
Risk of cardiac arrest Low Moderate High Cardiac Arrest

Gather & Share Information

🚨 Major Incident Reference

Escalation triggers

Major incident thresholds vary by region and clinical specialty. Common triggers include:

Declaration & coordination

Once declared, JESIP principles apply across all responding agencies. Use the METHANE report to communicate scene status:

Local plan

Each region maintains its own Major Incident Plan covering thresholds, command structure, casualty receiving hospitals, and surge capacity.

Placeholder — host integration to follow.
This area will display the locally-loaded Major Incident plan for the presenter's region. Each deploying organisation can plug in their own document, URL or contact details.