National Ambulance Service Command and Control Guidance...National Ambulance Service Command and Control Guidance Version 3.0 1 I n t r o d u c t i o n Over the last decade the duty

National Ambulance Service Command and Control Guidance

March 2019Version 3.0

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NARU DOCUMENT INFORMATION TABLE

Full Title

Version

Document Type

CMT Approval Date

Implementation Date

Superseded Documents

Related Documentsor Cross References

Circulation

Action Required

Lead NARU Contact

Document Protection

Summary ofAmendments


V.3.0 March 2019 Security Marking Not marked

National Guidance NARU Ref. NARU043

7th March 2019 Publication Date 1st April 2019

1st April 2019 Review Date January 2022

National Ambulance Service Command and Control Guidancev 1.2 October 2015

• NHS England EPRR Framework (2015)• HM Government (2005): Emergency Preparedness: Guidance on Pert 1 of the Civil Contingencies Act 2004• NARU / NHSE Standards for NHS Ambulance Service Command & Control (2018)• NARU National Ambulance Service Major Incident Action Cards• NARU (2017) National Provisions of Interoperable Capabilities• NARU National Ambulance Service CBRNE/HAZMAT Guidance• NARU National Ambulance Coordination Plan (2017) v 3.0• NARU Recognised Command Courses (2018) • Cabinet Office; National Resilience Standards (2018) v 1.0

• Chief Executives• Directors of Operations• Emergency Planning Leads• NHS England National and Regional Heads of EPRR• HART and Special Operations Managers• NARU On call cadre

For information.

Head of Compliance & Quality

This is a controlled document. Whilst this document may beprinted, the electronic version published on the NARU website(or held securely on the NARU server if protectively marked)remains the controlled copy. Any printed copies of thisdocument are not controlled. As a controlled document, thisdocument should not be saved onto local or network drivesbut should be accessed from the internet whenever possible.In the event that NARU also publishes hard / paper copies ofthe document, the controlled or live document remains theonline version which may be subject to change or amendment.Check the online status of the document via the NARU websiteat regular intervals. All documents containing the officialNARU badge are protected through standard English copyrightlaw provisions and in accordance with the terms of the NHSEngland NARU Contract.

• Review of 2015 National Ambulance Service Command and Control Guidance• Please see Update Table for any updates within this version.NB the up to date version of this document is available viathe Proclus website.

www.naru.org.ukNational Ambulance Service Command and Control Guidance

Version 3.0

3National Ambulance Service Command and Control GuidanceVersion 3.0

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4 www.naru.org.ukNational Ambulance Service Command and Control Guidance

Version 3.0

This guidance is designed to provide astructured approach to managing majoror complex incidents for the AmbulanceService, with a particular focus onmulti-agency responses. It is recognisedthat each organisation has specific needs and considerations to ensure thattheir incident response and businesscontinuity arrangements are addressedthrough appropriate plans.

This guidance should provideassurances to our multi agencypartners of our commitment to learnfrom lessons of previous incidents andevents and to ensure that the NHSAmbulance Service Providers remain anessential element of the civil protectioncapabilities across England.

The development of this Guidance has considered lessons identified from recent majorincidents and event responses across England, the UK and wider global events in additionto the updated practice among our Police and Fire and Rescue Service partners.

The aim of the Guidance is to assist the Ambulance Commander in taking appropriate andconsistent considerations to inform decision making, based on sound risk management inmaking consistent and informed decisions based on the information available at the time.

It is important to recognise and thankthe individuals who contributed to thedevelopment of this Guidance. It willundoubtedly provide further support andprotection to staff enabling them todeliver the best possible care and serviceto the public. This Guidance has beendeveloped in conjunction with andcontributions from Northern Ireland,Scottish and Welsh Ambulance Services.The Scottish Ambulance Service endorsesthis publication but recognises that thereare local differences which need to betaken into account in the context ofNHS Scotland.

I commend this Guidance for adoption byyour Service and believe it will furtherstrengthen the resilience arrangementsthat exist within the Ambulance Service.

