Hull and East Yorkshire Hull and East Yorkshire Hospitals NHS TrustHospitals NHS Trust

Membership Event: 7 October 2014Membership Event: 7 October 2014

Emergency Preparedness:Emergency Preparedness:

How would HEY respond to a major How would HEY respond to a major incident?incident?

What is a major incident?What is a major incident?

For the NHS a major incident is defined as:For the NHS a major incident is defined as:

““Any occurrence that presents serious threat Any occurrence that presents serious threat to the health of the community, disruption to to the health of the community, disruption to

the service or causes (or is likely to cause) the service or causes (or is likely to cause) such numbers or types of casualties to such numbers or types of casualties to

require special arrangements to be require special arrangements to be implemented by hospitals, ambulance trusts implemented by hospitals, ambulance trusts

or primary care organisations”or primary care organisations”

NHS Commissioning Board Command and Control FrameworkFor the NHS during significant incidents and emergencies (January 2013)

What are our What are our responsibilities?responsibilities?• To plan for, and respond to a wide range of To plan for, and respond to a wide range of

incidents and emergencies that could affect incidents and emergencies that could affect health or patient carehealth or patient care

• To ensure highest level of service is To ensure highest level of service is maintained, regardless of what might happen maintained, regardless of what might happen (Civil Contingencies Act (2004)) (Civil Contingencies Act (2004))

• To have trained, competent staff and To have trained, competent staff and facilities available 24/7 to effectively manage facilities available 24/7 to effectively manage a major incident or business continuity a major incident or business continuity incident (Health and Social Care Act incident (Health and Social Care Act 2012)2012)

• To ensure the needs of those using services To ensure the needs of those using services continue to be met continue to be met

(CQC Essential Standards) (CQC Essential Standards)

How prepared are we?How prepared are we?

• The Trust’s emergency preparedness, The Trust’s emergency preparedness, resilience and response (EPRR) plans resilience and response (EPRR) plans provide a structured framework for staffprovide a structured framework for staff

• The Trust’s Emergency Preparedness The Trust’s Emergency Preparedness intranet site, contains EPRR plans and is intranet site, contains EPRR plans and is accessible to staffaccessible to staff

• The Trust’s Resilience Committee is The Trust’s Resilience Committee is responsible for reviewing, testing, responsible for reviewing, testing, validating and updating plansvalidating and updating plans

• The Trust’s EPRR plans ensure the The Trust’s EPRR plans ensure the organisation maintains essential services, organisation maintains essential services, delivers optimum care, minimises disruption delivers optimum care, minimises disruption and brings about a speedy return to normal and brings about a speedy return to normal levels of functioning in the event of a major levels of functioning in the event of a major incident or business disruptionincident or business disruption

Emergency Preparedness Emergency Preparedness and Response (EPRR) Plansand Response (EPRR) Plans

EMERGENCY PREPAREDNESS, RESILIENCE & RESPONSE

Major Incidents Business Continuity

Acute Major IncidentsThreat to

Public HealthSeasonalVariation

Public InfrastructureDisruption

Internal Disruption

Failure of Service Provider

Maintaining Services

HEY as Supporting Responder

Winter

Heat Wave

Bank and Public Holidays

Fuel Supply Disruption

Terrorism

PREVENT

Others

Standard Operating Procedures

Significant Incident Planning

On-Call

PFI partners

Other supplier or contractor

Loss of facilities or evacuation

Industrial Action

Communications loss or disruption

Public utilities interruption

Interruption to critical functions

HEY as Lead Responder

Medical Emergency Response Incident Team

Generic

Chemical, Biological, Radiation &

Nuclear Incidents

Mass Casualties

Major Trauma

Pandemic

Outbreak of Infection

FireCBRN or other incident

PlannedEquipment loss

or failure

Failure of system Loss of data

What about training?What about training?

