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ANNEX 2
MAJOR INCIDENT PLAN
NHS South Yorkshire and Bassetlaw
December 2011
NHS South Yorkshire & Bassetlaw Oak House
Moorhead Way Bramley
Rotherham S66 1YY
Draft Version 1 – Created 7th December 2011
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Contents
Chief Executives Statement 7
1 Introduction 9
Initial Action sheets
1 Duties of First Person Receiving Report 11
2 Duties of Strategic Lead (GOLD) 13
3 Duties of Tactical Lead(s) (SILVER) 15
4 Duties of Silver Staff Officer 17
5 Duties of Emergency Log Book Keeper 19
6 Duties of Communications Lead 21
7 Duties of Medical Lead 23
8 Duties of Administration Support Team 25
9 Duties of Security Manager 27
2 Major Incident 29
2.1 Definitions 29
2.2 “Emergency” as defined by the Civil Contingencies Act 2004 29
2.3 “Major Incident” as defined by NHS Emergency Planning guidance 29
2.4 Declaring a Major Incident 29
2.5 Alert Messages 30
2.6 YAS Notification procedures 30
2.7 Internal NHS alert 32
2.8 Duties of First Person receiving a report 32
3 Escalation 33
Fig.1 – Trigger points for escalation 34
4 Command and Control 35
Fig.2 – Command and Control structure 35
4.1 Incident Management Model 36
Major Incident Plan 4
Fig.3 – Incident Management Model 36
4.2 Emergency Log Book 37
4.3 Bronze role – Operational 38
4.4 Silver role – Tactical 38
4.5 Gold role – Strategic 38
4.6 Major Incident Control Centre (MICC) 39
4.7 NHS Single Organisation Gold 40
4.8 NHS Locality PCT / CCG area Gold 40
4.9 NHS South Yorkshire & Bassetlaw area Gold 40
Fig.4 – NHS South Yorkshire & Bassetlaw Command & Control structure 42
4.10 Multi-agency Gold 43
4.11 Regional & National Command and Control 44
Fig.5 – Regional & National Command and Control structure 45
5 Activation of the South Yorkshire Strategic Co-ordinating Group 46
6 Roles of NHS organisations during a Major Incident 47
6.1 Department of Health 47
6.2 Strategic Health Authority (SHA) 47
6.3 NHS South Yorkshire and Bassetlaw 47
6.4 Primary Care Trusts 47
6.5 Primary & Community Care Services 48
6.6 Acute Hospital NHS Foundation Trusts 48
6.7 Yorkshire Ambulance Service 49
6.8 Regional Director of Public Health 49
6.9 Health Protection Agency 49
6.10 Scientific and Technical Advice Cell (STAC) 50
7 Roles of other organisations during a Major Incident 51
7.1 South Yorkshire Police 51
7.2 South Yorkshire Fire and Rescue 52
7.3 Local Authority 52
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7.4 Environment Agency 53
7.5 HM Coroner 53
7.6 Military 54
7.7 The Third Sector ( including Voluntary Sector & Faith Groups) 55
8 Business Continuity Management 56
Fig.6 – Stages of an Incident 56
9 Ethical considerations 58
10 Recovery 60
10.1 Closure of Major Incident Control Centre (MICC) 60
10.2 Staff Support 61
10.3 De-brief 61
Appendices
1 Legislation and Guidance 62
1.1 NHS Emergency Planning Guidance 2005 62
1.2 Civil Contingencies Act 2004 62
1.3 Human Rights Act 1998 63
1.4 Health & Safety at Work Act 1974 63
2 Useful abbreviations 64
3 Glossary of Emergency Response Terms 66
Useful Forms
Draft Strategic Aim and Objectives 71
Major Incident Message Log 73
Draft Agenda for Major Incident Team meeting 75
Attendance sheet 77
Exhibit List 79
Sample Exhibit List 81
Bibliography 82
Plan History 83
Distribution List 84
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CHIEF EXECUTIVES STATEMENT
NHS South Yorkshire and Bassetlaw has a duty to protect and promote the health of the
community, including in times of emergency. We are committed to complying with legislation
and guidance in relation to Emergency Preparedness, Resilience and Response.
The Civil Contingencies Act 2004 places a statutory duty on NHS organisations to prepare for
emergencies. The NHS Emergency Planning Guidance 2005 requires a trained and tested
Major Incident Plan be in place. The Operating Framework for the NHS in England 2012/13
states that Emergency Preparedness, Resilience and Response continues to be a core function
of the NHS. All NHS organisations are required to maintain a good standard of preparedness to
respond safely and effectively to a full spectrum of threats, hazards and disruptive events.
This is a generic Major Incident plan, designed to assist in the early management of a range of
potential events or incidents identified in the NHS South Yorkshire and Bassetlaw Emergency
Resilience Risk Assessment. It provides a framework in which to operate but does not restrict
managers from using their skills and knowledge to effectively respond to the individual
circumstances of an emergency.
All Directors are required to ensure that key staff are adequately prepared to respond effectively
in accordance with relevant resilience plans, and associated response arrangements required to
mitigate the effects of the emergency. All personnel have a responsibility to ensure they are
familiar with their individual role and responsibilities during an emergency.
The effectiveness of these arrangements will be monitored and reviewed and the NHS South
Yorkshire and Bassetlaw Cluster Board will require regular reports, at least annually regarding
Emergency Preparedness, Resilience and Response activities, including details of training and
exercising undertaken.
Signed for and on behalf of NHS South Yorkshire and Bassetlaw
Andy Buck
Chief Executive
Date:
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1 INTRODUCTION
The purpose of this plan is to provide a framework for the emergency co-ordination of all NHS
organisations to ensure an integrated and co-ordinated approach to any emergency or major
incident in order to minimise the impact on the health and welfare of the communities of South
Yorkshire and Bassetlaw.
The formation of PCT Clusters is necessary as part of the ongoing NHS Reforms to secure the
capacity and flexibility needed for the transition period. In particular the Shared Operating Model
for PCT Clusters (28th July 2011) outlines the expectation that PCT Clusters will maintain the
capacity of NHS Commissioners to carry out Emergency Preparedness, Resilience and
Response (EPRR) functions during the transition period. They are also expected to support the
development of the new EPRR function within the NHS.
NHS South Yorkshire and Bassetlaw is the Barnsley, Bassetlaw, Doncaster, Rotherham and
Sheffield Cluster of PCTs.
This plan reflects these transitional arrangements. However, it does not detract from the need
for each NHS organisation to have its own robust Major Incident plans and does not affect
routine operating procedures, rather it complements them and provides additional measures
and command and control options for incidents that would stretch resources and be beyond
internal capabilities or routine escalation procedures of individual organisations and requires a
wider co-ordination of NHS resources.
This is a generic Major Incident plan, designed to assist in the early management of a range of
potential events or incidents identified in the NHS South Yorkshire and Bassetlaw Emergency
Resilience Risk Assessment. As such it cannot provide detailed response options for every
conceivable event. Rather it provides a framework and a range of options to be considered by
those involved in managing the initial response stage.
In addition there are specific plans to deal with certain types of incidents and these should be
referred to and read in conjunction with the Major Incident Plan where appropriate:
Pandemic Influenza Plan
Mass Casualty Plan
Mass Treatment Plan
Initial Action sheets
The plan provides a series of “initial action” sheets for a variety of roles that could possibly be
required to respond to an incident. These provide a menu of actions to be considered. Not all
will be relevant to every type of incident but are intended to act as an aide memoir for the
individual to consider and select as appropriate to the circumstances.
Management decisions will need to be based on the attendant circumstances of the event.
Initiative and flexibility will be essential in response to changing circumstances. The plan is not
intended to restrict managers from using their knowledge and skills to effectively respond to the
individual circumstances of an emergency. The scale of any incident will dictate whether it is
desirable to activate the whole plan or just relevant sections of it. The Emergency Resilience
Unit can be contacted for further advice and support if required.
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Emergency Log Book
A comprehensive Log must be kept of all events, to record the context within which decisions
are made and any action to be taken and by whom. Appropriate “Emergency Log Books” are
kept in the Major Incident Control Centres across the Cluster area for this purpose. If these are
not readily available it is still important that contemporaneous records are kept in some other
form.
Later sections of this plan provide more detailed background information to assist in the
ongoing integrated emergency management required for an effective multi-agency response to
a Major Incident.
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Initial Action sheet 1
Duties of First Person Receiving Report
On receiving a message regarding an incident or event, establish and record the following details:
Your name and contact details
Time and date message received
Name and contact details of person giving the information
Details of information
Consider the below mnemonic to extract more detailed information:
C – Casualties, number and severity
H – Hazards, present or potential
A – Access/Egress
L – Location, exact
E – Emergency services, present or required
T – Type of incident
What is NHS South Yorkshire and Bassetlaw being asked to do at this stage
Has anyone else at NHS South Yorkshire and Bassetlaw been informed and if so what actions have they taken
Is NHS South Yorkshire and Bassetlaw being put on standby or has a Major Incident been declared
What other agencies (if any) have been informed
Inform the NHS South Yorkshire and Bassetlaw Lead Director for EPRR
If unavailable inform On-Call SILVER
See Over for list of other contacts who may need to be made aware depending on the circumstances.
Record overleaf time, date and method of notification where appropriate.
Once completed this document to be forwarded to the Emergency Resilience Unit for inclusion in the Emergency Log Book
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Incident Contact Record
Contact Person Who Took Call Time / Date Initials
Chief Executive
Lead Director EPRR
On Call Director
Director(s) of Public Health
Chief Operating Officer(s)
Emergency Resilience Unit
Yorkshire Ambulance Service
Acute Hospital Trust(s)
Community Service provider(s)
Health Protection Agency
Local Authority(s)
NHS North of England
All emergency contact details are contained in the Cluster On-Call information pack.
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Initial Action sheet 2
Duties of Strategic Lead (Gold)
The Strategic level of command for the NHS (often referred to as “Gold”) will normally be
assumed by the NHS South Yorkshire and Bassetlaw Director of Performance and
Accountability who is the Lead Director for EPRR. In the absence of this individual, this role will
be performed by the Director on the NHS Gold Commander On-Call rota.
The purpose of Gold is to provide overall Strategic co-ordination of all NHS resources across
South Yorkshire and Bassetlaw and to take overall responsibility for managing and resolving an
event or situation.
To perform this role effectively, this person must have the authority to make executive decisions
in respect of the organisations resources and finances, particularly if involved in a multi-agency
response.
If the incident requires a multi-agency response the Police will convene and chair a Strategic
Co-ordinating Group (SCG). The Health Gold would be expected to attend the SCG to
represent the NHS. Their role will be to co-ordinate the NHS response and contribute to the
overall strategic aim and objectives.
The considerations listed below are intended as an aide memoir for the Gold commander. Note: This is not an exhaustive list and items may be added or removed to suit the individual circumstances of the incident/event.
Determine a clear strategic aim and objectives for the health response to the incident (in a multi-agency response this task will be undertaken jointly by the SCG) Progress against the objectives should be reviewed regularly. See useful Forms for Draft Aim & Objectives
Consider appropriate location so as to be able to maintain effective strategic command of
the event. It is not recommended to be located directly with the Silver Team to avoid being drawn into the tactical level of response.
Consider the need for an appropriately resourced Support Team using the “Action Sheets” in this plan as a guide.
Where an SCG is established a Health Strategic Support Cell may be required and more information is available in Appendix A of the separate document “NHS South Yorkshire and Bassetlaw Strategic Framework for Emergency Preparedness, Resilience and Response” which should also be referred to.
A comprehensive Log must be kept of all events, containing issues arising, options considered, decisions made, and the reasoning behind those decisions and any action to be taken and by whom. Appropriate “Emergency Log Books” are kept in the Major Incident box at respective locations for this purpose. If these are not readily available it is still important that contemporaneous records are kept in some other form.
Appoint a person to act as “Log Keeper” on your behalf – a list of trained personnel is available in the On-Call folder. It is essential that the decision maker briefs the Log Keeper about the expectations of what is to be recorded. Note this role is not to be confused with a “Minute taker” which is a separate role that may be required for recording full details of any planning meetings.
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Ensure activation of sufficient district Silver control centres to implement tactical plans and establish a policy framework within which the Silver Team(s) will work. (see also – Command and Control section)
Prioritise demands and allocate resources to meet requirements. Consider the need for additional resources and requesting mutual aid where appropriate.
Where appropriate, consult with the Director(s) of Public Health.
Where appropriate, consult with NHS North of England.
Formulate and implement media handling and public communications strategies. Appoint a communications lead to manage internal messages for staff and external messages for the public. Approve any media statements (in consultation with partner organisations if involved)
It may be necessary to appoint a Business Continuity Manager to ensure core functions are maintained whilst the Silver Team and other personnel are engaged in the response phase.
Consider any wider implications. What are the impacts to health – immediate and short term and what actions to minimise these and any requirements for public warning. Liaise with DPH or HPA and consider any long term monitoring and health surveillance.
