/KPCT-07-21%20Kirklees%20PCT%20MI by NHS Kirklees

MAJOR INCIDENT PLAN

Version: Last Revised: Ratified by Trust Board: Review date:

1.26 January 2007 June 2007

DOCUMENT CONTROL Version history January

Version number 1.26

Document name

Author

Comments

James Williams

With amendments following circulation

Kirklees PCT Major Incident Plan

Purpose The purpose of this Major Incident Plan (MIP) is to ensure that the Kirklees PCT is able to provide a co-ordinated response to incidents and emergency situations whose impact cannot be handled within routine service arrangements (in concert with all other agencies), in a timely and appropriate manner. In addition, it is to ensure that the trust fulfils its requirements as Category 1 responder as specified by the Civil Contingencies Act of 2004 Document author / further information

James Williams Deputy Director of Public Health St Luke's House Blackmoorfoot Road Crosland Moor Huddersfield HD4 5RH 01484 466077 James.williams@kirkleespct.nhs.uk

Lead Director for Emergency Planning Date of issue Review date Where stored Paper electronically

AMENDMENT RECORD Date 29/01/07

Sections DistributionList

29/01/07

1.7.11 & 1.7.12

29/01/07

Section Q4

29/01/07

All Sections

Author Mary McKenxie (Sally Rees 01484 466119) Mary McKenxie (Sally Rees 01484 466119) Mary McKenxie (Sally Rees 01484 466119) Mary McKenxie (Sally Rees 01484 466119)

Details Description change Alteration of wording Newer versions of Documents Removal of ‘Metropolitan’ from Council name and abbreviations and change of service name from ‘Social Services’ to ‘Adult Services’

DISTRIBUTION LISTS Full Copies Name

Position

Address

No of Copies

Rob Napier

Chairman

Netherfield House, 12 Riley Lane, Kirkburton

Mike Potts

Chief Executive

St Luke’s House

David Anderson

PEC Chair

20 Cumberland Avenue, Fixby Huddersfield HD2 2JJ

Bryan Machin

Director of Finance

St Luke’s House

Carol McKenna

Director of Commissioning & Service Development

St Luke’s House

Dr Judith Hooper

Director of Public Health

St Luke’s House

Gwen Ruddlesdin

Deputy Director of Primary Care

St Luke’s House

Denise Campbell

Deputy Director of Primary Care

St Luke’s House

Eve Scott

Assistant Director of Corporate Services/Risk

St Luke’s House

Liz Harrison Howard Barnes

Communications Manager Consultant in Public Health Medicine Health Protection Agency

Clare Simpson

Senior PH Manager

Beckside Court

Pat Patrice

Senior Portfolio Manager

Beckside Court

Stephen McGuire

Assistant Corporate Services Manager

Beckside Court

Robert Flack

Associate Locality Director

Dewsbury Locality

Lynne Hall-Bentley

Associate Locality Director

Spen Locality St Luke’s House

Ian Wightman

Associate Locality Director

Batley Locality

St Luke’s House

Emergency Planning Cupboard Sally Rees

Corporate Services Administrator Secretary of Public Health

Graham Wardman

Emergency Plan Lead

Calderdale PCT

On call bag

(On Call Director)

St Luke’s House

role in EP

Keeps master & spare copies

Edited Copies - These are all part of the community response Name

Position

Address

No of Copies

Mill Hill

Julie Caddock

Locality Manager –Dalton / Almondbury / Newsome / Crosland Moor Locality Manager – Kirkburton / Denby Dale

Holme Valley

Kath Evans

Locality Manager – Ashbrow

PRCHC

1 1

Angela Horner

Locality Manager – Greenhead/Lindley

PRCHC

Karen Johnson

Locality Manager – Colne Valley

Golcar Clinic

Julie Livesey

Locality Manager – Holme valley

Holme Valley

Melanie Wells

Operational Risk Manager

Beckside

Sean Westerby

Emergency Plan Lead

Kirklees

Monica Plested

Clinical Services Manager

Holme Valley

Julia Calcraft

Matron

Holme Valley

Joan Booth

Ian Rufus

Emergency Planning Lead

Sergeant 247 Richard Haigh Sally McIvor Stephen Stead Julia Suddick Mary McKenzie

Head of Adult Social Care Operations Responsible for the co-ordination of Adult Services Emergency Plan information Direct Operational Management contact Maintenance and distribution of Adult Services emergency plan information

Geraldine Jarvis Sally Baines

Head of Human Resources

Sandie Milnes Angie Watson

Head of General Medicine Dewsbury & District Hospital

Maria Hayes

Head of General Medicine Mid Yorkshire Hospitals NHS Trust

Jackie Howarth

Calderdale Primary Care Trust

Maralyn Noble

Senior Administrator

Calderdale & Huddersfield Trust, HRI Operations Support Huddersfield Police Station, Castlegate HD1 2NJ

Oldgate House

Eddercliffe Grange Bradford Rd, Liversedge SF5 6LP

St Luke’s House

Batley Health Centre Henrietta St Batley

Halifax Rd Dewsbury WF13 4HS Rowan House Aberford Rd Wakefield WF1 4EE Dean Clough Walk-in Centre Dewsbury Hospital 12 Central Arcade Cleckheaton BD19 5HD

Judith Byram

Ravensthorpe H C

Lyn Milnes June Hardy

Oldgate House

Gillian Bell

Zeb Patel

Savile Town Clinic Pentland Rd, Dewsbury WF12 9JR Woodkirk House Dewsbury Hospital Shaw Cross Clinic Leeds Rd, Shaw Cross, Dewsbury

1 1 1 1

Comments

Edited Copies continuedâ&#x20AC;Ś No of Copies

Name

Position

Address

Caroline Mullins Diane Sheard Gillian Waterhouse Helen Frain

Portfolio Manager Portfolio Manager

Batley Health Centre Batley Health Centre

1 1

Portfolio Manager

Batley Health Centre

Jo Whincup

Portfolio Manager Portfolio Manager

Margaret Summers

Portfolio Manager

Nigel Grimshaw

Portfolio Manager

Peter Horner

Portfolio Manager

Karen Hemsworth Jean Selbie Kath Riley

Central Arcade Cleckheaton BD19 5HD Central Arcade Cleckheaton BD19 5HD Central Arcade Cleckheaton BD19 5HD Central Arcade Cleckheaton BD19 5HD Central Arcade Cleckheaton BD19 5HD Beckside Court Beckside Court Beckside Court

1 1 1 1 1 1 1 1

Comments

Contents Document Control Amendment Record Distribution list Contents Summary SECTION 1 – WHAT IS EMERGENCY PLANNING AND WHO DOES WHAT? -

Definition of a Major Incident Command and Control Systems What does the PCT do in Command and Control Business Continuity Management Kirklees PCTs Specific Roles & Responsibilities Roles & Responsibilities of PCT partner agencies during a Major Incident

SECTION 2 – WHAT TO DO IN STARTING AN EMERGENCY RESPONSE -

The Alerting Mechanism for the NHS PHASE 1 – Receipt of initial Information PHASE 2 – Director on Call Initial Action PHASE 3 – Management of Incident by PCT Strategic Command Group PHASE 4 – Post Incident Follow Up

SECTION 3 - SPECIFIC ACTION PLANS -

A B C D E F G H I

Creation of Minot Injury Facilities Rapid Discharge Arrangements PCT Capacity to Care for Patients in the Community Increased Levels of Home Care Increased/Redistributed Primary Care Capacity Primary Care Outreach Media Management Legal Advice Health Protection

SECTION 4 - ACTION GUIDES FOR STAFF INVOLVED IN A MAJOR INCIDENT -

PCT Switchboard On-Call Director Chief Executive Or Deputy Director of Public Health/Public Health Lead Incident Room Co-ordinator Senior Manager Service Lead Incident Manager Communications Lead Locality Managers/Team Leaders Informatics Manager Security Manager Message Taker Administration Manager

Health Liaison Officer In-Hours PCT Switchboard Operator/Receptionists Strategic Control Group

SECTION 5 - SETTING UP THE PCTS MAJOR INCIDENT CONTROL ROOMS -

Setting Up the Beckside Corporate Control Room o Corporate Control Room Procedures

Setting up the PCT Strategic Incident Room at St Luke’s House

APPENDICES A. B. C. D. E. F. G. H. I. J. K. L. M. N. O. P. Q. R.

Responsibilities Of NHS Organisations In Emergency Planning Integrated Emergency Planning Accountability /Governance Layout Of Incident Room St Luke’s House Emergency Cupboard St Luke’s House Inventory List Message Form Corporate Control Room Media Contact Sheet Corporate Control Room Signing In/Out Register Meeting Room 1 – Corporate Control Room Beckside Court Flow Chart - How Messages Are Circulated Around The Corporate Control Room Meeting Room 2 – Planning Room Beckside Court Meeting Room 3 – Press Room Beckside Court Resources Required For Meeting Rooms 1 And 2 Beckside Court Organisational & Agency Responsibilities Decision Log Risk Assessment Major Incident Operational Library References

Summary Purpose of this plan The Kirklees PCT Major Incident Plan is a component of preparedness and is meant to demonstrate that the PCT: • • • •

Has up to date plans to deal with major incidents and emergency situations that are compliant and tested in accordance with national guidance Has involved key partner in the preparation and testing of its major incident plan Has identified the financial resources needed to respond to incidents and emergency situations that could affect the provision of normal services Can mobilise staff to respond to incidents and emergency situations that could affect the provision of normal services

The PCT will manage each incident based on the specific nature and thorough assessment of the needs of the incident i.e: A slow increase of activity: this will be managed initially by the sitrep and escalation plans systems in most cases e.g. extreme weather. A sudden incident: this Plan will be invoked immediately. There are 3 key supporting plans to this MIP: the community services response plan and the business continuity plans (see appendices for operational response plans). This document has been written to give guidance to staff on how to respond to a `major incident’. Such an incident may occur at any of the Kirklees Primary Care Trust (PCT) premises, within or outside of the Kirklees area. The documents aims is to provide guidance on how to respond to a regional or national `emergency’. The speed, unpredictability and nature in which major incidents and other emergencies can develop, is such that it is essential to have precise and clear arrangements for co-ordination and command and control. The command and control arrangements for Kirklees PCT are clearly defined in this Plan (see Section 1). The Kirklees PCT’s has a key role in ensuring a resilient local and regional multi-agency response to major incidents. As part of the West Yorkshire Local Resilience Forum, the PCT must ensure it has the capacity to respond effectively and deal with issues that might impact on the health and well-being of the population it serves, as well as providing mutual support when called upon. This plan has been drawn up in conjunction and consultation with our multi-agency partners and will be updated at 12 monthly intervals, or following a Major Incident or multi-agency event to test resilience and preparedness. PCT Training/Testing Of Plans No plan can be deemed effective unless it is tested in practice. The training of staff and regular reporting of this plan will be carried out in accordance with the Department of Health’s Emergency Planning Guidance 2005 (1.1). As a minimum requirement, NHS organisations are required to undertake a live exercise every three years; a tabletop exercise every year and a test of communication cascades (subject to audit by the Strategic Health Authority and Audit Commission). A register of tests and outcomes is kept by the Major Incident lead. Document control All updates, distribution, testing and other amendment to this plan will be monitored and recorded by the PCTs Major Incident Planning Lead.

SECTION 1

WHAT IS EMERGENCY PLANNING AND WHO DOES WHAT?

1.1.1

Emergency planning aims where possible, to prevent emergencies occurring. Should an emergency occur, good planning aims to reduce, control or mitigate the effects of the emergency. Emergency planning is a systematic and ongoing process which should evolve as lessons are learnt and circumstances change.

1.1.2

Good emergency planning should begin with the establishment of a risk profile to help determine what should be prioritised. This process enables plans to be constantly reviewed and revised and action put in place to deal with identified risks (see the Risk section & Appendix P).

1.1.3

Emergency planning may be categorised into: • Contingency response • Major incident response

1.1.4

The difference between the two is one of degree. A contingency response is one where the occurrence of an event will lead to a particular path being followed. This will not necessarily disturb the day-to-day working of the organisation.

1.1.5

A major incident is defined as “any event whose impact cannot be handled within routine service arrangements”. It can only be recognised and declared for each organisation by that organisation itself. What might be a major incident for one organisation will not necessarily be so for another. The mix of responding organisations will depend upon the situation. The National Health Service may be involved in a leading or supporting role in emergency incidents, and may be at normal working or contingency response level, when others are at major incident level, or the converse may apply. Individual NHS Trusts may activate a major incident when their resources, or those of its neighbours are overwhelmed. The Civil Contingencies Act 2004 defines an emergency as: “An event or a situation which threatens serious damage to human welfare in a place in the UK, the environment of a place in the UK, or war or terrorism which threatens serious damage to the security of the UK.” This definition is concerned with consequences rather than the source. The NHS tends to refer to Major incidents rather than emergencies. For the NHS, a major incident is defined as: “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 hospitals, ambulance trusts or primary care organisations.” (1.1)

1.1.6

It is most important for all staff to realise that in a major incident, you will do what you usually do but around a fixed problem, i.e. the incident.

1.1.7

Planning is expected on a generic basis, with appropriate consideration of specific local hazards. Examples of additional causes which may give rise to a major incident include:

•

Big Bang – a serious transport accident, explosion, or series of smaller incidents

•

Rising Tide – a developing infectious disease epidemic, or a capacity/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, hospital acquired infections, violent crime

•

Deliberate release of chemical, biological or nuclear materials

•

Mass casualties

•

Pre-planned major events that require planning - demonstrations, sports fixtures, air shows

These may occur as an acute emergency or a slower escalation of response. 1.1.8

In addition to the risks of major incidents related to seven sites in Kirklees district registered under the Control of Major Accident Hazards (COMAH), at least two other specific types of major incidents have been identified, namely the risk of flood and of major incident on the motorway and railway networks (Kirklees Council 2006 Adult ServicesEmergency Plan): •

The Environment Agency operates a Flood Warning System. Kirklees MC has a specific section in the Emergency Plan for Weather/Flood/Reservoir events. The Environment Agency has identified four specific flood warning and one severe flood warning areas, the most major affecting Dewsbury town centre

•

The A1, M62 and M1 are all used to transport chemical and radioactive materials (both civil and military) as is the county’s rail network.

1.1.9

Given the causes of such incidents then planning and action for such are assessed according to the size of the incident both in numbers of population affected and number of organisations:

1.2

Definition: the scale of a major incident in the NHS

1.2.1

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 managed without activation of special measures by means of established management procedures and escalation policies.

1.2.2

The levels of incident for which NHS organisations are required to develop emergency preparedness arrangements are: •

Major - individual ambulance trusts and acute trusts are well versed in handling incidents such as multi-vehicle motorway crashes within the long established major

incident plans. More patients will be dealt with, probably faster and with fewer resources, than usual but it is possible to maintain the usual levels of service. •

Mass - much larger-scale events affecting potentially hundreds rather than tens of people, possibly also involving the closure or evacuation of a major facility (for example, because of fire or contamination) or persistent disruption over many days. These will require a collective response by several or many neighbouring trusts.

•

Catastrophic - events of potentially catastrophic proportions that severely disrupt health and social care and other functions (for example, mass casualties, power, water, etc) and that exceed even collective local capability within the NHS

•

Although not formally described, there may be events occurring on a national scale, for example fuel strikes, pandemic or multiple events that require the collective capability of the NHS nationally.

1.3 Command and Control systems 1.3.1

A generic management framework has been agreed nationally for managing a major incident. It embodies the same principle irrespective of the cause or nature of the incident and remains flexible to the individual circumstances.

1.3.2

The PCT may operate at one or more of three levels of working – operational, tactical and strategic. An appreciation of these can help to clarify roles in planning and avoid confusion in response.

1.3.3

•

Strategic or Gold - The term strategic refers to the person in overall executive command of each service (health, including ambulance services, police, fire, etc) with responsibility for formulating the strategy for the incident response. Each strategic command (sometimes called Gold) has overall command of the resources of their own organisation, but delegates tactical decisions to their respective tactical commanders (sometimes known as Silver). Strategic command has a key role in strategic monitoring of the response to an incident.

•

Tactical or Silver - The term tactical refers to those who will attend the scene, take charge and are responsible for formulating the tactical plan to be adopted by their service to achieve the strategic direction. Tactical command should oversee, but not be directly involved in, providing any operational response (sometimes referred to as Bronze) in the incident(s).

•

Operational or Bronze - The term operational refers to those who will provide the main operational response to an incident, that is, be closest to the scene, and control the resources of their respective service within a specific area of the incident. They will implement the tactics defined by tactical command.

For an incident it is important to note that: The Strategic Health Authority will co-ordinate the health community’s response to a mass or catastrophic incident. The Chief Executive of the Strategic Health Authority, or a nominated Deputy, will lead a Strategic Command Group, which will make and implement decisions in the event of such an incident.

1.3.4

Normal relationships and lines of communication between NHS organisations will be superseded by these arrangements. It is expected that the decisions and instructions of the Strategic Command Group will be acted upon immediately by all organisations. (Financial and performance implications will be regarded as secondary issues to be considered separately).

1.3.5

It is recognised that independent contractors, including GPs, cannot be subject to these command-and-control arrangements. It is expected that PCTs will endeavour to engage and co-ordinate the contribution of such contractors in responding to extraordinary major incidents where required.

1.4

What does the PCT do in command and control?