FOREWORD

Anthony C. MarshChief Executive Officer, West Midlands Ambulance Service University NHS Foundation TrustChairman, Association of Ambulance Chief Executives (AACE)National Ambulance Chief Executive Lead for Emergency Preparedness


CONTENTS

1.0 Introduction 6

Scope 6

Legal Requirements 7

2.0 Preparing to Command 8

Ambulance Service Responsibilities 8

Interoperability 9

Leadership 11

Human Factors 11

Business Continuity Management 12

3.0 Command and Control 13

Integrated Emergency Management

(IEM) 13

Decision Making 15

The Command and Control Structure 17

Strategic Commander 18

Tactical Commander 18

Operational Commander 20

Span of Control 21

Functional Roles 24

Record Keeping and Logging 24

4.0 Incident Management 26

Ambulance Service Strategy 26

Tactical Options 27

Risk Identification and Management 28

Operations and Resource

Management 30

Communications Interoperability 31

Command Briefing 32

Information Sharing 32

Post Incident Procedures 34

5.0 Competencies and Training 35

National Occupational Standards

(NOS) 35

Ambulance Commanders Continual

Professional Development 35

ANNEX 1

Strategic Commander:

Command and Control Roles,

Performance Criteria and

Responsibilities 41

ANNEX 2

Tactical Commander:



Responsibilities 42

ANNEX 3

Operational Commander:



Responsibilities 44

ANNEX 4

Functional and Additional Support Roles 45

ANNEX 5

Ambulance Service Strategy 47

ANNEX 6

Command Tabards 49

ANNEX 7

Ambulance Service Personal Protective

Equipment Capabilities 51

ANNEX 8

Model Command Structure 52

ANNEX 9

NOS CPD Evidence Record 54

ANNEX 10

Tactical Plan Template 55

ANNEX 11

Casualty Management Plan 59

ANNEX 12

Standards for NHS Ambulance Service

Command & Control 61

Glossary and Bibliography 62

Contents

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1.0 INTRODUCTION

1

Introduction

The Ambulance Services of theNational Health Service (NHS) dealon a day to day basis with thousandsof diverse incidents, many of whichare resolved without the need for the implementation of a dedicatedCommand and Control structure.However, when an incident becomescomplex or resource intensive thensuch an agreed structure will berequired to facilitate the efficientand successful management ofthe incident.

SCOPEThis document offers guidance tosupport the contract standards setwithin ‘Standards for NHSAmbulance Service Command &Control’ and should be read inconjunction with those provisions.As such, this guidance is subordinateto those contractual obligations.This Guidance document is designedto assist those responsible forplanning, training and exercising,responding and recovering from amajor incident.

NHS Mandate for this Document

Legislation and StatutoryProvisions

Ministerial Mandate / LeadGovernment DepartmentDirective

National Multi-Agency Doctrine(if backed by Government)

NHS Standard Contract(Inc. Service Condition SC30 -EPRR)NHS England EPRR Framework NHS England EPRR CoreStandards

1.1

1.2

National Provisions forInteroperable Capabilities(the national safe systemof work)NHS Command & ControlGuidance (this document)

Since the publication of the firstedition of this guidance, the JESIPprogram has been imbedded withinthe three blue light services andwider. This guidance fully adopts themodels and principles of JESIP.

LEGAL DUTIES AND OBLIGATIONSFurther to the contract obligations,the following legal obligations applyto command and control by the NHSAmbulance Service:

The Health and Safety at WorkAct 1974 and its subsequentprovisions requiring a safesystem of work for Ambulanceemployees.

The Civil Contingencies Act 2004including the obligations placedupon Category 1 responders.

Common law (tort of negligence),specifically the established dutyof care between AmbulanceService and the patient. Potentialliability arising from negligenceor gross negligence. Negligencemay also give rise to liabilityunder the CorporateManslaughter & CorporateHomicide Act 2007.

Post incident inquests, inquiries andlegal action have concentrated theirscrutiny on the quality of commanddecision making and the subsequentimpact on patient outcomes.

1.3


1

Introduction

Over the last decade the duty of carefor the NHS Ambulance Service hasbeen legally clarified and theexpectation of Coroner’s, InquestChairman, and Judges hasincreased. High standards ofCommander competence are nowthe starting point for any suchinquiry particularly where theemergency event was within thecontemplation of the National RiskRegister for Civil Emergencies andwhere similar events have occurredin the past.