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Initial Action sheet 3
Duties of Tactical Lead(s) – Silver(s)
The role of Silver is to develop and implement a Tactical plan to achieve the Strategic direction
set by GOLD and will be required to work within the framework of policy outlined at the Strategic
level. This is essential to ensure a consistent and co-ordinated response within an ethical
framework across the entire area affected. Tactical command should oversee, but not be
directly involved in, providing any operational response at the Bronze level.
The NHS Gold commander will need to establish sufficient Tactical level groups (Silver
Commands) to implement the actions set at the Strategic level. There is a potential for there to
be up to Five Silver level commands, corresponding to the 5 PCT/CCGs in the South Yorkshire
and Bassetlaw cluster. The role of each Silver level group will be to co-ordinate the overall
health response for their respective locality and provide the link to their local service providers.
The Silver level of command will be assumed by the Chief Operating Officer or nominated
deputy of the relevant PCT/CCGs involved. Out of hours, the Silver role may need to be
performed in the initial stages by the NHS South Yorkshire and Bassetlaw Silver On-Call officer
until such time as district silvers can be established.
The considerations listed below are intended as an aide memoir for the Silver commander. Note: This is not an exhaustive list and items may be added or removed to suit the individual circumstances of the incident/event.
If not already activated consider the need to escalate to a wider Strategic level of command (GOLD), either at local or regional level. See also “Action Sheet 2”
The District Silver Team(s) are the conduit responsible for cascading information and actions to all other local NHS resources, including Acute Hospital Trusts, Community Services and Primary Care providers.
Each Silver commander will consider the need to open their respective Control Centres and establish an appropriately resourced support team. The size and membership of this team will vary depending on the incident involved
Delegate and assign tasks to the support team using the relevant “Initial Action” sheets (in some cases an individual may be given more than one role – particularly in the initial stages) Keep a record of any tasks assigned.
Appoint a Deputy / Staff Officer to be responsible for receiving and disseminating information. This will be a key role to efficiently manage and filter information. This is essential to prevent information overload and by receiving a reliable and concise summary of relevant information will create the time to enable effective decision making.
Appoint a person to act as “Log Keeper” on your behalf – a list of trained personnel is available in the On-Call folder. It is essential that the decision maker briefs the Log Keeper about the expectations of what is to be recorded. Note this role is not to be confused with a “Minute taker” which is a separate role that may be required for recording full details of any planning meetings.
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A comprehensive Log must be kept of all events, containing issues arising, options considered, decisions made, and the reasoning behind those decisions and any action to be taken and by whom. Appropriate “Emergency Log Books” are kept in the Major Incident box at respective locations for this purpose. If these are not readily available it is still important that contemporaneous records are kept in some other form.
It may be that other organisations locally and regionally are also responding. If so, appoint PCT liaison personnel to attend Silver and/or Gold commands at relevant locations. See also section 4 Command and Control for more information
Consider which external partner organisations or internal departments should be present in the PCT/CCG incident control centre to support the integrated management required for the particular incident.
Further departments or personnel to be considered are:
Public Health Yorkshire Ambulance Service
Human Resources Acute Hospital Trust
Strategy & Contracting Community Service providers
Finance GP out of hours service
Information Services General Practitioners
Estates and Facilities Infection Prevention and Control
Performance and Governance Medicines Management
Health & Safety Staff Support Services
Administrative and secretarial support Emergency Resilience Manager
External partners who may need to be involved or at least informed:
NHS North of England South Yorkshire Police
Health Protection Agency South Yorkshire Fire & Rescue Service
Other Primary Care Trusts Local Authority
Scientific & Technical Advisory Cell Environment Agency
Utility companies Voluntary Organisations
At this point, review the current situation and consider the following questions with direct regard to the role of the PCT/CCG:
What information do we have?
What information do we require?
What other actions are necessary – by whom?
Who else do we need to contact?
Provide continual updates for the Strategic level of command if active.
Check objectives have been achieved and actions completed. Then, invoke stand down procedure and any recovery issues.
Arrange de-brief (multi-agency if appropriate) to identify any learning or good practice.
Write report on the incident; include outcomes, learning points and future management issues. Liaise with the Emergency Resilience Unit and arrange for a review of the Major Incident Plan
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Initial Action sheet 4
Duties of Silver Staff Officer
The Staff Officer will work directly in support of and deputise for the Silver Commander and
should be an assistant Director or other senior management level and able to co-ordinate and
disseminate resources and information.
This will be a key role to efficiently manage information. This is essential to avoid the Incident
Manager being overloaded with spurious information.
With overall responsibility for receiving and disseminating information, this role requires the
authority and ability to be able to filter and deal with routine matters whilst selecting vital
information required by the Incident Manager to effectively manage the incident.
Providing a reliable and concise summary of relevant information to the Silver Commander will
create the time to enable effective decision making based on an accurate overview of the
situation.
The considerations listed below are intended as an aide memoir for the Staff Officer. Note: This is not an exhaustive list and items may be added or removed to suit the individual circumstances of the incident/event.
Open the Major Incident Control Centre using locally available set up arrangements and ensure the relevant I.T. and communications equipment is functional
In consultation with the Silver Commander arrange for the attendance of sufficient support staff to fill the roles required to effectively manage the specific incident. The “Initial Action” sheets suggest potential roles, but this can be varied depending on the overall circumstances.
Organise, in liaison with the Silver Commander, allocation of rooms, telephone lines and support staff for organisations/departments involved
Set up and maintain communications links with the Strategic level of command if active.
Set up and maintain communications links with any commissioned service providers involved in the response.
Appoint “Board keepers” and ensure all outstanding tasks are recorded on the dry wipe boards (or flip charts) and these are allocated for action accordingly.
Ensure the Log Keeper is aware of and recording all policy decisions. All records of the incident and responses to it must be maintained and retained.
Organise, on the request of the Incident Manager, the calling in of further personnel as required by the scale of the incident. Consider management of a long-term incident in terms of relieving personnel at regular intervals. Time is required for handover briefs.
Consider staff welfare, monitor the time on duty and ensure breaks and refreshments are available.
At the conclusion of the event ensure a hot de-brief is undertaken to capture any early examples of good practice or lessons identified to inform the full de-brief at a later stage
Ensure collection of all records pertaining to the Incident, which should be retained for 30 years in line with the NHS Code of Practice for Records Management.
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Initial Action sheet 5
Duties of Emergency Log Book Keeper
In the event of a major incident it is vital in order to facilitate operational debriefing and
to provide evidence for Audit purposes, to keep acurate records.
Record keeping also assists the decision–maker in reaching a reasoned, lawful and
justifiable decision at the time of a major incident.
This role should be performed by an appropriately trained person – a list of trained
personnel is available in the On-Call folder.
A comprehensive Log must be kept of all events, containing issues arising, options
considered, decisions made, and the reasoning behind those decisions and any action
to be taken and by whom.
Emergency Log Books are kept at the respective Major Incident Control Centre sites
across the Cluster. If these are not readily available it is still important that
contemporaneous records are kept in some other form.
Liaise with the Decision Maker (Gold or Silver Commander) to ascertain what logging
requirements are required, remember this role is separate from a minute taker
In line with training maintain a chronological log of all events in the Approved Emergency
Log book.
Write in permanent black ink using C.I.A. – Clear, Intelligible, Accurate
Initial and time and date each entry
At appropriate pause points after any meetings or significant discussions consult with
the Decision Maker to confirm accuracy of the Log Book, paying particular attention to
any policy decisions or actions required. Make amendments as required in accordance
with training and good practice.
Sign off notes at the end of the incident or at the end of your duty when you handover to
another Log Keeper.
Remember NO ELBOW
NO – Erasures
NO – Leaves torn out of the book
NO – Blank spaces – rule them through
NO – Overwriting
NO – Writing above or below the lined area
At the end of the incident, collate all documents, drawings, maps and other materials pertaining
to the incident for a hot de-brief.
These documents should be retained for a full de-brief at a later date and for any potential enquiries.
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Initial Action sheet 6
Duties of Communications Lead This role will be carried out by one of the communications managers. In their absence this
function may need to be performed by another appropriate manager.
The purpose of this role is to provide accurate, clear and timely advice to the public, the media
and other internal and external stakeholders and will require regular liaison with the Incident
Commanders.
Public
There is a duty to warn and inform the public during an emergency or major incident. Where
other organisations are also involved in the response it is essential to ensure a co-ordinated
response in accordance with the South Yorkshire media protocol.
Great care should be taken that no information about individual cases, or premature or
uncorroborated estimates of casualty numbers are released by any agency.
Media
Rapid development of a media strategy is essential. Any media statements will need to be
approved by the NHS Gold Commander for an incident only involving a Health service
response. See Initial Action sheet 2 for more information
Where a multi-agency response is required a lead agency should be identified to co-ordinate
information for the media / public. This would normally be South Yorkshire Police but not
exclusively so. The lead agency would be responsible for implementing the media strategy and
ensuring partner agencies are informed of developments. This could be done through the
Strategic Co-ordinating Group (SCG) if active.
Consider
An immediate holding statement
Appointing a media spokesperson
Timing and content of media releases
Necessity for a media conference
Necessity for a joint media centre
External stakeholders
It will be necessary to maintain regular liaison with communications leads from our partner
agencies. This will enable all organisations to share information and ensure that consistent
messages are being communicated as above.
Internal stakeholders
Regular and consistent updates will need to be communicated to staff to ensure a well informed
workforce able to support the response to a developing situation.
Record keeping
Ensure records are kept of all relevant details of the incident and any information circulated.
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Initial Action sheet 7
Duties of Medical Lead
This function may be assumed by a Director of Public Health or the Medical Director from NHS
South Yorkshire and Bassetlaw, depending on the geographic spread of any health emergency.
The Medical Lead will be responsible for providing and co-ordinating medical advice in
consultation with Clinical Leads from any responding provider services. It is stressed that the
Medical Lead should provide clinical advice to support the overall response and work within the
framework of policy outlined at the Strategic level. This is essential to ensure a consistent and
co-ordinated response within an ethical framework. Considerations are:
Assess the impact on local health and health services
Where clinical services need to be reduced, provide advice on priority medical services
Where appropriate provide advice on changes to discharge and admission criteria
Arrange epidemiological investigation and follow-up of affected individuals as necessary.
Obtain advice from relevant sources of expertise where necessary
Liaise closely with the Incident Commander.
Consider wider health implications and need to alert Regional colleagues
Ensure records are kept of all information and advice given, either personally or through the Gold Commanders‟ Emergency Log Book Keeper.
Health Protection Agency (HPA)
The Health Protection Agency provides public health advice to government departments, NHS
organisations, the statutory agencies and directly to the public. It provides a central source of
authoritative scientific/medical information and other specialist advice on both the planning and
operational responses to public health emergencies.
Where necessary the Medical Lead should liaise with the Health Protection Agency.
See also section 6.9 for more information on the role of the HPA.
Scientific and Technical Advice Cell (STAC)
If the emergency or incident requires a South Yorkshire wide multi-agency response then it is
likely that a Strategic Co-ordinating Group (SCG) will be activated.
See also section 4 Command and Control for more information
A Scientific and Technical Advice Cell (STAC) is most likely to be required in response to
complex incidents involving multiple scientific and technical issues, where there is potential for
conflicting expert opinion. Where appropriate the SCG will request the formation of a STAC.
If a STAC is formed then this group will become responsible for co-ordinating medical advice
and providing information through the SCG.
See also section 6.10 for more information on the role of the STAC.
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Initial Action sheet 8
Duties of Administration Support Team
There may be many individuals required to effectively manage this function, depending on the
scale of the incident. The role should be carried out by Personal Assistants and Project Support
officers.
Working under the direction of the Staff Officer, Duties will include:
Answer and Log incoming calls, using the appropriate message logs included in this
plan. Log faxes and any other written information, recording time received and action
taken.
Onward transmission of information to internal departments and partner agencies as
directed
Take minutes / notes of Incident Team meetings as required. Note: This is a separate
role to the Emergency Log Book keeper
Maintain Dry Wipe boards / Flip charts with details of:
Key events
Actions allocated with status and who assigned to
Key contacts (internal and external)
Resources deployed or available
Casualty information
Ensure Staff Officer is updated with any important new information.
Support the Emergency Log Book keeper by filing records, photograph dry wipe boards before
cleaning and ensure all flip charts and notes are retained. A sample “Exhibit List” is included in
this plan to give an indication of the type of information needed to be retained, note this is not
an exhaustive list.
All records pertaining to a Major Incident should be retained for 30 years in line with the NHS
Code of Practice for Records Management.
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Initial Action sheet 9
Duties of Security Manager
This role if required will be performed by the Local Security Management Specialist (LSMS) or in their absence a member of the HR/Health and Safety Team and will be responsible for maintaining the health and safety of staff, patients and visitors.
Liaise with the Silver Commander to agree on any additional requirements needed to maintain the health and welfare of those involved or responding to the incident
Liaise with the Communications Lead to establish level of media involvement and provide support in facilitating / managing any media attending at PCT sites
Assume overall responsibility for the security of personnel, buildings and grounds.
Consider the need for a lock down of premises. Restricting or preventing access / egress to whole or part of a building. Any such action must be legal, necessary and proportionate.
Ensure that the building and grounds are secure, whilst maintaining access for essential staff who may be responding to the incident
Request volunteer(s) to assist in this role if needed
Liaise with South Yorkshire Police for additional support if required.
