Reception of casualties from abroad - Web viewWORD. This document is the ... which is possibly CBRN,...

NHS Greater Glasgow & Clyde

Major Incident Plan

June 2015 - Version No 1.5

Version 1.5Issue Date June 2015Review Date May 2016

of 62


of 62

Document Control

Not Protectively Marked

Title: Board Major Incident Plan

Version Date Purpose/Change Authorised

1.5 June 2015 Updates to document SJ

Document owner(s): Sally Johnston

Amendments:

Changes to pages 15,17,47,52,53

Authorised by:

CONTENTS

PageForeword 6

Section 1: Introduction1.1 Why do we Need a Plan? 9

1.2 Who is the Plan for? 9

1.3 Scale of Incidents 10

1.4 Mass Casualty Situations 11

1.5

1.6

Types of Incident

Other Types of Incidents

12

13

Section 2: Accountability – Roles and Responsibilities2.1 What is the Role of NHS GGC 15

2.1.1

2.2

Additional Responsibilities for NHS GGC

Role of the Acute

16

16

2.3 Health & Social Care partnerships 17

2.4 General Practice 18

2.5 Mental Health 18

2.6 Provision of Health Care Services at Reception Centres 19

Section 3: Command and Control3.1 Tiers of Command 20

3.2 Mutual Aid 21

3.3 Role of Strategic Command 21

3.4 Role of the STAC (Science and Technical Advisory Cell) 21

3.5 Role of Scottish Government 22

3.6 Role of the Scottish Government Health and Social Care Directorates

22


of 62

Section 4: Plan Activation4.1 Activation

4.2 Triggers

4.3 Action on Receipt of Alert

4.4 Escalation and de Escalation

23

24

25

26

Section 5: Recovery Phase5.1 Multi-Agency Recovery 27

5.2 Internal Recovery 28

5.3 Debrief 29

Section 6: Risk Assessment6.1 Hazard and Risk Assessment 30

Section 7: Business Continuity 30

Section 8: Training for Major Incidents8.1 Training Roles and Responsibilities 31

Section 9: Communications and Media9.1 Communications 31

9.2 Specific Groups – Vulnerable Persons 35

AppendicesAppendix 1 Communication channels 39

Appendix 2

Appendix 3

Action cards

Triage Category

40

52

Appendix 4 POD Information 54

Appendix 5 Glossary of Terms 55

Appendix 6 Plan Production 58


of 62

Intentionally left blank


of 62

FOREWORD

This document is the Major Incident Plan for NHS Greater Glasgow and Clyde (NHS GGC). It

outlines the arrangements to be undertaken by the board at the time of a Critical Incident, Major

Incident or Civil Emergency. It has been prepared in the light of advice from Preparing

Scotland, NHS Planning for Emergencies 2013, Civil Contingencies Act 2004. The process

adopted ensures an integrated approach to Emergency Management.

Although the Business Continuity Plan is not part of the Major Incident Plan it is an integral part

of it. The Major Incident Plan, the Business Continuity Plan and the On Call packs should be

viewed as inextricably linked.

Major incidents are rare but this does not mean however, that they will not happen and NHS

GGC need to ensure preparedness and that plans are updated and communicated to relevant

staff so that an appropriate response can be launched if it becomes necessary.

As Chief Executive, I acknowledge that the final responsibility for Emergency Planning rests

with my appointment and that it is my responsibility to ensure that Emergency Plans are in

place and fit for purpose. However, all relevant staff must familiarise themselves with the

contents of this, not only to monitor their own particular areas of responsibility as preparation for

their response to an incident, but to feed back useful information and suggested improvements

to the Civil Contingencies Unit. I am satisfied that this plan ensures that NHS GGC have

effective arrangements in place to respond to a Critical or Major Incident within our own health

community or to offer support to neighbouring health boards.

Robert CalderwoodChief Executive


of 62

STOPIf you have received notification that a

Major Incident has been declared

And you have not read this plan

DO NOT READ IT NOW

Find your relevant Action Card in Section 3

AND FOLLOW THE INSTRUCTIONS


of 62

MAJOR INCIDENT / EMERGENCY PLAN

SECTION 1: INTRODUCTION

Definition of an Emergency – Civil Contingencies Act (CCA) (Nov 2004)“An event or situation which threatens services by damage to:

a) Human welfare in a place in the United Kingdom

b) The environment of a place in the United Kingdom

Or

c) The security of the United Kingdom”

Human WelfareLoss of human life

Human illness or injury

Homelessness

Damage to property

Disruption of a supply of money, food, water, energy or fuel

Disruption of electricity or other systems communication

Disruption of facilities for transport or disruption of services relating to health

The specific duties of Health Boards under the CCA are to:

Assess risk

Maintain emergency/major incident plans

Maintain business continuity plans

Communicate with the public

Share information

Cooperate

Although the term emergency is used in the CCA, it is often used interchangeably with major

incident in civil contingencies planning In the NHS major incident is defined as:


of 62

Any occurrence that presents 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 one or more territorial and/or special health boards simultaneously or in support of each other. It requires considerable resources and strategic input as it potentially threatens the survival of an organisation.

1.1WHY DO WE NEED A PLAN?

The Civil Contingencies Act requires all organisations that are classified as Category One

responders, including Local Health Boards to have emergency plans that make explicit how the

organisation will respond effectively in the event of a Major or Emergency Incident.

Category 1 responders are the main organisations involved in responding to incidents and are

subject to the full set of civil protection duties.

NHS Greater Glasgow and Clyde (NHS GGC) need to be able to adopt an all risk approach and

to plan for and respond to a wide range of major incidents that could affect the smooth running

of the NHS and ultimately public health or patient care. These could be anything from extreme

weather conditions or a major disease outbreak, to a major transport incident. NHS GGC need

to be sufficiently resilient to deal with the consequences of these incidents that may put the

organisation under severe pressure, while maintaining patient care.

1.2WHO IS THE PLAN FOR?

It is important that NHS GGC is aware that the plan exists and understands fully their

contribution to the success of the implementation of the plan.

The plan describes what needs to happen, and who needs to do what, should an emergency

occur. Some emergencies will have an impact on the whole of the organisation while others

may only impact on parts of the organisation.

Directors should take responsibility for ensuring that staff expected to respond in the event of a

Major Incident have undergone sufficient training and are aware of responsibilities.


of 62

Directors/Managers must ensure that they are sufficiently familiar with the plan and that they

are ready and able to mount an immediate response in accordance with the provision of the

plan.

1.3 Scale of Incidents

NHS organisations are accustomed to normal fluctuations in daily demand for services. Whilst

at times this may lead to facilities being fully stretched, such fluctuations are usually managed

without the activation of special measures.

During major incidents or emergencies some services may be disrupted or experience a surge

in demand. NHS GGC should identify services likely to be affected and prepare plans to

mitigate the impact on the users of critical services

There are three levels of incident which require emergency preparedness arrangements. These

are:

Level 1 Incidents (major) - each individual NHS organisation must plan to handle incidents in

which its own facilities may be overwhelmed due to a number of reasons. Examples include

flooding, power failure, Information Technology system breakdown, Laboratory error, exceeding

service capacity etc. Planning successfully for these wider disruptive challenges will require

more than simply scaling up the current plans of individual agencies.

Level 2 Incidents (mass) - much larger scale events affecting potentially hundreds or

thousands rather than tens of people, possibly involving closure or evacuation of a major facility

or persistent disruption over many days: these will require a collective response with

neighbouring health boards.

Level 3 Incidents (catastrophic)- Events of potentially catastrophic proportions that severely

disrupt health and social care and other functions and that exceed collective capability within

the NHS.


of 62

1.4 TYPES OF INCIDENT

Type of Incident Example

Big bang Serious transport accident, explosion or series of

smaller incidents.

Rising tide A developing infectious disease epidemic,

communicable disease or a capacity or staffing

crisis,

Cloud on the horizon A serious threat such as a major chemical or

nuclear release developing elsewhere and

needing preparatory action.

Headline news Public or media alarm about a personal threat.