Command decisions have a directimpact on clinical outcomes, survivalrates and the safety of respondingstaff. A key outcome of thisguidance is, therefore, to increasethe effectiveness of NHS AmbulanceService command by maintaininghigh standards of competence andcredibility among NHS AmbulanceService Commanders. Both thepublic and the NHS Ambulancepersonnel that put their lives atrisk to respond to complexemergency situations have a rightto expect no less.

Command decisionshave a direct impacton clinical outcomes,survival rates andthe safety ofresponding staff.

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2.0 PREPARING TO COMMAND

2

Preparing to Command

AMBULANCE SERVICERESPONSIBILITIES NHS, Ambulance Service Providershave the responsibility for alerting,mobilising and coordinating theinitial NHS response to short noticeor sudden impact emergenciessuch as critical or major incidents.This includes:

Initiate and maintain AmbulanceService command plans toprovide appropriate support andguidance to all NHS respondersand other agencies.

Coordination of all NHScommunications will be throughthe host/responding ambulanceservice provider[s].

The management of the health,safety and welfare of all NHSresponders at the scene of theincident.

The provision of effectivecasualty triage, treatment andtransport including the selectionof appropriate receivinghospitals.

Provision of specialist incidentresponse capabilities, includinghazardous area working,decontamination of casualtiesand response to terroristincidents.

Appropriately trained andcompetency assessedcommanders with evidence ofContinued Professional.

Commander development asper the Standards for NHSAmbulance Service Commandand Control.

2.1

Ensuring all Strategic and Tactical Commanders contributing toan on-call rota should beappropriately Security Cleared to attend sensitive meetings andbriefings implied by their role.

All Commanders must have anin-depth knowledge of their ownorganisation’s Major Incident Planand relevant procedures.

Command decisions have thegreatest impact on the performanceof the NHS at the scene of major andcomplex incidents. Those decisionsalso directly affect clinical outcomes,survivability and staff safety.

NHS Ambulance Service providersmust ensure that the command rolesset out in the diagram below (Figure1) are maintained and available atall times within their service area.They create the fundamental chainof command. The NationalAmbulance Service Command andControl Guidance defines theseroles in more detail.

The NHS Ambulance Serviceprovider must ensure that thereis sufficient resource in place toprovide each command role(Strategic, Tactical and Operational)with the appropriate requiredsupport roles set out in the diagrambelow (Figure1) at all times.

All roles within this structure mustbe staffed by competent and crediblepersonnel that have been trainedand exercised to discharge thesefunctions to a suitable standard(defined by this Guidance and withinthe Standards).

2.2

2.3


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INTEROPERABILITYInteroperability is the extent towhich organisations can worktogether coherently as a matter ofroutine. It is about working togetherto achieve a joint aim for the benefitof a group of people, community,or an organisation. Interoperabilityplanning requires accounting foremergency management andincident response contingenciesand challenges.

Using the JESIP Principles, theemergency services personnel willbetter understand the capabilitiesof their peers and will be competentin establishing, a joint understandingof risk shared situational awarenessand the use of the Joint DecisionModel.

2.4JESIP KEY TASKS

To establish joint interoperabilityprinciples and ways of working(doctrine).

To develop greater understandingof roles, responsibilities andcapabilities amongst tri-serviceresponders.

To improve the training for alllevels of command.

To implement a joint testing anexercising strategy for all levelsof command to ensure lessonsidentified progress to lessonslearned through procedural andcultural change.

StrategicCommander

Strategic Advisor

Loggist

Strategic Medical Advisor

CHAIN OF COMMAND COMMAND SUPPORT

TacticalCommander

OperationalCommander

Ambulance ServiceFunctional Roles

NILO/Tactical Advisor

Loggist

Medical Advisor

Forward Doctor

Loggist

Figure 1 - The Chain of Command and Supporting Structures

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If the principles are followed then the result should be a jointly agreed working strategy whereall parties understand what is going to happen when and by who, this strategy should include:

What are the aims and objectives to be achieved?

Who by - police, fire, ambulance and partner organisations?

When - timescales, deadlines and milestones

Where - what locations?

Why - what is the rationale? Is this consistent with the overall strategic aims and objectives?

How are these tasks going to be achieved?