Arrange for reception cover if necessary and brief staff as to any requirements of entry / exit
Ensure all staff wear and display I/D badges. Challenge if not worn
Any essential visitors should sign in and out and wear a visitors badge. Any non essential visitors should be advised to attend at another time
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2 MAJOR INCIDENT
2.1 Definitions
Most incidents are geographically local and limited in time and impact and are dealt with in an
effective and efficient way by the emergency services and the Acute Trusts. Some events
require a broader level of co-ordination which may necessitate the involvement of NHS South
Yorkshire and Bassetlaw.
2.2 The Civil Contingencies Act 2004 provides a definition of “Emergency” as:
An event or situation which threatens serious damage to human welfare
An event or situation which threatens serious damage to the environment
War or terrorism which threatens serious damage to security
This definition of emergency defines the sorts of events that we should be prepared for.
Additionally it sets a threshold level to trigger the activation of this plan and our duty to respond
if it is:
Within our functions and necessary to take action to reduce, control or mitigate the
effects of the emergency
and
Would be unable to take that action within routine service arrangements and requires
changing the deployment of resources or acquiring additional resources.
2.3 NHS Emergency Planning Guidance 2005 provides a definition of a Major Incident:
Any occurrence that presents a serious threat to the health of the community, disruption to the
service or causes (or is likely to cause) such numbers or types of casualties as to require
special arrangements to be implemented by hospitals, ambulance trusts or primary care
organisations.
2.4 Declaring a Major Incident
It is essential to remember that an incident may have a huge impact on one part of the health
service, while leaving other areas relatively unaffected. In a similar way, an NHS major incident
is not necessarily a major incident for other organisations, such as Police, Fire or Local
Authority. It is for this reason that any organisation either singularly or jointly can declare a
“Major Incident” based on either of the above definitions and the impact on their organisation.
If NHS South Yorkshire and Bassetlaw is affected by an incident that meets either of the above
definitions then a Major Incident should be declared and this plan activated. It is good practice
to inform our partner organisations but the level of their response will depend on the impact of
the incident on their own organisation.
Whether the response only involves NHS South Yorkshire and Bassetlaw or requires a co-
ordinated multi-agency response there may be a need to build appropriate command and
control structures. See section 4 Command and Control for more information.
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Where other organisations are involved then integrated emergency management procedures
should be implemented and an appropriate lead organisation identified. See also section 6 and
7 for roles and responsibilities of other organisations.
2.5 Alert Messages
To avoid uncertainty and confusion in declaring the stages of a major incident, the NHS uses
the following alerting messages:
“Major incident standby” where a situation is unclear at an early stage or has the
potential to escalate.
“Major incident declared – activate plan” to indicate that the major incident plan
should be activated.
“Major incident stand down” when the major incident response is no longer required.
This can follow either of the above alerting messages.
2.6 Yorkshire Ambulance Service Notification
Yorkshire Ambulance Service (YAS) are the NHS contact for the other emergency services in
the event of an incident and it is therefore most likely that any notification of an incident will
come from them.
YAS use the below alert levels and will notify the organisations shown depending on whether it
is a local, South Yorkshire or Regional incident.
LEVEL 1 - INCIDENT CONTAINED WITHIN THE RESOURCES OF A SINGLE LOCALITY PCT/CCG
Incident/Event
RECEIVING ACUTE TRUST (Action)
AFFECTED PCT/CCG (Action)
HPA (SYHPU) If required
SHA (information and DH liaison role)
PCT CLUSTER SILVER ON CALL Information only in case of escalation resulting in the need for SY & B co-ordinating role
YAS
Key: Organisation leading the response
Major Incident Plan 31
LEVEL 2 -
Incident/Event
SY & B ACUTE TRUSTS (Action)
SY & B PCT/CCGs (Action)
HPA (SYHPU) (Action)
SHA (DH liaison role and potential for escalation beyond South Yorkshire resources)
PCT CLUSTER GOLD ON CALL (SY & B NHS co-ordinating role)
YAS
Key: Organisation leading the response
INCIDENT CONTAINED WITHIN THE RESOURCES OF THE SOUTH YORKSHIRE &
BASSETLAW AREA
INCIDENT CANNOT BE CONTAINED WITHIN THE RESOURCES OF THE SOUTH YORKSHIRE
& BASSETLAW AREA AND ASSISTANCE SOUGHT FROM OTHER AREAS VIA SHA LEVEL 3 -
Incident/Event
SY & B ACUTE TRUSTS (Action)
SY & B PCT/CCGs (Action)
HPA (SYHPU) (Action)
SHA (Regional co-ordinating role and DH liaison)
PCT CLUSTER GOLD ON CALL (SY & B NHS co-ordinating role)
YAS
Key: Organisation leading the response
Major Incident Plan 32
2.7 Internal NHS alert
It is possible that a local NHS service provider may be the first organisation to declare a Major
Incident in which case the local PCT/CCG should be notified immediately and where
appropriate escalated to the PCT Cluster to provide an overall co-ordinating role to support the
affected service.
It is essential that Yorkshire Ambulance Service is informed of the circumstances, in order that
they can commence the cascade system outlined above to notify any other organisations as
required.
2.8 Duties of First Person Receiving Report
The first person in NHS South Yorkshire and Bassetlaw taking a report of an incident or event
should use “Initial Action sheet 1” as an aide memoire to record relevant information. This
document can then assist with the assessment and dissemination of information to escalate the
response as required by the circumstances.
Further “Initial Action sheets” are available in this plan to provide a prompt for key post holders
potentially required to respond during a Major Incident.
The On-Call folder contains necessary contact information for key personnel and organisations
for both office hours and 24 hour emergency call out if needed.
Major Incident Plan 33
3 ESCALATION Sudden impact events (“Big Bang”) whilst clearly challenging to manage are instantly
recognised due to their sudden and dramatic nature and obvious impact, thereby allowing
appropriate Resilience arrangements to be immediately activated.
Alternatively, increasing Demand and Capacity on Healthcare services can develop gradually,
almost unnoticed for some time (“Rising Tide or Creeping Crisis”) The impacts and disruption to
services and health care could be prolonged and the response may need to be sustained, with
potentially decreased levels of staff over a considerable period of time and affecting all health
and social care services.
Early recognition of a “Rising Tide” situation will allow for timely intervention and thus minimise
the impact and lead to a more efficient recovery. For this reason this plan identifies various
trigger points for action to ensure a consistent and co-ordinated approach to manage any
phased escalation of response. (See Fig. 1 below)
Note: these trigger points are intended as a guide to the Incident Commanders, and do not
preclude initiative and flexibility to respond to the particular circumstances of an incident.
Where a Major Incident impacts across Health Care Organisations, NHS South Yorkshire and
Bassetlaw will provide an overall co-ordinating role to ensure an integrated emergency
management approach involving any Health Care Organisations as necessary in order to
effectively and efficiently respond. All commissioned provider services will be expected to co-
operate and work flexibly to support the overall health response and divert resources to those
areas in most need and therefore minimise the impact on health to the community of South
Yorkshire and Bassetlaw.
See also Section 4 “Command and Control” for more information.
The relevant Business Continuity plans should also be referred to.
Fig.1 – Trigger points for escalation
Trigger Point Characteristics Strategies
Trigger Point – 0
Status normal for season
Normal staffing levels for season
Normal prioritisation of services
Patient contact at normal seasonal levels
All routine services being delivered
Ongoing surveillance monitoring
Ongoing liaison and partnership working
Business Continuity Plans in place
Major Incident Plans in place
Ongoing major incident training for key personnel
Plans routinely exercised, reviewed and updated
Trigger Point – 1
Slight effect on services
Can be managed internally by one organisation
Requires changed deployment of resources to manage
Up to 25% increase in patient contact
Inform NHS South Yorkshire & Bassetlaw of situation
Implement Business Continuity Management plans
Consider planned closures
Consider reduction in non critical activities / services
Trigger Point – 2
Moderate effect on services
Potential to impact on other Health Care organisations
Requires additional deployment of resources to manage sustained increased demand of up to 50%
Escalation of service reductions and closures (including reduced treatment regimes)
Unplanned closures of some services
Inform NHS South Yorkshire & Bassetlaw of Major Incident Standby
Activate PCT/CCG led co-ordinating group(s)
Consider need for Clinical Executive Group
Implement Business Continuity Management plans
Triage of patients attending service
Implementation of admission and discharge criteria
Trigger Point – 3
Major disruption to services
Critical services not coping
Demand outstripping supply
Continued or increasing pressure above level 2 point
Increased dependency between Health and Social Care Organisations to manage patients
Declare a Major Incident and implement this plan
Activate NHS South Yorkshire & Bassetlaw led co-ordinating group
Activate Clinical Executive Group
Alternative care settings implemented
Triage of patients attending service
Implementation of admission and discharge criteria
Trigger Point – 0
Recovery – returning to normal operations
Returning to normal operations
Returning to normal staffing levels
Inform NHS South Yorkshire & Bassetlaw of Major Incident stand down
Identify priorities for phased resumption of deferred treatment and services
4 COMMAND AND CONTROL
Most incidents are geographically local and limited in time and impact and are dealt with in an
effective and efficient way at the operational level by the Ambulance service and Acute Trusts.
However some events require a broader level of co-ordination. Whether the response only
involves the NHS or requires a co-ordinated multi-agency response there may be a need to
build appropriate command and control structures.
Command, Control and Co-ordination are important concepts in the multi-agency response to
emergencies. A nationally recognised three tiered command and control structure known as
Strategic (Gold), Tactical (Silver) and Operational (Bronze) has been adopted by the
emergency services and most responding agencies and private organisations, as outlined in
Fig.2.
Fig.2: Command and Control structure
The NHS South Yorkshire and Bassetlaw command and control arrangements are based upon
this system. These arrangements help to ensure interoperability between responders. The
level of command required will be determined by the nature and seriousness of the incident.
Invariably with spontaneous incidents, the command structure builds from the bottom up with
the „Operational‟ level being activated first and the other levels forming as the situation
escalates beyond the control of normal operations. It is possible with some incidents, that the
activation of the three levels will be concurrent.
Major Incident Plan 36
4.1 Incident Management Model
It is not possible or advisable for a generic Major Incident Plan to be too prescriptive before all
the facts and issues are known as there is a danger that the decision making process will be
flawed if made to fit the plan rather than the circumstances prevailing.
Management decisions will need to be based on the attendant circumstances of the event.
Initiative and flexibility will be essential in response to changing circumstances. The plan is not
intended to restrict managers from using their knowledge and skills to effectively respond to the
individual circumstances of an emergency.
The Incident Management Model outlined below is a useful process to analyse the problem and
identify an appropriate and reasoned solution. It can be used at each Command level as
required. If there is more than one problem then prioritise accordingly and deal with one issue at
a time, then repeat the process until all actions are allocated.
Fig. 3: Incident Management Model
Information:
Consider all the information available at this time. This may only be the information obtained by
the first person taking the report and completing “Initial Action sheet 1” using the mnemonic
CHALET.
Repeat the process as new information emerges.
Consider also, what resources are available at this time.
Risk Assessment:
Consider who may be harmed and how and what control measures can be applied to minimise
these risks. Further advice may be required from the Medical Lead or the Health Protection
Agency. Risk could also include harm to reputation or financial implications.
Plans/Policies:
As well as the various Emergency Resilience plans, what other policies may be useful to assist
in the management of this incident eg HR policies, ESR, Estates and IT policies etc.
Plans/Policies
Actions
Information
Risk Assessment
Options
Major Incident Plan 37
Options:
Then consider the context within which decisions are made, what response options are
available, always consider alternative options with advantages and disadvantages of each, are
the options lawful, necessary and proportionate?
Actions:
Using this thought process, select the most reasonable option and this will form the plan of
action. Record the decision made and ensure the task is allocated. Move on to the next problem
and repeat this process until all actions are allocated and concluded.
4.2 Emergency Log Book
A comprehensive Emergency Log must be kept of all events at both the Strategic (Gold) and
Tactical (Silver) level, containing issues arising, options considered, decisions made, and the
reasoning behind those decisions and any action to be taken and by whom. Appropriate
“Emergency Log Books” are kept at the respective Major Incident Control Centre sites across
the Cluster for this purpose. If these are not readily available it is still important that
contemporaneous records are kept in some other form.
The Gold / Silver commander should appoint a person to act as “Log Keeper” on their behalf –
a list of trained personnel is available in the On-Call folder. It is essential that the decision
maker briefs the Log Keeper about the expectations of what is to be recorded. Note this role is
not to be confused with a “Minute taker” which is a separate role that may be required for
recording full details of any planning meetings.
The senior people likely to be deployed in either a Gold or Sliver command role will make
management decisions on a regular basis in their usual role. These routine management skills
are transferable to managing an emergency or Major Incident. The most significant difference
will be the essential requirement to make speedy decisions often under extreme pressure using
limited information. It is this factor that makes it essential that your rationale is accurately
documented accordingly.
This plan provides a framework in which to operate and the Incident Management Model at
Fig. 3 above provides a useful process to help identify an appropriate and reasoned solution.