Internal incidents Fire, breakdown of utilities, major equipment

failure, IT failure, and hospital acquired infections,

violent crime, and serious untoward incidents.

Deliberate

Hazmat

Release of chemical, biological, radiological or

nuclear materials and conventional bombs or

explosive devices.

Accidental release of a chemical

Pre-planned major events Demonstrations, sports fixtures, air shows,

typically where advanced notice enables a pre-

planned response to be made.

Displaced Persons Large numbers of displaced/evacuated members

of the public due to flooding, wide-scale and

prolonged utility failures, severe weather, large

scale fire etc. or repatriated British Nationals.

Act of Terrorism The calculated use of violence (or the threat of

violence) against civilians in order to attain goals

that are political or religious or ideological in

nature; this is done through intimidation or

coercion or instilling fear.


of 62

1.5 MASS CASUALTY SITUATIONSA mass casualty incident is:

‘A disastrous single or simultaneous event(s) or other circumstances where the normal major incident response of several NHS organisations must be augmented by extraordinary measures in order to maintain an effective, suitable and sustainable response.’

Such incidents typically result in hundreds of casualties; have the potential to overwhelm health

services; disrupt business-as-usual arrangements of some health care facilities/services for

several days; and require the activation of mutual aid arrangements. These circumstances will

require Health Boards to undertake detailed scenario, capacity and surge/ escalation-planning

Events which may cause a mass casualty situation

Aviation Disasters

Major Road Traffic Accidents

Chemical Incidents

Train Crashes

Terrorist Activity

Infectious Disease Outbreak

Mumbai style event (marauding terrorist)


of 62

1.6 Other types of incidents

Reception of casualties from abroad

Plans made in support of military actions overseas have led to the practice of local airports

being a point of disembarkation of injured persons from hostilities elsewhere. It is conceivable

that an incident in another country could also produce large numbers of casualties, which would

require the deployment of resources from the NHS to receive these and to transport to the

designated hospitals

A major overseas burns incident is an example where such an incident may occur. In such

circumstances, the Reception Team (Medical Incident Commander and a Site Medical Team)

would depart to whichever airport is designated to receive these casualties and to make

appropriate arrangements for reception and transportation to the hospital.

Medical Records staff would also need to attend as part of the Reception Team to document

casualties details on disembarkation, manage patient records and assist with the transfer of the

casualty as appropriate.

The Hospital Control Centre would also require to be mobilised to control the situation at the

hospital with particular regard to reception arrangements, treatment, portering and medical

records.

All of the above would be done in co-ordination with the Scottish Ambulance Service.

Prison Incidents

The NHS response to an incident producing casualties from a prison, or similar establishment,

will require special consideration. Casualties may arise from any of the following: riot,

disturbance, acts of terrorism, fire, accidents, food poisoning, the use and abuse of drugs and

natural disasters etc.

In the event of such an occurrence the Police would advise in the same way as other incidents

that a major event has taken place and is ongoing. If requested NHS GGC would be required to

respond by sending a Site Medical Team and a Medical Incident Officer to the location.


of 62

A flexible response will be required to address the primary medical conditions. However it is the

responsibility of HM Prison Service and Police Scotland for the security of the public, Prison

staff, NHS personnel and the other patients.

In order to reduce the disruptive effect of the arrival of casualties in hospital, either in significant

numbers or with serious medical problems, it may be necessary to declare a major incident in

circumstances which otherwise might not be justified.

In the interest of both security and privacy it will be necessary to designate a specific area (as

agreed with the Police) for the treatment of casualties from a prison major incident.

Casualties among Prison staff, Police and Emergency Services may need to be separated from

prisoners following a riot or serious disturbance.

Radiation Incidents

There are two major nuclear installations adjacent to the NHS Greater Glasgow & Clyde area, which provide the potential for an incident. They are -

The Hunterston Nuclear Power Station operated by Scottish Nuclear

The Clyde Submarine bases (Faslane) operated by the Ministry of Defence

Both installations have detailed local instructions covering the handling of casualties, should an incident occur, and there are clearly laid down procedures, in conjunction with the appropriate local authority, for dealing with the local population.

NOTE: A small reactor is located at the National Emergency Laboratory, East Kilbride.


of 62

SECTION 2: ACCOUNTABILITY – ROLES AND RESPONSIBILITIES

2.1 WHAT IS THE ROLE OF NHS GGC?

Co-ordination of the NHS response to a Major Incident

Co-ordination of the primary care, community and mental health response in conjunction

with the Health and Social Care Partnerships

To provide Director level representation at the Local Resilience Partnerships (LRP) or

Regional Resilience Partnerships (RRP) (when established) to co-ordinate the strategic

management of health services and provide a strategic view on long term threats

To provide Public Health advice to the LRP or RRP and support a Science and Technical

Advice Cell (if established)

The provision of a 24 hour emergency management and access to clinical response

The deployment of a Site Medical Team and Medical Incident Officer via Emergency

Medical Retrieval Service (EMRS) in conjunction with Scottish Ambulance Service

Provision of care and advice to evacuees, survivors and relatives, including replacement

medication

To continue to provide core business services

To commission additional/extra services, e.g. private hospitals

Co-ordination of bed capacity in(care homes) in liaison with Health and Social Care

Partnerships and any available local bed management system in liaison with Local

Authorities

Providing support, advice and leadership to the local community on health aspects of an

incident

Assessing the effects of an incident on vulnerable care groups, such as children, dialysis

patients, elderly, medically dependent, or physically or mentally disabled and identify and

share information when required

Administration of medications, prophylactics, vaccines and countermeasures

Establishing with the Local Authority, facilities for mass distribution of countermeasures; for

example, vaccinations and antibiotics

Provision of psychological and mental health support to staff, patients and relatives in

conjunction with the appropriate provider /Local Authority


of 62

Proactively communicate information to all health board staff and public and ensuring

relevant guidance and advice is available, including private facilities where appropriate

Working with the Local Authority and community to support the recovery phase

Assessing the medium term impact on the community and priorities for the restoration of

normality

Supporting screening, epidemiology and long term assessment and management of the

effects of an incident

Considering the need for long term monitoring

2.1.1 In Addition NHS GGC Must Ensure the Following

Have a named person responsible for co-ordinating all aspects of Major Incident

planning

Consider all possible types of Major Incidents that could affect their population and

providers of healthcare with a risk approach and utilising the community risk register

Perform adequate risk assessment at all stages of the incident, and to provide a robust

and appropriate corporate response.

Establish an Incident Team if required and operate an internal ‘Command Post’ to log

and control communication flows

Have a training programme for their staff who are likely to involved in a Major Incident

response

Have an on-call arrangement that allows emergency plans to be triggered at any time

day or night

Have appropriate alerting arrangements for Major Incidents and authorising/initiating

protocols to mount the Major Incident response

2.2 Role of the Acute Division Provide a safe and secure environment for the assessment and treatment of patients

Provide a safe and secure environment for staff that will ensure the health, safety and

welfare of staff including appropriate arrangements for the professional and personal

indemnification of staff

Provide a clinical response including provision of general support and specific/specialist

health care to all casualties, victims and responders


of 62

Liaise with the ambulance service, independent sector providers, and other agencies in

order to manage the impact of the incident

Ensure that the hospital / division reviews all its essential functions throughout the

incident

Provide appropriate support to any designated receiving hospital or other neighbouring

service that is substantially affected

Provide limited decontamination facilities and personal protective equipment to manage

contaminated self presenting casualties

2.3 Health and Social Care Partnerships

Community Services are responsible for the provision of staff, which may include Community

Nurses, Health Visitors, Children’s Nurses, mental health ,Social workers and other specialist

staff, to:

Provide care and advice to evacuees, survivors and relatives, including the replacement of

medication

Provide assistance to acute hospital staff or set up emergency treatment centres, as

necessary

Administer medications, prophylactics, vaccines and counter measures

Identify, and assess the impact of the incident on, vulnerable groups and individuals who

may need additional support and assistance

Assist Acute services and support accelerated discharge

Provision of psychological and mental health support to staff, patients and relatives

Support to rest and evacuation centres

NHSGGC may be required to provide reciprocal support to local authorities in the event of

a major incident, in terms of staff, facilities and resources

Community Services must be able to mobilise appropriate staff to provide a 24 hour, 7 day a week, response.