• Briefing all new staff during inductionBriefing all new staff during induction

• eLearningeLearning

• Face to face trainingFace to face training

• Table top exercisesTable top exercises

• Live major incident exercisesLive major incident exercises

• Medical Emergency Response Incident Team Medical Emergency Response Incident Team (MERIT)(MERIT)

• DecontaminationDecontamination

• Radiation monitoringRadiation monitoring

What if a major incident What if a major incident happens?happens?• Incident which can not be managed within Incident which can not be managed within

normal resourcesnormal resources• Emergency Department (receiving / supporting Emergency Department (receiving / supporting

hospital) formally notified by Yorkshire hospital) formally notified by Yorkshire Ambulance ServiceAmbulance Service

• Assessment by doctor in charge of EDAssessment by doctor in charge of ED• ““Major Incident Declared Activate Plan” or Major Incident Declared Activate Plan” or

“Stand By”“Stand By”• ED may be asked to send Medical Emergency ED may be asked to send Medical Emergency

Response Incident Team (MERIT) to incidentResponse Incident Team (MERIT) to incident• Hospital switchboard operators initiate Hospital switchboard operators initiate

cascade call out of staff with specific cascade call out of staff with specific responsibilities and skills using bleeps / group responsibilities and skills using bleeps / group call systemscall systems

Command and Control – Command and Control – once the Major Incident once the Major Incident Plan has been declaredPlan has been declared

• Bronze (Operational) CommandBronze (Operational) Command will lead will lead operational responses in each clinical areaoperational responses in each clinical area

• Silver (Tactical) CommandSilver (Tactical) Command, also known as , also known as the Hospital Control Team, will lead and co-the Hospital Control Team, will lead and co-ordinate the Trust’s operational response ordinate the Trust’s operational response

• Gold (Strategic) CommandGold (Strategic) Command will have will have Executive control of the organisation, Executive control of the organisation, command resources, manage external command resources, manage external communications and plan recoverycommunications and plan recovery

What happens during a What happens during a major incident?major incident?

• Determined by scale of incidentDetermined by scale of incident• Individual and departmental Action Cards Individual and departmental Action Cards

allocated – main tasks and sequence followedallocated – main tasks and sequence followed• Possibly contain impact of incident within EDPossibly contain impact of incident within ED• Possibly create additional capacity on wards, Possibly create additional capacity on wards,

operating theatres and critical care facilitiesoperating theatres and critical care facilities• Possibly suspend planned operating Possibly suspend planned operating

sessions, OPD clinics, planned admissions, sessions, OPD clinics, planned admissions, transfer or discharge existing patients – transfer or discharge existing patients – medically assessedmedically assessed

• Hospital Lockdown to control site entry / exit Hospital Lockdown to control site entry / exit

Are any specific areas Are any specific areas created during a major created during a major incident ?incident ?

• Incident Command and Information CentreIncident Command and Information Centre

• Staff Holding AreaStaff Holding Area

• Patient Transport and Discharge AreaPatient Transport and Discharge Area

• Relatives CentreRelatives Centre

• Media / Press CentreMedia / Press Centre

How do the Hospital How do the Hospital Control Team know what is Control Team know what is happening during the happening during the incident?incident?• The Hospital Information Team update the The Hospital Information Team update the

Hospital Control Team every 30 minutesHospital Control Team every 30 minutes

• Hospital Information Team confirm:Hospital Information Team confirm: - Adult / Paediatric bed availability- Adult / Paediatric bed availability - Critical Care facilities available- Critical Care facilities available - Operating Theatre availability- Operating Theatre availability - Discharge status- Discharge status - Major Incident patient status- Major Incident patient status

• The Hospital Control Team provide Gold The Hospital Control Team provide Gold Command with regular information updatesCommand with regular information updates

What happens after “Stand What happens after “Stand Down” of the major Down” of the major incident?incident?• Immediate Trust debriefing – what went well, Immediate Trust debriefing – what went well,

lessons learned and opportunity to thank stafflessons learned and opportunity to thank staff

• Formal Trust debriefing (within 1 week) – all Formal Trust debriefing (within 1 week) – all staff directly and indirectly involvedstaff directly and indirectly involved

• Formal Inter- Agency Debriefing (YAS, Police, Formal Inter- Agency Debriefing (YAS, Police, etc)etc)

• Final Major Incident report to Trust Board and Final Major Incident report to Trust Board and Trust Development Authority (within 2 weeks)Trust Development Authority (within 2 weeks)

• Review and amend Trust Major Incident PlanReview and amend Trust Major Incident Plan

• Ongoing staff awareness through Major Ongoing staff awareness through Major Incident training and exercisesIncident training and exercises

Thank you.Thank you.

Any Questions?Any Questions?