However the decision maker needs to reach and evidence that they reached a reasonable
decision, based on the circumstances and information available at the time. A “reasonable
decision” is one that other decision makers would have reached in the same circumstances.
This is akin to other legal doctrines throughout the health sector.
Correct use of the Emergency Log book in consultation with the Log Keeper will support
effective decision making and provide a clear audit trail to minimise problems should the
incident be later scrutinised by a court or public enquiry.
Major Incident Plan 38
4.3 BRONZE Role – Operational
This level is usually the first to be activated as they respond to events at the operational level as
they unfold. As an incident escalates beyond this level of control, the command structure starts
to build to provide the level of co-ordination required to effectively resolve the incident. The term
Bronze refers to Operational team leaders who will manage the physical response to achieve
the tactical plan defined by Silver.
Controlling the management of resources within their given area of responsibility. There may be
several Bronze commanders based on either a functional or geographic area of responsibility.
4.4 SILVER Role -Tactical
Responsible for developing and implementing a Tactical plan to achieve the Strategic direction
set by GOLD and will be required to work within the framework of policy outlined at the Strategic
level irrespective of whether GOLD Command is set at the South Yorkshire, Regional, or
National level. This is essential to ensure a consistent and co-ordinated response within an
ethical framework across the entire area affected.
They provide the pivotal link between Gold and Bronze levels. Tactical command should
oversee, but not be directly involved in, providing any operational response at the Bronze level.
It will be necessary to establish sufficient Tactical level groups (Silver Commands) to implement
the actions set at the Strategic level. There is a potential for there to be up to Five Silver level
commands, corresponding to the 5 PCT/CCGs in the South Yorkshire and Bassetlaw cluster.
The role of each Silver level group will be to co-ordinate the overall health response for their
respective locality and provide the link to their local service providers.
The Silver level of command will be assumed by the Chief Operating Officer or nominated
deputy of the relevant PCT/CCGs involved. Out of hours, the Silver role may need to be
performed in the initial stages by the NHS South Yorkshire and Bassetlaw Silver On-Call officer
until such time as locality silvers can be established.
All emergency contact details are contained in the Cluster On-Call information pack
See Also “Initial Action” sheet 3
4.5 GOLD Role – Strategic
The purpose of the Strategic command level is to take overall responsibility for managing and
resolving an event or situation. Establishing a framework of policy within which tactical
managers will work by determining and reviewing a clear strategic aim and objectives.
See Useful Forms for draft Aim and Objectives
The strategic commander has overall control of the resources of their own organisation and
should ensure sufficient resources are made available to achieve the strategic objectives set.
Also considering the longer term resourcing implications and any specialist skills that may be
required.
This level of management also formulates media handling and public communications
strategies, in consultation with any partner organisations involved.
Major Incident Plan 39
The Strategic Lead will then delegate actions to the respective Tactical (Silver) command level
for them to implement a Tactical Plan to achieve the Strategic aim. All Strategic actions should
be documented to provide a clear audit trail using the appropriate Emergency Log books.
There can only be one Strategic level decision making body to ensure a co-ordinated response,
particularly where more than one organisation is involved, otherwise there is potential for a
disjointed approach without a common policy agreed by all those involved. The Strategic
command will therefore be set at the level appropriate to the scope of the incident and escalate
up the scale where necessary as outlined below.
4.6 Major Incident Control Centre (MICC)
In order for an NHS Commander at either Gold or Silver level to make informed decisions,
sufficient support will be required to ensure an effective two way flow of information, to be able
to receive and report on the current health overview and to be able to disseminate information
and implement necessary actions.
The function of a MICC is to provide a central communication facility to collect, collate and
disseminate information on activity and pressures across any Health and Social Care
organisations involved and to provide the necessary oversight for the Gold or Silver commander
to make informed decisions. This will be essential in order to create sufficient resources to
effectively respond to the incident, whilst trying to maintain other priority functions.
The MICC will need an adequately resourced support team to effectively manage an incident
and provide the appropriate support to the commander. The size and membership of the
support team will be dictated by the scale and nature of the incident and will be decided by the
NHS Gold / Silver Commander, using the “Action Sheets” in this plan as a guide.
Likewise the location and number of MICC will be decided by the NHS Gold / Silver
Commander based on the nature and scale of the incident. Each local PCT/CCG within the
Cluster maintains their own MICC facility for this purpose and one or all of these may need to
be activated in the event of a widespread health emergency.
Where a number of local PCT/CCGs have an active MICC it is likely that NHS South Yorkshire
and Bassetlaw would provide an overall Strategic (Gold) level co-ordinating role and each
locality would effectively become a local Health SILVER level team responsible for working
within the framework of policy outlined at the Strategic level.
In this case, the NHS South Yorkshire and Bassetlaw Gold Commander will establish an
appropriate control facility to maintain sub regional Strategic level co-ordination. This would
normally be the Major Incident Control Centre at NHS Sheffield, however a flexible approach
will be used to provide resilience across the Cluster and any of the PCT/CCGs could host this
facility.
Where a multi-agency Gold level response is required the Police will establish a Strategic Co-
ordinating Group (SCG) See also Section 4.10 to Section 5 for more information.
Major Incident Plan 40
4.7 NHS Single Organisation Gold
Where an incident is contained within a single locality and a single NHS organisation (e.g.
Acute Trust) and is manageable within their resources, it will implement its own Major Incident
procedures and command structure to manage the incident internally, keeping partner
organisations informed of the situation.
4.8 NHS Locality PCT/CCG area Gold
Where an incident extends beyond a single NHS organisation, but is contained within the health
sector of a single locality (i.e. Barnsley, Bassetlaw, Doncaster, Rotherham or Sheffield, Clinical
Commissioning Group / PCT area) the Strategic level of command and control will be assumed
by the Chief Operating Officer or nominated deputy of the PCT/CCG covering that locality. The
purpose will be to co-ordinate the overall Health response involving all commissioned provider
services locally to minimise the impact on health to the local community. Commissioned
provider services will be expected to co-operate and work flexibly to support the overall Health
response.
If required the PCT/CCG will also provide NHS representation to any multi-agency tactical
group that may be set up for that district. The PCT/CCG will keep NHS South Yorkshire and
Bassetlaw informed of the situation.
4.9 NHS South Yorkshire and Bassetlaw area Gold
Where an incident involves a South Yorkshire and Bassetlaw wide health response, but does
not impact on multi-agency partners, the Strategic level of command may be assumed by the
PCT Cluster to co-ordinate the Strategic level health response across the sub region. NHS
South Yorkshire and Bassetlaw will then provide and cascade strategic direction to any of the
locality PCT/CCGs involved (see Fig. 4)
The nature or scale of an incident will determine the requirement to establish this level of
Strategic co-ordination of the NHS across the South Yorkshire and Bassetlaw area.
Such NHS co-ordination may be required if, a PCT/CCG is asking for support, an incident
involves more than one PCT/CCG or at the request of NHS North of England. Any such
request should come from a Director at any constituent PCT/CCG and be made to the Cluster
Gold On-Call.
This role of PCT Cluster area Gold will normally be performed by the Director of Performance
and Accountability who is the Emergency Preparedness Lead for the PCT Cluster. In the
absence of this individual, this role will be performed by the Director on the NHS Gold
Commander On-Call rota.
All emergency contact details are contained in the Cluster On-Call information pack.
The NHS Gold commander will need to establish sufficient Tactical level groups (Silver
Commands) to implement the actions set at the Strategic level. There is a potential for there to
be up to Five Silver level commands, corresponding to the 5 PCT/CCGs in the South Yorkshire
and Bassetlaw cluster. The role of each Silver level group will be to co-ordinate the overall
health response for their respective locality and provide the link to their local service providers.
(See Fig. 4)
Major Incident Plan 41
Out of hours, the Silver role may need to be performed in the initial stages by the NHS South
Yorkshire and Bassetlaw Silver On-Call officer until such time as district silvers can be
established.
In order for the NHS Gold Commander to make informed decisions, sufficient support will be
required to develop and maintain clear lines of communication with respective Silvers to collect,
collate and disseminate information on activity and pressures across all Health and Social Care
organisations involved. See also section 4.6 Major Incident Control Centre.
If required the PCT Cluster will also provide NHS representation to any multi-agency Strategic
Co-ordinating Group (SCG) that may be formed (see also section 4.10 to section 5). The PCT
Cluster will keep NHS North of England informed of the situation.
Major Incident Plan 42
Fig.4: NHS South Yorkshire and Bassetlaw Command and Control structure
Strategic (Gold)
Tactical (Silver)
Operational (Bronze)
Major Incident Plan 43
4.10 Multi-agency Gold
Where Strategic level multi-agency co-ordination is required to deal with an emergency it will be
necessary to activate the South Yorkshire Strategic Co-ordinating Group (SCG) commonly
referred to as “Gold command” or simply “GOLD”. See Also Section 5.
In the event that NHS Bassetlaw are requested to provide support to a multi-agency Major
Incident being managed by the Nottingham and Nottinghamshire SCG then the South Yorkshire
NHS Gold Commander On-Call should be informed.
The role of the SCG is to agree joint aims and objectives to manage the incident and co-
ordinate the overall strategic response of all organisations involved in the management of the
Major Incident.
Consequently SCG representatives should be Chief Officer level and have the appropriate mix
of seniority and authority and be empowered to make executive decisions in respect of their
organisations finance and resources.
The Health Gold would be expected to attend the SCG to represent the NHS. The Health Gold
MUST be in possession of an NHS photo ID card. Their role will be to co-ordinate the overall
Health service response and contribute to the overall strategic aim and objectives. The Health
Gold will keep NHS North of England informed of the situation.
This role of Health Gold will normally be performed by the NHS South Yorkshire and Bassetlaw
Director of Performance and Accountability who is the Emergency Preparedness Lead for the
Cluster. In the absence of this individual, this role will be performed by the Director on the NHS
Gold Commander On-Call rota.
All emergency contact details are contained in the Cluster On-Call information pack.
The NHS Gold commander will need to establish sufficient NHS Tactical level groups (Silver
Commands) to implement the actions set at the Strategic level. There is a potential for there to
be up to Five Silver level commands, corresponding to the 5 PCT/CCGs in the South Yorkshire
and Bassetlaw cluster. The role of each Silver level group will be to co-ordinate the overall
health response for their respective locality and provide the link to their local service providers.
See Fig. 4 above in relation to NHS Command and Control.
Out of hours, the Silver role may need to be performed in the initial stages by the NHS South
Yorkshire and Bassetlaw Silver On-Call officer until such time as district silvers can be
established.
Depending on the incident, multi-agency Tactical groups may be set up, usually by South
Yorkshire Police. Representation of the NHS at district level will be managed by the respective
PCT/CCG. If a South Yorkshire level Tactical group is established, the PCT Cluster, will liaise
with the relevant PCT/CCGs to determine the most appropriate representation to be deployed
for the NHS.
In order for the NHS Gold Commander to make informed decisions, sufficient support will be
required at the SCG to ensure an effective two way flow of information, to be able to receive
and report on the current health overview and to be able to disseminate information and actions
Major Incident Plan 44
back to active Health Silvers. As a minimum the support should include a Staff Officer /
Emergency Planning Advisor and a Log Keeper and should have access to relevant emergency
plans, laptop, mobile phone and charger.
Where further support is required, it may be necessary to establish a Health Strategic Support
Cell (HSSC) The size, membership and location of a HSSC will be determined by the Gold
commander based on the nature or scale of the incident. Further information is available in
Appendix A of the separate document “NHS South Yorkshire and Bassetlaw Strategic
Framework for Emergency Preparedness, Resilience and Response” which should also be
referred to.
4.11 Regional and National Command and Control
In the event of an incident escalating beyond local boundaries, or if its duration or nature is such
that regional resources are required, then the NHS North of England will co-ordinate the health
service response. Where an incident is beyond the capacity of the region, the Department of
Health can implement national co-ordinating arrangements via the DH Major Incident Co-
ordination Centre. See Fig. 5 overleaf, which incorporates both sub-regional multi-agency
working and regional/national command and control arrangements.
Major Incident Plan 45
Fig. 5: Multi-agency Command and Control structure
D of H
NHS
North of England
COBR
SY & B Health Strategic
Support Cell (HSSC) (Health Gold Support)
South Yorkshire Strategic
Co-ordinating Group (SCG)
YAS NHS HPU
Gold Gold Director
Commander Commander
Constituent PCTs
Tactical (Health Silver)
X5
Commissioned Services
Acute
Commissioned Services
Mental Health
Commissioned Services
Community
Commissioned Services
Primary Care
Media Cell
NHS Direct
Scientific & Technical
Advice Cell (STAC)
(Remote) Tactical
Co-ordinating
(Group(s) (TCG)
NHS Direct
National
Regional
Sub-regional
Resilience and
Emergencies
Division - North
Major Incident Plan 46
5 ACTIVATION OF SOUTH YORKSHIRE STRATEGIC CO-ORDINATING GROUP (SCG)
Where Strategic level multi-agency co-ordination is required to deal with an emergency it will be
necessary to activate the South Yorkshire Strategic Co-ordinating Group (SCG)
It is possible that before activating an SCG that a Strategic Assessment Meeting may be called
as a pre-emptive forum to consider and prepare for an emerging risk. The purpose of such a
meeting is to share information and provide an early warning of a potential incident to allow as
much planning time ahead of a potential or planned future event.