2.4 General Practice


of 62

Voluntary involvement in treatment of minor injuries and general health treatment

Keeping up to date with locally or nationally issued Public Health advice

Awareness of disease presentations associated with biological release

Ensuring the Consultant in Public Health medicine is informed when a disease

presentation, which is possibly CBRN, is suspected

Provide medical assistance at Rest Centres, Vaccination Centres and other treatment

areas

Assist with service provision of patients from Practices directly affected

Assist colleagues from affected Practices

Balance Major Incident role with the business continuity of the practice.

2.5 Mental Health and Learning Disabilities

Mental Health provides a range of services, both inpatient and within the community, for people

with mental health and learning disabilities.

The role of Mental Health and Learning Disabilities could include:

The provision of a 24 hour mental health response

Supporting the provision of care and advice to evacuees, survivors and relatives, including

replacement medication where appropriate

Assisting in the identification of vulnerable individuals and groups

Assisting in the assessment of the effects of an incident on vulnerable individuals and

groups

Providing psychological and mental health support to staff, patients and relatives, in

conjunction with other providers

Working with other organisations and communities to support the recovery from an

incident.

Mental Health may also be able to assist the overall health response through the

provision of staff, facilities, capacity and equipment.

2.6 Provision of Health Care at Reception Centres


of 62

Reception Centres will be set up when required by the local Authorities, the purpose of the

Centres will be to temporarily house those who survived a Major Incident without obvious injury

or to provide shelter for those evacuated from their homes, as result of risk from direct risks or

threats. Examples are buildings near collapse or exposure to dangerous radiation or

chemicals. Although the people within the Centre are unlikely to need hospital care they may

require some first aid, comforting or practical support e.g. access to medication. Some may

require screening prior to being allowed to leaving the Centre.

SECTION 3: Command Control and Coordination (C3)


of 62

In general, major incidents are local, time-limited and effectively dealt with either by emergency

services or the designated hospital’s Emergency Department. However, some will be of a

greater magnitude with potential consequences beyond the Local Health Board area. These

types of incidents will necessitate a higher level of coordination initially by the Local Resilience

Partnership (LRP) or Regional Resilience Partnership (RRP) as well as by the Scottish

Government Resilience Room (SGoRR).

NHS Greater Glasgow and Clyde must have a pre-determined C3 arrangement in place (at

Board, hospital/divisional level) to respond effectively and efficiently to a major incident that it

can either handle alone or through support provided as part of a wider multi-agency response.

In accordance with the principles of integrated emergency management the board has adopted

the emergency management structure that is common to all of the Emergency Services within

the United Kingdom.

Operational (Bronze) The operational (bronze) level of command refers to those who provide the immediate ‘hands

on’ response to the incident, carrying out specific operational tasks either at the scene or at a

supporting location such as a hospital or rest centre.

Operational personnel will need to have a clear understanding of the tactical plan and be able

to implement it within their functional or geographical area of responsibility.

Tactical (Silver) The purpose of tactical management is to ensure that actions taken at the operational level are

co-ordinated, coherent and integrated in order to maximise effectiveness and efficiency. Where

the responding agencies involved appoint tactical commanders or managers, consideration

must be given to how they and their personnel will communicate and co-ordinate with each

other.

Strategic (Gold)


of 62

The strategic (gold) command level is responsible for determining the overall management,

policy and strategy for the incident whilst maintaining normal services at an appropriate level.

They should ensure appropriate resources are made available to the health board Tactical

Command and manage communications with the public and media.

Additionally they will identify the longer term implications and determine plans for the return to

normality once the incident is brought under control or is deemed to be over.

3.2 Mutual AidTo support NHS Greater Glasgow and Clyde a Mutual aid agreement with neighbouring LHBs

is an important aspect of emergency preparedness. They ensure that an NHS body will have

access to appropriate supplementary and/or specialist resources and support from other health

organisations in the event of a major incident across Scotland. In the event of the type of

casualty requiring specialist treatment mutual aid may be requested if appropriate from the

United Kingdom.

3.3 Role of Strategic (Gold) Command

To establish policy direction with regard to the situation

Prioritise and co-ordinate the actions taken by all of the services represented on the

group

To provide a link to central government

Convene, attend and address regular press conferences

3.4 Role of the STAC (Science and Technical Advisory Cell)

The focus of the STAC is to provide Scientific, Environmental and Public Health advice during

the response and recovery phases of an emergency.

The initial formation of the STAC will be actioned by local and regional responders and in the

first few hours of an incident, the STAC will be led by Public Health colleagues from either the

NHS or Health Protection Scotland (HPS). The STAC Chair will be responsible for alerting

other organisations and members of the team.

3.5 Role of Scottish Government


of 62

The Scottish Government, although not a category 1 or 2 responder, has a key role in civil

protection and resilience. When the scale or complexity of an incident is such that it would

benefit from central government coordination or support, the Scottish Government (SG) will

activate its emergency response arrangements through the Scottish Government Resilience

Room (SGoRR). The role of SGoRR will vary according to the nature, scale and impact of the

incident During a SGoRR activation, Health Boards should submit Situation Reports (SitReps)

to SG Health and Social Care Directorates (HSCD) via the NHS Scotland Resilience Team.

The reporting requirement and frequency will vary according to the impact of the incident and

Health Boards will be informed of this at the time of the response.

3.6 Role of the Scottish Government Health and Social Care Directorates (HSCD)

HSCD’s role during an emergency response is to:

Collate and coordinate incident information provided by Health Boards;

Brief the Cabinet Secretary for Health and Wellbeing and HSCD Director- General;

Provide government support for the NHS and the particular Health Board involved and

ensure that all other health boards are in readiness to support if necessary;

Maintain an up-to-date overview of national critical care capacity;

Assess the impact of the incident on the Board’s scheduled work and determine any action

that needs to be taken;

Assess whether mutual aid is required from other nations in the UK if local capacity and

capability is overstretched or inadequate; and

Maximise available communication channels at national and local levels to Inform the public

his section outlines the role of the Scottish Government in civilh exceptional service pressuresSECTION 4: PLAN ACTIVATION AND ACTION CARDS

Alert Message


of 62

Major incident Declared – Activate PlanThis alert the NHS that identified agencies have activated their Major Incident plan, and they may need to activate its plan and mobilise additional resources

4.2 TriggersThis plan can be triggered in several ways to a potential or actual significant / major incident:

In response to internal pressure within the NHS (an internal decision) in response to a local

incident

External alert that an agency has called a major incident “Stand By”


of 62

Major Incident – StandbyThis alerts the NHS that a major incident/emergency may need to be declared. Major incident standby is likely to involve the participating NHS organisations in making preparatory arrangements appropriate to the incident/emergency.

Major Incident - Stand downThe emergency services will usually notify agencies when all casualties have been cleared from the scene and the initial response phase is over. However, it is the responsibility of each individual agency to assess when it is appropriate for them to stand down.

The decision to move to this phase signifies that the incident has been contained or that there is no longer the possibility of further escalation.

External alert that a major incident has been “Declared”/”Implemented”

External alert that a multi-agency Tactical Command is being called

External alert that an LRP is being called

In response to a national direction.

4.3 ACTION on receipt of an alert: Activation algorithm

Initial risk assessment for CMT and/or Public Health on call An assessment of the situation will determine what action needs to be taken. Using the

information at hand and taking account of a worst case scenario where knowledge is limited,

consider the following and record all relevant information.

Questions to consider Information Collected?*

What is the size and nature of the incident?


of 62

Area and population likely to be affected - restricted or widespread

Level and immediacy of potential danger - to public and response

personnel

Timing - has the incident already occurred or is it likely to happen?