1.4.1

The command and control in the PCT can be summarised by the following table:

Table 1 Operational (bronze)

Tactical (silver)

Strategic (gold)

Co-ordination

Policy & high-level liaison

Frontline PCT staff in major incident planning and response

1.4.2

Primary and community care service providers and managers

Operational Command Group

Chief Executive Office & on call directors; representation in another’s agency gold command (Police) Strategic Command Group

The NHS service-wide objective for emergency preparedness and response is: “To ensure that the NHS is capable of responding to major incidents of any scale in a way that delivers optimum care and assistance to the victims, that minimises the consequential disruption to healthcare services and that brings about a speedy return to normal levels of functioning; it will do this by enhancing its capability to work as part of a multi-agency response across organisational boundaries.” (The NHS Emergency planning Guidance 2005)

1.4.3

1.4.4

The underpinning principles for NHS emergency preparedness and response are: •

Speed and flexibility

•

Active mutual aid

It is the nature of major incidents that they are unpredictable and each will present a unique set of challenges. The task is not to anticipate them in detail. It is to have a set of expertise available and to have developed a set of core processes to handle the uncertainty and unpredictability of whatever happens.

1.5

Business Continuity Management

1.5.1

The PCT is required (under the CCA) to maintain plans to ensure that it can continue to exercise its functions in the event of an emergency so far as is reasonably practicable.

1.5.2

Business continuity management is a process which ensures that business can continue in the event of a disruption. The five critical functions that the PCT should consider in developing arrangements for business continuity are: 1. 2. 3. 4. 5.

1.5.3

Human Resources Buildings Supply Chain Service Capacity Utilities including Communications

In addition the PCT has specific responsibilities for planning its response to a major incident are to: •

Fulfil the requirements as a Category 1 responder under the Civil Contingencies Act (see appendices for full details)

•

Co-ordinate a local NHS response to a major incident

•

Develop a command and control structure that allows appropriate linkages to, membership of, communication with and other responses to local resilience arrangements including strategic, tactical and operational commands

•

Be accountable to the SHA or equivalent

•

Implement national policy and guidance in local context

•

Demonstrate high level of preparedness of primary care and community services and ensure that they can respond at any time

•

Mobilise primary and community care resources to support acute trusts and non acute trusts

•

Ensure that the PCT’s own staff, GPs, primary care and community care staff are appropriately trained and competent to plan for and to respond to a major incident with the induction process for staff including both general and specific guidance on planning and responding to major incidents

•

Ensure that the PCT’s own escalation plans for dealing with pressures recognises the higher-level requirements of a major incident

•

Develop contingency plans for business continuity in the event of a protracted incident

•

Ensure the resilience of its own estate, facilities and systems

•

Establish and maintain working relationships with other emergency services, local major organisations and other key stakeholders

•

Train and exercise in conjunction with local NHS partners and external multi-agency partners to an agreed schedule with the Local Resilience Forum

•

Take into account the needs of vulnerable groups of patients including children. This is particularly important in the event of a sustained major incident

•

Participate in local and SHA or equivalent emergency planning forum

•

Maintain, test and review internal capacity and emergency plans

(1.2)

1.5.4

Therefore, the PCT will have arrangements that cover: •

Executive authority to commit PCT resources for the whole healthcare economy

•

Working in a strategic role with key agencies

•

Ensuring appropriate senior management teams are in place to manage the PCT role during an incident

•

Management and deployment of operational staff

(1.2)

1.6

Kirklees PCTs Specific Roles & Responsibilities in a Major Incident

1.6.1

The PCT will: •

Assist acute trusts by providing staff where appropriate and supporting accelerated discharge

•

Co-ordinate community hospital bed capacity in liaison with local acute hospitals and any available local bed management system

•

Liaise with local authorities

•

Assess the effects of an incident on vulnerable care groups, such as children, dialysis patients, elderly, medically dependent, or physically or mentally disabled

•

Establish with local authority facilities for mass distribution of countermeasures; for example, vaccinations and antibiotics

•

Facilitate the administration of medications, prophylactics, vaccines and counter measures

•

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

•

Support screening, epidemiology and long term assessment and management of the effects of an incident

•

Provide psychological and mental health support to staff, patients and relatives in conjunction with the appropriate provider

•

Proactively communicate information to all PCT staff and ensure relevant guidance and advice is available, including communication to private facilities/providers where appropriate

•

Continue to provide core business services

•

Maintain liaison with and co-ordinate the response with the Strategic Health Authority or equivalent

•

Work with the local authority and community to support the recovery phase

•

Assess the medium term impact on the community and priorities for the restoration of normality

•

Consider the need for long term monitoring

•

Preserve all plans and documentation used or produced during the course of the emergency response (1.3)

Key principles for the PCT to use in any major incident are in section 2

1.7

Roles and responsibilities of PCT partner agencies during a Major Incident

Co-ordination with other agencies Multi-agency work is a fundamental aspect of the PCT major incident planning and response. Key agencies in the planning and response to major incidents are: the Police, Fire and Ambulance Services (‘the blue light’ services), the Mid Yorkshire NHS Trust, Calderdale and Huddersfield NHS Trust. Kirklees Metropolitan Authority with its Emergency Planning Services, and Adult Services. The Yorkshire and Humber Strategic Health Authority, other Acute Hospital Trusts, Mental Health Trust, PCTs, and partner agencies in the West Yorkshire or wider area, such as the Environment Agency.

1.7.1 i.

Representation at Police Strategic Coordinating Group One of the key responsibilities of the Kirklees PCT in Major Incident planning and response. is to provide representation at Police SGC. The PCT is aware that it could be requested to provide support in terms of representation at the Gold or Silver command and control levels of any agency involved in the response to a major incident. The Kirklees PCT representative at SGC must have a clear remit and be able to commit resources or be able to immediately contact someone in the PCT to do so.

ii.

The SGC must include a Public Health Advisor, usually a senior DPH and a senior HPA rep, part of this role is to manage the development and provision of a Health Advice Team which will usually be held at the Strategic Coordinating Centre.

1.7.2

Health Protection Agency (HPA)

Major incidents involving communicable disease, chemical and radiological hazards and terrorist deliberate release require specialist input. The Health Protection Agency. The HPA team i.e. the local Consultant/team in Communicable Disease Control must always be consulted and in many instances will lead the public health response on behalf of the Director of Public Health of Kirklees PCT.

ii.

The HPA: •

Provides expert advice to the DH on health protection policies and programmes

•

Is accountable through the CMO to the DH at a national level

•

Provides advice and support to NHS and RDsPH

•

Provides specialist emergency planning advice to NHS organisations

•

Provides resources to support the provision and delivery of Health Advice to the SCGs and RCCCs

•

Cooperates with others to provide health protection advice and information to the NHS, to the media and the public, in agreement within the DH

•

Provides training and exercise support on behalf of the DH.

1.7.3

Health Advice Team

Recent NHS guidance has indicated that health advice, including chemical biological radiological and nuclear advice will now be provided through the Health Advice Team (HAT) led by the designated Public Health Advisor. This replaces previous arrangements, i.e. a Joint Health Advisory Cell is no longer formed.

ii.

The HAT will include DPH or equivalent and is responsible for: •

Providing consistent PH and HP messages

•

Ensuring use and dissemination of its advice

•

Providing comprehensive and authoritative advice

iii.

The HAT may include specialists from a wide range of disciplines. Whilst desirable to bring experts together this is not always practicable and therefore members will be encouraged to use all methods of communication including video and teleconferencing resources.

1.7.4

Role of the GPs

The role of the GPs and their practices will normally be focussed on the continuity of care of their patients who have been affected by the major incident (see the prompt card of the Emergency Response Coordinating Group Senior Manager). The use of GPs within a major incident will be dependant on circumstances and availability. It is also likely that

the acute trusts may be reluctant to rely on GPs who are not adequately trained, unless overwhelmed by the major incident. The primary responsibility of the GPs will therefore consist of looking after their patients. There is the possibility of drawing on GP resources from adjacent PCTs. Kirklees PCT will involve Local Care Direct (formerly PENDOC) as extra resources to support the general practices if needed. (See contacts pack) 1.7.5

Responsibilities of the Police

The Police Force always leads the Major Incident Response, unless they direct others to do so or the Ministry of Defence (MoD) or the Cabinet Office Briefing Room (A) (COBRA) takes over.

1.7.6

•

The Police co-ordinate all the activities of those responding at and around the scene

• •

Police will form a Gold Command Team (strategic) to manage the incident. Unless severe weather or other natural phenomena have caused a disaster, information is preserved to provide evidence for subsequent enquiries and possibly criminal proceedings

•

Where practicable, the Police establish cordons to facilitate the work of the other emergency services in the saving of life, protection of the public and the care of survivors

•

They oversee any criminal investigation and facilitate inquiries carried out by the responsible accident investigation body, such as the Health and Safety Executive

•

They co-ordinate press information regarding the incident (the PCT may be required to contribute to the health information/human side of the story)

•

In the event of any situation which is or which is suspected to be the result of a terrorist incident, all activities within cordons are under the direct control of the Police

•

On a shared basis with Kirklees Council, Adult Services, the Police, and its Senior Identification Officer in particular, have a role to play in the support to the bereaved family

•

The Police set up a Casualty Bureau.

Police Casualty Bureau

•

In the event of a disaster, the role of the Police Casualty Bureau is to provide a central contact point for those seeking or providing information about persons who might have been involved in the major incident and to collect data and collate all records

•

As part of this process the police will send documentation teams to the receiving hospital(s), the mortuary and the survivor reception centre

•

The Police Casualty Bureau also handles enquiries from the general public about relatives and friends who might have been involved. This function interfaces with Mid

Yorkshire Hospitals NHS Trust, Calderdale and Huddersfield NHS Trust and Kirklees Council’s Major Incident plans 1.7.7

Role of the Strategic Health Authority (SHA)

The SHA will be notified of any major incident implementation by the lead director of the PCT. In the event of a mass catastrophe response they will coordinate the response of the local NHS. •

Responsibility for co-ordinating the NHS response on-site and determining the hospital(s) to which injured persons are taken, depending on the types of injuries received.

•

The Ambulance Service will seek the attendance of the Medical Incident Officer where necessary.

•

The Ambulance Service, in conjunction with the Hospital Medical Incident Officer and medical teams, seeks to save life and limb through effective emergency treatment at the scene. In conjunction with the Fire Service, they determine the priority for release of trapped casualties and transport the injured in order of priority to receiving hospitals.

•

They will also be involved in transporting discharged patients from responding hospitals to homes or to residential or nursing home accommodation, to create beds for casualties or decant beds.

•

They are responsible for patient decontamination (1.4). The Ambulance Service will provide, as far as possible, on-site resuscitation and decontamination (in accordance with the Ambulance Service Association guidance) working in conjunction with the Fire Service and other specialist teams (1.5).

•

The Ambulance Service has a Major Incident Plan that interfaces with the Gold, Silver and Bronze Command Structure of the other agencies.

1.7.8

Role of the South and West Yorkshire Mental Health Trust

The Associate Director - Adult Psychological Therapies of South and West Yorkshire Mental Health Trust will co-ordinate the provision of psychology support in the aftermath of an accident or incident. The majority of emotional support, counselling and practical interventions will be provided by statutory agencies or voluntary agencies. The coordination and provision of support to workers in these agencies will be organised by the Associate Director – Adult Psychological Therapies (1.6).

1.7.9

Role of the Voluntary Sector

In the course of a major incident, requests for assistance may be made to the voluntary organisations by the three emergency services, District Councils and the NHS. An agreement has been reached in West Yorkshire on how such requests will be coordinated (1.7). Any spontaneous offers of voluntary help will be referred to the Local Authority Emergency Planning Unit.

1.7.10 Responsibilities of the Fire Service • •

The first concern of the Fire Service is to rescue people trapped in a fire, wreckage or debris They will prevent further escalation of the disaster by: o Extinguishing fires or undertaking protective measures to prevent them o Dealing with released chemicals or other contaminants, in order to render the incident site safe. Focusing the main effort of decontamination at the incident site minimises the risk of secondary contamination (1.5) o Assisting the Ambulance Service with casualty handling and the Police with recovery of bodies

•

The Fire Service is responsible for the health and safety of personnel of all agencies working within the inner cordon of a Major Incident and will liaise with the Police about who should be allowed access to ensure that they are properly equipped, adequately trained and briefed

•

Submit a hazard analysis of chemicals involved in a release to the main responding hospital and the Health Protection Agency.

1.7.11 Responsibilities of Kirklees Council i.

Kirklees Council may be requested by the Police, or may choose once it is aware of the incident, to provide a wide range of welfare services (1.8): •

Rest/reception/evacuation centres

•

Social support

•

Coordinating and providing family liaison support on a shared basis with the Police and the Senior Identification Officer in particular

•

Disaster Appeal Fund

•

Rebuilding and development work

•

Temporary mortuary

•

Making available camping equipment from stocks held within the Youth & Community Education Service

1.7.12 Adult Services i.

In the event of a major disaster the Directorate of Adult Services of Kirklees Council will be responsible for:

•

Arranging for the provision of meals, temporary accommodation and any other assistance specified in the National Assistance Act 1948, to people who by reason of age, infirmity, disability or other circumstances are in need of care

•

Arranging for Social Workers to be available for short-term counselling & emotional support. Long-term and more specialised counselling will be organised by the South West Yorkshire Mental Health Trust

•

Providing information as appropriate regarding ‘vulnerable’ clients

•

Providing immediate support and counselling at the scene, rest centres and hospitals. Long-term support may be required under the coordination of the South and West Yorkshire Mental Health Trust.

1.7.13 Responsibilities of the Environment Agency i.

ii.

The Environment Agency has primary responsibilities for the environmental protection of water, land and air in England and Wales. It is responsible for maintaining and operating flood defences on rivers and coastlines. These responsibilities cover: •

Direct, remedial action to prevent and mitigate the effects of the incident

•

Providing specialist advice, giving warnings to those likely to be affected and monitoring the effects of the incident

•

Investigating the cause

The Environment Agency also collects evidence for future enforcement or cost recovery.

1.7.14 Involvement of the Military i.

In the event of a major incident, the armed services are authorised to provide all possible assistance to the emergency services where a threat to life exists. Local authorities can call directly upon military assistance under the Military Aid to the Civil Community (MACC) system.

ii.

The immediate assistance the military may be able to provide will depend on what is available at the time of the incident. Whilst no resources are specifically set aside for such assistance, if the incident is sufficiently grave, additional troops and assets may be tasked into the affected area.

iii.

In the event of a major incident, all requests for military assistance must be directed through the appropriate command and control structures.

iv.

There are two military divisions that cover West Yorkshire and contact details are included in the contacts pack.

SECTION 2 2.1

WHAT TO DO IN STARTING AN EMERGENCY RESPONSE

The Alerting Mechanism For The NHS

2.1.1 Overview i. Ambulance Trusts have specific responsibilities in terms of alerting NHS organisations in the event of a civil emergency and/or major incident. These are: •

Immediately notify, or confirm with police and fire controls, the location and nature of the incident, including identification of specific hazards, for example, chemical, radiation or other known hazards

•

Alert the most appropriate receiving hospital(s) based on local circumstances at the time

•

Alert the wider health community as the incident dictates.

ii.

Although many major incidents are triggered by `big bang’ incidents such as traffic accidents, explosions etc, there are other potential circumstances where an NHS major incident is triggered by a `rising tide’ or non-acute traumatic event, for example, infectious outbreak, power cuts, covert radiation leakage. In such cases the ambulance services may be involved but may not be the natural `alerting’ NHS organisation. In the event of a rising tide event, and/or a widespread incident, the communication cascade mechanism used should ensure referral via the Strategic Health Authority (SHA). The SHA will take responsibility for implementing command and control mechanisms and also the appropriate deployment of NHS resources. NHS organisations should endeavour to use the standard alerting messages whenever possible and for this reason, the alerting messages have been standardised (1.1).

iii.

If a MAJOR INCIDENT IS DECLARED by anyone other than the Ambulance Service, the Ambulance Service should be notified immediately.

2.1.2

Standard Messages used by NHS Organisations

To avoid confusion about when to implement plans, it is essential to use these standard messages:1. Major Incident – Standby This alerts the NHS that a major incident may need to be declared Major incident standby is likely to involve the participating NHS organisations in making preparatory arrangements appropriate to the incident, whether it is a `big bang’, a `rising tide’ or a pre-planned event

3. Major Incident – Cancelled This message cancels either of the first two messages at any time Fig 1

2. Major Incident Declared – Activate Plan This alerts NHS organisations that they need to activate their plan and mobilise additional resources

4. Major Incident Stand Down All receiving hospitals are alerted as soon as all live casualties have been removed from the site. Where possible, the Ambulance Incident Commander will make it clear whether any casualties are still en-route. While ambulance services will notify the receiving hospital(s) that the scene is clear of live casualties, it is the responsibility of each NHS organisation to assess when it is appropriate for them to stand down

*The decision to place the PCT operational (silver) or strategic command (gold) groups on standby or fully convene these groups, will be taken by the director on call following consultation with the CEO and DpH. (see action cards) The following section provides further guidance as to the activation of the PCT emergency plan.

2.1.3 Notification of a Major Incident to the PCT i.

This following details the key actions required to manage any emergency situation. Four generic phases with key tasks are identified (Table 2) and are to be read in conjunction with the contacts pack and the community response plans.

ii.

Kirklees PCT should be informed wherever a major incident is declared in the PCT’s geographical area or boundaries. This will normally be via Calderdale and Huddersfield NHS Trust Mid Yorkshire Hospitals NHS Trust, Yorkshire Ambulance Service or other key agency.

iii.

The PCT should be informed with a request for action:

iv.

•

where there are implications to public health beyond the immediate trauma response provided by the Ambulance Service and Acute Trust

•

when there is a need/input from primary healthcare and community services

•

when there is a significant impact on local services such as those of the local authority.