Once called, an SCG will normally meet at the Strategic Co-ordination Centre (SCC) facility at
the South Yorkshire Fire and Rescue Training and Development Centre, Handsworth.
South Yorkshire Police are responsible for activating the SCC by contacting South Yorkshire
Fire and Rescue Control, however other Category 1 responders can request activation through
South Yorkshire Police. The Primary Care Trust is a Category 1 responder (see Appendix 1.2
for definition)
South Yorkshire Police will initially take the chair of an SCG and take responsibility for inviting
all organisations required by the circumstances of any particular event. There may be
emergencies where the chair is later taken up by another organisation, depending on the nature
of the emergency (e.g. Health emergency).
The initial notification to the Health Gold On-Call regarding the setting up of an SCG may come
direct from South Yorkshire Police or from Yorkshire Ambulance Service Operations Centre.
The Health Gold should attend the Strategic Co-ordinating Centre (SCC) with official
identification card with photo ID.
The Health Gold may need to consider arranging sufficient support to effectively perform their
role at an SCG. See also Section 4.10 above. Further information is also available in the
separate document “NHS South Yorkshire and Bassetlaw Strategic Framework for Emergency
Preparedness, Resilience and Response” which should be referred to.
It is important to point out that the SCG does not have collective authority to issue executive
orders. Each organisation represented on the SCG retains its own responsibilities and
exercises control of its own operations in the normal way. The SCG, therefore, has to rely on a
process of discussion and consensus to reach decisions, and ensure that the agreed joint
strategic aims and objectives are implemented through their respective organisations at the
tactical (silver) and operational (bronze) levels. The effectiveness of the SCG rests on every
representative having a clear understanding of roles, responsibilities, and constraints of other
SCG representatives.
These arrangements are compliant with the South Yorkshire Local Resilience Forum (LRF)
Strategic Leaders guide which should also be referred to.
Major Incident Plan 47
6 ROLES OF NHS ORGANISATIONS DURING A MAJOR INCIDENT
6.1 DEPARTMENT OF HEALTH
In addition to it‟s Lead Government Department role, the Department of Health takes control of
the NHS resources in England in the event of a complex and significant emergency, including
those on a national and international scale, through its Emergency Preparedness Division Co-
ordinating Centre. It provides the co-ordination and focal point for the NHS and supports the
Health Ministers and Secretary of State. It also co-ordinates with the health departments in the
devolved administrations where health is a fully devolved function.
6.2 STRATEGIC HEALTH AUTHORITY (SHA)
NHS North of England is the Cluster Strategic Health Authority, formed as part of the ongoing
NHS Reforms and is made up from the 3 former Strategic Health Authorities of NHS North
West, NHS North East and NHS Yorkshire and Humber.
NHS North of England (SHA) are the regional headquarters of the NHS and, as such, are able
to mobilise and commit resources across the authority area. They are responsible for co-
ordinating the health response for a widespread incident affecting the authority area. They
provide the link with the Department of Health.
They are supported in this function by delegating responsibility to PCT Clusters in each county
area. Subsequently, NHS South Yorkshire and Bassetlaw will provide a command and control
function to co-ordinate the NHS response across the sub region.
6.3 NHS SOUTH YORKSHIRE AND BASSETLAW
NHS South Yorkshire and Bassetlaw is the Barnsley, Bassetlaw, Doncaster, Rotherham and
Sheffield Cluster of PCT‟s. The formation of Clusters is necessary as part of the ongoing NHS
Reforms to secure the capacity and flexibility needed for the transition period.
In particular the Shared Operating Model for PCT Clusters (28th July 2011) outlines the
expectation that PCT Clusters will maintain the capacity of NHS Commissioners to carry out
Emergency Preparedness, Resilience and Response (EPRR) functions during the transition
period. They are also expected to support the development of the new EPRR function within the
NHS.
Where an incident involves a South Yorkshire and Bassetlaw wide health response, the
Strategic level of command may be assumed by the PCT Cluster to co-ordinate the Strategic
level health response across the sub region. NHS South Yorkshire and Bassetlaw will then
provide and cascade strategic direction to any of the sub regional PCT/CCGs involved (see also
Section 4 Command and Control)
6.4 PRIMARY CARE TRUSTS (PCT)
Individual Primary Care Trusts (PCT) in each of the Localities of Barnsley, Bassetlaw,
Doncaster, Rotherham and Sheffield retain the responsibility for ensuring that local NHS
organisations and services are engaged in NHS emergency preparedness activities.
PCT‟s in this sub region are at different stages of transition towards developing as Clinical
Commissioning Groups (CCG) and are therefore referred to throughout this plan as PCT/CCG.
Major Incident Plan 48
In the event of a major incident the PCT/CCG would provide a local command and control
function, reporting to the PCT Cluster and providing the conduit responsible for cascading
information and actions to all local service providers, including acute hospital trusts, community
service providers and primary care services.
Each Locality PCT/CCG has a Director of Public Health (DPH) who is responsible for the health
of the local population. Working closely with the Health Protection Agency, the DPH is
responsible for ensuring a local health response to any public health emergency.
6.5 PRIMARY and COMMUNITY CARE SERVICES
The provision of primary and community care services covers a range of health professions,
including general practitioners, community nurses, health visitors, mental health services and
pharmacists, many of whom would need to be involved, particularly during the recovery phase
of an emergency.
In the early stages, following an incident, the focus would be on the follow-up to injuries incurred
at the incident, i.e. the continuing recovery of patients, physiotherapy, chest clinics, orthopaedic
clinics, dressings, drug regimes and the post-traumatic stress caused by the event. Depending
on the nature of the emergency, there may then be a requirement for more long-term health
monitoring/surveillance.
All contact details for community care providers are contained in the Cluster On-Call information
pack. However it is not expected that direct contact would come from NHS South Yorkshire and
Bassetlaw.
Contact would normally be made through the respective locality PCT/CCG who are responsible
for the co-ordination of local service providers.
6.6 ACUTE HOSPITAL NHS FOUNDATION TRUSTS
Acute hospital trusts in South Yorkshire and Bassetlaw are listed below.
Barnsley Hospital NHS Foundation Trust
Doncaster & Bassetlaw Hospitals NHS Foundation Trust
Rotherham NHS Foundation Trust
Sheffield Children‟s NHS Foundation Trust
Sheffield Teaching Hospitals NHS Foundation Trust
All emergency contact details are contained in the Cluster On-Call information pack. However it
is not expected that NHS South Yorkshire and Bassetlaw would make direct contact with
hospital trusts.
Contact would normally be made either direct from Yorkshire Ambulance Service or through the
respective PCT/CCG who are responsible for the co-ordination of local service providers.
In the event of an emergency resulting in large numbers of casualties, the ambulance service
will designate receiving hospital(s) from one of the above organisations.
The primary responsibility of Acute Hospital trusts during a major incident is the provision of
care to incident victims in the hospital setting. However, if an Ambulance Incident Commander
Major Incident Plan 49
(AIC) requests the attendance of specialist medical teams, potentially it would be Acute Trusts
that supply this mobile clinical response to provide general support and specialist healthcare to
casualties at the scene of the emergency.
Hospitals may need to implement internal escalation procedures to manage increased capacity
in collaboration with primary care services and other health care providers.
6.7 YORKSHIRE AMBULANCE SERVICES
As part of the NHS, Yorkshire Ambulance Service (YAS) have the responsibility for responding
to and co-ordinating the on-site NHS response to short notice or sudden impact emergencies.
This includes identifying the receiving hospital(s) to which injured people should be taken, which
depending on the types and numbers of injured, may include numerous hospitals remote from
the immediate area where the incident has occurred. The person with overall responsibility for
this, at the scene of an emergency, is the Ambulance Incident Commander (AIC). If necessary,
the AIC may seek the attendance of a Medical Incident Commander (MIC) and/or mobilise
specialist medical teams, for instance Medical Emergency Response Incident Teams (MERITs).
Both the MIC and these specialist medical teams would come from across the local NHS.
Ambulance Trusts, in conjunction with the MIC, medical teams and other emergency services,
endeavour to sustain life through effective prioritisation of emergency treatment at the scene.
This enables the AIC to determine the priority for release of trapped, treatment and where
necessary, decontamination of casualties. This will allow patients to be transported in order of
priority, to receiving hospitals.
Ambulance services may seek support from other organisations specifically the third sector
(e.g. British Red Cross, St John Ambulance) in managing and transporting casualties. If these
resources are deployed, these organisations would work under the direction of the Ambulance
Trust.
6.8 REGIONAL DIRECTOR OF PUBLIC HEALTH
Represent the Chief Medical Officer. In the event of a major public health emergency, the
RDsPH – working closely with the directors of the HPA – provide public health advice, support
and leadership to help SHAs and the wider NHS manage the emergency. They ensure co-
ordination with regional resilience mechanisms in preparing for and responding to outbreaks of
infectious diseases and other public health emergencies.
6.9 HEALTH PROTECTION AGENCY
The Health Protection Agency (HPA) is a non-departmental public body which makes public
health advice available to government departments, the NHS, the statutory agencies and
directly to the public. It provides a central source of authoritative scientific/medical information
and other specialist advice on both the planning and operational responses to public health or
other emergencies. This includes providing authoritative messages about health protection
measures in order to reduce public anxiety.
The HPA will undertake analysis of the health threat and in consultation with the Director of
Public Health, propose an appropriate treatment response to an infectious disease outbreak or
radiological and chemical incidents which have the potential to cause disruption, to
communities, on a large scale.
Major Incident Plan 50
As part of the initial analysis process, particularly where it appears that a new virus is emerging,
the HPA may advise on any necessary surveillance testing of suspected cases to confirm the
virus and to better understand the epidemiology of a novel disease.
They will support the management of incidents and provide specialist input to Incident
Management Teams and will be involved as a member of a Scientific and Technical Advice Cell
(STAC) if required. They also provide the gateway to further specialist advice at a national level
if necessary.
The will also provide impartial and authoritative advice to health professionals, other agencies
and the public in monitoring long term effects of an outbreak.
6.10 SCIENTIFIC & TECHNICAL ADVICE CELL (STAC)
A STAC is most likely to be required in response to complex incidents involving multiple
scientific and technical issues, where there is potential for conflicting expert opinion. Where this
is the case a STAC should only be formed at the request of a multi-agency Strategic Co-
ordinating Group (SCG) Once requested the formation of a STAC will be arranged through the
NHS Sheffield Director of Public Health during office hours and through the Health Protection
Agency second on call rota outside office hours.
All emergency contact details are contained in the Cluster On-Call information pack.
The purpose of the STAC is to provide a single point of understandable advice to the Chair of
the SCG. A South Yorkshire STAC may be co-located with the South Yorkshire SCG and report
directly to it. It should not provide advice to any other interested parties other than through the
SCG.
The STAC should not have a role in managing the incident, rather provide information and
advice about the scientific, technical, environmental and public health consequences of the
incident, including the impact of any evacuation or containment, impact on environmental
health, and effects on animal health. Its prime responsibility is to support the SCG strategy.
The STAC will take its tasking from the SCG. The SCG will ask specific questions of the STAC
and the STAC‟s role is to give a definitive answer, once it has consulted within the STAC and
decided upon the best course of action/answers.
The STAC will advise the SCG of the public health messages and advice to be given to health
care professionals and the public.
These arrangements are compliant with the Scientific and Technical Advice Cell Concept of
Operations which should also be referred to.
Major Incident Plan 51
7 ROLES OF OTHER ORGANISATIONS DURING A MAJOR INCIDENT
7.1 SOUTH YORKSHIRE POLICE
The police will normally co-ordinate the activities of those responding to a land-based sudden
impact emergency, at and around the scene. There are however exceptions, for example the
Fire and Rescue Service would co-ordinate the response at the scene for a major fire.
For the police, as for other responders, the saving and protection of life is the priority. However
they must also ensure the scene is preserved, so as to safeguard evidence for subsequent
enquiries and, possibly, criminal proceedings. Once lifesaving is complete, the area will be
preserved as a crime scene until it is confirmed otherwise (unless the emergency results from
severe weather or other natural phenomena and no element of human culpability is involved).
The police oversee any criminal investigation. Where a criminal act is suspected, they must
undertake the collection of evidence, with due labelling, sealing, storage and recording. They
facilitate inquiries carried out by the responsible accident investigation bodies, such as the
Health and Safety Executive (HSE) or the Air, Rail or Marine Accident Investigation Branches. If
there is the possibility that an emergency has been caused by terrorist action, then that will be
taken as the working assumption until demonstrated otherwise.
Where practical, the police, in consultation with other emergency services and specialists,
establish and maintain cordons at appropriate distances. Cordons are established to facilitate
the work of the emergency services and other responding agencies in the saving of life, the
protection of the public and property and the care of survivors.
Where terrorist action is suspected to be the cause of an emergency, the police will take
additional measures to protect the scene (which will be treated as the scene of a crime) and will
assume overall control of the incident. These measures may include establishing cordons to
restrict access to, and require evacuation from, the scene, and carrying out searches for
secondary devices.