THE PRINCIPLES FOR JOINT WORKING- How Interoperability is achieved in the context of an operational response

Emergency Response Plans shouldinclude considerations ofgovernance, Standard OperatingProcedures (SOP), technology,training and exercises, and usagewithin the context of the stress andchaos of a major response effort; allof these should be jointly consideredand assessed if they includeassumptions of interoperability.

2.5 Coordinated decision makingbetween agencies and departmentsis necessary to establish effectiveand coherent governance and iscritical to achieving interoperability.Agreements and SOPs should followJESIP models and principles toachieve interoperability.

2.6


2


LEADERSHIPLeadership is a key attribute of anAmbulance Commander and onewhich they must display whencarrying out their role during anemergency response. They mustalso be visible, confident andmeasured in their decision making.

Good communication is at theheart of an effective response.Communication is a key element atevery level of command. Effectiveleaders will provide clear andeffective communication and possessthe skills to motivate staff during theresponse. Commanders must focuson the needs of the task, of the groupand of the individuals under theircommand. Effective Commanderswill maintain the highest levels ofintegrity, to gain the trust andultimately, the respect of theircolleagues and peers.

Commanders should considerthe following factors which affectleadership:

Effective leadership requiresCommanders to have an honestunderstanding of who they are, whatthey know, and what they can do.

Not all staff will be the same;different people require differentstyles of leadership.

There will be assumptionsmade about the level of trainingreceived by staff and their abilities.

Leadership requires two-waycommunication.

Treat each incident on its merits.

A post incident inquiry will investigatethe level of training and competenceof any Commander involved with theresponse; Trust and individuals withcommand responsibilities must beable to demonstrate competence forthe role, how they achieved, updatedand maintained it.

2.7

2.8

2.9

2.10

Regulations require organisations toafford individuals in command rolesthe time to undertake training andexercise in line with the function thatthey are expected to carry out duringan incident. When allocating roles,consideration should be given to theappropriateness of the task to theindividual’s training, experience andcompetence.

All Ambulance Service Providershave signed up to the existingNational Occupational Standards(NOS) for Commanders and NHSEngland’s Standards for NHSAmbulance Service Command &Control. Delivery of training andindividual Continual ProfessionalDevelopment (CPD) against theseStandards will help to ensure aconsistent approach across theAmbulance Service Providers’emergency response.

HUMAN FACTORS The term ‘human error’ is oftenused to describe the limitations of anindividual in relation to the cause ofan error, often setting the cause ofan incident out of the reach andcontrol of managers and executives.Society no longer views this personalapproach as acceptable andorganisation’s must understandhuman performance and limitations(factors) as an individual element inthe control and management of risks.

The Health and Safety Executive(HSE) defines human factors as'the environmental, organisationaland job factors, and human andindividual characteristics whichinfluence behaviour at work'. Theylist 3 key aspects which affect howindividuals behave in relation tohealth and safety; these are:

The job

The organisation

The individual

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2.12

2.13

2.14

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Commanders must ensure that alldecisions they make on the use ofresources are risk assessed. Bythinking about these aspects, we areasking questions about the following:

What are people being askedto do and where (the task andits characteristics)?

Who is doing it (the individualand their competence)?

Where are they working (theorganisation and its attributes)?

A fourth element which should beconsidered is the actual situationunder which the individual is beingasked to perform the task.

Building on the HSE model a usefulacronym for this is STOP:

Situation The situation orenvironment which a person isexpected to work within has a biginfluence on how they will behavetowards a given task. Influencingfactors may include the presence orabsence of Senior Officers, weatherconditions or familiarity with the typeof situation gained throughexperience or training.

Task People need to be trained tocomplete the tasks that they arebeing asked to undertake, anexample would be the TacticalCommander role. Although the taskmay have some generic elements,application of the elements may behindered or improved by the situationin which they are being applied.

2.15

2.16

2.17

Organisation Organisational factorshave the greatest influence onindividual and group behaviour.The organisation will dictate theenvironment and parameters withinwhich the individual will work, be itthrough organisational culture,policies or procedures.

Person People bring to their jobpersonal attitudes, skills, habits andpersonalities which can be strengthsor weaknesses depending on thetask demands. Individualcharacteristics influence behaviourin complex and significant ways.Their effects on task performancemay be negative and may not alwaysbe mitigated by job design. Somecharacteristics, such as personality,are fixed and cannot be changed.Others, such as skills and attitudes,may be changed or enhanced.