A request for action may be from: •

A senior manager within the PCT

•

The responsible senior officer from any of the emergency services or a senior officer within the Acute Trust

•

The Duty Public Health specialist after enquiry following a routine notification of an incident

•

The PCTs emergency response can only be initiated by a PCT Director

During normal office hours: Notification of an incident should be made to the Director of Public Health (this Director is the nominated Director for Major Incidents/Emergency Planning). This can be done by phoning 01484 466000.

vi.

Out of normal office hours: Any of the above people can instigate action by contacting the on-call Director of the PCT via Huddersfield Switchboard (01484 342000) who have a copy of the rota and contact numbers.

The director on call has the comprehensive contact pack for all relevant contacts.

Table 2 Phase

Description

Key tasks

Receipt of initial information by any member of the PCT (see section 2.2)

On-call Directorâ&#x20AC;&#x201C; initial action

1. Collection of information 2. Key messages to the informant (see Phase 1 section 2.2) 3. Contact the on-call director 1. Assess information and decide an emergency response is required. 2 Open incident management log 2. Verify +/- collect additional information 3. Assess risk and define status of incident 4. Inform DPH 5. Initial cascade of information 6. Initiate formation of PCT incident team 7. Oversee Set up PCT incident room 8. Scale incident up or down (find alternative arrangement Business continuity plans) 9. Inform the regional public health group. 1. Reassess risk and status of incident 2. Assess what action needed 3. Assess level of multi-agency co-operation needed 4. Assess sustainability of action 5. Activate Business Continuity or Generic Plans 6. Reassess action/risk in light of new information/outcome of action 7. Constantly record all information/decisions made 8. Initiate appropriate recovery planning options 1. Standing down process 2. Audit management of incident 3. Ongoing monitoring of effects and public/staff support where relevant 4. Lessons learned/debrief implement learning 5. Plans for post incident recovery

(See action cards for Director on call)

Management of incident by PCT strategic command group (See Action cards)

Post incident follow-up

2.1.4

Generic incident management principles

The following key principles (A.R.M.R) underpin planning and response to a Major Incident. • • • •

Assess React Manage Recover

ii.

This process is not linear but cyclical. Within the management phase, it may be appropriate to re-Assess the situation, which may result in a different set of Reactions, and tasks to Manage the incident. For example, the initial assessment of an incident may lead to reaction and management phases that prove to be inadequate, or the scale and nature of the incident may change. Any assessment should also include looking at issues related to the post incident Recovery options. These options should be assessed and recovery started as soon as is deemed safe to do so. Flexibility is required at all times. It may be appropriate to re-assess the situation at any point.

iii.

Outline of key incident management priorities and principles within Kirklees PCT 1. All major incidents should be managed using the PCTs appropriate emergency planning command and control systems and should not be managed by an individual in isolation. 2. Maintenance of essential services over a prolonged period of dealing with an event. 3. Maintaining access for the public to GPs for mainstream essential services. 4. During an emergency, day to day work will be prioritised and staff may be required to work extra hours to ensure that essential business is completed. The PCTs HR team are developing an appropriate support policy for staff in these situations (see HR policy). 5. Safety of staff at work, i.e. minimising risk from infection and abuse. 6. Separating people with symptoms of infection from the rest of the population. 7. Working within existing resources, staff, premises and equipment. This means not relying on extra supplies of routine equipment once an incident (particularly pandemic) has started. 8. Using mainstream systems in a event rather than inventing new ones. 9. People involved doing what they usually do but for the specific event. 10. Patient confidentiality remains important. 11. Ensuring safety of stocks and distribution of vaccine and relevant drugs both in storage conditions and abuse by the public. 12. Maintaining supply of all drugs. 13. Minimising waste and dealing with it safely. 14. During an emergency, normal procedures for staff consultation may not be therefore normal systems of engagement and consultation may not be possible. The principles of ensuring staff safety will be foremost however the normal chain of command may be overridden in exceptional circumstances in line with decisions from the PCTs Strategic Emergency Planning Group. 15. All staff must wear identification badges during an incident.

2.2

PHASE 1 - RECEIPT OF INITIAL INFORMATION

2.2.1

Information about a potential emergency situation could come from a variety of different sources for example:

Table 3 Potential Sources of alert information Official: I.e. DoH; government office Yorkshire and Humber; SHA; Chief Medical Officers cascade; Health Protection Service; NHS Trust, other PCT’s emergency services (ambulance, fire , police); Environment Agency etc. Unofficial: I.e. Media - Radio, print media, TV; ‘Grapevine’; Member of public

ii.

Whilst it is probably that this information will be received by the Switch board at Huddersfield Royal Infirmary (HRI). Initial contact may come into any member of staff. All members of staff have a duty and responsibility to collate and pass on this information to the director on call to ensure a proper activation of the PCTs emergency response. They should therefore ensure they contact the HRI switchboard as soon as they are made aware of an major incident. (see switchboard action card and additional information at Section 4)

2.2.2

Collection of information from informant

As a minimum the following information should be collected by the member of staff receiving the initial call: • • • • • •

Name, title, telephone number and organisation of the informant Name, title, telephone number of the person from the informant’s organisation who can be contacted for further information Nature of the incident and location. Number of casualties / estimate of effect What other services have been informed / are currently involved (e.g. fire, police, ambulance, acute trust, other PCTs, LA emergency planners) Is the media aware / involved?

ii.

An incident notification form should be completed and a copy placed in the incident management log.

2.2.3

Message to the informant

The informant should be given the following information: • Name and title of the person they are speaking to • Name and title of the person who will take charge and deal with the information as a matter of urgency • No other information should be given

ii.

If appropriate (i.e. urgent action is requested by the informant) the informant should be immediately transferred to the manager in charge.

iii.

If the informant is a member of the media and requests a statement, no further information should be given but an assurance that a statement will be issued in due course by the press officer.

2.2.4

Contacting the Director on call

Huddersfield Royal Infirmary switchboard (Calderdale and Huddersfield NHS Trust (CHT)) operate several on-call rota’s e.g. mental health, Health Protection Unit (Public Health), PCT ‘oncall’ managers/directors. You may need to specify which rota(s) needs to be activated. i.

Rota for the PCTs on-call directors is available from: • •

ii.

Information should be passed to the on-call Director, day or night, if there is thought to be an actual (i.e. now) or potential (in near future) risk: • • • •

iii.

During office hours PCT Headquarters St Lukes House Huddersfield 01484 466000 or Beckside Court Batley 01422 35111 Out of hours Huddersfield Royal Infirmary switchboard 01484 342000

To the health of individual(s) in the PCT area Disruption to the local health service Damaging media story Need to mobilise local resources to help neighbouring health services

Do not assume the on-call director already knows about the incident; document and pass the information on. If in doubt, err on the side of caution and pass the information on.

2.3

PHASE 2 – Director on Call Initial Action

2.3.1

Open incident management log and start to record all:

• • •

Information received Reason decision made Action taken N.B: Date, time and sign all entries The log may be used as evidence in subsequent public enquiries / criminal investigations. The log must provide a chronology of events and a list of decisions / actions taken, with reasons. Forms are available in appendix. When computers are used the information must be printed immediately to ensure that nothing is lost in the event of a system failure.

2.3.2

Verify information and seek and record additional information as necessary Informant or other sources may need to be contacted to verify the initial information. Additional information may be needed so that a rapid risk assessment can be made and the appropriate PCT response initiated.

2.3.3

Assess risk and define status of incident

Risk assessment – the following needs to be assessed: 1. What is at risk? • The health of local individual(s) • Local health services • Public confidence in NHS • Health/services of neighbouring areas 2. Current level of damage 3. Worst case scenario and likelihood of occurrence (see Risk Assessment Template Appendix P for supporting information and 5x5 matrix)

ii.

If serious risk, think – who needs to be involved i.e. does the scope of the incident exceed the PCTs capacities and capabilities/is there a need to alert other agencies. For further guidance review the West Yorkshire Emergency Planning Forum. “Who Does What in Emergencies?” (see Section 1). Copies available in the reference libraries in incident rooms (see also organisational roles and responsibilities Appendix N).

2.3.4

On-call director immediate actions (see action card in Section 4 for specific responsibilities) 1. Contact CEO and DPH to inform them that an incident is taking place. 2. Take initial control of the incident 3. Inform the individuals listed in Table 4 of the nature of the incident or arrange a cascade for this to happen within this list 4. Decide location of incident room and level of incident, or ascertain where incident room is located if lead agency is police, acute trust etc. 5. Follow risk assessment and business continuity process to assess whether PCT operational response group or strategic command group need to be placed on standby.

Table 4 Initial cascade of information from on call director Individual * PCT Chief Executive

DPH

PCT Manager responsible for emergency planning Nominated incident room cocoordinator Communications Manager

Strategic Health Authority

Information switchboard should give individual • Very brief outline of incident • On-call Directors mobile number • Need to go to PCT *identified incident room as soon as possible • Very brief outline of incident • On-call Directors mobile number • Need to go to PCT *identified incident room as soon as possible • Very brief outline of incident • Need to go to PCT incident room as soon as possible

Contact Details (See also Section 5) •

• •

•

• • • • • •

Kirklees Council Emergency Planning lead

• • •

Regional Director • of Public Health • (GOYH) •

Very brief outline of incident Need to go to PCT incident room and begin setting it up as soon as possible Very brief outline of incident On-call Director's mobile number Need to go to PCT incident room as soon as possible Very brief outline or incident Incident team in process of being formed On-call Directors mobile number and incident room number Very brief outline of incident Multi-agencies assistance Impact on Kirklees locality

•

Very brief outline or incident • Incident team in process of being formed On-call Manager’s mobile number and incident room number

* there will need to be a nominated deputy at all times and/or clear understanding within the PCT as to who will assume these roles if individual is not immediately available or unlikely to be available within approximately 1 hour.

2.3.5

PCT Major Incident rooms are located at:-

i. ii.

Board Room St Luke’s House/Committee room St Luke’s House Meeting Room 1 Beckside Court (see Section 4 Action Cards for Incident Room Coordinator Role setup)

iii.

The site of the major incident room will depend on the site and nature of the event. Geography may dictate that If in the Huddersfield area then the Boardroom at St Luke’s House may be utilised. If in the north Kirklees area then meeting room 1 at Beckside court may be utilised.

iv.

In addition should there be a need to establish an operational control room there are a number of community incident rooms that have been identified to support the community operational response. Other agencies have also agreed to provide the Kirklees PCT with access to their incident rooms should mutual support be required (details in contact pack).

Please remember to cancel any meetings planned in the room used.

2.3.6

Initial cascade of information (see Action Cards, Section 4)

Following risk assessment and a decision to initiate the PCT response the on-call director should personally inform the HRI switchboard (out of hours) of the situation and ask them to do the following: • Record all information received regarding the incident • Pass any further information to the on-call PCT director/incident room • Pass all inquiries for information from press/public to the incident room

2.3.7

Formation of PCT Strategic Command Group

Directors and other Senior Managers will generally fulfil their normal roles during an incident, however they may have additional duties during a major incident. Following risk assessment and depending on the type of incident, the PCT may take a decision to convene the operational or strategic incident management teams. They will also identify a person to be an incident commander. Possible members and roles are shown in Table 5.

Table 5: PCT Strategic Command Group Person Incident Director (Chief Exec or nominated deputy from directors) DPH Senior Manager Responsible for Emergency Planning. Incident room co-coordinator Incident log administrator Head of Communications

Role Strategic lead able to release resources Public health advice Emergency planning advice Support DPH in advising on emergency planning and undertake any required duties Set up incident room Implement cascade Manage personnel Maintains records and information in/out Manage media and public information

HR manager Risk Manager Business Continuity Manager Locality Manager(s) Senior manager liasing with other incident rooms eg hospital trust

HR advice Linked to risk management strategy and business continuity Linked to business continuity Linked to community response May need to be based in other incident rooms eg hospital or council.

ii.

The Incident Room Coordinator will be tasked with setting up the incident room, there is also a list of trained staff to support this.

2.3.8

Set up the incident room (see Appendix D, I, K, L & M)

Instructions on the layout of the incident rooms are in the emergency cupboards at St Lukes House and Beckside Court •

ii.

Each PCT incident room is pre-wired and arrangements are in place to equip at short notice with: • • • •

iii.

In the event of a major incident which involves a major casualty event (MAJAX) the acute trusts (Mid Yorks-Calderdale and Huddersfield NHS Trust) will establish their own incident rooms at their premises. The PCT will liaise directly with the affected acute trust.

Computers Phones Faxes Lock up cupboard, white boards and stationary etc.

THE PCT EQUIPMENT IS TESTED ON A REGULAR BASIS AND ANY DEFICITS RECORDED.

2.4

PHASE 3 – Management of Incident by PCT Strategic Command Group Once formed, the PCT Incident Team should:

2.4.1

Reassess risk and status of the incident It is important to be aware that the situation may rapidly change and levels of risk may escalate suddenly.

2.4.2

Assess what action is needed (see Table 6 below for some examples)

NOTE This is the strategic plan and all actions below in Table 6 will be delivered using relevant community response plans, escalation plans, hospital plans, or business continuity delivery plans. Table 6 Type of incident Surge in demand for NHS care

Decrease of disruption to supply of NHS care Untoward incident

Release/outbreak CBRN

Displaced population High risk media story

Examples of action that may be required (see section 3 for fuller explanation of action stages as indicated by alphabetical letters 3) • Creation of minor injury facilities in primary care / near incident site (A) • Rapid discharge arrangements (B) • PCT capacity to provide care in community (C) • Increase levels of home care available (D) • Increase/redistribution of capacity in primary care (E) • Media strategy/public information (G) • Helpline (H) • Psychological support (I) • Urgent investigation of incident / look back exercise (J) • Legal advice (K) • May be associated disruption to service (B/C/D/E) • Media strategy/public information (G) • Helpline(H) • Psychological support (I) • Health protection (K) • Increased capacity acute/primary care (A/B/C/D/E) • Media management (G) • Care of displaced population (F) • Care of displaced population (F) • Helpline (H) • Psychological support (I) • Media strategy/public information (G) • Helpline(H) • Psychological support (I) • Legal advice (K)

Section 3 of this plan provides details of how to implement different actions.

2.4.3

Assess what level of multi-agency co-operation is needed

Different levels of response may be established, depending on the size and nature of the incident (e.g. CBRN deliberate release).

ii.

Health advice at Regional Strategic Gold level will now be provided through a Health Advice Team (HAT) led by the designated Public Health Adviser. See the responsibilities section in the appendix for further info.

2.4.4

Response to an Extended Incident

This is more likely to happen if a ‘rising tide’ continues to rise or a ‘big bang’ incident becomes broader and more protracted. A “recovery Working Group” should be convened as soon as possible once the immediate containment of the incident has occurred.

2.4.5 .

Reassess regularly •

Use the key questions in 2.4 to reassess the situation regularly

2.4.6

Constantly record all information/decisions made, sequentially with time and signature

Incident log manager/administrator will ensure this happens. All involved must use the standard recording systems.

ii.

It is important that all information and decisions with rationale are recorded in the standard formats logged and filed. If individuals wish to keep their own notes then these must be in the incident room notebooks and remain the property of the PCT.

2.5

PHASE 4 – POST INCIDENT FOLLOW UP

2.5.1

Stand down procedures

All staff should assume that the major incident plan remains in force until told otherwise by their line manager. The lead incident Director within the Strategic Command Group will declare the incident over for the PCT, following consultation with key personnel and relevant agencies. The following considerations will be taken info account: • • • •

The Incident has been controlled. The immediate needs of affected people have been met. Public concerns have been addressed This will result in a notification to staff to ‘stand down’ from all emergency procedures.

ii.

Information about the cessation of the incident should be cascaded to all line managers as soon as possible at the end of the incident.

iii.

Procedures should be put into place to ensure business can return to normal as smoothly and as quickly as possible. Before it disbands, the team should decide how to ensure that experience gained and lessons learned are not lost. They should agree ways to: • partner agencies • All involved should be thanked for their involvement.

2.5.2

Debrief

The Incident Director will debrief staff following a stand down, outlining the recovery process and delegating responsibilities. The recovery options should be identified as soon as possible at the start of an incident stage down of a major incident.

ii.

The following tasks are required to be undertaken by named managers, identified by the PCTs Strategic Command Group:

2.5.3

Completing the recording of the incident • •

records and files created with regard to the incident are collected, safely stored and, if required, produced for the revision of plans an official report to assist with the gathering and preparation of evidence for any subsequent inquiry is prepared

2.5.4

Audit of the incident • oversight of the debriefing and recording process and a formal review is conducted, feeding results into a review procedure. • evaluation of the PCTS response to the major incident (including a multi-agency evaluation) is undertaken How was the incident handled? What problems were there? What needs to be changed to ensure a better response next time if appropriate? • Identification of any support services needed by staff involved in the major incident • Consider the effect of the incident in relation to PCT business i.e. LDP targets/waiting lists etc • Review the major incident plan and operational plans for improvement • consideration of the legal and financial risks that might ensue • Ensure shared learning and a full debriefing with other agencies involved.

2.5.5

Ongoing monitoring

In conjunction with the Health Protection Unit, the PCT should ensure that, where appropriate, health effects from the an incident are monitored.

2.5.6

Incident Report

An Incident report should be produced within four weeks of declaring the Incident over. The lead incident Director should write the initial report in collaboration with the incident management team. It should be borne in mind that the report will be a public document and may be used in any public enquiry or legal proceedings. Patient confidentiality should be maintained throughout the report.

ii.

Following the publication of the Report, a formal review of the major incident plan should be instigated, immediately addressing any areas of concern raised by the report.