All agencies with staff working within the inner cordon remain responsible for the health and
safety of their staff. Each agency should ensure that personnel arriving at the scene have
appropriate personal protective equipment and are adequately trained and briefed. Health and
safety issues will be addressed collectively at multi-agency meetings on the basis of a risk
assessment. If it is a terrorist incident the police will ensure that health and safety issues are
considered and this will be informed by an assessment of the specific risks associated with
terrorist incidents.
The police process casualty information and have responsibility for identifying and arranging for
the removal of fatalities. In this task, they act on behalf of HM Coroner, who has the legal
responsibility for investigating the cause and circumstances of any deaths involved.
Survivors or casualties may not always be located in, or immediately around, the scene of an
incident. It is, therefore, important to consider the need to search the surrounding area. If this is
necessary, the police will normally co-ordinate search activities on land. Where the task may be
labour intensive and cover a wide area, assistance should be sought from the other emergency
services, the Armed Forces or volunteers.
Major Incident Plan 52
7.2 SOUTH YORKSHIRE FIRE AND RESCUE SERVICES
The primary role of fire and rescue services in an emergency is the rescue of people trapped by
fire, wreckage or debris. They will prevent further escalation of an incident by controlling or
extinguishing fires, rescuing people and undertaking other protective measures. They will deal
with released chemicals or other contaminants in order to render the incident site safe or
recommend exclusion zones. They will assist other agencies in the removal of large quantities
of flood water. They will also assist ambulance services with casualty-handling, and the police
with the recovery of bodies.
In some areas there are agreements between fire and rescue and the police for controlling
entry to cordons. Where this is the case fire and rescue are trained and equipped to manage
gateways into the inner cordon and will liaise with the police to establish who should be granted
access and keep a record of people entering and exiting.
Although the National Health Service (NHS) is responsible for the decontamination of
casualties, fire and rescue services will, where required, undertake mass decontamination of
the general public in circumstances where large numbers of people have been exposed to
chemical, biological, radiological or nuclear substances. This is done on behalf of the NHS, in
consultation with ambulance services.
7.3 LOCAL AUTHORITY
Local authorities play a critical role in civil protection. They have a wide range of functions that
are likely to be called upon in support of the emergency services during emergency response
and recovery. Local authorities are one of the main bodies representing the community and
their role in emergency response and recovery largely reflects this.
The local authority will play an enabling role in close collaboration with a wide range of bodies
who are not routinely involved in emergency response (e.g. Regional Development Agencies in
England, building proprietors and land owners).
In particular, the local authority will work with partners to:
provide immediate shelter and welfare for survivors not requiring medical support and
their families and friends via Evacuation, Rest, Humanitarian and other Centres to meet
their immediate to short term needs.
provide medium to longer-term welfare of survivors (e.g. social services support and
financial assistance which may be generated from appeal funds and also provide help-
lines which should answer the public‟s questions as a one stop shop). Local authorities
have a large part in addressing community needs via drop-in centres and organising
anniversaries and memorials as part of the recovery effort.
provide Investigating and Enforcement Officers under the provision of the Food and
Environment Protection Act 1985 as requested by Defra;
facilitate the inspection of dangerous structures to ensure that they are safe for
emergency personnel to enter;
clean up of pollution and facilitate the remediation and reoccupation of sites or areas
affected by an emergency;
liaise with the coroner‟s office to provide emergency mortuary capacity in the event that
existing mortuary provision is exceeded.
co-ordinate the activities of the various voluntary sector agencies involved and
spontaneous volunteers;
Major Incident Plan 53
may provide catering facilities, toilets and rest rooms for use by all agencies in one
place, for the welfare of emergency response personnel in the event of a protracted
emergency. This will depend on the circumstances and available premises;
lead the recovery effort, which is likely to carry on for a considerable time and is likely to
involve many organisations who are not ordinarily involved in, or used to the speed and
scale of the recovery effort.
7.4 THE ENVIRONMENT AGENCY
The Environment Agency is the leading public body for protecting and improving the
environment. As an environmental regulator, with a wide range of roles and responsibilities, it
responds to many different types of incident affecting the natural environment, human health or
property.
The Environment Agency‟s main priorities, during the response and recovery phases are to:
prevent or minimise the impact of the incident;
investigate the cause of the incident and consider enforcement action; and
seek remediation, clean-up or restoration of the environment.
The role of the Environment Agency at an incident depends on the nature of the event. For
example:
in a flood event, it focuses on operational issues such as issuing flood warnings,
predicting the location, timing and magnitude of flooding and operating its flood defence
assets to protect communities and critical infrastructure.
in a pollution incident, it will seek to prevent/control and monitor the input of pollutants to
the environment. In emergencies involving air pollution the EA will co-ordinate a multi-
Agency Air Quality Cell to provide interpreted air quality information.
in other emergencies (such as animal disease outbreaks), its principal role is usually to
regulate and provide advice and support on waste disposal issues.
7.5 HM CORONER
The role of the coroner is defined by statute (see www.statutelaw.gov.uk for details). In an
emergency, the coroner will be responsible for establishing the identity of the fatalities and the
cause and circumstances of death. Essentially, they will determine who has died, how and
when and where the death came about. The coroner will be supported by a deputy and an
assistant deputy. Current legislation dictates that a body lying in a coroner‟s district (irrespective
of where death has occurred) will trigger and determine jurisdiction, provided the deceased has
died from violence or sudden death of an unknown cause. If an emergency spans across more
than one district, a lead coroner should be established to deal with all fatalities.
Following the recovery of the deceased from the scene (which in most circumstances will be led
and co-ordinated by the police and carried out by trained body-recovery teams), it will be for the
coroner to decide whether a post mortem is required to establish the cause of death. On the
instruction of the coroner, a pathologist carries out the post mortem. If the death does not
require an inquest, the death may be registered on receipt of a coroner‟s certificate detailing the
cause of death; if an inquest is required, the coroner registers the death when the inquest is
concluded.
Coroners should have an emergency plan for dealing with multiple deaths for the local authority
mortuaries which are within their remit. This should include how dealing with multiple deaths
Major Incident Plan 54
might impact on their normal working arrangements. Additionally, they are instrumental in the
development of local and regional emergency plans for extraordinary emergency mortuary
arrangements. It is also vital that coroners are familiar with any local emergency mortuary plans
developed by Category 1 and 2 responders.
7.6 MILITARY
The Armed Forces‟ national structure, organisation, skills, equipment and training can be of
benefit to the civil authorities in managing the response to, and recovery from, emergencies.
This support is governed by the Military Aid to the Civil Authority (MACA) arrangements. The
Ministry of Defence (MoD) joint doctrine publication Operations in the UK: The Defence
Contribution to Resilience sets out the detailed rules and procedures governing the employment
of the Armed Forces for MACA operations. Reserves, including Civil Contingencies Reaction
Forces (CCRFs), can be deployed alongside regular service personnel. The Defence
Contribution to Resilience includes templates for requesting military assistance. The solution to
any military assistance requests will be determined by the availability of military resources and
the commander‟s judgement.
The Armed Forces maintain no standing forces for MACA tasks. There are, by definition, no
permanent or standing MACA responses. Assistance is provided on an availability basis and the
Armed Forces cannot make a commitment that guarantees assistance to meet specific
emergencies. Neither the production of contingency plans nor Armed Forces‟ participation in
civil exercises guarantees the provision of MACA support. It is therefore essential that
responding agencies do not base plans upon assumptions of military assistance: the Armed
Forces should be called upon only as a last resort. The provision of Armed Forces‟ support
requires approval by a Defence Minister following a request by a government department. Unit
commanders have prior approval, in certain limited circumstances, to provide urgent assistance
where it is necessary to save life, alleviate distress or protect property in the event of an
emergency without specific approval.
The Army acts as the lead service for MACA on land. The Regional Brigade Headquarters will
be able to give advice and should be contacted in the first instance. All such headquarters have
24-hour emergency contact telephone numbers. The MoD‟s Joint Regional Liaison Officer
(JRLO) may act in a liaison capacity within local or regional civil emergency control centres
when appropriate, providing a link to the MoD‟s UK command structure. Liaison involves the
provision of advice and exchange of information. It does not guarantee the provision of support.
In exceptional circumstances, requests for assistance may be directed to any service unit,
station or establishment.
Where there is a direct threat to life, the MoD may, at its discretion, choose to waive the
recovery of costs for assistance provided. In cases where human life is not deemed to be in
danger, civil organisations will be required to meet all or some of the costs of the service
response. When the response moves towards the recovery phase and danger to human life
subsides, continued military assistance will be considered as routine and charged for at rates
determined by the MoD. Civil authorities should consider the disengagement of military
assistance at this point if very high costs are to be avoided.
Major Incident Plan 55
7.7 THE THIRD SECTOR (including voluntary sector and faith groups)
The Third Sector can provide an extensive and diverse range of operational and support skills
and services to statutory responders. These skills and services include:
practical support (first aid; support to ambulance services; supporting hospital
personnel; referral to other organisations; search for survivors and rescue; refreshments
and emergency feeding; transportation and medical services - e.g. diagnosis and
administration of drugs);
psycho-social support (comforting; befriending; listening; help-lines; support lines;
support networks; advice; counselling; spiritual support and group therapy;
equipment (communications - e.g. radios; medical aid equipment - e.g.mobility aids;
bedding; clothing and hygiene packs - e.g. washing kits);and
information services (public training - e.g. first aid and flood preparation,
communications and documentation).
Statutory responders should be aware of the capabilities and capacity of local voluntary
organisations and the means of accessing their services, whether as individual volunteers or as
members of local or national volunteer organisations. Statutory responders should develop and
implement agreed processes for activating call-out mechanisms and systems for organising,
managing, briefing and debriefing volunteers. The voluntary sector should also be included in
post response review and evaluation activity.
Mutual aid arrangements do exist within and between many of the Third Sector organisations,
for activation as required, particularly across boundaries. In the event of a major or international
emergency, third sector support may be accessed through the head offices of the relevant
voluntary organisations or through the National Voluntary Sector Civil Protection Forum
(NVSCPF). In extreme circumstances or times of conflict, support may be provided by the
National Voluntary Aid Society Emergency Committee (NVASEC) - a standing committee that
will be convened at the request of the Ministry of Defence, Department for Health and the Civil
Contingencies Secretariat.
Through local multi-agency liaison arrangements (e.g. the Local Resilience Forum), the
statutory services will maintain an overview of the services that are offered across a range of
voluntary organisations and will provide an agreed system for co-ordinating the Third Sector
response, including members of the public who may volunteer their services in response to an
incident (convergent volunteers). It is important to avoid double-counting and gaps in service
provision by indicating which statutory responder has first call on (or priority need for) any
particular voluntary sector contribution.
Agencies using volunteers may become responsible for the health and safety of volunteers.
These volunteers should be appropriately equipped, trained, supervised and supported by their
own organisations. Statutory responders may also enter into agreements with voluntary
organisations in relation to the payment of costs.
Major Incident Plan 56
8 BUSINESS CONTINUITY MANAGEMENT (BCM)
The purpose of this plan is to provide a framework for the emergency co-ordination of all NHS
organisations to ensure an integrated and co-ordinated approach to any emergency or Major
Incident, in order to minimise the impact on the health and welfare of the communities of South
Yorkshire and Bassetlaw.
However, it does not detract from the need for each NHS organisation to have its own robust
Major Incident and Business Continuity Management plans. It does not affect routine operating
procedures, rather it complements them and provides additional measures and command and
control options for incidents that would stretch resources and be beyond internal capabilities or
routine escalation procedures of individual organisations and requires a wider co-ordination of
NHS resources.
Business Continuity Management is an important feature of the overall response to a Major
Incident, as clearly, there is potential that the response to a large scale Major Incident can also
impact on routine business functions, either because of the nature of the incident itself or the
fact that a high proportion of resources are by necessity diverted to respond to the incident.
Whilst the Major Incident and Business Continuity roles are different these are not discreet
activities and BCM activities should overlap and be invoked once the initial Major Incident
response has been implemented and relevant control measures established to mitigate the
immediate threat. Likewise, Recovery activities should commence the return to normality at the
earliest opportunity.
Fig.6 – The below diagram outlines the relationship between the various stages of an incident.
Tim
e Z
ero
Incident!
Timeline
Incident response
Business continuity
Recovery
Major Incident Plan 57
It is therefore feasible that the BCM team may be running in tandem with a Major Incident team.
Where a Command and Control structure is in place to manage an ongoing Major Incident the
BCM team Manager will liaise and report to the overall Incident Manager. Effectively there will
be a Silver BCM Team Manager and a Silver Major Incident Manager both working to their
respective responsibilities, under the Strategic Direction of Gold.
Where possible BCM is best dealt with at the local level and there is a potential for there to be
up to Five Silver level commands, corresponding to the 5 PCT/CCGs in the South Yorkshire
and Bassetlaw cluster. Each Silver Command may have its own Major Incident Lead and a
separate BCM Lead. The role of each Silver level group will be to co-ordinate the overall health
response for their respective district and provide the link to their local service providers. (See
Fig. 4)
The NHS South Yorkshire and Bassetlaw Gold commander will need to provide a strategic level
co-ordination of both the Major Incident response and Business Continuity Management
activities.