What is the status of the incident?Under control

Contained but possibility of escalation

Out of control and threatening

Unknown and undetermined

What is the likely impact?On people involved, the surrounding area

On property, the environment, transport, communications

On external interests - media, relatives, adjacent areas and partner

organisations

What specific assistance is being requested from the NHS?Increased capacity - hospital, primary care, community

Treatment - serious casualties, minor casualties, worried well

Public information

Support for rest centres, evacuees

Expert advice, environmental sampling, laboratory testing, disease

control

Social/psychological care

How urgently is assistance required?Immediate

Within a few hours

Standby situation

*Key √ = Yes X = no ? = Information awaited N/A = Not applicable

In making this assessment, it is important to distinguish between:

Events that can be dealt with using normal day to day arrangements.

Events that can be dealt with within the resources and emergency planning

arrangements of NHS GGC

Events that require a joint co-ordinated response from health

Events that require an establishment of an LRP


of 62

4.4 Escalation and de-Escalation

Escalation or de-escalation of the incident does not necessarily occur sequentially. It can be

driven by the nature and scale of the incident and the appropriate response.

Reasons for escalation / de-escalation can include:

Criteria for Escalation Criteria for De-escalation increase in geographic area or

population affected (pandemic, flooding etc.)

the need for additional internal resources

increased severity of the incident increased demands from

government departments, the service or from partner agencies or other responders

heightened public or media interest

reduction in internal resource requirements

reduced severity of the incident reduced demands from partner

agencies or government departments

reduced public or media interest decrease in geographic area or

population affected

Changes in incident escalation level will be authorised by the CMT or Public Health on call

SECTION 5: Recovery

5.1 Multi-agency

Police will ordinarily lead and coordinate the response element to an incident but seek at an

early stage to establish a recovery group led by the relevant Local Authority (LA). The


of 62

transition from initial response stage to recovery and the change in lead responsibility from the

Police to the LA will be determined on a case by case basis.

Some Key points on Recovery:

Response and recovery are not two discrete activities and the response and recovery

phases do not occur sequentially.

Recovery is the process of restoring and rebuilding the community and managing the

expectations of those affected in the aftermath of an incident.

The recovery period can be labour intensive and may stretch organisations to

extraordinary levels.

Recovery is not solely about the physical reconstruction and restoration of the

amenities and the environment; there may be a significant impact on the socio-

economic environment.

The aim of the recovery phase is to reach a point where additional demands on

services due to the incident have been reduced to the level at which they were before

the incident occurred.

Recovery is the spiritual, emotional and welfare of a community being restored.

Recovery also includes the physical and mental welfare of the workforce involved in the

response phase

A Major Incident is likely to have a profound effect upon a community and extend far deeper

than the replacement of bricks and mortar. The wishes and involvement of the community will

be an essential consideration in any action undertaken.

All agencies will be under pressure to restore any services interrupted as a result of an incident

especially from those not directly affected by the incident. Whilst the public will accept and

make allowances for a period of disruption whilst the response is on-going; expectations will

rise as time progresses, and there will be pressure to restore services to demonstrate that the

NHS and other agencies/organisations involved are coping and that “life” is returning to

“normal”.

5.2 Internal


of 62

It may be necessary to form a strategic group tasked with recovery, both of the local NHS

community and of ‘routine’ business. This group will be led by a relevant director or nominated

deputy and will be separate to the boards co-ordination centre although close links are

essential. In the event of NHS GGC invoking a recovery group this will initially be based upon

the membership of the Corporate Management Team and co-opting deputies/individuals where

required.

Depending on the type of incident, it may involve a wide group of disciplines and departments/

health funded organisations and will need to co-ordinate its work with Local Authorities who

lead on community recovery.

Issues to be addressed will/may include:

Occupational health and welfare of all staff and their families.

Bereavement affecting or involving NHS staff.

Mid/Long term community support and medical and clinical services.

Psychological support in conjunction with MIST and or relevant Local Authority

Physical reconstruction of facilities.

Reviewing key priorities for service provision and restoration.

Long term public health issues in conjunction with Health Protection Scotland and Public

Health England

Financial implications, remuneration and commissioning agreements.

Staffing and resources to address the new ‘environment’.

Socio-economic effect of the incident on staff and the public.

VIP visits.

Funerals, Memorials and Anniversaries.

Staffing levels and resilience.

Routine annual performance targets.

Ongoing needs for assistance from and to NHS partners or other agencies.

Equipment and supplies.

Rewarding, thanking and acknowledging the efforts of staff.

Reputational damage/impact

It may be necessary for NHS GGC to engage legal counsel to give advice on elements of response and recovery.


of 62

5.3 Debriefing

Post Incident DebriefsFollowing any major incident a number of debriefs will be held to look at what went well and what could have gone better. It is vital that this review is undertaken to look at how well the organisation managed the incident.

The debrief process is not intended to criticise individuals, but to ensure lessons are learned and good practice is implemented. It is important that, as far as possible, a ‘no blame’ culture is adopted.

Hot DebriefA ‘hot’ debrief will be held immediately after the stand down has been issued. This will be led by the SIMT Co-ordinator and will involve all members of the SIMT, together with any personnel who were also involved and may be able to attend.

This debrief will be informal and will concentrate on initial thoughts on the response. It provides an opportunity for staff to express immediate issues of concern and also allows the organisation to thank staff and possibly identify those who may be in need of additional support.

Internal DebriefAn internal debrief will be held as soon as possible after the incident has ended (and prior to the multi agency debrief). All those involved at a strategic, tactical and operational level should be invited to attend. This debrief will be more formalised and will be recorded in writing. It will look at each area of the response and identify any issues to be addressed and how plans / procedures can be improved.

Multi Agency DebriefA multi agency debrief will be held within two to four weeks following the completion of the rescue phase of any major incident. This will be chaired and co-ordinated by the lead agency (usually the police or local authority). It will be attended by one or more representatives from all the agencies involved in responding to the incident. There may also be an additional debrief once the recovery phase is complete.

SECTION 6: RISK ASSESSMENT

6.1 HAZARD AND RISK ASSESSMENT

NHS GGC has contributed to the development of a community risk register. This register has

been developed for two primary reasons. Firstly, to reassure the people and communities of

Strathclyde that an assessment of potential hazards and threats has been made. Secondly, to


of 62

satisfy the requirements outlined in the Civil Contingencies Act 2004 and its Statutory Guidance

(Emergency Preparedness).and Preparing Scotland.

http://www.firescotland.gov.uk/your-area/west/local-senior-officers.aspx(The community risk register can be found on the Civil Contingencies intranet site)

SECTION 7: Business Continuity

A major incident may impact on the normal business of NHS GGC in many ways, including the

loss of premises or services (e.g. water, telephony, electricity IT,etc).

Business continuity plans are maintained by each individual directorate detailing critical

activities and priorities. These should be taken account of when responding to a major incident.

To ensure that business continuity issues are addressed during the incident, a Strategic

Business Continuity team with responsibility for considering the implications of the incident on

core business including:

Human resources (e.g. staff shortages, redeployment of staff, use of retired staff,

use of volunteers etc)

Buildings (e.g. back up arrangements, alternative locations etc)

Supply chains (food, linen, drugs etc)

Utilities / communications (e.g. water supply, electricity supply, alternative

communications options etc)

Service capacity (e.g. flexible use of beds, alternatives, decanting, care of patients

at home, temporary suspension of work / targets etc)


of 62

http://www.firescotland.gov.uk/your-area/west/local-senior-officers.aspx

SECTION 8: TRAINING FOR MAJOR INCIDENTS

8.1 TRAINING ROLES AND RESPONSIBILITIES

Pivotal to successful management of any Major Incident is the need to ensure that all staff have

a clear understanding of their roles and responsibilities should such an incident occur. In order

to ensure that NHS GGC response is appropriate and efficient, training and exercising events

have been organised to assist on call personnel for Major Incidents.

SECTION 9: COMMUNICATIONS AND MEDIA

9. COMMUNICATIONS

Communications are one of the most important elements to get right in an emergency. Within NHSGGC the communication response will be managed by the Corporate Communication Directorate in close collaboration with senior directors. The 24-hour number for the Directorate is 0141 201 4429. This is the number that must be contacted to instigate a communications response to a major incident.