2.5.7

Documentation

It is essential that all decisions and actions taken by Primary Care Trust staff are documented. In the event of a public enquiry or legal action this documentation may be called upon. All notes, paperwork or other material should be collected and kept in a secure location until it is agreed that it is safe to destroy it. It is important that incoming calls are documented as well as outgoing to show the flow of information

2.5.8

Social, Psychological and Psychiatric Support

There is a crucial role for properly trained mental health personnel in the treatment and support of victims of all ages, their families and carers, and of staff involved in the response. Support may be needed both in the immediate aftermath of the incident and in the longer term

ii.

Psychiatrists, psychologists, social workers and religious leaders may carry out this work. The quality of their training and experience is as important as their profession. A system of triage will help to identify priorities and ensure that those who most need help receive it. Many people are best served by support from family and friends but some may need further professional help some time after the events.

iii.

Inappropriate counselling can be harmful. Major incident planners should be conscious of the dangers of over-medicalising the normal and appropriate emotions of fear and distress.

iv.

Kirklees PCT staff have access to counselling services through: a. Occupational Health (this provision is limited). b. the PCT maintains a list of staff trained in counselling who have volunteered to support their colleagues c. Kirklees Council have trained a number of staff through Adult services to provide psychological support to individuals affected by a traumatic incident. d. SWYMHT have some resources to support as well.

Individuals caught up in a major incident may need the supportive framework provided by social and psychological services in which they can come to terms with the effects of the disaster on their lives. Not only does this rapidly get help to those who need it, but it may also reduce long-term and chronic demands on health and social services.

SECTION 3

SPECIFIC ACTIONS PLANS

This section explores specific actions the PCT may need to take in response to the types of incident envisaged in Table 5. There are supporting plans for these either from Business Continuity, adverse incidents or PCT escalation plans.

CREATION OF MINOR INJURY FACILITIES

At the scene of the incident

•

It is not envisaged that PCT staff will attend an external incident.

•

If there is a specific request for assistance from the incident. PCT staff will only enter the outer cordon.

•

Entry to the inner cordon would only be with specialist advisors and the appropriate safety equipment adequate for the risk. (see appendices for setting up cordons etc)

•

Specialist medical equipment or POD stock will be accessed through Yorkshire Ambulance Service.

Minor injury facilities in Kirklees PCT buildings

•

The PCT has a walk in centre on the grounds of Dewsbury Hospital. This could be used to treat minor injuries during an incident. In addition some GP practices may be able to support the treatment of walking wounded and patients with some minor injuries (a full audit of PCT capabilities is ongoing)

•

Activation and delivery of minor injury treatment plan will be through PCT Business Continuity Plans when completed.

•

Staff will be drawn from the PCT’s Skills register and by agreement with the GPs and the out of hour’s providers. In an emergency, Local Care Direct can provide day cover for surgeries, this cost would be borne by the Kirklees PCT.

RAPID DISCHARGE ARRANGEMENTS

The PCTs Business Continuity Plans have mechanisms for: where are these ? •

Activating rapid pre-discharge assessments

•

Partnership working with Adult services

•

Partnership working with acute trusts

•

Transport plans

PCT CAPACITY TO CARE FOR PATIENTS IN THE COMMUNITY

Kirklees PCT has some community bed capacity that can be used to support the management which may require supporting patients in the community. This capacity is accessed through the PCTs relevant Escalation and Business Continuity plans. These plans will be initiated under arrangements by the Operational Command Group, in partnership with locality managers and director of provider services. These plans facilitate the: • •

Identification of relevant capacity in PCT community premises in and out of hours Calculating the number of patients that can be cared for at each location and range of care that can be given

•

Identification of other locations (e.g. nursing homes, residential homes) that could provide intermediate care

•

Partnership working with the local authority

•

Financial arrangements

INCREASED LEVELS OF HOME CARE

The PCTs escalation and Business Continuity plans have mechanisms to support: •

Delivering additional home care support

•

Access to additional staff via skills register

•

Access to necessary equipment

•

Calculating the number of patients that can be cared for

•

Identifying the level of care that can be provided

•

Financial arrangements

INCREASED / REDISTRIBUTED PRIMARY CARE CAPACITY

In the event of Primary Care facilities becoming unavailable patients can be redirected in and out of hours access to via Local Care Direct and other mutual support systems.

PRIMARY CARE OUTREACH

The Business Continuity plans (when completed) will have mechanisms for: • Providing care for displaced persons in partnership with the Local Authority for people living in temporary accommodation or LA evacuation centres; • Transport plans for mobilising staff and equipment; • Access to medicines through pharmacy arrangements; • Financial arrangements.

MEDIA & COMMUNICATIONS MANAGEMENT

In any emergency or crisis situation, clear communications between all those involved is vital. Effective communications with a range of audiences, including the media, must be seen as integral part of emergency planning. Appropriate mechanisms will be required for providing information to staff, partners, stakeholders, any patients who are/have been involved or affected by the incident and the public at large.

Crisis communications activity will be aimed towards making sure effective communications with those affected by the crisis (e.g. staff, patients and carers) and minimising the effect of negative media interest on the reputation and image of the Primary Care Trust. The PCT will also make direct arrangements with NHS Direct and enable them to effectively respond to the questions of the concerned public.

The role of the communications/press officer will depend upon the nature of the incident and the level of response required from the PCT but will involve liasing with senior managers involved and any partner agencies to make sure appropriate briefing mechanisms are in place and that messages to the public via the media are clear and consistent (see Section 5.15 of (1.1)).

Working with all agencies a media strategy/plan containing key facts will be drawn up. This will be reviewed on a daily basis in response to media coverage. Consideration will also be given to setting up a central media point near to the incident and/or a media briefing centre nearby.

LEGAL ADVICE

Some form of legal advice will be provided by relevantly trained PCT personnel (i.e. Health and Safety etc). The PCT has access to specific legal advisors. Contact details are in the contacts pack. How to obtain legal advice in and out of hours (to be arranged).

Under no circumstances must any document, which relates or may in any way relate (however slightly) to the incident, be destroyed, amended, held back or mislaid. For these purposes â&#x20AC;&#x153;documentsâ&#x20AC;? means not only pieces of paper, but also photographs, audio, and videotapes, and information held on word processor or other computer. It also includes internal electronic mail.

HEALTH PROTECTION

The remit responsibilities and role of the PCT with regard Health Protection is contained within the roles and responsibilities section in the appendices. PCT will expect the HPA to provide assistance and support in terms of a health protection incident.

SECTION 4

- ACTION GUIDES FOR STAFF INVOLVED IN A MAJOR INCIDENT

NB: Please remember that the job you are given may not be your normal job

Structure

This chapter contains the following action guides Topic Switchboard On-call Director Chief Executive / Deputy Director of Public Health/Public Health Lead Incident Room Co-coordinator Senior Manager Service Lead Incident Director Communications Lead Locality Managers/Team Leaders Security Manager Message Taker Administration Manager In-Hours PCT Switchboard Operator/Receptionists Strategic Command Group

PCT Switchboard

Notification of an incident

Notification of an incident will come from either:• The Chief Executive • The Director of Public Health • On-call Director • A Service Director • On-call senior manager • Duty Senior Nurse • Team leader / co-ordinator • From an external agency • Any other source

On receipt of notification

To be directed by Incident Director

Refer to contacts pack for all contact details

ACTION CARD HRI PCT SWITCHBOARD

Step 1

Action

Inform the following: The Chief Executive The on-call Director

Complete the actions listed on message sheet

Deal promptly with all internal and external calls and record any information on message sheets

Any important information must be passed on to the Incident control team immediately.

All enquiries from relatives of patients will be referred to a nominated member of the incident control team specified to you at the time of the incident

All enquiries from the media, must be referred to the Incident Control Team

ACTION CARD DIRECTOR ON-CALL Step

Action

Respond to initial report and assume command. Assess whether incident meets criteria for an emergency response using appropriate initial risk assessment Ensure emergency services have been called (if necessary) Start log of events Inform Chief Executive, Director of Public Health, Ensure that Huddersfield Royal Infirmary switchboard is aware of the incident Inform the individuals listed in Table 4 of the nature of the incident or arrange a cascade for this to happen within this list (see cascade list below)

2 3

Assess risk and define status of incident and need to place PCT operational or strategic command groups on standby. Please note that the Community Response mechanisms within North Kirklees and South Kirklees (Old North Kirklees PCT and Huddersfield PCTs) is different based on differing on call rotas for locality managers i.e. locality managers are not on call in the South therefore should you need to initiate the community response for the south you will need to use the relevant contact information within the contacts pack.

Nominate person to open incident room ie incident room coordinator and ensure that incident team are assembled Ensure that the incident log is started and monitoring of actions initiated Hand over all information to the CEO or DPH when they arrive on scene or whoever is the incident director Manage the incident and take any other immediate appropriate action you deem necessary in light of the circumstances including alternative arrangements until the PCTs strategic control group is convened

6 7 8

Cascade List PCT Chief Executive DPH PCT Manager responsible for emergency planning Nominated incident room co-coordinator Communication Manager Strategic Health Authority KIRKLEES COUNCIL Emergency Planning lead Regional Director of Public Health (GOYH)

ACTION CARD CHIEF EXECUTIVE OR DEPUTY Step 1

2 3

Action Assess the situation and PCTâ&#x20AC;&#x2122;s response (scale up or down); take command if necessary Agree incident director Receive briefing from other incident control team members

Assess the overall implications to the health economy and cascade out if necessary Attend the site of incident (if necessary)

Attend Gold Command (if required) see section for definition

Co-ordinate with the PCTs strategic command group, services major incident and emergency delivery plan implementation

Ensure recovery options have been considered

Maintain contact with incident room

Liaise with PCT board members

Any other action deemed necessary

ACTION CARD DIRECTOR OF PUBLIC HEALTH/PUBLIC HEALTH LEAD

Step

Action

Start log of events

Receive briefing from director on call on the nature and scale of emergency Assess the impact of the emergency on health and the health service Provide appropriate Public Health support and advice as circumstances dictate Co-ordinate specialist support from the Health Protection Agency, other health bodies or government departments Provide an overall health perspective on the incident, the implementation of medium and long term recovery, and the restoration of normality Support PCT strategic commend team in co-coordinating mutual aid from or to other trusts/agencies across the region For CBRN incident co-ordinate with HPA and Regional Director of Public Health to ensure appropriate PCT response is provided. Keep all records in a safe place

3 4 5 6

7 8

ACTION CARD

INCIDENT ROOM CO-ORDINATOR Step

Action

Set up incident room as directed

(Please remember to cancel any meetings planned in the room used)

Implement call out of personnel to staff the Incident Room

Receive and record all messages appertaining to the incident and show action taken (until message taker arrives) using manual forms until computers are set up. All computer documentation should be securely backed up and saved to CD/ Memory Sticks to preserve data. Maintain records of:

• • • • • • •

Internal or external incidents Details of all staff on duty from all disciplines during the incident Details of fatalities and injuries Nature and extent of any injuries Location of hospitals to which transferred Location within hospital to which transferred Any other information

Maintain liaison with Strategic Command Group

7 8

Maintain good communication links ensuring actions are taken on information received Agree the number of additional telephones with informatics

Remember to take breaks and adequate rest periods

Organise your shift relief through incident control team

11 12

Ensure rota’s are completed to ensure that the incident room can operate throughout the incident Maintain health and safety within the incident room

Any other action deemed necessary

ACTION CARD SENIOR MANAGER (Service Lead) Internal Incident Step

Action

Respond to initial reports of incident ensuring emergency services (if necessary) have been called using 999 Note details as set out in previous section Assume command (until relieved) Contact On-call Director to brief the situation Agree responsibilities and tasks with them Ensure Huddersfield Royal Infirmary (out of hours) PCT HQ SLH and Beckside switchboard is informed of incident Prepare areas to provide an appropriate response in line with incident and business continuity plans Have someone designated to send and receive messages from and to the PCT incident control room Do not provide media statements; refer to communications officer in incident control

2 3 4 5 6 7

ACTION CARD INCIDENT DIRECTOR

Step

Action

Assess the situation and PCT’s response (scale up or down); inform CE or nominated deputy

Ensure that appropriate plans have been activated and cascaded

3 4

Set up an incident room (if not already set up) Liaise with other members of the incident control team and other agencies

5 6

Liaise with on-call director and strategic command group Attend site of incident (if deemed necessary)

7 8

Consider dispatching a forward liaison officer to the scene Ensure that the incident control team members understand their roles

Provide regular updates to the SHA’s strategic co-ordination group and the police gold command (if they are operational), as well as the SHA’s Emergency Planning Lead and the Regional Health Emergency Advisor

Ensure all actions are recorded

11 12

Mobilisation of support services as required Act as spokesperson for the PCT to the media (but only after agreement with the press officer)

Issue instructions to all PCT staff to cease the destruction of documents

14 15

Ensure rota system is in place for management of the incident Any other action deemed necessary

ACTION CARD COMMUNICATIONS LEAD

Step

Action

Start an incident log of events, discussions, disagreements and decisions.

Receive a full briefing of the facts from officer in charge of PCTâ&#x20AC;&#x2122;s response. Identify the organisation responsible for taking the lead role in media handling. This will normally be the organisation that has the strategic or tactical role in responding to the incident. The level of response required from the PCT will determine the role of the PCTâ&#x20AC;&#x2122;s Communications/Press Officer. Draft a PCT holding statement and agree a media strategy/plan with partners involved, containing key messages and facts and Q&A sheets, where necessary. Review key messages on a daily basis in response to media coverage. Consider asking for the invoking of the West Yorkshire Emergency Protocol. Contact the Strategic Health Authority Communications team and advise them of the situation, requesting extra support if needed. The Health Authority is responsible for informing and briefing the Department of Health and ministers. Also contact Communication Leads for HPA, police, fire, ambulance, local authority and other agencies responding. Make sure all relevant partner organisations and stakeholders have been briefed of the situation and receive regular updates for example, PCT staff, GPs and other contractors, Local Authority, MPs, PPIF etc. Set up a media office or work with the lead agency in doing this. This is a base for the Communications Team to take all media enquiries, log all calls, issue statements and handle requests for media interviews. If necessary, arrange for 24 hour cover for this office. Keep a record of all information that is released to the media. The Press Office does not need to be situated in the same geographic area of the incident. Pass details to any strategic health or police media cell.

6 7

The PCT will only issue information to the media on matters concerning their organisation. The PCT Communications/Media Officer will share (fax/email) all media releases or statements with the organisations/partners involved prior to distribution or as they are distributed to the media. When necessary, liaise with Communications/Media Officers of other organisations regarding drafting media statements that all appropriate partners are in agreement with, for example: other Trusts, Local Authority, YAS, NHS Direct, West Yorkshire Police, Fire Service etc. Advise on the most appropriate spokesperson/people who should give media interviews on behalf of the PCT. Depending upon the situation this may need to be the Chair/Chief Executive or a clinician. Consider where the interviews should take place. Permission must be obtained in advance if it is necessary for interviews to take place at premises owned by partners or other NHS organisations.

The lead organisation should consider whether a `media briefing centre’ facility will be needed for the duration of the emergency. This would be a `room/place’ where the media would assemble and receive all briefings and conferences. It might be necessary to provide email, ISDN, fax, photocopier and telephone facilities for the media to use. All those attending the `media briefing centre’ whether Communications/Media Relations Officers or media representatives, will need to have appropriate accreditation/identification passes. Make sure that every possible effort is made to directly contact patients/carers involved in the incident before the media. Consider the use of a range of communication techniques to reach all target audiences – media, mailings, press advertising, face to face, websites/intranets, call centres. Tailor information to different audiences and make maximum use of technology available. Think about what information the public needs to know – basic details, implications for them, advice and guidance, helpline numbers, other implications such as traffic disruption, reassurance. The lead organisation should arrange a media briefing or issue a media statement as soon as possible. Agree with the Chief Executive/senior member of the emergency planning team how often the media will be briefed (the appropriate degree of regularity will depend upon the situation). Set up a process for a senior member of the emergency planning team to provide sufficiently regular updates to the media office (bearing in mind media deadlines). Agree with the Chief Executive who will check and approve statements/updates before being issued to the media.

Organise for daily media monitoring of the situation – covering broadcast, print and web media. Review what is being reported about the situation – if necessary, reacting to correct inaccuracies. Use media coverage to gauge `public mood’ and how messages are being received and reported back – tailor key messages disseminated to staff, public, media and stakeholders as appropriate. Agree the level of recording required – whether this is to be done by the PCT or if it is necessary to employ a media-monitoring organisation. This will depend upon the nature and significance of the incident.

Make any arrangements to receive VIP visitors

When the situation/crisis is over make sure that a full de-briefing meeting takes place to learn from the incident and revise checklist and systems as appropriate.

ACTION CARD LOCALITY MANAGERS/TEAM LEADERS

Step

Action

Proceed to normal office base unless directed to attend PCT strategic incident control room. Receive briefing from incident director

2 3

4 5 6

8 9 10 11 12 13

Establish and maintain contact with the Operational Incident Manager at the Trust HQ. Assume the role of Team Coordinator for community response in your locality Liaise with managers to mobilise general practitioners, community nurses and health visitors (as required) Liaise with the South West Yorkshire Mental Health Trust and the Local Authority to access psychological and psychiatric health support as required. Liaise with Kirklees Adult Services to provide services for people with special needs in terms of age, disability or spiritual support Activate the appropriate emergency delivery plan (BCM/ Escalation) (if necessary) Liaise with other NHS providers and PCTs to facilitate mutual aid (as required) Ensure PCT and community staff have adequate supplies of PPE and ensure risk assessments take place Any other action deemed necessary On ‘Stand Down’ ensure that there is a smooth transition to normal methods of working and recovery. Following the incident, submit to the PCTs Emergency Planning lead director a post incident report, together with the Major Incident documentation used during the incident

Under no circumstances must any document, which relates or may in any way relate (however slightly) to the incident, be destroyed, amended, held back or mislaid. For these purposes “documents” means not only pieces of paper, but also photographs, audio, and videotapes, and information held on word processor or other computer. It also includes internal electronic mail.

