Coherent incident response requires a robust command and control structure, with the ability to make rapid informed decisions across an organisation and also across a health economy. In the UK, health incident management is based on a 'medallion' structure, with gold, silver and bronze corresponding to strategic, tactical and operational command levels [14] . North American and Asian health institutions tend to use the Hospital Emergency Incident Command System [15] . The common theme in both systems is a clear command and control structure with which healthcare staff should be familiar [4, 14, [16] [17] [18] [19] . Their generic hierarchical structure allows application to a wide range of incidents whilst retaining familiarity gained from training and exercises. The importance of familiarity with the command and control structure was highlighted in a recent Delphi study [20] and European survey [21] .