The communications response and the agency with lead responsibility for communications will

vary according to the nature and scale of the incident. Typically, these fall into four main

categories:

Major incident involving multiple casualties

Terror/security incident

Public health outbreak

Major disruption to NHSGGC services

The communications response will be led by the Lead Responder agency. This will typically be

a Category 1 responder.

Having a clear lead in the early stages of an emergency is an important factor in the success of

warning and informing the public. The Lead Responder will have overall responsibility for:

Delivering urgent warnings to the public

Co-ordinating communication activity with other responder agencies


of 62

Assisting other responders to communicate

It is important to note that a Lead Responder is not expected to carry out the duty to warn and

inform in isolation. The duty remains a responsibility for all Category 1 responders. In agreeing

to appoint a Lead Responder, it sets out a collective arrangement that allows for partnership

working and a co-ordinated approach to communicating with the public.

A system of activation should be adopted that involves an around-the-clock response. It is

important that a process is in place to identify an emergency, to activate the joint arrangements

and quickly put in place an approach to handle the communication aspects.

Depending on the severity or scale of the incident, the Lead Responder will be as necessary

supported by the Scottish Government Resilience (SGoR) who will set the strategic direction for

the national response, ensure effective communications between all responders, liaise with the

UK government where appropriate, provide information and advice to Ministers and issue

national advice and information to the public.

However, it is also necessary to recognise that there may be an important communication role

of UK Government Departments and Agencies. These organisations, along with some national

agencies, may either work with the Scottish Government as part of a joint response, or have

discrete responsibilities.


of 62

9.1 Communications strategy:

1. Quickly establish all agencies involved in managing the major incident and its aftermath.

2. Establish a Public Communications Group to ensure effective and regular

communications between all agencies.

3. The Public Communications Group agrees a system to ensure effective co-ordination of

ongoing communications response e.g. establishment of a Public Communications

Group email cell and regular conference calls between all agencies involved. Depending

on the scale of the incident, the Public Communications Group can be facilitated by

SGoR if appropriate. All communications should be shared throughout the duration of the

incident with this group.

4. Set clear communications objectives. In agreeing these objectives it is important to think

about how communications can be proactive in nature. The objectives may include: (a)

providing information on the incident and raising awareness of any risks (b) alerting

people to any immediate danger (c) providing information for avoiding harm and

obtaining assistance (d) advising on steps being taken to handle the situation (e)

explaining steps taken to recover and return to normal.

5. Agree the audiences including any vulnerable groups with particular communications

needs identified by Strategic and Tactical Command.

6. Determine the communication channels to be used. (See appendix 1 for the channels

that might be available during an emergency.)

7. Provide ongoing strategic communications advice to the Strategic and Tactical

Command. It is important that this strategic advice is not limited to the area of media

relations. The media have an important role in warning the public, however, there is a

need to consider a full range of communication channels at a strategic level.

A key element of any emergency strategy needs to be the engagement with the public.


of 62

Strategic communication advice also has an impact on the development of the wider

response strategy. There should be procedures in place to:

Provide information about public awareness or opinion to inform strategy

Support the identification of key individuals or groups critical to the success of

the strategy

Advise on strategic engagement with the media as a key channel of

communication

8. Agree process for managing any ‘on-site’ media at the location of the incident/on

NHSGCC premises. A media centre is not recommended however it is not realistic to

expect the media to remain off-site on public grounds. Therefore if required an area

should be identified where media can be cohorted.

9. Agree communication roles. In order to ensure consistency of communication it is

important to consider who should take the roles as spokespeople for the various

agencies.

10.Create resilience to respond to potentially protracted period of intense communications

activity. Where necessary this may include the provision of mutual aid by other Boards

not involved in the incident.

11.Recovery is a vital part of the process. There is a similar requirement for communication

with the public on the plans for recovery. This is part of an ongoing dialogue with the

public and provides a platform for future communications. It should be noted that the

Lead Responder may change at this stage.

12.Once recovery is complete, review Public Communications Group’s effectiveness as part

of overall incident debrief.


of 62

9.2 Specific Groups – Vulnerable persons

The care and support needs of a range of groups require special consideration.

The Local Authorities health may need to assist the responding agencies with the identification

of vulnerable persons who may be affected by the incident.

Within the Civil Contingencies Act 2004 and Preparing Scotland Care for People Affected by

Emergencies, the particular needs of vulnerable persons are recognised. The general

definition of vulnerable persons is: people present or resident within an area, known to local responders, who because of dependency or disability need particular attention during emergencies.

In terms of the Act, vulnerable persons are defined as those:

Under the age of 16

Inhibited in physical movement, whether by reason of age, illness (including mental

illness), disability, pregnancy or other reason.

Deaf, blind and visually impaired or hearing impaired.

In terms of Preparing Scotland

Children and young adults

Children may be involved in a Major Incident, either as casualties or as members of families or

groups caught up in the event. Catering for the needs of children and young people raises

particular issues. Particular attention should be paid therefore to Schools, Nurseries, Childcare

Centres and medical facilities for children.

There are a number of key issues to consider:

The relaying of accurate information to children and young people as well as adults is

vital.

The families of children and young people caught up in a tragedy need full and

accurate information as quickly as possible.


of 62

Formal debriefing meetings for children, young people and adults can be an important

part of the rehabilitation process. Staff with relevant expertise should be consulted at

an early stage of the response to any emergency where children and young people are

involved or affected. Working with children and young people brings its own particular

strains – arrangements must include the welfare needs of support workers.

It is important that staff and volunteers who have a specified role in dealing with children and

young people in the event of an emergency have undergone appropriate checks.

Elderly people and people with disabilities

Responders should give careful consideration to the needs of elderly and disabled people

involved in or affected by an emergency; they may have needs which necessitate additional

sensitivity, care or support, or the deployment of specific resources (e.g. mobility aids).

Disabilities are wide ranging and may include: physical or sensory impairment (e.g. hearing or

sight), learning difficulties, and mental health problems.

Local Authorities and Health will be aware of hospitals, residential and nursing homes, and day

centres where elderly people or people with disabilities reside or visit for day care.

In the event of an emergency, families and neighbours may also bring to the attention of

responding agencies elderly and disabled people who do not regularly receive Local Authority

or Health.

The Local Authorities and health may need to assist the responding agencies with the

identification of vulnerable persons who may be affected by the incident.

It is important that response arrangements make provision to meet any special needs and are

able to provide additional sensitivity, care or support that may be required. These needs may

relate to:

Information and effective Communication and understandingPractical advice and support

Medication; and Reassurance Personal emotional and psychological support Shelter and physical wellbeing


of 62

People with Learning difficulties and mental health problems

Existing facilities and procedures may be sufficient to assist people with learning difficulties and

mentally ill people during the course of a major incident. However, there may be small

numbers for whom additional and/or specialist assistance may be required.

Non speaking English communities

At the scene of an incident simple language guides should generally be available to assist with

incident management. Existing arrangements by Responder organisations may be sufficient

for dealing with the usual number of people from the non-English speaking communities.

However, the scale of an incident or the particular nature of the incident or the particular group

involved in an incident may require assistance being sought from other sources. There may be

a need for help from translators and interpreters. Any interpreters used should be aware of the

principles of responding to and recovering from emergencies.

Faith, religious, cultural and minority ethnic communities

Any emergency occurring in the UK is likely to involve members of different faith, religious,

cultural and ethnic minority communities. Their needs should be borne in mind by responding

agencies.

Particular faith, religious, cultural and minority ethnic requirements may relate to medical

treatment, gender issues, hygiene, diet, clothing, accommodation and places for prayer.

Depending on the faith, religion, culture and ethnicity of the deceased or bereaved, there may

also be concern about how the deceased are managed, and the timing of funeral

arrangements.

Sections of faith communities may have well established emergency arrangements. It is

therefore important to integrate their requirements into general contingency planning as far as

possible.

Reaching vulnerable persons and those who have difficulty understanding the message

The most appropriate method of communicating with vulnerable individuals should be adopted.