ACTION CARD SECURITY MANAGER (this will need to be a designated role)

Step

Action

Start an incident log of events

Receive briefing from incident control room

Take overall responsibility for security

Maintain effective access control to the incident room

Arrange for adequate reception cover

Ensure health and safety of people entering the building

At the end of the shift, pass all information over to the next manager Keep all records in a safe place

ACTION CARD MESSAGE TAKER

Step

Action

Start a log of events

Ensure a record of all events, discussions, disagreements and decisions Receive briefings from the incident control team

3 4

Accurately record incoming and outgoing messages on the appropriate forms provided

Pass all information to the incident co-coordinator

Maintain details of the calls you make and receive

Assist the incident co-coordinator as directed

Keep all records in a safe place

ACTION CARD ADMINISTRATION MANAGER

Step

Action

Start a log of events

Receive briefings from the incident room coordinator / director

Ensure message-takers accurately record messages in and out

Priorities incoming messages and ensure they are drawn to the attention of appropriate staff

Allocate tasks as directed by the incident room coordinator

6 7

Ensure all communications are effectively and accurately logged Maintain records on control white boards and flip charts

Book visitors in and out of the control room

Ensure all staff log in and out

File all logs at the end of each shift

Any other action deemed necessary

ACTION CARD IN HOURS PCT SWITCH BOARD OPERATOR/RECEPTIONISTS

Step

Action

Start a log of events

Pass all press enquiries to the press officer

Receive and greet visitors

Carry out duties as instructed by the incident control team

Pass on all urgent messages immediately using message pad

Maintain a professional approach at all times on the phone

Keep all records in a safe place

ACTION CARD STRATEGIC COMMAND GROUP

Step

Action

Reassess risk and status of incident

Assess what action is needed-composition and formation of PCT operational command group Assess level of multi-agency co-operation needed and health ability to respond (consider wider cascade; advise strategic health) Assess sustainability of action within current PCT capacity and capability Assess formation and

Activate Major Incident Plan

Reassess action / risk in light of new information / outcome of action Constantly record all information and decisions made with reasons Media releases must be made with agreement of partner agencies for consistency of messages via the Communications lead Implement standing down process

7 8

9 10 11

Monitor effects of incidents on public / staff Provide support (when necessary) Audit management of incident

Strategic Command Group

HRI switch board

Chief Executive

Director of Provider Services Director of Public Health

Facilities Support

Director of Commissioning

Public Health on-call

Contact via HRI Switchboard PCT 01484 342000 * Ask for public health on call

On-call Director

Contact via HRI Switchboard 01484 342000

Any other PCT managers

Contact as appropriate Working Hours: PCT HQ 01484 466000 Out of Hours through on-call Director manager: HRI switchboard 01484 342000

SECTION 5 5.1

Setting up the PCTs Major Incident Control Rooms

Setting Up the Beckside Corporate Control Room

The PCT Director, a deputy or nominated representative, will use this checklist of procedures in the event of a major incident. 5.1.1

Corporate Control Room Procedures

Once the telephone call has been received from the PCT Director on Call or deputy that an Corporate Control Room is to be established, the Emergency Planning Manager should coordinate implementation of the following procedures using any member of the Emergency Response Co-ordinating Group: 5.1.2

Establish Corporate Control Room

•

Commence a time log as soon as telephone call is received to set up Corporate Control Room (Phase 2, Section 2.3)

•

This will all be recorded electronically as soon as feasible (A USB stick is available containing all details).

•

Meeting Room 1 to be used as the Corporate Control Room.

5.1.3

Setting up a Helpline

See section 4.4 5.1.4

Rooms

•

Check electronic diary or printed sheets for meeting rooms 1, 2 and 3 either transfer to alternative accommodation or cancel.

•

Arrange for agreed layout to be put in place (Appendix H, K & L).

•

Collect resources and layout as per plan (Appendix M)

5.1.5

Staffing

•

Assess staffing needs and call in staff from database (in contacts pack)

•

Deploy incoming staff to: o o o o

Man 10 telephone lines 4 staff members to handle incoming calls 4 staff members to handle outgoing calls 2 supervisors

o o 5.1.6

Act as runners to liaise between Corporate Control Room and Major Incident Coordinator Set up e-mail directories and act as secretary to Incident Co-ordinator

Telephones

•

Emergency number to be given to incident co-ordinator for use of public/outside agencies

•

All those with mobile phones ensure that they are working and charged up.

•

The mobile telephone number of each officer present must be recorded on a clear list.

•

Give instruction to the Mid Yorkshire Hospitals NHS Trust switchboard to transfer any calls relating to the Major Incident to the relevant number at the PCT, 0800 3891840. (This number is only activated in case of a major incident)

•

Set up spare phone line to be used as Helpline for any major incident

•

Ensure answering service is working on the main PCT line

•

Out of hours. Give instructions to the Mid Yorkshire Hospitals NHS Trust switchboard that any calls relating to the incident only should be diverted to the relevant number, as above.

5.1.7

Major Incident Information For Reception Staff

In case of a Major Incident, any calls received, please put through to Meeting Room 1. • 5.1.8

01924 351501. Equipment

•

Computers for the Corporate Control Room should be made available for emails etc plus a printer

•

Anybody involved in the Major Incident is asked to bring laptops, Blackberrys and mobile phones plus charger in with them

•

All I.D Badges must be worn at all times

•

Use of USB memory sticks for back up and in case of network crashing

5.1.9

Equipment/Sundries

•

Ensure flipchart paper/pens are available in the Corporate Control Room/Meeting Room 1

•

Ensure the photocopier is made available and working for any copying required

•

Collect stationery and set up as in Appendix M.

•

Collect the following from reception o o o o

Year Book External/internal telephone directory Up to date list of contractors including telephone number and fax numbers Pharmacy cascade list

•

Copy of all key on call rotas (Contacts Pack) and Major Incident plans are available

•

Copies of the Major Incident library, –electronic and paper versions, are available.

5.1.10 Refreshments •

Ensure drinks and food can be made available if necessary

•

If not, send member of staff to supermarket/local shop, so ensure petty cash is available.

5.1.11 Media If it seems likely that there will be a media presence on site, arrange to bring Meeting /Room 3 into use, plus any other additional rooms which may be needed. Liase with the Communications Team. 5.1.12 General •

Photocopy message forms (section Appendix E).

•

Arrange photocopying of any other forms requested by Major Incident Co-ordinator

•

Support and take further instructions from the Major Incident Co-ordinator

5.1.13 Budget Code •

5J7N 611615 7351 – Major Incident Code, all receipts must be kept during a Major Incident and handed to the Emergency Planning Manager stating who it is from.

5.1.14 Alternative Sites for Corporate Control Room •

Secondary Centres : if Beckside Court was unable to hold a Major Incident i.e. had no electricity or had flooded then all resources •

All Resources

•

USB Sticks

•

Laptops

•

Blackberries and Mobiles

•

Documents in the Emergency Planning filing cabinet

•

Stationary

Must be moved to the new premises 5.1.15 Secondary Control Centres/Incident Rooms •

The PCTs of Calderdale and Kirklees are willing to mutually offer secondary control centres to each other (in Contacts Pack)

•

The Mid Yorkshire Hospitals NHS Trust has also agreed to be a potential secondary control centre as well (in Contacts Pack)

•

Batley Health Centre (Sandie Milnes & Brenda Powell)

5.2

Setting up the PCT Strategic Incident Room at St Lukes House

5.2.1

The following actions are required to establish the Strategic Incident Room at St Lukes House:

•

The keys for the Emergency Planning Cabinet (Key number 2) are held in the key cabinet in the general office on the ground floor of St Luke’s House. The Emergency Planning cabinet is situated in the Board room of St Luke’s house.

•

Ensure that diary bookings for Boardroom are checked and are either transferred to alternative accommodation or cancelled (Reception Staff can do).

5.2.2

5.2.3

Room Layout •

Arrange for agreed layout to be put in place for Boardroom (see following pages)

•

Put fax machine in Board Room (Place answer machine on line 8)

Staffing •

Assess staffing needs and liaise with each directorates’ Coordinator to call in staff as appropriate.

•

Deploy incoming staff to:-

Set up additional telephone lines if required. To provide administration and communications support

5.2.4

5.2.5

5.2.6

5.2.7

Telephones •

This is the telephone number to be given to other healthcare bodies and outside agencies eg Police, Ambulance who wish to contact the PCT. 0845 045 1145. DO NOT give this number to anyone else.

•

If you are able to use internal systems eg St Lukes or HRI then use extension 6131

•

Ensure appropriate messages are recorded on answer phones if used at main switchboard or in the Operational Incident Room.

•

Give instructions to the NHS Trust switchboard at St Luke’s

•

All those with mobile phones ensure that they are working.

•

Collect telephone handsets from Emergency Cupboard in the Boardroom and connect to lines in Boardroom where required.

•

In certain circumstances the PCTs may set up a general enquiries helpline.

IT Equipment •

PC’s for the incident room should be made available for e-mail etc plus a printer. The PCs to be used are one from room 103 and one from room 007

•

Managers who are called to the incident and have laptops should bring them to the incident rooms.

Equipment/Sundries •

Collect the following from reception - Year book - External/Internal telephone directory - Abbreviated dialling list - Up to date list of contractors including telephone number and fax numbers - Pharmacy cascade list

•

On Call Rota from Public Health

Refreshments • Ensure drinks and food can be made available if necessary. The Catering manager may be able to assist with this during normal working hours (extension 2320) •

If not send member of staff to supermarket/local shop

Appendices A

RESPONSIBILITIES OF NHS ORGANISATIONS IN EMERGENCY PLANNING

The following section provides the context and legal framework that underpin this plan and inform the PCTs responsibilities as a Category 1 responder as defined by the Civil contingences act 2004. The Civil Contingencies Act places a duty on Category 1 responders to develop and maintain plans to prevent emergencies ‘Healthcare organisations protect the public by having a planned, prepared and where possible, practised response to incidents and emergency situations which could affect the provision of normal services’. HCC core std c24 The six core duties of NHS Category 1 responders are :1. 2. 3. 4. 5. 6.

Co-operative with other local responders to enhance co-ordination and efficiency Share information with other local responders to enhance co-ordination Assess local risks to inform emergency planning Put in place Emergency Plan Put in place Business Continuity Management arrangements Put in place arrangements to make information available to public about civil protection matters and advise the public in the event of an emergency

Statutory guidance (The Civil Contingencies Act, 2004) can be accessed electronically or in hard copy within the PCT emergency planning reference library.

There are eight key guiding principles to follow to ensure effective recovery after any emergency incident •

Continuity – emergency response and recovery should be grounded in the existing functions of organisations and familiar ways of working, albeit on a larger scale, to a faster tempo and in more testing circumstances

•

Preparedness – all organisations and individuals that might have a role to play in emergency response and recovery should be properly prepared and be clear about their roles and responsibilities

•

Subsidiarity – decisions should be taken at the lowest appropriate level, with coordination at the highest necessary level; local agencies are the building blocks of the response to and recovery from an emergency of any scale

•

Direction – clarity of purpose comes from a strategic aim and supporting objectives that are agreed, understood and sustained by all involved. This will enable the prioritisation and focus of the response and recovery effort

•

Integration – effective co-ordination should be exercised between and within organisations and levels (i.e. local, regional and national) in order to produce a coherent, integrated effort

•

Co-operation – flexibility and effectiveness depends on positive engagement and information sharing between all agencies and at all levels

•

Communication – good two-way communication is critical to effective response and recovery, and reliable information should pass, without delay, to those who need to know, including the public

•

Anticipation – ongoing risk identification and analysis is essential to the anticipation and management of the direct and indirect consequences of emergencies

The Department of Health Emergency Preparedness Division issued the NHS Emergency Planning Guidance in October 2005. All NHS organisations therefore have the following responsibilities

INTEGRATED EMERGENCY PLANNING •

An integrated emergency planning process is in place that is built on the principles of risk assessment, co-operation with partners, emergency planning, communicating with the public and information sharing

•

There is a major incident plan that is kept up to date, accessible, tested regularly and specifically addresses any potential causes of a major incident for which the identified NHS organisation is at particular risk

•

Major incident plans take account of the requirements of the Civil Contingencies Act 2004

•

The needs of vulnerable persons, including children, are taken into account

•

Appropriate arrangements are in place to provide and receive mutual aid locally, regionally and nationally

•

Working as appropriate with DH, appropriate arrangements are in place to provide and receive mutual aid nationally and internationally

•

Planning is undertaken in conjunction with NHS Direct, NHS Professionals, NHS Estates and the National Blood Service and other appropriate agencies

•

Planning is undertaken in conjunction with local partners in the independent healthcare sector including Independent Sector Treatment Centres (ISTCs) and their equivalents, and staffing agencies.

ACCOUNTABILITY /GOVERNANCE

The Chief Executive Officer is responsible for ensuring that the Kirklees PCT has a Major Incident Plan in place. This plan is built on the principles of risk assessment, co-operation with partners and the principles of integrated emergency planning, communicating with the public and information sharing. The plan has been developed in line with the requirements and guidance of the Civil Contingencies Act 2004 and NHS Performance Management Framework, (Public Health Core Standard C24). In order to ensure appropriate governance and accountability of emergency planning within the PCT the Chief Executive Officer will ensure that the Board receives regular reports, at least annually, regarding emergency preparedness covering the following issues: •

reports on exercises undertaken by the PCT

•

training and testing undertaken by the PCT

•

any significant updates or revisions to Emergency Plans

LAYOUT OF INCIDENT ROOM - ST LUKE’S HOUSE

EMERGENCY CUPBOARD ST LUKE’S HOUSE INVENTORY LIST Item

Stock

Emergency Plan Write On’s for Overhead Log Sheets for Incident Room Manager Message Taking Forms Media Contact Sheets Trays Kirklees Council Wards Map Fax Machine Room Plans Incident Room Instructions Flip Chart Paper 4 Way Extension Plug Ink Cartridge for Fax Coloured Plastic Pockets Red Blue Yellow Green Wind Up Radio Telephones Answering Machine A4 Pads Desk Tidies Staple Extractors Foldback Clips 30mm 32mm 40mm 50mm 60mm 70mm Scissors 12” Ruler Flipchart Pens Colour Flipchart Pens Date Stamps Ink Pads Pencils Pens (Red) Pens (Blue) Pens (Black) Pens (Green) Coloured OHP Pens Sellatape Sharpeners Staplers Staples 24/6mm Erasers Hole Punch Paper Clips (Large) Post It Notes Tape Dispenser Tray Risers Ink Pad Ink

1 1 Box

Date Checked 11/5/06 11/5/06 11/5/06

10 1

11/5/06 11/5/06 11/5/06 11/5/06

1 1 1

11/5/06 11/5/06 11/5/06

2 1 1

11/5/06 11/5/06 11/5/06

1pk 1pk 1pk 1pk 1 8 1 14 4 10

11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06

1 Box 1 Box 1 Box 2 Boxes 1 Box 1 Box 10 10 1 Box 1 Pack 8 5 2 Boxes 1 Box 1 Box 2 Boxes 2 pens 1 Pack 10 10 8 4 Boxes 1 Box 4 2 Boxes 19 1 4 1 Bottle

11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06

Date Checked

Blue Tack Rubber Bands Coloured Post it Notes Torches ‘D’ Batteries Floppy Disks Lever Arch File Lever Arch File with Index Lever Arch File with plastic pockets

2 1 Box 12 Pads 11 43 Box 50 9 1

11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06 11/5/06

11/5/06

MESSAGE FORM PART ONE Message Received from or sent to:Name: …………………………………………………

REF:

At (location): …………………………………………………………………………….. Telephone: STD code …………………Number…………………………………….. Call handler: …………….………………………Time: ……………….Date: ……................………... MESSAGE: Incoming Calls / Incoming Action …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… ………………………………………………….....................................................………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………….. ACTION REQUIRED: / Outgoing Calls / Outgoing Action PART TWO …………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………… SUPERVISOR (NAME): ………………………………….TIME: ………..DATE: ………... ACTION TAKEN: ………………………………………………………… PART THREE ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ……………………………………………………………………………… ACTION TAKEN BY (NAME): ………………………….TIME: …………..DATE: ………... VERIFIED SUPERVISOR (NAME): ……………….…. TIME: …………...DATE: ………... The call handler will complete Part One and pass the pink and yellow copies to the supervisor. The supervisor will enter the action to be taken at Part Two and pass the outgoing operator for action. The outgoing operator will complete Part Three and return the pink copy to the supervisor.

KIRKLEES PCT INCIDENT CONTROL ROOM MEDIA CONTACT SHEET MEDIA CONTACT SHEET

Date and time of call

Deadline

Name of caller: Where were they from? (i.e. paper / TV / radio station) Tel: What did they want? (i.e. nature of enquiry)

Which PCT: ❏

Calderdale PCT

❏

Kirklees PCT

Enquiry taken by (your name & telephone number) If a statement was given, what was it?

Who gave the statement/info? If this is going to be used in an article/programme, etc, do you know when?