This will be essential to ensure a whole systems approach involving any local Health Care
Organisations as necessary in order to effectively and efficiently manage a widespread
disruption to services. This integrated emergency management will ensure priority is given to
the most urgent corporate functions so that NHS South Yorkshire and Bassetlaw is able to
maintain key priority functions and recover other functions in priority order.
Some services may not individually be experiencing a direct impact, but may be required to
support those who are adversely affected. Commissioned provider services will be expected to
co-operate and work flexibly to support the overall health response and divert resources to
those areas in most need.
This collaborative working will ensure the highest level of service achievable in the
circumstances is continued across the entire Health service and therefore minimise the impact
on health to the community of South Yorkshire and Bassetlaw.
Major Incident Plan 58
9 ETHICAL CONSIDERATIONS
NHS South Yorkshire and Bassetlaw has a duty to protect and promote the health of the
community, including in times of emergency. The purpose of this plan is to put in place
appropriate arrangements to facilitate an efficient and effective response to a Major Incident
impacting on the NHS and the health of the community. As such it aims to, as far as reasonably
practicable, maintain the key principles and values of the NHS Constitution 2010 and also
discharge the positive duty placed on us by the Equality Act 2010, the Human Rights Act 1998,
and the Health and Safety at Work Act 1974.
During a Major Incident, NHS South Yorkshire and Bassetlaw NHS will provide an overall co-
ordinating role to ensure an integrated emergency management approach involving any local
Health Care Organisations as necessary in order to effectively and efficiently respond and
therefore minimise the impact on health to the community of South Yorkshire and Bassetlaw.
Commissioned provider services will be expected to co-operate and work flexibly to support the
overall health response and divert resources to those areas in most need.
The health and welfare of patients, staff and other stakeholders is the primary consideration.
Managing a Major Incident in a health care organisation will involve many difficult decisions.
These may create tension between the needs of individuals and the needs of the population.
Such decisions can be personal or wider, for example, affecting the organisation and delivery of
health or social care services.
Decisions will need to be made in accordance with the law and relevant National Guidance and
professional codes. In particular the Ethical Framework for Policy and Planning published by the
Department of Health in November 2007 should be referred to.
During a Major Incident it is possible that a Scientific and Technical Advice Cell (STAC) will be
formed to provide expert medical opinion to assist Strategic commanders develop appropriate
response options.
Where patient care is compromised due to the impacts of a Major Incident, then NHS South
Yorkshire and Bassetlaw may request the formation of a local Clinical Executive Group to
provide clinical advice on priority medical services to the NHS Strategic commander. Such a
group should consist of Clinical Executive Leads from NHS South Yorkshire and Bassetlaw,
relevant Acute Hospital Trusts, relevant Community Service providers and Professional leads
from relevant Local Authorities.
It is stressed that in the response phase, the Clinical Executive Group is not to debate or divert
from GOLD Policy or STAC guidance but to provide appropriate advice on local clinical
response options to achieve the overall strategy. The group should consider issues such as
changes to discharge and admission criteria or reductions or suspension of functions and
services locally to provide the necessary capacity to deal with exceptional demand on services
within an ethical framework and to minimise the impact on the health of the community during a
large scale response required for a Major Incident.
The overriding principle will be to provide the highest level of care available under the
circumstances and ensuring that people with an equal chance of benefiting from health and
social care resources have an equal chance of receiving them.
Major Incident Plan 59
During a Major Incident decisions often have to be made quickly using the best information
available at the time. Consulting those concerned as much as possible in the time available, be
open and transparent about what decisions were made and why they were made. Decisions
should then be recorded and communicated accordingly.
Major Incident Plan 60
10 RECOVERY
Response and recovery are not two discrete activities and should not occur sequentially. As the
emphasis moves from response to recovery the Strategic Lead should identify an individual or
group to Lead on the Recovery phase. For a multi-agency incident the Recovery process will
most likely be implemented by the Strategic Coordinating Group, which should activate a
Recovery Coordinating Group.
The Response phase will be formally stood down when deemed appropriate and all
organisations officially informed of any hand over arrangements and new points of contact need
to be communicated to all partners and all staff involved. The decision of when to stand down
the Response phase may be different for each organisation involved.
The overall priority for Recovery will be the restoration of the well being of individuals,
communities and the infrastructure that supports them, The Local Authority will take the lead in
facilitating the rehabilitation of the community and the restoration of the environment.
Depending on the nature of the incident, in the early stages of recovery, the NHS focus would
be on the follow-up to injuries incurred at the incident, i.e. the continuing recovery of patients,
physiotherapy, chest clinics, orthopaedic clinics, dressings, drug regimes and psychosocial
care, there may then be a requirement for more long-term health monitoring/surveillance.
It will then be important to re-establish normal clinical care and associated functions as soon as
possible, including managing the backlog of any cancelled or reduced activities. The Recovery
Coordinator will oversee a phased recovery of functions and procedures based on priorities
identified in the Business Impact Analysis. Early consideration needs to be given to replenishing
stocks of essential supplies that may have been depleted during the response. Where
appropriate the Department of Health and Strategy & Contracting will need to evaluate and
return to routine performance management measures.
Where Critical National Infrastructure of the NHS has been compromised wide area support
may be required from NHS North of England or the Department of Health. The NHS Gold
Commander will have a key role in supporting the co-ordination of any recovery efforts
especially where there are competing priorities for scarce resources.
Liaison may also be required with the Department for Communities and Local Government,
Resilience and Emergencies Division – North and other Government departments who may
have a role in recovery e.g. Government Decontamination Service (GDS).
10.1 Closure of the Major Incident Control Centres (MICC)
When the decision is taken to close the various MICC which may have been activated, it is the
responsibility of the Silver Staff Officer to ensure that all records and documentation are
collected and retained for de-brief and post incident review.
It will also be necessary to ensure that the incident control rooms are cleared and returned to
their normal state and that any equipment used or loaned is returned to where it belongs.
The Silver Staff Officer will facilitate a hot de-brief session before standing down personnel and
retain details of this to be used in the full de-brief at a later stage.
Major Incident Plan 61
10.2 Staff Support
It should be recognised that staff will have been working under considerable pressure possibly
over an extended period of time and will need to recover before they can return to full efficiency.
Also members of staff may have been personally affected during the incident. Welfare support
should be considered where appropriate.
“Planning for the psychosocial and mental health care of people affected by major incidents
and disasters” is the title of interim guidance issued by the DH in July 2009 and should be
referred to.
All organisations have responsibility for their employees in terms of their staff health and well-
being and this is an important part of the incident and recovery management planning process.
Occupational Health Units should be involved at an early stage and consider the potential need
for psychosocial care for their staff and where appropriate should provide interventions based
on the principles of Psychological First Aid and provide access to augmented Primary
Healthcare services and Specialist Mental Health Services.
10.3 De-brief
At the conclusion of the incident there will need to be a full de-brief and evaluation of what
worked well and what lessons have been identified. Consideration should be given to arranging
internal and where appropriate multi-agency de-briefs.
All records pertaining to the response should be retained and stored for the de-brief and may
also be required as part of any external enquiry. This will include the “Emergency Log Book”
and the De-brief report. It will also be necessary to retain all other documents and notes created
during the incident.
The Emergency Resilience Unit will ensure that validation takes place across the South
Yorkshire and Bassetlaw health community and that de-briefs are evaluated to build on good
practice and to ensure that lessons identified are acted upon, taking steps to adapt systems
and services to improve future responses.
Findings should be reported to the relevant Boards of all organisations involved. Resilience
plans and associated training and exercise programmes should be reviewed to reflect the
outcomes of the de-brief.
Major Incident Plan 62
Appendix 1
LEGISLATION & GUIDANCE
The Civil Contingencies Act 2004 places a statutory duty on NHS organisations to prepare for
emergencies. The NHS Emergency Planning Guidance 2005 requires a trained and tested
Major Incident Plan be in place. The Operating Framework for the NHS in England 2012/13
states that Emergency Preparedness, Resilience and Response continues to be a core function
of the NHS. All NHS organisations are required to maintain a good standard of preparedness to
respond safely and effectively to a full spectrum of threats, hazards and disruptive events.
1.1 Chief Executive
The NHS Emergency Planning Guidance 2005 states, the Chief Executive of NHS South
Yorkshire and Bassetlaw has overall responsibility for Emergency Planning. They will ensure
that the organisation has a Major Incident Plan in place that is built on the principles of Risk
Assessment, co-operation with partners, communicating with the public and information
sharing. They will ensure that the Board receives regular updates, at least annually, regarding
emergency preparedness, including reports on exercises, training and testing undertaken by the
organisation. The Chief Executive will also ensure that adequate resources are made available
to allow the discharge of these responsibilities.
The Chief Executive must ensure that Board level responsibility for Emergency Planning is
clearly defined and there are clear lines of accountability throughout the organisation leading to
the Board. The Director of Performance and Accountability is designated to take responsibility
for Emergency Preparedness, Resilience and Response and is supported in this role by the
Emergency Resilience Unit.
1.2 Civil Contingencies Act 2004
The purpose of the Act is to establish a statutory framework for civil protection at the local level.
It provides a clear set of roles and responsibilities for Category 1 responders which includes the
NHS (full list of Category 1 responders below)
Statutory Duties placed on Category 1 responders:
Assess the risk of emergencies occurring
Put in place emergency plans
Put in place Business Continuity Plans
Warn and inform the public in the event of an emergency
Share information with other local responders
Co-operate and co-ordinate with other local responders
The Civil Contingencies Act requires that emergency plans are validated through training,
exercising and testing. NHS guidance stipulates a minimum requirement for each NHS
organisation is for a live exercise to be conducted every 3 years, a tabletop exercise to be
conducted every 1 year and a communications cascade test to be conducted every 6 months
Major Incident Plan 63
Category 1 Responders
Police Forces Foundation Trusts
British Transport Police Health Protection Agency
Fire Authorities Local Authorities
Ambulance Services Environment Agency
Primary Care Trusts Maritime and Coastguard Services
Acute Trusts
1.3 Human Rights Act 1998
Section 6(1) of the Human Rights Act 1998 makes it unlawful for a public authority to act in a
way which is incompatible with rights under the European Convention on Human Rights.
It is essential that any proposed course of action be:
Proportionate
Legal
Accountable
Necessary
Based on the best available information.
The principle purpose of this plan is to provide an appropriate response framework to facilitate
the protection of life in the event of a Major Incident affecting the health and welfare of the
community of South Yorkshire and Bassetlaw. As such it aims to discharge the positive duty to
protect life that is placed on NHS South Yorkshire and Bassetlaw by the Convention Rights.
Accordingly it is important that every effort is made to take account of the advice given in this
plan in order to fulfil this duty.
1.4 Health and Safety Legislation
NHS South Yorkshire and Bassetlaw as an employer has a duty under the Health & Safety at
Work etc Act 1974 to ensure, so far as is reasonably practicable, the health, safety and welfare
at work of all its employees.
Health and Safety advisors should be consulted to assist with carrying out risk assessment for
any activities outside normal working conditions.
Major Incident Plan 64
Appendix 2
USEFUL ABBREVIATIONS
AAIB Aircraft Accident Investigation Branch
ACP Ambulance Control Point
ACPO Association of Chief Police Officers
A & E Accident & Emergency
AFIO Ambulance Forward Incident Officer
AIC Ambulance Incident Commander
ALP Ambulance Loading Point
AMMC Ambulance Mobile Medical Control
AWE Atomic Weapons Establishment
BCM Business Continuity Management
BCP Business Continuity Plan
BRC British Red Cross
BT British Telecom
BTP British Transport Police
CBRN Chemical, Biological, Radiological, Nuclear (terrorist attack)
CCA Civil Contingencies Act 2004
CCDC Consultant in Communicable Disease Control
CCG Clinical Commissioning Group
CFOA Chief Fire Officers Association
CHALET Casualties, Hazards, Access, Location, Emergency Services, Type of Incident
CHEMDATA Chemical Database
COBRA Cabinet Office Briefing Room
COMAH Control of Major Accident Hazard Regulations 2005
CPHM Consultant in Public Health Medicine
DEFRA Department for Environment, Food & Rural Affairs
DH Department of Health
DIM Detection, Identification & Monitoring equipment
DOE Department of the Environment
DOHSC Department of Health & Social Care
DPH Director of Public Health
DTI Department of Trade & Industry
EA Environment Agency
EPRR Emergency Preparedness, Resilience and Response
FCO Foreign & Commonwealth Office
FSA Food Standards Agency
GIS Geographical Information System
GNN Government News Network
Major Incident Plan 65
GOYH Government Office for Yorkshire & Humber
GP General Practitioner
HART Hazardous Area Response Team
HAZMAT Hazardous Materials
HO Home Office
HPA Health Protection Agency
HPU Health Protection Unit
HSE Health & Safety Executive
IED Improvised Explosive Device
JTAC Joint Terrorist Analysis Centre
LAESI Local Authority & Emergency Services Information (on nuclear weapon transport)
LRF Local Resilience Forum
MACC Military Aid to the Civil Community
MERIT Medical Emergency Response Incident Team
METHANE My name, Exact location, Type, Hazards, Access, Number of casualties, Emergency Services (Alternative to CHALET)
MICC Major Incident Control Centre
MoD Ministry of Defence
MTPAS Mobile Telephone Preference Access Scheme
NAIR National Arrangements for Incidents Involving Radioactivity
NHS National Health Service
ODPM Office of Deputy Prime Minister
PCT Primary Care Trust
PNICC Police National Information & Co-ordination Centre
RCCC Regional Civil Contingencies Committee
RDPH Regional Director of Public Health
RIMNET Radioactive Incident Monitoring Network
RRF Regional Resilience Forum
RVP Rendezvous Point
SCC Strategic Co-ordinating Centre
SCG Strategic Co-ordinating Group
SHA Strategic Health Authority (NHS Yorkshire & Humber)
SIO Senior Investigating Officer (police)
SITREP Situation Report
SJA St Johns Ambulance
STAC Scientific & Technical Advisory Cell
VIP Very Important Person
WHO World Health Organisation
WRVS Women‟s Royal Voluntary Service
Major Incident Plan 66
Appendix 3
GLOSSARY OF EMERGENCY RESPONSE TERMS
Assembly Point: A building or an area on the periphery of an evacuation zone where evacuees
can gather to get further information, await directions for, or transport to, a Rest Centre and
meet up with friends and relatives.