This may be the use of versions of documents produced for specific communities (older people,


of 62

ethnic groups) or the delivery of information via (for example) the management of schools or

day centres.

Warning vulnerable persons and those who have difficulty understanding the message

Vulnerable persons who live in residential homes or sheltered accommodation or attend day

centres are relatively easy to warn during an emergency because the establishment will be

known to Local Authorities and other responders.

Vulnerable persons living in the community are more difficult to contact. General advice to the

public to adopt a ‘good neighbour’ approach to help those less able to help themselves is

always advisable; but specific efforts will sometimes be needed by responders to deliver alerts

to those vulnerable persons who are known to them.

The Category 1 responder with lead responsibility for communicating with the public will need

to be assured that these vulnerable people can be contacted.

Arrangements will need to address how information and assistance can be managed by Local

Authorities and Health who are in regular contact with the vulnerable individuals.


of 62

Appendix 1 Communications Channels

Communications channels

In developing a communication plan it is important to consider how these different channels

could be used to ensure information reaches the appropriate audiences. An important element

will be the consideration of timescales.

Channel 1 - Broadcast media/media Radio broadcasts TV broadcasts Press

Channel 2 - Online communication Social media e.g. twitter Email - active/push communication Website - passive/pull communication

Channel 3 - Direct communication Establishment of a dedicated helpline (N.B. for specific health-related issues this service

is provided by NHS24) SMS/Cell broadcasting Door-to-door delivery Local signage/electronic notice boards Local PA/Loudhailers/Sirens

Channel 4 - Internal Communications Using internal processes to inform staff Use of staff as communicators

Channel 5 - Opinion formers/Community Leaders MPs/ MSPs/Councillors/Community councils

Channel 6 - Indirect/Network communications Voluntary organisations/community groups Business groups/trade associations


of 62

Appendix 2 Action Cards


of 62

ACTION CARD CMT Officer on CallResponsible for: The CMT Officer on Call is the lead for strategic liaison with Scottish Government and local partner agencies. Local resilience Partnership (LRP) is the multi agency group that seeks to unify the emergency response efforts of the Category One responders within the Strathclyde area. Each agency within the LRP must be prepared to send a representative who has sufficient authority to commit their organisation to undertake actions and to guarantee that the resources that they offer are delivered.Number

1. Setting the strategy within which the response is to be conducted

2.Considering the wider context within which the emergency is unfolding and taking account of the long term risks and potential impacts that may have strategic implications

3. Approving resource allocation required for the response

4. Ensuring accounts are maintained of all expenditure authorised as a result of the major incident response

5.Maintaining an overview of the emerging situation and the board’s response within the Acute Division, Partnerships and Public Health Department

6. Providing an appropriate level of guidance to the silver level roles within all areas of the organisation

7. Prioritising appropriate elements of the response in order to ensure the most effective allocation of resources

8. Deciding which normal services are to be reduced in order to provide resources needed for the response

9. Maintaining an overview of the NHS GG&C’s response and reporting it to Scottish Government as required

10. Contributing to the development of a common strategy across all agencies responding to the emergency

11. Representing the interests of NHS GG&C at a strategic level

12. Advising partner agencies of the impacts of the emergency on the board

13. Advising partner agencies of the capabilities and requirements of NHS GG&C

14. Identify the requirement to establish a board co-ordination centre to co-ordinate the board response


of 62

ACTION CARDOn call Consultant in Public Health

MedicineRole: If the incident involves hazardous substances, is likely to affect public health or is complex enough to require a Scientific and Technical Advice Cell (STAC) the on call Consultant in Public Health Medicine should assume the following responsibilities.

Number Action Time Completed

1.Liaising with Police and Fire & Rescue in order to establish initial

assessment of the situation

2.Liaising with the appropriate agencies to assess the local public

health impact of the incident

3.Discussing and deciding what immediate measures are required

to protect public health

4.Advising the emergency services of the decision and helping to

prepare a press statement if required

5.

Ensure that local Emergency Departments are aware of the

incident and the hazardous substance involved, inform GPs and

other relevant staff in the community of the incident, give advice

on remedial measures and ask for records to be kept of all those

affected

6.Providing the CMT Officer on Call with situation reports (through

the Board Emergency Coordination Centre once established)

7. Logging key actions and decisions.

8.Liaising with Police and Fire & Rescue in order to establish initial

assessment of the situation


of 62

ACTION CARD LoggistRole: recording and documenting all issues/actions/decisions made by the Incident Director/Incident Manager.

If the Incident Director attends SCG they will be accompanied by a loggist if possible. Within the Board Coordination, a loggist will always be present working direct to either the Incident Director or the Incident Manager.Number Action Time

Completed

1. The loggist must use the log book provided.

2.

On arrival all staff must wear Identification Badges. If the badges are

unclear the loggist must ask for clarification of who is present within

the room and their title.

3.The log must be clearly written, dated and initialled by the loggist at

start of shift and include the location.

4. All persons in attendance to be recorded in the log.

5. The log must be a complete and continuous record of all issues/

decisions /actions as directed by the Incident Director/Incident

Manager.

6.

Timings have to be accurate and recorded each time information is

received or transmitted. If individuals are tasked with a function or

role this must be documented and when the task is completed this

must also be documented.

The loggist is NOT: A gopher A general administrative support

The loggist MUST NOT: Take minutes Record for more than one decision maker Keep a separate chronological log Have responsibility for the decision/action


of 62

The log and all paper work becomes legal documentation and could be used at a later date in a public enquiry or other legal proceedings.

ACTION CARD Board Emergency Coordination Centre Manager

Role: Ensuring that the board’s strategic directions are carried out. They analyse and then allocate tasks that are received and liaise with the board’s senior management to ensure that the response is being conducted within the strategy that is set.


1.Contacting suitable officers to undertake the roles required to

respond to the emergency

2.Being aware of the need for subsequent shifts and to contact, check

availability then standby suitable officers

3.Monitoring all incoming communications and assigning tasks to the

appropriate members of staff

4.

Maintaining an overview of the tactical and operational response

ensuring that work is prioritised to comply with the strategic direction

set

5. Liaising with other Category One responders

6.Ensuring that a current situation report is maintained and being

prepared to provide short notice briefs to top management

7. Making sure that the board’s senior management is made aware of

any pressing issues that may alter or influence the board’s response

strategy



of 62

ACTION CARD Communications

Role: The effective management of information for the public and media in consultation with other NHS and partner agencies


1.Assume responsibility for managing all public information and media

communications on behalf of NHS Greater Glasgow and Clyde

2. Quickly establish all agencies involved in managing the major incident and its aftermath

3. Establish a Public Communications Group to ensure effective and regular communications between all agencies.

4.

The Public Communications Group agrees a system to ensure effective co-ordination of ongoing communications response e.g. establishment of a Public Communications Group email cell and regular conference calls between all agencies involved. Depending on the scale of the incident, the Public Communications Group can be facilitated by SGoR if appropriate. All communications should be shared throughout the duration of the incident with this group.

5.

Set clear communications objectives. In agreeing these objectives it is important to think about how communications can be proactive in nature. The objectives may include: (a) providing information on the incident and raising awareness of any risks (b) alerting people to any immediate danger (c) providing information for avoiding harm and obtaining assistance (d) advising on steps being taken to handle the situation (e) explaining steps taken to recover and return to normal

6.Agree the audiences including any vulnerable groups with particular communications needs identified by Strategic and Tactical Command.

7. Determine the communication channels to be used. (See appendix 1 for the channels that might be available during an emergency.)

8.

Provide ongoing strategic communications advice to the Strategic and Tactical Command. It is important that this strategic advice is not limited to the area of media relations. The media have an important role in warning the public, however, there is a need to consider a full range of communication channels at a strategic level. A key element of any emergency strategy needs to be the engagement with the public

9. Strategic communication advice also has an impact on the


of 62

development of the wider response strategy. There should be procedures in place to

10.Provide information about public awareness or opinion to inform strategy

11. Support the identification of key individuals or groups critical to the success of the strategy

12. Advise on strategic engagement with the media as a key channel of communication

13.