Actioned by: Please fax this form IMMEDIATELY to the Communications Team on 01484 466139 Communications contact: Liz Harrison/Peta Wolstencroft tel: 01484 466223/07796691804 or Carol Hirst tel: 01484 466004

CORPORATE CONTROL ROOM SIGNING IN/OUT REGISTER

Date

Name

Organisation

Whom Visited

Time In

Time Out

MEETING ROOM 1 – CORPORATE CONTROL ROOM BECKSIDE COURT

2 double sockets & 2 computer points

White board / Message board / major incident table Hospitality Table

Major Incident Pilot Telephone Point and Fax machine 0800 389 1840 redirect to “hunt group”

Flipchart

Supplies Table

Supervisors Logger actions taken

Outgoing Calls

Incoming Calls

Printer

Double socket

Ten desks/PCs or laptops with email accounts & shared drive Signing in Table

Screen

Fire Extinguishers

2 double sockets and 2 computer points

Double socket

Floor Plate

FLOW CHART - HOW MESSAGES ARE CIRCULATED AROUND THE CORPORATE CONTROL ROOM

Table 1 – Incoming Calls Receives calls

Table 2 – Supervisor Decides actions

Table 3 – Outgoing calls Do actions

MEETING ROOM 2 – PLANNING ROOM BECKSIDE COURT

DVD recorder

Microphones

Double socket

Floor Plate

Double socket

Screen

Double socket Double socket Hospitality Table Fire Extinguishers

MEETING ROOM 3 â&#x20AC;&#x201C; PRESS ROOM BECKSIDE COURT

(If necessary commandeer the open plan area)

Hospitality table

Hat/coat stand

PCT

Press

Seating for press

RESOURCES REQUIRED FOR MEETING ROOMS 1 AND 2 BECKSIDE COURT

1. Fax machine 2. Collect telephone handsets from switchgear room 1st floor next to kitchen and put into meeting rooms 1 and 2 3. Ensure there is a supply of; • • • • • • • • • • • • • • • • • • • • • • • • • •

USB Sticks – available to transfer information if the Corporate Control Room needs to be transferred to another base Paper Trays Media Forms Message Forms Register Signs for Incoming / Outgoing Calls Flipchart paper Marker pens Pens (blue, black, red) Whiteboard markers Pencils Rulers Scissors Files (box) Paperclips Elastic bands Bulldog clips (various sizes) Blu-tac Sellotape Staples Staplers Staple removers Lined paper Printer paper Chargers for mobile phones and Blackberries Spare visitors Badges All held in the switchgear room marked up “Emergency Planning Equipment”

ORGANISATIONAL & AGENCY RESPONSIBILITIES N1 The Police Service The police will normally co-ordinate all the activities of those responding at and around the scene of a land-based sudden-impact emergency. The saving and protection of life is the priority, but as far as possible the scene must be preserved to provide evidence for the subsequent enquiries and possibly criminal proceedings. Once life saving is complete, the area will be preserved as a scene of crime until it is established as otherwise (unless emergency results from severe weather or other natural phenomena and no element of human culpability is involved). Where practicable 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 other organizations in the saving of life, the protection of the public and the care of survivors. Where terrorist action is suspected as the cause of an incident, the police will normally take additional measures to protect the scene. These include establishing cordons under the Terrorism Act 2000 and carrying out searches for secondary devices. They also take initial responsibility for safety management for those working within cordons at such incidents. The police will 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 enquiries carried out by the responsible accident investigation bodies, such as the Health and safety Executive, or the Air or Marine Accident Investigation Branch. The police process casualty information and have responsibility for identifying and arranging for the removal of the dead. 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 of casualties may not always be located on the immediate vicinity of a disaster scene. It is therefore important to consider the need to search the surrounding area. If this is necessary the police should normally co-ordinate search activities on land. Where the task may be labour intensive and cover a wide area, assistance should be sought from other emergency services, the military or volunteers. N2 The Fire and Rescue Service The primary role of the Fire and Rescue Service 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, by rescuing people and by 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 also assist the ambulance service with casualty handling and the police with the recovery of bodies. The Fire and Rescue Service is likely to take the lead on health and safety issues for personnel of all agencies working within the inner cordon. However, safety of staff should normally be resolved and agreed between relevant agencies at the scene following an appropriate risk assessment. Any conflicts over responsibility for safety should be raised and resolved at multi-agency meetings. The Fire and Rescue Service will manage access to the inner cordon under their Incident Command System, liaising with the police about who should be allowed access. It is expected that other agency

workers attending the scene arrive with the appropriate level of personal protective equipment and that they are adequately trained and briefed. However, in the event of any situation which is, or which is suspected to be, the result of terrorism, police will assume overall control and take initial responsibility for rescuing people and saving lives remains with the Fire and Rescue Service. Although the National Health Service is responsible for the decontamination of casualties, the Fire and Rescue Service will in practice often undertake mass decontamination of the general public in circumstances where large numbers of persons have been exposed to chemical and biological substances. This is done on behalf of the NHS, in consultation with the ambulance service. N3 The Ambulance Service Ambulance services have the responsibility for coordinating the on-site National Health Service response and determining the hospital(s) to which injured persons should be taken, which may depend on the types of injuries received. The officer of the ambulance service with overall responsibility for the work of the service at the scene of a major incident is the Ambulance Incident Officer (MIO) (see below) The Ambulance Service, in conjunction with the MIO and medical teams, endeavours to sustain life through effective emergency treatment at the scene, to determine the priority for release of trapped casualties and decontamination in conjunction with the fire services. They also, transport the injured in order priority to receiving hospitals. The Ambulance Service may seek support from voluntary aid societies (British Red Cross, St Johnâ&#x20AC;&#x2122;s Ambulance and St Andrewâ&#x20AC;&#x2122;s Ambulance) in managing and transporting casualties.

N4 The National Health Service i.

Hospitals Hospitals with Major Accident and Emergency Departments have been designated as potential casualty receiving hospitals. They respond to requests from the ambulance service to receive casualties for medical treatment and also provide appropriately trained staff to act as mobile medical teams and MIOâ&#x20AC;&#x2122;s. An MIO has an overall responsibility (in close liaison with the AIO) for the management of medical resources at the scene of a major incident. He/she should not be a member of a mobile medical team. Other hospitals provide support to receiving hospitals by taking patient transfers, etc.

ii. Public Health The NHS ensures public health advice is available to the emergency services, NHS organisations and the public on a 24 hour basis. As well as having a public health function with PCTs and the Strategic Health Authorities there is a special health authority that focuses on emergency planning in the form of The Health Protection Agency. The Health Protection Agency (HPA) is an independent body that protects the health and well-being of the population. The Agency plays a critical role in protecting people from infectious diseases and in preventing harm when hazards involving chemicals, poisons or radiation occur.

We also prepare for new and emerging threats, such as a bio-terrorist attack or virulent new strain of disease. The advice is crucial for the control of communicable diseases and for public health concerns relating to hazards in chemical, biological, radiological and nuclear incidents. iii. Primary and community care services The provision of primary and community care support is a crucial aspect of the NHS response. Theses services cover 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 following a major incident. Primary care trusts should therefore be involved in emergency planning processes. N5 HM Coroner The role of the coroner is defined by statute. Coroners have responsibilities in relation to bodies lying within their district who have met a violent or unnatural death, or sudden death of unknown cause. They have to determine who has died, how and when and where this death came about. This function is regardless of whether or not the cause of death arose within their district. They normally undertake this duty at a formal inquest (though if the incident results in a public inquiry chaired by a judge, a full inquest may not be held). Coroners should have an emergency plan relating to multiple fatalities, and coroners’ officers should be familiar with its content. They should also be familiar with the police major Incident Plan for their own area and with the local authority emergency plan. The powers and duties of the coroners do not vary with the number of people who are killed or the circumstances in which the deaths occur. A body at the scene of an incident should not be moved without the authority of the coroner and only the coroner may authorize a postmortem and the release of the body to the relatives. In general, the police act as the coroner’s officers when dealing with facilities arising from an incident. N6 The Maritime and Coastguard Agency (MCA) The Maritime and Coastguard Agency (MCA) is an executive agency within the Department of Transport. The MCA’s Directorate of Operations consists of separate but integrated branches – HM Coastguard (responsible for search and rescue (SAR), prevention and response); the Counter Pollution and Response Branch; the Press Office; the Survey and Inspection Branch (ensures that the UK merchant fleet meets the correct safety standards and Port State Control of non-UK ships); an Enforcement Branch ( carries out investigations and prosecutions following breaches of merchant shipping legislation); and a Technical Services Branch. Co-located with the MCA is the secretary of States Representative (SOSREP). SOSREP is empowered under the Merchants Shipping Act 1995 and subsequent legislation to intervene on behalf of the Secretary of State for Transport in salvage operations, given certain conditions. This includes powers to require that a ship be moved to, or be removed from a specified area or locality from UK waters; there are also powers to establish a Temporary Exclusion Zone. SOSREP has similar powers, delegated by the Secretary of State of the Department of Trade and Industry, regarding pollution from offshore oil and gas installations. These powers may only be exercised if there is a threat of significant pollution of the UK environment.

The primary responsibility of HM Coastguard is to initiate and co-ordinate civil maritime search and rescue (and in some cases maritime incidents resulting from an air accident) within the United Kingdom Search and Rescue Region. This includes mobilising, organizing and dispatching resources to assist people in distress at sea, in danger on the cliffs or shoreline, or in danger in inland areas due to flooding. Local coastal safety committees based on police force boundaries ensure effective coordination of resources between police and coastguard for land-based incidents on or adjacent to coastlines. The Counter Pollution and Response Branch are responsible for dealing with pollution at sea and, in conjunction with local authorities, for the shoreline clean-up. It also has responsibility for approving Oil Spill Contingency Plans for Ports and Harbour Authorities and for providing appropriate training. HM Coastguard may assist other emergency services and local authorities during civil emergencies such as flooding at the specific request of the police or local authority in a limited capacity as follows. They may provide: 1. On-scene VHF communications by use of mobile and Portable radios, particularly important if Royal national Lifeboat Institution units are deployed; 2. Communication links between relevant command posts; and 3. Coastguard liaisons with other services at appropriate levels of command.

N7 Local Authorities Each local authority manages a civil contingency planning function. Civil protection personnel act as a hub to co-ordinate planning, training and exercising within local authority departments. The effectiveness of this coordination is fundamental to the discharge of related community responsibilities in an emergency, whatever the cause. Local authority planning is carried out in close cooperation with the emergency services, utilities, many other industrial and commercial organisations such as the Ministry of Defence (MoD) or Department of Health, other statutory organisations such as the Environment Agency, and many voluntary agencies. The principal concerns of local authorities in the immediate aftermath of an emergency are to provide support for the people in their area. In the first instance they do so by cooperating closely with the emergency services in the response phase. However, they also have many specific responsibilities of their own. They will use the resources of local authority departments to mitigate the effects on people, property and infrastructure and play a key role in coordinating the response from the voluntary sector. They also endeavour to continue normal support and care for local and wider community throughout and disruption. In incidents involving multiple fatalities, the coronerâ&#x20AC;&#x2122;s office will liaise with the local authority on the establishment if temporary mortuaries. As part of the local response, plans should already have been agreed for opening additional spaces at existing public or NHS mortuaries and/or establishing temporary mortuaries. These plans should include how to locate staff. As the emphasis moves from response to recovery, the local authority will take a leading role in facilitating the rehabilitation of the community and restoration of the environment. Even a relatively small emergency may overwhelm the resources of the local authority in whose area it occurs. Against this possibility, plans need to be made that will, in appropriate circumstances, trigger arrangements for mutual aid from neighbouring authorities, delivering

cross-boundary assistance if required. Arrangements may range from simple agreements offering whatever assistance is available in the event of an incident to more formal arrangements for the shared use of resources. This could include the use of vehicles, equipment and people. Payment arrangements may need to be included in any such agreement. Emergency financial assistance may be available for affected local authorities. This is done under the Bellwin Scheme in England and Wales, and by similar arrangements in Scotland and Northern Ireland.

N8 The Environment Agency The Environment Agency (EA) has primary responsibilities for the environmental protection of water, land and air in England and Wales. The devolved administrations for Scotland (In Scotland the Scottish Environment Agency provides a similar service) and Northern Ireland (In Northern Ireland the Department of the Environment (Environment and Heritage Service) has similar responsibilities) have similar respective responsibilities. The EA has key responsibilities for maintaining and operating flood defences on certain specified rivers and coastlines. Whenever necessary, the EAâ&#x20AC;&#x2122;s role is to provide remedial action to prevent and mitigate the effects of the incident, to provide specialist advice, to give warnings to those likely to be affected, to monitor the effects of an incident and to investigate its cause. The EA also collects evidence for future enforcement or cost recovery. It also plays a major part in the UK Governmentâ&#x20AC;&#x2122;s response to overseas nuclear incidents.

N9 The Private Sector Industrial or commercial organisations, including the utilities, may play a direct and vital part in the response to emergencies, especially if their personnel operations or services have been involved. It is therefore essential that they are integrated into both the planning process and the command and control structures. This requirement is not, however, limited to those companies nominated as responders under Schedule 1 of the Act, the Local resilience forums should engage the full breadth of organisations identified by their risk analysis. Many companies, including utility providers and infrastructure managers, have diffuse operating areas that do not share formal and common boundaries with public sector agencies. The Local resilience forum provides a medium for simplifying the otherwise complex integration and liaison arrangements in advance of an emergency occurring. There are, however, finite limits to this process, and public sector planners and managers need to have a clear understanding of the structures and business imperatives of the companies involved. Those responsible for large outdoor and indoor sporting and musical venues many also have a role in the response to an emergency occurring elsewhere. It is therefore important that local planners integrate such organisations into the arrangements for managing both extrinsic and intrinsic risks of an emergency. In the recovery phase the private sector usually becomes the predominant actor owing to the scale of its resources and its range of specialized expertise. This is especially so in those emergencies where the losses are insured and the major domestic insurance companies become engaged. For these reasons the strategic planning process should aim to create a framework of positive and flexible policies for the active engagement of the private sector from the outset, and for the effective programme management of extended recovery operations.

N10 The Voluntary Sector Volunteers can contribute a wide range of activities, either as members of a voluntary organization or as individuals. When responding to an emergency, they will always be under the control of a statutory authority. Within West Yorkshire Wakefield City Council has the lead to develop voluntary capacity in an emergency. N11 The Armed Services i.

Military Aid to the Civil Community (MACC) is the provision of unarmed military assistance to the civil authorities when they have an urgent need for help to deal with an emergency arising from a natural disaster or major incident. The guiding criteria are urgency and necessity within exceptional circumstances, which imply a requirement to save life, alleviate distress or protect property. The Armed Forces maintain no standing forces for MACC tasks. There are, by definition, no permanent or standing MACC responses. Assistance is provided on an availability basis and the armed forces cannot make a commitment that guarantees assistance to meet the specific emergencies. Neither the production nor of contingency plans nor the participation in civil exercises guarantees the provision of MACC support. It is therefore essential that responding agencies do not base plans upon assumptions of military assistance. The regional Civil Contingencies Reaction Forces are part of the Reserve Forces and require mobilization before deployment. They are not, therefore, well placed to provide MACC support, but if they are required they will mobiles and deploy as rapidly as possible to assist continuing operations. The Army acts as the lead Service for MACC on land. The Regional Brigade Headquarters will be able to give advice and should be contacted in the first instance. All such headquarters have a 24 hour emergency contact telephone numbers and established liaison relationships with the members of Regional and Local Resilience Forums. In exceptional circumstances, requests for assistance may be directed to any Service unit, station or establishment. Any request for assistance should focus on the capability required: the solution will be determined by the availability of military resources and the commanderâ&#x20AC;&#x2122;s judgement. In all circumstances, Service personnel employed on MACC tasks will operate in formed bodies under military command. Where there is a direct threat to life the MoD may, at its discretion, choose to waive the recovery of costs. 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, a danger to human life no longer exists and 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 and if very high costs are to be avoided. This will usually occur at the same time as the leadership and coordination responsibility transfers from the emergency services to the local authority or other organization, and while the engagement of private sector resources is advancing.

ii.

Search and Rescue The MoD has responsibility for providing SAR facilities for military operations, exercises and training within the UK and, by agreement, is responsible for civil aeronautical SAR on behalf of the Department for Transport. Where the coverage provided by military SAR assets meets the civil SAR coverage requirements, they will

be made available for civil maritime and land-based SAR operations. The MoD establishes and maintains the Air Rescue Co-ordination centre (ARCC) at Kilnoss for the operation and coordination of civil and military aeronautical SAR, and requests for SAR should be placed directly with ARCC.

N12 Objectives for a combined response Irrespective of the particular responsibilities of organisations and agencies that may be involved with the emergency response, they will all work for to the following common objectives: • saving and protecting life • relieving suffering • protecting property • providing the public with information • containing the emergency – limiting its escalation or spread • maintaining critical services • maintaining normal services at an appropriate level • protecting the health and safety of personnel • safeguarding the environment • facilitating investigations and enquiries • promoting self help and recovery • restoring normality as soon as possible; and • evaluating the response and identifying lessons to be learned. N13 Management Framework i.