BRONZE: Operational level of management which reflects the normal day-to-day arrangements
for controlling events or situations. It is the level at which the management of „hands-on‟ work is
undertaken at the incident site(s) or associated areas.
Casualty Bureau: Central police controlled contact and information point for all records and
data relating to casualties.
Casualty Clearing Station: An area set up at a Major Incident by the Ambulance Service in
liaison with the Medical Incident Commander to triage, assess and treat casualties and direct
their evacuation.
Category 1 responder: A local responder organisation listed in Schedule 1 Part 1 of the Civil
Contingencies Act 2004 and likely to be involved with a central role in the response to most
emergencies.
Category 2 responder: A local responder organisation (though it may not be locally based)
listed in Schedule 1 Part 3 of the Civil Contingencies Act 2004 and likely to be involved in some
emergencies or in preparedness for them.
CheMet: A scheme administered by the Meteorological Office, providing information on weather
conditions as they affect an incident involving plumes of hazardous materials.
Command: The authority for an agency to direct the actions of its own resources (both
personnel and equipment)
Community Risk Register: An assessment of the risks within a local resilience area agreed by
the Local Resilience Forum as a basis for supporting the preparation of emergency plans.
Control: The authority to direct strategic and tactical operations in order to complete an
assigned function and includes the ability to direct the activities of other agencies engaged in
the completion of that function. The control of the assigned function also carries with it a
responsibility for the health and safety of those involved.
Control Room: Centre for the control of the movements and activities of each emergency
service‟s personnel and equipment. Liaises with other services control rooms.
Co-ordination: The harmonious integration of the expertise of all the agencies involved with
the objective of effectively and efficiently bringing the incident to a successful conclusion.
Major Incident Plan 67
Cordon – inner: Surrounds and protects the immediate scene of an incident.
Cordon – outer: Seals off a controlled area around an incident to which unauthorised persons
are not allowed access.
Domiciliary care: Care given in the home to the elderly and disabled, including home helps,
meals on wheels and attendance by care assistants.
Emergency: An event or situation which threatens serious damage to human welfare or to the
environment in a place in the UK, or war or terrorism which threatens serious damage to the
security of the UK.
Escalation: Point at which it becomes necessary to involve additional plans / arrangements in
order to respond to the incident effectively.
Evacuation: The process by which people are moved away from a place where there is
immediate or anticipated danger to a place of safety, offered appropriate temporary welfare
facilities and enabled to return to their normal accommodation / activities when the threat to
safety has gone, or to make suitable alternative arrangements.
Evacuation assembly point: Building or area to which evacuees are directed for
transfer / transportation to a reception centre or rest centre.
Exercise: A simulation to validate an emergency plan or rehearse its procedures.
Forward Control Point: Each service‟s command and control facility nearest the scene of the
incident – responsible for immediate direction, deployment and security.
Friends and relatives reception centre: Secure area set aside for use and interview of friends
and relatives arriving at the scene (or location associated with an incident, such as an airport or
port). Established by the police in consultation with the local authority.
GOLD: Strategic management level, either single or multi-agency. Establishes a policy and
overall framework within which tactical managers will work. It establishes a strategic aim and
objectives and ensures long-term resourcing / expertise.
Hospital Documentation / Liaison Team: Team of police officers responsible for completing
police casualty record cards in hospital.
Identification Commission: Group representing all aspects of the identification process, which
is set up to consider and determine the identity of the deceased to the satisfaction of HM
Coroner.
Lead responder: A local responder charged with carrying out a duty under the Act on behalf of
a number of responder organisations, so as to co-ordinate its delivery and to avoid unnecessary
duplication.
Major Incident Plan 68
Major incident: Any occurrence that presents a serious threat to the health of the community,
disruption to the service or causes (or is likely to cause) such numbers or types of casualties as
to require special arrangements to be implemented by hospitals, ambulance trusts or primary
care organisations.
Major Incident Plan: Pre-planned and exercised procedures which are activated once a major
incident has been declared.
Media centre: Central location for media enquiries, providing communication, conference,
monitoring, interview and briefing facilities and access to responding organisation personnel.
Staffed by spokespersons from all the principal services / organisations responding.
Media Liaison Officer: Representative who has responsibility for liaising with the media on
behalf of his / her organisation.
Media Liaison Point: An area adjacent to the scene which is designated for the reception and
accreditation of media personnel for briefing on arrangements for reporting, filming and
photographing, staffed by media liaison officers from appropriate services.
Media plan: A key plan for ensuring co-operation between emergency responders and the
media in communicating with the public during and after an emergency.
Mutual Aid: An agreement between responders, within the same sector or across sectors and
across boundaries, to provide assistance with additional resources during an emergency which
may go beyond the resources of an individual responder.
Public Information Line: A help-line set up during and in the aftermath of an emergency to
deal with information requests from the public and to take pressure off the Police Casualty
Bureau (which has a separate and distinct purpose).
Receiving hospital: Any hospital selected by the ambulance service from those designated by
Strategic Health Authorities to receive casualties in the event of a major incident.
Reception Centre: Secure area to which uninjured survivors can be taken for shelter, first aid,
interview and documentation. This facility is run by the local authority.
Recovery: The process of restoring and rebuilding the community, and supporting groups
particularly affected, in the aftermath of an emergency.
Rendezvous point: Point to which all vehicles and resources arriving at the outer cordon are
directed for logging, briefing, equipment issue and deployment.
Rest Centre: Premises taken over by the Local Authority for the temporary accommodation of
evacuees from an incident.
Major Incident Plan 69
SILVER: Tactical level of management which provides overall management and co-ordination
of the response to an emergency. Determines priorities in allocating resources and requests
further resources as required.
Strategic Co-ordinating Group: A group comprising senior managers of appropriate
organisations which aims to achieve effective inter-agency co-ordination at a strategic level.
This group should normally be located away from the immediate scene.
Temporary or Resilience mortuary: Building or vehicle – usually separate from the public
mortuary – adapted for temporary use as a mortuary in which post mortem examinations can
take place.
Triage: Process of assessment of casualties and allocation of priorities by the medical or
ambulance staff at the site or casualty clearing station prior to evacuation. Triage may be
repeated at intervals and on arrival at a receiving hospital.
Utilities: Companies providing essential services, e.g. gas, water, electricity, telephones.
Voluntary sector: Bodies, other than public authorities or local authorities, which carry out
activities otherwise than for profit.
Vulnerable establishment An institution housing vulnerable people during the day or at night.
Vulnerable people: People present or resident within an area known to local responders who
because of dependency or disability need particular attention during emergencies.
Warning and informing the public: Establishing arrangements to warn the public when an
emergency is likely to occur or has occurred and to subsequently provide them with information
and advice.
Major Incident Plan 70
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Major Incident Plan 71
Draft Strategic Aim
AIM
To provide an integrated and co-ordinated response to mitigate and minimise the impact on the
health and welfare of the South Yorkshire and Bassetlaw community
OBJECTIVES
Protect and preserve life
Provide information and advice to the public, staff and media
Co-ordinate the local NHS response
Co-operate and co-ordinate with other responding organisations
Assist an early return to normality
Major Incident Plan 72
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Major Incident Plan 73
MAJOR INCIDENT – MESSAGE LOG
Message No. 1.
Time received: Date received:
Received by:
Message from (name):
Organisation: Role:
Telephone No: E-Mail address:
Details of information / message
Action Required?
Action allocated to: Time / date allocated:
Action resulted: Time / date resulted:
Message finalised and for filing Signature: ………………………………………Print Name……………………………………………
Continue overleaf if necessary
Major Incident Plan 74
Finalised forms to be submitted to the Emergency Resilience Unit for retention
Major Incident Plan 75
Major Incident Team meeting
AGENDA
Time / Date:
Location:
1. Introductions to include roles and responsibilities
2. Complete attendance list
3. Review and update of Actions from any previous meetings
4. Overview of the present situation – Chair
Initial Impact (casualties /hazards)
Resources available / required
Further information required
Initial actions to be allocated
5. Establish / Review Aim and Objectives of the emergency response
6. Communication Links required
Internal / external
Local / regional
7. Media policy and information for the public
8. Confirm and agree any Policy Decisions for recording with the Emergency Log Book keeper
9.
10. Any other business
Details of next meeting:
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Major Incident Plan 77
Attendance Sheet
Meeting: Time / Date:
Name Organisation Signature
Major Incident Plan 78
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Major Incident Plan 79
MAJOR INCIDENT
EXHIBIT LIST
No. Reference Description Produced by
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Major Incident Plan 81
MAJOR INCIDENT
EXHIBIT LIST
No. Reference Description Produced by
1 IR 1 Yellow post it note with rough notes timed 08:00 on 21.11.2011
Ian Ramsay
2 IR 2 Blue post it note with rough notes timed 08:10 on 21.11.2011
Ian Ramsay
3 GY 1 Rough notes on A4 paper timed 08:12 on 21.11.2011 Gaynor Young
4 DS 1 Agenda for first planning meeting timed 09:30 on 21.11.2011
Diane Smith
5 LC 1 Minutes of first planning meeting timed 09:30 on 21.11.2011
Lisa Corbridge
6 EB 1 Flip chart containing details of casualties timed 09:45 on 21.11.2011
Emma Black
7 EB 2 Flip chart containing details of resources available timed 09:50 on 21.11.2011
Emma Black
8 EB 3 Photograph of dry wipe board containing details of outstanding issues timed 10:25 on 21.11.2011
Emma Black
9 EB 4 Photograph of dry wipe board containing details of current actions allocated timed 10:32 on 21.11.2011
Emma Black
10 LC 2 Minutes of second planning meeting timed 14:00 on 21.11.2011
Lisa Corbridge
11 GY 2 Major Incident Message Log No 1 Gaynor Young
12 GY 3 Major Incident Message Log No 2 Gaynor Young
13 IR 3 E:mail sent by Ian Ramsay at 14:12 on 21.11.2011 Ian Ramsay
14 IR 4 E:mail received by Ian Ramsay at 14:15 on 21.11.2011 Ian Ramsay
15 JB 1 Emergency Log book from 08:00 to 17:00 on 21.11.2011
Jill Burkinshaw
Bibliography
Cabinet Office Emergency Response & Recovery Guidance 2009 Cabinet Office Emergency Preparedness Guidance 2005 Civil Contingencies Act 2004 NHS Emergency Planning Guidance 2005 Strategic Command Arrangements for the NHS during a Major Incident 2007 Business Continuity Institute Good Practice guidelines 2010 BS 25999 - 1 Code of Practice for Business Continuity Management BS 25999 - 2 Specification for Business Continuity Management NHS Resilience and Business Continuity Management Guidance 2008 Department of Health Major Incident planning and assessment tool for Primary Care Trusts 2009 Department of Health Ethical Framework for Policy and Planning November 2007
Department of Health Managing Demand and Capacity in Health Care Organisations April 2009 Department of Health NHS Constitution March 2010 Human Rights Act 1998 Health & Safety at Work Act 1974 Equality Act 2010 NHS South Yorkshire & Bassetlaw Strategic Framework for EPRR South Yorkshire Local Resilience Forum Strategic Leaders Guide South Yorkshire Scientific and Technical Advice Cell Concept of Operations NHS Shared Operating Model for PCT Clusters
Major Incident Plan 83
Plan History
Details By Date
Draft Version 1 of a new generic Major Incident plan developed to reflect transition to PCT Cluster arrangements as part of ongoing NHS Reforms
Ian Ramsay 7.12.2011
Review
Next Review Due: December 2012
Any exercise or activation of this plan will require a de-brief and review of the plan
Major Incident Plan 84
Distribution List
Copy No. Issued to Department
An electronic version of this plan is also available on – Cluster external website ??