Agree process for managing any ‘on-site’ media at the location of the incident/on NHSGCC premises. A media centre is not recommended however it is not realistic to expect the media to remain off-site on public grounds. Therefore if required an area should be identified where media can be cohorted.

14.Agree communication roles. In order to ensure consistency of communication it is important to consider who should take the roles as spokespeople for the various agencies.

15.Issue media statements as required and ensure that, where appropriate, the website. Twitter feed, and Staffnet are updated regularly as necessary.

16. Ensure that all information supplied to the media is correct – casualty numbers should only be given out once they have been confirmed by the Police and Ambulance Services.

17.Monitor and keep records of all media coverage of the incident and ensure that the on call are made aware of what is being reported. Ensure that any misinformation is promptly corrected.

18.On stand down, ensure that all original documentation (including notes, flip charts, e-mails etc) is kept.ment all information given out, including details of who it was given to.

19.Review Public Communications Group’s effectiveness as part of overall incident debrief.

Logging key actions and decisions.


of 62

ACTION CARD Call TakerRole: The strategic communications hub of the Board Emergency Coordination Centre can expect to make and receive a large number of calls and as such an appropriate number of call handlers should be appointed to assist.Number Action

1. To be the initial point of contact for all calls coming into the team

2. Logging all of the messages received and sent

3.Highlighting pressing issues to the Board Emergency Coordination

Centre Manager.

4. To be the initial point of contact for all calls coming into the team

5. Logging all of the messages received and sent

6.Highlighting pressing issues to the Board Emergency Coordination

Centre Manager.


of 62

ACTION CARD Contact CentreRole: the central conduit through which all of the board’s response arrangements can be activated. The Scottish Ambulance Service Medical Dispatch Centre will notify the Contact Centre when a major emergency occurs. The contact centre will then notify the designated hospitals and board staff as required.


Ensuring that a suitable trained officer is available to answer the

telephone at all times

1.To make an accurate record of the alert message that is received

from the Scottish Ambulance Service Medical Dispatch Centre

2. Verifying that the message is legitimate

3.Activating the major incident call out plans for the designated

hospitals

4. Notifying the Blood Transfusion Service

5. Notifying the Central Decontamination Service

6. To contact the Acute Division’s on call director, pass on the alert

message and inform them of the need for an Acute Coordinating

Officer

7.To contact the on call Consultant in Public Health Medicine and pass

on the alert message


of 62

ACTION CARD FacilitiesRole: Providing advice and assistance in respect of estates and facilities issues


1.Identify what additional facilities are available to support the

response to the incident if required.

2.Advise on availability of / access to additional premises as necessary

and provide guidance on health and safety issues.

3.Ensure that any problems with facilities (e.g. heating, water,

electricity etc) are appropriately managed and promptly resolved.

4. Provide / arrange for specialist support and assistance as necessary.


6.On stand down, ensure that all original documentation (including

notes, flip charts, e-mails etc) is kept.


of 62

ACTION CARD Acute Coordinating OfficerRole: Where a major emergency is high profile, protracted or threatens to cause enough casualties to overwhelm the board’s capacity to respond the Acute Coordinating Officer is required to assist in the coordination of the response.Number Action Time

Completed

1.Coordination of a major incident that involves the activation of

more than one Hospital Major Incident Plan

2.

Notifying the CMT Officer On Call and keeping them informed

(through the Board Emergency Coordination Centre once

established)

3.Maintaining an overview of the response/available resources

within each receiving hospital

4.Maintaining an overview of the response/available resources

within each supporting hospital

5.Facilitating the sharing of resources between hospitals where

required

6.Requesting and facilitating mutual aid from neighbouring boards

where required

7. Passing situation reports to the CMT Officer on Call



of 62

ACTION CARD Partnerships Directors (or nominated officer

Role: Partnerships may also be required to mobilise their resources in order to facilitate a whole system response to a major incident. As partnerships are not routinely expected to provide emergency care a great deal of flexibility may be required when responding to a major incident.Number Action Time

Completed

1.Providing the CMT Officer on Call with situation reports (through

the Board Emergency Coordination Centre once established)

2.Disseminating situations reports received from strategic to their

partnership

3.Establishing which services can be reduced in order to free up

resources to assist the response

4.Creating capacity to treat P3 casualties within the community (if

required)

5.

Advising General Practitioners, Hospital Emergency Departments

and Council Rest Centres of referral/contact arrangements for

those badly affected by the incident to access mental health

services.



of 62

Appendix 3

Triage Category

Category Priority Order of Treatment

Patient Condition

Immediate Priority 1 1 Casualties needing immediate lifesaving resuscitation and/orsurgery

Urgent Priority 2 2 Stabilised casualties needing early treatment but delay is acceptable

Delayed Priority 3 3 Casualties requiring treatment but a longer delay is acceptable

Expectant Priority 4 4 Casualties severely injured who are unlikely to survive even if treated aggressively

Dead Priority 5 No further medical interventionuseful

Note: the triage process is dynamic - the condition of patients may change during the progress of the incident and therefore their condition would be monitored and frequently reassessed.

Numbers of Priority 1 & 2 patients that NHS GGC could support

Hospital P1 P2

Glasgow Royal Infirmary 8 30

Queen Elizabeth University Hospital

12 50

Royal Alexandra Hospital 5 20

Inverclyde Hospital 3 10

Total Number for NHS GGC

28 110


of 62

Hospitals

The decision as to the designation of hospitals will be made by the duty ambulance control

officer at Scottish Ambulance Service Medical Dispatch Centre, The objective of designation is

to allow for a regulated flow of casualties to the most appropriate health care facility in order to

ensure that casualties receive the optimum level of care.

Support Hospitals - These hospitals will support the Major Incident designated hospitals by

dealing with minor casualties from the incident or patients transferred from other hospitals.

Receiving Hospital Control Room Contacts

Hospital Control Room A&E Dept

Glasgow Royal Infirmary 0141 211 4961/2/3 0141 211 4314/4484

Queen Elizabeth University Hospital

0141 201 1478 0141 201 1456

Paisley Royal Alexandra 0141 314 6198 0141 314 6195

Inverclyde Hospital 01475 504 387 01475 633 777

Support Hospital Contacts

Hospital Contact

Royal Hospital for Children 0141 452 4056

Vale of Leven 01389 754121

New Victoria Hospital 0141 347 8475

New Stobhill Hospital 0141 355 1536


of 62


of 62

APPENDIX 4

POD Information

Callers should clearly give the details of the incident, the number of pods requested and their contact details:

Biological pods (oral ciprofloxacin)

To treat 100 or 250 adults, or 50 or 100 children, for 5 days, with post-exposure prophylaxis for anthrax, plague or tularaemia.

Further stocks of ciprofloxacin To complete a treatment course, and stocks of doxycyline to change treatment if required

Ciprofloxacin intravenous injection

For post-exposure treatment.

Gentamicin intravenous/intramuscular injection

For post-exposure treatment.

Potassium iodate tablets To block the uptake of radioactive iodine, plus information leaflets for the public.

Prussian blue For the treatment of thallium poisoningNaloxone For the treatment of opioid poisoning

The decision to request these medical supplies will normally be taken by the local, DPH, or Consultant in Public Health Medicine of their request.

Should an operational need for access to items from the central stockpile arise, the Scottish Ambulance Service West Ambulance Control Centre (ACC) should be contacted on 03333 990119. The caller should request to be transferred to the National Duty Manager.