In order to achieve an integrated response to a major emergency, the capabilities of the emergency services must be closely linked with those of local authorities and other agencies. The national generic management framework has a common architecture irrespective of the cause or nature of the incident, but it remains flexible to varying circumstances. This framework defines relationships between differing levels of command and management, and allows each agency to tailor its own response plans to interface with the plans of others. It also ensures that all parties understand their and each other’s roles in the combined response, thus helping to ensure the flexibility needed to suit local circumstances. Under the framework, the management of the response to major emergencies will normally be undertaken at one or more of three ascending levels – operational, tactical and strategic – that are defined by their differing functions rather than by specific rank, grade or status. The terms ‘Bronze’, ‘Silver’ and ‘Gold’ (for ‘operational’ and ‘tactical’ and ‘strategic’ respectively) are in common use in many organisations as substitutes – for example ‘Bronze commanders’, ‘Gold Control’. They provide less clarity, however, for those unfamiliar with the topic. Interpretation of what they mean varies and further confusion can arise if they are equated too closely with rank structures. The terms ‘operational’, ‘tactical’ and ‘strategic’ are therefore used in this publication to clarify the functions. At the start of any incident for which there has been no warning the operational level will be activated first. Escalation or a greater awareness of the situation may require the implementation of the tactical level and, finally a strategic level should this prove necessary. The precise identity and location of the strategic level will depend on the nature and severity of the emergency, its geographical spread in terms of area and

boundaries crossed, and manifold other factors. In each case, the principle of ‘coordination at the highest necessary level’ should be applied in reaching the appropriate solution. In its planning, each agency will need to recognise these three management levels and each of their requirements. This will allow the integration of management processes across agency boundaries. It is not intended that the management levels necessarily predetermine the rank or seniority of the individuals discharging the functions. If any one agency activates it’s Major Incident Plan (declaring a major incident) then others need to assess their potential involvement and liaison arrangements in line with agreed protocols. It may or may not be necessary for others to start to activate their own major incident plans. The authority to declare a major incident for an organisation is vested in appropriate officers of that organisation. A major incident for one is not necessarily a major incident for others. ii.

Operational Level The operational level of management reflects the normal day-today arrangements for responding to smaller-scale emergencies. It is the level at which the management of ‘hands on’ work is undertaken at the incident site(s) or associated areas. First responders will take appropriate immediate measures and assess the extent of the problems. Within the imperatives of tasks there must be due regard to risk reduction measures and the health and safety of personnel. Operational commanders or managers will concentrate their resources in the specific tasks within their areas of responsibility. They will act on delegated responsibility from their parent organisations until other levels of command are established. Individual agencies retain full command of the resources that they apply within a geographical area or use for a specific purpose. Each agency should communicate fully and continually with others to ensure an efficient and combined effort. The police will normally act as the coordinator of the operational response at an identifiable scene. These arrangements will be adequate for the effective coordination and resolution of most minor emergencies. However, for more serious incidents that require significantly greater resources it may be necessary to implement an additional level of management. A key function of an operational commander or manager will be to consider whether circumstances warrant a tactical level of management.

iii.

Tactical Level A tactical level of management is introduced to provide overall management of the response. Tactical managers: • determine priorities in allocating resources • obtain further resources as required • plan and coordinate when tasks will be undertaken • assess prevailing risks • strike an overall balance between tasks and risks • take appropriate risk reduction measures; and • give due regard to the health and safety requirements of staff and public. Where there is an identifiable scene, tactical management is usually undertaken from an incident control point established in the vicinity. Many tactical functions will then be discharged at or close to the scene. However, some agencies (for example, local

authorities) will prefer to operate from their administrative offices but will often send liaison officers to enhance coordination. Planning must also take into account that there may be a number of individual scene or in fact no actual scene to attend (for widespread disruption, health emergencies, if the incident is overseas etc). Inter-agency meetings at appropriate intervals between tactical managers and relevant liaison officers will aim to achieve effective coordination. Tactical managers must concentrate if overall general management. While they need to be aware of what is happening at operational level, they should leave the responsibility for dealing with that level to the operational managers. When the situation warrants it, a strategic level of management/command should be established as early as possible. iv.

Strategic level In exceptional circumstances, one or more agencies may find it necessary to implement a strategic level of management. Major emergencies can place considerable demands on the resources of the responding organisations, with consequent disruption to day to day activities. They may have long term implications for people or the environment. Such matters require attention by senior management, and possibly also by elected members in local authorities. The purpose of implementing a strategic level of management is to establish a framework of policy within which tactical managers will work. Strategic managers will: • establish a framework for the overall management of the incident • determine the strategic aim and objectives, and review them regularly • formulate and implement an integrated media policy • ensure that there are clear lines of communication with tactical commanders and managers • ensure there is long term re-sourcing and expertise for management/command resilience • prioritise the demands of tactical commanders and managers • allocate resources and expertise to meet tactical commanders’ requirements • undertake appropriate liaison with strategic managers in other agencies • plan beyond the immediate response phase for recovering from the emergency and returning to a state of normality; and • avoid and prevent engagement in details and decisions more properly and effectively managed at lower levels. Strategic command for major incidents should be seen as standard practice, not the exception. It is easy to dismantle if not required, and removes the potential for tactical managers/commanders to be reluctant for a strategic level of management/command. The need for a strategic level may arise if tactical management does not have the required resources or expertise available. It may also arise if there is a need to coordinate more than one incident/scene for which tactical command has been established. Strategic management is normally undertaken away from any major emergency scene. The requirement for strategic management may be confirmed to one particular agency. However, certain incidents require a multi-agency response at the strategic level when the issues which arise affect the responsibilities or activities of more than one organisation. Experience has shown that such issues can best be dealt with by establishing a Strategic Coordinating Group. This does not replace individual agencies’ strategic management mechanisms, which will continue, but complements them to ensure that policy and approaches are effectively coordinated.

Strategic Coordinating Group

The purpose of the Strategic Coordinating Group (SCG) is to determine and promulgate policies for the execution of the response, and to ensure their coherence and integration with any subsequent recovery phase. It defines the desired outcomes of the consequence management operations, sets the strategic aims, integrates actions, drives forward planning and monitors progress. The Group must think and decide forwards on an extended time-scale well beyond the immediate, scanning for emerging risks and opportunities; look sideways across the full breadth of consequences, agency responsibilities and geographic boundaries; and consider interests and political ramifications from local to national. The SCG does not have the collective hierarchical authority to issue executive orders. Each organisation represented retains its own responsibilities, and has varying degrees of control over itâ&#x20AC;&#x2122;s entitles operating at the lower levels. The Group therefore has to rely on a process of coordination through consensus rather than command in order to secure consistency between the overall strategic intent and the actions taken by the diverse agencies at the tactical and operational levels. The effectiveness of the SCG therefore rests upon every member having a grasp of the responsibilities and capabilities of all other participants within an overall framework of mutual trust and understanding born of sound preparation, liaison and training. Satisfying these prerequisites for success is a major responsibility of the Local Resilience Forum in the preparation phase. The SCG should be based at an appropriate pre-planned location, away from the distractions of the disaster scene. In most circumstances it will be a police responsibility to establish the group and chair initially. For this reason it is usual to locate the SCG at police headquarters in the first instance. However, during the transition to recovery phase when the emergency services may have little or no involvement, it will normally relocate to the local authority or other relevant organisation (e.g. Environment Agency). There are some types of emergency, notably those that do not originate in a single event or emerge slowly, in which other arrangements will apply. In those circumstances an agency other than an emergency service may initiate and lead the SCG. In due course the leadership may pass to another agency for the recovery phase in common with other forms of emergency. The SCG is normally made up of a nominated senior member from each of the key organisations involved with the response. Each person must be empowered to make decisions in respect of their organisationâ&#x20AC;&#x2122;s resources without the need to refer back; and to have the authority to seek the aid of others in support of their role. vi.

The response to localised emergencies Within the United Kingdom there is substantial experience of emergencies occurring within the bounds of relatively small areas. To bring some order to the almost inevitable confusion it is important that emergency services establish control over the immediate area and also build up arrangements for coordinating the contributions to the response. Each service needs to establish its own control arrangements, but continuing liaison between the services is essential. An effective response depends on good communication and mutual understanding. It is generally accepted that the first members of the emergency services to arrive on the scene should make a rapid assessment and report back to their control room â&#x20AC;&#x201C; not immediately become involved with rescue. Any immediately available information should be provided about: a) where it is;

b) what is involved; and c) which services and resources are present or required. As soon as possible, information should be given on hazards (actual and potential), access to the scene, estimates of the number and main types of injuries, possible control and rendezvous points and any other relevant information. The control room that received the initial message should, in accordance with established plans, alert the other emergency services and local authorities. In accordance with their own procedures, those agencies will then alert personnel or activate appropriate response plans to the level they judge necessary. Agreed protocols should be in place for these agencies to alert any relevant commercial, industrial, voluntary or other organisations as appropriate. For localized incidents, tactical management is usually undertaken from an incident control point established in the vicinity of the incident site. The normal procedure for a major emergency with an identifiable scene is that the police assume the management of overall coordination. This approach ensures that resources are used to best effect and avoids situations where, for example, assets may be called upon simultaneously by different agencies. This is particularly the case for major emergencies that occur near or cross boundaries; where the operational boundaries of agencies are dissimilar; or when organizational changes are under way or have recently been completed.

O DECISION LOG The purpose of the log is to record the decision made, to provide insight into the rationale for the decision, and to provide a context as to what information was available at the time of the decision. This is important for explaining or justifying an action taken in a court of law or during a public enquiry, after the emergency incident. Instructions for completion of this log are overleaf. INSTRUCTIONS Ref code – This will initially be blank and will be completed Date – Please enter day, month, year eg 10.11.06 or 10/11/06 Time – Please enter hour and minutes when decision made. Decision made – this is a brief summary of the decision made Rationale / considerations – this must include the other options which were considered and rejected, as well as any key factors which influenced the decision made. Decision maker – add the decision makers name. This is essential. The decision maker should initial the log at the time to confirm they made the decision.

KIRKLEES PCT DECISION LOG Ref code

Date

Time

Decision made

Rationale / considerations

Decision maker Name

Initials

To be actioned by (name)

To be actioned by (date/ time)

RISK ASSESSMENT ( The Kirklees PCT is conducting a full business continuity management and risk assessment of all critical services) The following table contains the assessment of risks which relate to the provision of the critical service, where RISK is a combination of LIKELIHOOD and IMPACT (R = L x I). NAME OF ASSESSOR(S):

IDENTIFY THE RISK EVENT

Enter a description of the risk event.

LIKELIHOOD OF OCCURRENCE (circle number)

SEVERITY OF IMPACT (circle number)

OVERALL RISK SCORE AND RISK RANKING

INCIDENT BEING ASSESSED:

DATE:

IDENTIFY THE CAUSE OF THE RISK EVENT

Enter a description of the circumstances, events or failings that could/have triggered the risk event.

IDENTIFY THE CONSEQUENCES OF THE RISK EVENT

Enter a description of the consequences to the organisation if the risk event occurs is not managed.

Probable

Possible

Unlikely

Rare

Negligible

Catastrophic

Major

Moderate

Minor

Insignificant

(See Risk Assessment Descriptors)

(See Risk Assessment Matrix) Multiply the Likelihood Score by the Impact Score.

LIKELIHOOD

IMPACT

RISK SCORE

RISK RANK

The following descriptors can be used when assessing the LIKELIHOOD of a potential risk event: Likelihood Scoring & Descriptors

Descriptor

Likelihood of occurrence

Probable

Possible

Unlikely

Rare

Negligible

More likely to occur than not.

Reasonable chance of occurring.

Unlikely to occur.

Will only occur in rare circumstances.

Will only occur in exceptional circumstances.

>50%

>5%

>0.5%

>0.05%

>0.005%

>1 in 2 chance

>1 in 20 chance

>1 in 200 chance

>1 in 2,000 chance

>1 in 20,000 chance

The following descriptors can be used when assessing the IMPACT of a potential risk event: Impact Scoring & Descriptors

Descriptor

Severity of impact

Almost Certain

Likely

Possible

Unlikely

Rare

Permanent loss of core service or facility.

Sustained loss of service which has serious impact on delivery of patient care.

Some disruption in service with unacceptable impact on patient care.

Short term disruption to service with minor impact on patient care.

Interruption in a service which does not impact on the delivery of patient care or the ability to continue to provide a service.

Non-permanent loss of ability to provide a service.

In terms of assessing business continuity or whether an incident exceeds current capacity and merits implementation of strategic or operational command groups the following matrix may be of assistance: -

LIKELIHOOD IMPACT

Probable

Possible

Unlikely

Rare

Negligible

Almost Certain

25 HIGH

20 HIGH

15 HIGH

10 MEDIUM

5 LOW

4 Likely

20 HIGH

16 HIGH

12 MEDIUM

8 MEDIUM

4 LOW

3 Possible

15 HIGH

12 MEDIUM

9 MEDIUM

6 LOW

3 VERY LOW

2 Unlikely

10 MEDIUM

8 MEDIUM

6 LOW

4 LOW

2 VERY LOW

1 Rare

5 LOW

4 LOW

3 VERY LOW

2 VERY LOW

1 VERY LOW

In terms of rating risks, the following Risk Rankings are attached to particular scores within the matrix: -

RED AMBER YELLOW GREEN

- High Risk - Medium Risk - Low Risk - Very Low Risk

MAJOR INCIDENT OPERATIONAL LIBRARY

The Kirklees PCT Major Incident Operational Library is located in the book case backing onto meeting room 6 on the 1st floor, at Beckside Court. Some books are located in the Library, on the bookshelves, and are intended as being identified for Major Incident Events.

The main sections are: Q3 Q4 Q5 Q6 Q7

Resource Documents â&#x20AC;&#x201C; National Resource Documents â&#x20AC;&#x201C; Local Contacts/ Rota Chemical Major Incident Communicable Disease & Deliberate Biological Release o Q7.1 Anthrax o Q7.2 Botulism o Q7.3 Plague o Q7.4 Smallpox o Q7.5 Tularaemia

Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q15 Q16 Q17 Q18 Q19

Major Incidents Involving Radioactivity Ambulance, Fire and Police Communication Systems Media and General Public Reporting, Evaluation, and Audit Community Safety Decontamination Water Shortage Pandemic Flu Preparing for Emergencies On-Line Management of Acute Stress for Health Professionals Glossary

Resources are stored as paper copies and electronically unless indicated otherwise. Electronic versions are stored on a memory stick in the filing cabinet labelled Major Incident Plan in the first floor filing room.

Q3 Resource Documents - National Chin, J. (2000) Control of Communicable Diseases Manual, American Public Health Association, Washington Department of Health (1998) Planning for Major Incidents. The NHS Guidance, NHS Executive, London (paper only) See also: www.doh.gov.uk/epcu/index.htm Department of Health (2003) Planning for major incidents: process over next 3 months Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005 Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance, Acronyms 2005 Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005, Bibliography Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005 Underpinning material: Acute Trusts and Foundation Trusts Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005 Underpinning material: Immediate Medical Care at the scene of a major incident Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005 Underpinning material: Non Acute Trusts and Foundation Trusts including specialist Trusts Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005 Underpinning material: Primary Care Organisations Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005 Underpinning material: Strategic Health Authority. Department of Health Beyond a major incident (2004) Department of Health (2002) Reporting and Management of Serious Untoward Incident Department of Health (2004) Letter re Call Out Protocol for Establishing a Joint Health Advisory Cell HM Government (2005) Emergency Response and Recovery (non statutory guidance to complement Emergency Preparedness) Department of Health (2004) Emergency Planning â&#x20AC;&#x201C; Development of an integrated plan for the management of blood shortages Letter to all SHA Chief Executives (2003) Arrangements from 1 July to assist SHAs and to handle incidents and events following the dissolution of DHSCs National Audit Office (NAO) report (2002) Facing the challenge: NHS Emergency Planning in England (electronic only)

Department of Health (2002) Letter: Emergency Planning: UK Reserve National Stock for Major Incidents Department of Health (2006) Heatwave Plan Huddersfield Central and South Huddersfield Primary Care Trusts (20 December 2005) Major Incident Plan/Emergency Plan Version 4

Resource Documents - Local

West Yorkshire NHS Strategic Health Authority (2003) Strategic Command Arrangements In the Event of an Extraordinary Major Incident Kirklees Primary Care Trust (2004) Heatwave Plan Kirklees Primary Care Trust (2004) Patch-Wide Approach to Winter Pressures (paper only) Kirklees Primary Care Trust (2004) incident risk assessment and business continuity planning: priority areas Kirklees Council (2006) Adult Services Emergency Plan, Sept 2006 Kirklees Council (2006) Adult Services Flu Pandemic Plan, Nov 2006 West Yorkshire Emergency Planning Officers Forum (2002) Who does what in emergencies 2002) A guide to emergency preparedness and response in West Yorkshire, (paper only) Mid Yorkshire Hospitals NHS Trust (2003) Major Incident Plan (MAJAX) Calderdale Primary Care Trust (Dec 04- Jun 05) Emergency Plan (paper only) South West Yorkshire Mental Health Trust (no date) Major Incident Plan, draft (paper only) Huddersfield Central & South PCTs (2004) Emergency Plan (paper only) Bradford South & West PCT (2003) Critical (Emergency/Major) Incident Plan (paper only) Wakefield PCTs (2002) Health Emergency Plans for Wakefield (paper only) South and West Yorkshire Mental Health Trust (2003) Major Incident Plan Mid Yorkshire Health and Social Care Economy (2005) Winter Planning Framework Draft WY Information Sharing Protocol (2006) Draft WY Temporary Mortuary Sites (2006) Yorkshire and the Humber on call changes Letter 2006 Yorkshire and the Humber Health Emergency Planning and Resilience Update (2006)

West Yorkshire Emergency Planning Officers Forum (2006) Voluntary Organisations and Major Incidents

Cascade/Contacts/Rota

National Calderdale and Kirklees PCT (2002) National Care Standards Commission: out of office hours contact numbers Department of Health (2002) The Public Health Link system Department of Health (2002) Directory of Consultants in Communicable Disease Control and Port Health Authority Medical Officers in England, Wales and Northern Ireland Yorkshire and the Humber Calderdale and Kirklees Primary Care Trusts (2002) Registrar of Doctors in Calderdale & Kirklees Primary Care Trusts â&#x20AC;&#x201C; Instructions for Activation Of Out-Of-Hours Cascades To Calderdale And Kirklees GPs Barnes, H. (2002) Gold level of emergency structures in the NHS, South Huddersfield PCT (paper only) Regional Directorate for Public Health Government Office for Yorkshire & the Humber (2002) StHA and PCT Emergency Planning for major incidents West Yorkshire Strategic health Authority (2003) Reception Arrangements for Military Patients (RAMP) At Leeds/Bradford International Airport (paper only) Calderdale and Kirklees Calderdale & Kirklees PCTs, Health Protection Dept (2002) Emergency Planning, temporary version (Paper only) Howard Barnes (2003) GP Alert Instructions (Paper Only)

Chemical Major Incident

Useful Web Sites: Public Health Laboratory Service: http://www.phls.co.uk Chemicals (CDC) http://www.atsdr.cdc.gov Chemicals (Toxbase): http://www.spib.axl.co.uk Planning for major incidents The NHS Guidance. Nov 1998 and the November 2002 update: www.doh.gov.uk/epcu/index.htm 'The decontamination of people exposed to chemical, biological, radiological or nuclear (CBRN) substances or material'. (file size:754kb).