The National Duty Manager will establish the identity of the caller, their direct contact number, the quantity of specified items required from the stockpile and where they are to be delivered. The ACC will be aware of the location of the items and will make the necessary arrangements via the Scottish Ambulance Service on call Tactical Advisor for transportation by the most appropriate means, which may utilise the existing commercial contract or emergency service vehicles.


of 62

Appendix 5

GLOSSARY OF TERMS AND ABBREVIATIONS

A & E Accident and Emergency [Department]

AIO

Ambulance Incident Officer - Ambulance Officer with overall responsibility for the work of the Ambulance Service at the scene of Major Incident. Works in close liaison with the Medical Incident Officer (MIO) to ensure effective use of the medical and ambulance resources at the scene

Bronze(Operational) Command

Operational Command – This is the front line control at the scene of any incident. Each of the Emergency Services at the scene carries its own operational responsibilities and deploys their own resources under the command of their own incident officers. Close liaison is essential and, where appropriate, the Police will normally act as the coordinator of the overall response at the scene. In a large incident, there may be several operational points reporting to tactical control

Cascade System System whereby one organisation calls out others who in turn initiate other calls as necessary

Casevac [caz-i-vak] Military-speak for casualty evacuationCasualty Bureau See Police Casualty Bureau

Casualty Clearing Station

An area set up at a Major Incident by the Ambulance Service, in liaison with the Medical Incident Officer, to assess, triage and treat casualties and direct their evacuation

Casualty Label Colour coded label used by Ambulance Service and medical teams to identify the priority of a casualty

CBRN Chemical Biological Radiological NuclearCPHM Consultant in Public Health Medicine

COMAH sites Industrial sites which are subject to the Hazards Regulations Control of Major Accident Hazards Regulations -

Controlled Area The area contained - if practicable - by the outer cordon

Cordon (inner) Surrounds and provides security for the immediate site of the major incident

Cordon (outer) Seals off the controlled area to which unauthorised persons are not allowed access – See Controlled Area

DPH Director of Public Health

Environmental Health Officer (EHO)

A professional Officer responsible for assisting people to attain environmental conditions which are conducive to good health. Most EHOs work for Local Authorities and are concerned with administration, inspection, education and law enforcement

EMRS Emergency Medical Retrieval ServiceEvacuation (or Rest) Centre

Building designated by Local Authority for temporary accommodation of people evacuated from their homes.

Gold (Strategic) Command

Strategic Command – This is the senior tier of management usually based in a pre-planned location with extensive communication facilities away from the scene of the incident. ‘Gold Command’ would only be used in a large incident to make strategic decisions about deployment of resources, managing populations, providing information and restoring normality.

MTPASthis is a national means of maintaining outgoing ‘land line’ call services for GTPS-listed subscribers, in times of crisis or war (incoming calls continue to be received).

Health Protection An agency which provides specialist advice and support for health


of 62

Scotland (HPS) protection and health emergency planning.+Hospital Control Team Team managing the whole hospital’s response to a Major Incident

Hospital Coordination Centre

The Centre set up at a receiving hospital to manage the in-hospital response; to collate, for internal use, data concerning casualties received (their condition, bed states, theatres available); and to provide information to the Police documentation team, as appropriate

ITU Intensive treatment unit

JCRRPJoint Casualty Reporting and Reception Plan. Military plan for coping (with NHS help) with military casualties evacuated to the UK from an area of conflict overseas

LRP Local Resilience Partnership

Major Incident

Any emergency that requires the implementation of special arrangements by one or more of the Emergency Services, the NHS or the Local Authority. For the NHS, a Major Incident is any occurrence which 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 Services or Health Authorities

MEC Medical Evacuation Cell (military)MIO Medical Incident OfficerNHS 24 24 hour health telephone helpline, staffed by nurses.NPIS National Poisons Information Service

PODSUK Reserve National Stock for rapid deployment in Major Incidents including equipment ,modesty ,nerve agent antidote and biological pods

Police Casualty Bureau

Police central contact and information point for all records and data relating to casualties, evacuees and others affected by the incident

RAYNET Radio Amateurs Emergency NetworkRDPH Regional Director of Public Health

Receiving hospital Any hospital designated to receive casualties in the event of a major incident

Rest Centre See Evacuation (or Rest) Centre

RIMNETRadioactive Incident Monitoring Network – The national response system (for overseas nuclear accidents) operated by the Department of the Environment, Transport and the Regions

RRP Regional Resilience PartnershipSCoRDS Scottish Resilience Development Service

SMS Short Message System/Service in Global Messaging System (GMS) cellular ‘phones

Silver (Tactical)Command

Tactical Command – With more serious incidents, agencies introduce a tactical level of management, at or close to the scene of the incident or in Administrative Offices. In a conventional ‘big bang’ type of Major Incident, the Ambulance Service would provide on-site tactical management. In other circumstances, a Health Authority or Trust may wish to establish a tactical level of management. The Tactical Command is used to determine priority in allocating resources, plan and coordinate when a task will be undertaken, and obtain other resources as required. The ‘Tactical Commanders’ are supported by regular interagency meetings and carry out overall general management.

SNBTS Scottish National Blood Transfusion Service


of 62

http://www.doh.gov.uk/epcu/#evacuation

STAC Scientific Technical Advisory Cell

Survivor Reception Centre

Centre set up by Local Authority or Police where people not requiring acute hospital treatment can be taken for shelter, first aid, interview and documentation. This is normally short term accommodation (i.e. operating for several hours)

Temporary Mortuary

Building accessible from a disaster area and adapted for temporary use as a Mortuary in which post mortem examinations can take place

TriageProcess of assessment and allocation of priorities by medical or Ambulance personnel prior to evacuation of the injured. Triage may be repeated at intervals and on arrival at the receiving hospital

VAS Voluntary Aid Societies –St Andrew’s Ambulance (St John Ambulance in UK) and British Red Cross Society


of 62

APPENDIX 6MAJOR INCIDENT PLAN PRODUCTION AND MAINTENANCE

It is essential to ensure that NHS GGC Major Incident Plan fully integrate with the plans of

all other organisations across the NHS and other public sector organisations.

All Major Incident Plans are subject to an annual review, on an ongoing basis. Additions

should be made to the plan in line with national guidance. There should be a nominated

lead with responsibility for the management and updating of the plan. When post holders

change there should be a clear and detailed handover.

Plans should be concise, helpful, easy to use and well presented with logical page

numbering clear text and written in straightforward English, (avoid the use of specialist

jargon).

Where abbreviations have to be used full explanations must appear at least once in the text

and/or in the Glossary.

It is recommended that the plan should be control numbered and issued within hard covers

to enable storage. The plan title should appear on the front of the plan and on the spine.

The use of ‘ACTION CARDS’ has been widely adopted in the NHS. All key post holders

should have a card, which briefly details the actions they should take in an emergency. The

on call pack should be carried with individuals throughout their on call period. Cards should

be protected by laminates and regularly checked and reviewed.

Staff on call should be familiar with the plan and its state of review at all times.

The Chief Executive has Overall statutory responsibility for Emergency Preparedness,

The civil Contingencies Unit will maintain and review the plans annually or as guidance or

events dictate.

It is the responsibility of all staff to make themselves aware of the Major Incident Plan and

other relevant documentation.


of 62

REQUEST FORM FOR CHANGES TO PLAN HOLDERS

Please photocopy this form when submitting change to plan holders. This form should remain in the Incident Plan for future duplication.

CHANGE OF PLAN HOLDER

Please change the register of plan holders:

From ………………………………………………………………………………………….

Job Title……………………………………………………………………………………….

Place of Work…………………………………………………………………………………

To……………………………………………………………………………………………….

Job Title………………………………………………………………………………………...

Place of Work……………………………………………………………………………………………

Signed…………………………………………………………………………………………

Date……………………………………………………………………………………………...

Print Name……………………………………………………………………………………

Position Held…………………………………………………………………………………

Please return to: Civil Contingencies Unit West House Gartnaval Hospital


of 62

RECORD OF AMENDMENTS

All amendments to the Major Incident Plan should be inserted into the folder immediately upon receipt and the original destroyed. This record sheet should be completed when any amendments are made.

AMENDMENT SIGNATURE DATE AMENDMENT NO.


of 62

REGISTER OF HOLDERS

Plan No. Name Title in Organisation1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21


of 62

Reception of casualties from abroad - Web viewWORD. This document is the ... which is possibly CBRN,...

Documents

Transcript of Reception of casualties from abroad - Web viewWORD. This document is the ... which is possibly CBRN,...