Department of Health (2002) Emergency Planning: UK Reserve National Stock For Major Incidents (paper only) Department of Health (2002) Deliberate Release of Biological and Chemical Agents, Guidance to help plan the health service response (in Section 11.1) Focus on Chemical Incidents (2003) Chemicals at sea, Public Health Preparedness and Response to Chemical Incidents in Europe, etc, Issue No. 7 (paper only) NHS Management Executive (1993) Arrangements to deal with health aspects of chemical contamination incidents, Health Service Guidelines HSG(93)38. (paper only) Department of Health (2002) Chemical Contamination Incident Department of Health (2002) Chemical Exposure Assessment Form Department of Health (2002) DH, PCT and National Focus Responsibilities and Roles Department of Health (2002) Chemical Deliberate Release – Immediate Checklist Department of Health (2002) Key actions and tasks in the event of a chemical major incident Department of Health (2002) Nerve Agents – Guidelines for action in the event of deliberate release Department of Health (2002) Mustard – Guidelines for action in the event of deliberate release Department of Health (2002) Pralidoxime mesylate for treatment of organophosphate nerve agent poisoning. Department of Health (2002) Pre-hospital guidelines for the emergency treatment of deliberate or accidental release of hydrogen cyanide Department of Health (2002) Pre-hospital guidelines for the emergency treatment of deliberate release of Organophosphorus Nerve Agents Department of Health (2002) Patient – Group direction for the administration of atropine by paramedics and nursing staff to patients with nerve agent poisoning Department of Health (2002) Patient – Group direction for the administration of Pralidoxime Mesylate by Paramedics and Nursing Staff to Patients with Nerve Agent Poisoning Department of Health (2002) Patient – Group direction for the administration of Obidoxime Chloride by Paramedics and Nursing Staff to Patients with Nerve Agent Poisoning Department of Health (2002) Patient – Group direction for the administration of glucose injection 50% by Paramedics and Nursing Staff to patients with Cyanide Poisoning Department of Health (2002) Patient – Group direction for the administration of Dicobalt Edetate to Patients with Cyanide Poisoning by Paramedics and Nursing Staff

Communicable Disease and Deliberate Biological Release

Useful web Sites: WHO Regional Office for Europe: http://www.who.dk EuroSurveillance: http://www.eurosurv.org/main.htm Public Health Laboratory Service: http://www.phls.co.uk Centres For Disease Control, Atlanta: http://www.cdc.gov Travel Health: http://www.tripprep.com Scots Guidelines Site: http://www.show.scot.nhs.uk/sign/graphic.htm Deliberate Release Portable Document Format (Pdf) File List. 02/2003 www.phls.org.uk/topics_az/deliberate_release/menu.htm Department of Health (2002) Deliberate Release of Biological and Chemical Agents, Guidance to help plan the health service response (paper only) Department of Health (1996) Green Book on Immunisation, London See also : www.doh.gov.uk/greenbook Department of Health (2002) Deliberate Release of Biological and Chemical Agents, Guidance to help plan the health service response (in Section 6.1) Department of Health (2002) Getting Ahead of the Curve. A strategy for combating infectious diseases including other aspects of health protection, London (in Section 6.1) Department of Health. (2003) Contingency Plans for smallpox (paper only) Department Of Health (2002) Getting Ahead Of The Curve: Future Arrangements For Microbiology Laboratory Services Department of Health (2003) Health Clearance for Serious Communicable Diseases: new Health Care Workers (paper only) Public Health Laboratory Service (2001) PHLS interim guidelines for health professionals dealing with packages suspected of containing anthrax (paper only) Regional Review Group For Communicable Disease Control (1999) The Vaccine Cold Chain from manufacturer to patient: guidance for the storage and transport of vaccines, Northern and Yorkshire NHS Region (paper only) Regional Review Group for Communicable Disease Control (1999) Infection Control Facilities in Health Care Premises. (paper only) Stuart, J. (2002) Guidelines for public health management of meningococcal disease in the UK, Communicable Disease Public Health 5(3): 187-204 (paper only) PHLS (2002) Communicable Disease & Public Health: Guidelines for public health management of meningococcal disease in the UK Kirklees Primary Care Trust (2002) Immunisations Protocol (paper only)

Department of Health (2002) Guidance: Public Health Response to Deliberate Release of Biological and Chemical Agents Department of Health (2002) Aide Memoire – Bioterrorism Department of Health (2002) Patient Group Direction for the further supply of doxycycline capsules to adults and children over 12 years known to have been exposed to a biological agent Department of Health (2002) Biological Agent Unknown / Awaiting Confirmation. Information for healthcare workers. Department of Health (2002) Patient Group Direction for the supply of Ciprofloxacin tablets by Healthcare Professionals to adults and children aged over 12 years exposed to suspected biological agent. Department of Health (2002) Patient Group Direction for the further supply of Ciprofloxacin tablets by Healthcare Professionals to adults and children aged over 12 years exposed to suspected biological agent. Department of Health (2002) Patient Group Direction for the supply of Ciprofloxacin tablets by Healthcare Professionals to children under 12 years old known to have been exposed to a biological agent Department of Health (2002) Antibiotic Treatment with Ciprofloxacin for exposure to a biological agent. Information for parents / carers. Department of Health (2004) Dispensing Instructions for Ciprofloxacin Tablets 250mg Department of Health (2004) Dispensing Instructions for Ciprofloxacin Tablets 500mg Department of Health (2004) Dispensing Instructions for Ciprofloxacin suspension 250mg in 5ml Department of Health (2004) Ciprofloxacin suspension – how to use oral syringe Department of Health (2004) Biological Agent Unknown / Awaiting Confirmation Information for Healthcare Workers Department of Health (2004) Antibiotic Treatment with Ciprofloxacin for exposure to a biological agent Q7.1 Anthrax Department of Health (2002) Aide Memoire: Anthrax Covert Deliberate Release Department of Health (2002) Aide Memoire: Anthrax Overt Deliberate Release Department of Health (2002) Aide Memoire: Anthrax Suspected Covert Deliberate Release Department of Health (2002) Anthrax – Briefing Note for Members of the Public Department of Health (2002) Epidemiological Information for Case of Confirmed or Suspected Anthrax (Outline Questionnaire)

Department of Health (2002) Anthrax: Overt Deliberate Release Exposure and Prophylaxis Form Q7.2 Botulism Department of Health (2002) Aide Memoire: Botulism: Covert Deliberate Release Department of Health (2002) Aide Memoire: Botulism: Overt Deliberate Release Department of Health (2002) Botulism – Briefing Note for Members of the Public Department of Health (2002) Epidemiological Information for Case of Confirmed or Suspected Botulism (Outline Questionnaire) Department of Health (2002) Aide Memoire: Overt Deliberate release Botulism – Immediate Checklist. Q7.3

Plague

Department of Health (2002) Aide Memoire: Covert Deliberate Release Plague – Confirmed Release Department of Health (2002) Aide Memoire: Covert Deliberate Release Plague – Suspected Release Department of Health (2002) Aide Memoire: Overt Deliberate Release Plague Department of Health (2002) Plague – Briefing Note for Members of the Public Department of Health (2002) Epidemiological Information for Case of Confirmed or Suspected Plague (Outline Questionnaire) Department of Health (2002) Aide Memoire: Overt Deliberate release Plague – Immediate Checklist. Department of Health (2002) Plague: Overt Deliberate Release Exposure and Prophylaxis Form Q7.4

Smallpox

National Department of Health (2005): • • •

Smallpox Mass Vaccination: An operational Planning Framework Smallpox Plan: Guidelines for Smallpox Response and Management in the Post-eradication Era Smallpox: An Overview and Key Documents: Smallpox vaccination of Regional Response Groups

Department of Health (2002) Aide Memoire: Covert Deliberate Release Smallpox – Confirmed Release Department of Health (2002) Aide Memoire: Overt Deliberate Release Smallpox

Department of Health (2002) Smallpox Virus – overt deliberate release immediate checklist Department of Health (2002) Smallpox Virus: Deliberate Release Exposure and Vaccination Form Department of Health (2002) Smallpox – Briefing Note for Members of the Public Department of Health (2003) Guidelines for smallpox response and management in the post-eradication era (smallpox plan) Department of Health (2003) Guidelines for smallpox response and management in the post-eradication era (smallpox plan) Appendices Department of Health (2002) Smallpox-Questions and Answers (paper only) Department of Health. (2003) Smallpox diagnostic algorithm (paper only) Q7.5

Tularaemia

Department of Health (2002) Aide Memoire: Overt Deliberate Release Tularaemia Department of Health (2002) Aide Memoire: Covert Deliberate Release Smallpox – Suspected Release Department of Health (2002) Epidemiological Information for Case of Confirmed or Suspected Tularaemia (Outline Questionnaire) Department of Health (2002) Tularaemia: Deliberate Release Exposure and Prophylaxis Form Department of Health (2002) Aide Memoire: Tularaemia: Overt Deliberate Release Immediate Checklist

Major Incidents Involving Radioactivity

Useful Web Site: http://www.nrpb.org.uk Department of Health (1989) Guidance on Accidents Involving Radioactivity, Annex to HC (89)8, HN(FP)(89)8 (paper only) Department of Health (1989) Guidance on Stable Iodine (potassium iodate tablets) Distribution Arrangements: Role of Health Authorities, Addendum to Annex to HC(89)8 (paper only) Home Office (2003) Strategic National Guidance, The decontamination of people exposed to chemical, biological, radiological or nuclear (CBRN) substance or material, London (paper only) Local Authority and Emergency Service Information (2002) Nuclear Weapon Transport Contingency Plans (paper only)

McColl, NP. , Kruse. P. (2002) Technical Handbook on the National Arrangements for Incidents Involving Radioactivity, NAIR Technical Handbook, 2002 Edition, Oxon: National Radiological Protection Board (paper only) Department of Health (2002) Release of radioactivity into the environment – contingency planning and response Department of Health (2002) Patient – Group direction for the supply of potassium iodate tablets by Authorised Persons to Patients Exposed to Radioactive Iodine Department of Health (2001) Potassium Iodate Tablets information leaflet Q9

Ambulance, Fire and Police

Ambulance Service (2001) Standing operational procedures to support the deployment of modesty and equipment pods from the UK reserve national stock for major incidents Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005 Underpinning material: Ambulance Services COMAH Off-Site Emergency Plan (2005) Mitchell Cotts Chemicals (Paper Only) COMAH Off-Site Emergency Plan (2005) CIBA Speciality Chemicals Water Treatments LTD (Paper Only) COMAH Off-Site Emergency Plan (2005) A H Marks & Company LTD ( Paper Only) Q10

Communication Systems

Department of Health (2002) The Public Health Link system (paper only) Information Authority (1998) ACCOLC (Access Overload Control For Cellular Radio Systems) (paper only) Cabinet Office (2004) – ACCOLC Registration Application NHS Information Authority – FAQ on ACCOLC Registration Cabinet Office (2004) – ACCOLC - FAQ HPA Colindale (2004) Responding to Suspect Packages and Materials – Actions to be taken

Cabinet Office (2005) CTP Stakeholder Information Pack Cabinet Office (2005) CTP Stakeholder Information Pack Annex C Q11

Media and General Public

Commission for Health Improvement (2002) Guidelines For The NHS In Establishing And Running Helplines HM Government: Preparing for Emergencies Leaflets

Kirklees Primary Care Trust (2004) Public Information Strategy: preparing for emergencies â&#x20AC;&#x201C; what you need to know booklet South Huddersfield PCT (2002) Public Helplines and Emergency Planning

Q12

Reporting, Evaluation, and Audit

National Audit Office Report (2002): Facing the challenge: NHS Emergency Planning in England (paper only) Regional Directorate for Public Health. Yorkshire & the Humber (2003) Major Incident Planning: Self Assessment Audit. (paper only) Thames Valley, SE Region Report on the Joint Health Advisory Cell 6 Dec 02 exercise with radioactive substance. (paper only) West Yorkshire Fire and Civil Defence Authority (1997) Dunblane the first year (paper only) Dewsbury Healthcare Trust (2001) Meningitis Campaign Report (paper only) Q13

Community Safety

West Yorkshire Police (2003) Community Impact Assessment. Minutes of meeting held on 19/03/2003,Vigilance and Reassurance Key Contacts, Responses to Possible Community Tensions, Kirklees Community Issues-questions and facts Huddersfield Q14

Decontamination

National Strategic National Guidance (Dept of Environment, Food & Rural Affairs, March 2004) The decontamination of the open environment exposed to chemical, biological, radiological or nuclear (CBRN) substances or material Department of Health (2002) Mobile Decontamination Facilities and Personal Protective Equipment for Chemical Incidents Home Office (2003) The decontamination of people exposed to chemical, radiological or nuclear (CBRN) Substances. Strategic National Guidance. Q15

Water Shortage

Regional Leeds Health Authority (2001) Water Shortage Response Plan Leeds Health Protection Unit (April 2002) Public Health Action in the Event of a Water Contamination Incident in Leeds

Leeds Health Protection Unit (April 2002) Public Health Action in the Event of a Flooding Incident in Leeds West Yorkshire Emergency Planning Officers Forum (November 2005) WY Flooding Concept of Operations Q16

Pandemic Flu

National UK Health Departments (October 2005) Pandemic Flu: UK Influenza Pandemic Contingency Plan UK Health Departments (October 2005) Pandemic Flu: Frequently Asked Questions Department of Health (2005) Pandemic Flu – Key Facts Department of Health (2005) Preparing for an Influenza Pandemic in the UK – Covering Letter Department of Health (2005) Questions You Might Be Asked – Pandemic Flu and its Impact Department of Health (2005) Pandemic Flu – Important Information for You and Your Family Department of Health (2005) Explaining Pandemic Flu – a guide from CMO World Health Organisation (2004): Guidelines for global surveillance of Influenza A/H5 (Avian Flu) Department of Health (2005) UK Operational Framework for stockpiling, distributing and Using Antiviral Medicines in the Event of Pandemic Influenza Health Protection Agency (2005) A logorithm for management of returning travelers from countries affected by Avian Influenza DEFRA (2005) – Disease Fact sheet: Avian Influenza UK Health Departments (2005) Influenza Pandemic Contingency Planning: Operational Guidance for Health Service Planners in England Department of Health (2005) Guidance for Pandemic Influenza: Infection Control in Hospitals and Primary Care Settings Department of Health (2005) Explaining pandemic influenza – slide set Department of Health (2005) History of influenza pandemics – slide set Department of Health (2005) The virology and epidemiology of influenza viruses – slide set Department of Health (2005) Avian influenza - slide set Department of Health (2005) Predicting the impact - slide set Department of Health (2005) Containing pandemic flu - slide set

Department of Health (2005) Pandemic flu research findings – health professionals – slide set Department of Health (2005) Pandemic flu research findings – general public – slide set Department of Health (2005) Pandemic flu modelling – slide set Department of Health (2005) UK response – slide set Department of Health (2005) Pandemic flu – images – slide set LACORS (2005) Contingency Plan Annex A - Avian Flu V1 Department of Health (2006) NHS National Workshop on Pandemic Flu Department of Health (2006) Flu News Local Wakefield West PCT IC Business Continuity Plan for Pandemic Flu (2006) Wakefield West PCT Wakefield Pandemic Influenza Plan Version 3 (2006) Wakefield West PCT Outline Influenza Pandemic Plan (2006) Q17

Preparing for Emergencies On - Line

Regional Yorkshire & Humber: (2005) Guidance for Using ‘Preparing for Emergencies’ On-line -

Responders

Practitioners

Q18

Management of Acute Stress in Health Professionals

National Department of Health (8 July 2005) Information to Health Professionals regarding the management of acute stress and post traumatic stress disorder (PTSD) resulting from the explosions on the London transport systems on 7th July 2005

Q19

Glossary

Department of Health Emergency Preparedness Division (2005) The NHS Emergency Planning Guidance 2005, Glossary of Terms

REFERENCES

1.1 The NHS Emergency Planning Guidance 2005 (1.1.5, 2.1.1, 3.G3) 1.2 The NHS Emergency Planning Guidance 2005, Underpinning Materials (1.5.3, 1.5.4) 1.3 The NHS Emergency Planning Guidance 2005, Primary Care Organisations (1.6.1) 1.4 Ambulance Service 2001 (1.7.7) 1.5 Department of Health 2002, Deliberate Release of Biological and Chemical Agents (1.7.7, 1.7.10) 1.6 South and West Mental Health 2003, Trust Major Incident Procedure (1.7.8) 1.7 West Yorkshire Emergency Planning Officers Forum 2002 (1.7.9) 1.8 Kirklees Council 2006 Adult Services Emergency Plan (1.7.11)