BUSINESS CONTINUITYMANAGEMENT Business Continuity Management(BCM) is a statutory requirementfor all Ambulance ServiceProviders to undertake. The CivilContingencies Act 2004 (CCA), theHealth, Social Care Act 2008(Regulated Activities) Regulations2010, NHS England EPRRFramework 2015 and the NHS CoreStandards and Standard Contractrequire Ambulance Service Providersto have Business Continuity Plansin place to ensure the AmbulanceService Provider is able to exerciseits civil protection duties as definedby the CCA, in addition to being ableto continue to perform its day to dayfunctions. It is considered bestpractice for all Ambulance ServiceProviders to align to the ISO 22301standard.

2.18

Figure 2 - STOP acronym

Organisation PersonTaskSituation


3

Command and Control

3.0 COMMAND AND CONTROL

Command is the exercise of vestedauthority which is associated witha rank or role within an organisationto give direction to achieve definedobjectives.

Control is the application ofauthority combined with thecapability to manage resourcesto achieve defined objectives.

The objectives for Command andControl are set within the Standardsfor NHS Ambulance ServiceCommand & Control (2018).

The Ambulance Service, along withthe other blue light emergencyservices, employ a 3-tier commandsystem comprising of a StrategicCommander, Tactical Commanderand an Operational Commander.

This is a hierarchical systemwhereby individuals are empoweredthrough their role within thestructure, providing them withspecific authority over others forthe duration of the incident or event.This is regardless of the individual’srank in the organisation’s day to daystructure. During an incident wherethe command structure is activated,the day to day rank of the individualchanges into that person’s rolewithin the incident.

Selection for each role within thecommand structure should bebased on an individual’s commandcompetence which must bedemonstrated through thecompletion of appropriate trainingand exercises. There is a commonacceptance that some day-to-dayroles within an organisation requirean individual to undertake specificcommand roles in the event of amajor incident; where this is therationale then the relevant command

3.1

3.2

3.3

training should be provided for thatpost holder.

Consequently, NARU has embarked on acomprehensive programme to maximisethe benefits that National OccupationalStandards and the Standards for NHSAmbulance Service Command & Controloffer to commanders. Whilst NARUhas produced action cards for theambulance commanders and otherroles, it is good and leading practice thatthere is a minimum set of standards forthese commanders and the CPDscheme must be able to be evidencedshould the need arise, for example postincident enquiry, public inquiry.

The Ambulance Service responseto a major incident will besupplemented by other HealthService responders. NHS EnglandEPRR Framework gives guidance oncommand, control and coordinationarrangements required in planning,preparing and responding toemergencies. NARU ClinicalGuidance: Medical Support MinimumRequirements for a Mass CasualtyIncident provides guidance on theminimum medical support requiredto provide the clinical supervisionand advice necessary – not only tomaximise the clinical outcomes or those affected by the incident– but also to maximise the careavailable to the patients who wouldstill require access to pre-hospitalcare and transport across thehealth community.

INCIDENT MANAGEMENT SYSTEM(IMS)This Guidance provides Commanderswith a clear and organisedframework in which to operate safelyand assists in the mobilisation,organisation and deployment of allresources under their command.

3.4

3.5

Command and Control

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It defines the command structurewhich can be adapted to fit anyincident of any size, regardless of thetype and level of resources employed.

Ambulance Service Providers shouldensure that the IMS is communicatedto all relevant personnel and thatthe concept of its use and theterminology within it are fullyembedded and understood.

The Strategic, Tactical andOperational system is the spine ofIncident Management, with alladditional roles feeding to and fromthe spine. Commanders must remain

3.6

3.7

focused on their level ofresponsibility in the commandstructure, without becoming involvedunnecessarily with matters of thecommand tiers above or below.Everyone in the command structuremust be disciplined and channelcommunications appropriately. Forexample, , the Strategic Commandershould not communicate directlywith the Operational Commanderor vice versa.

CSCATTT provides AmbulanceCommanders with the key principlesfor dealing with any incident:

3.8

Table 1 – CSCATTT adapted from Major Incident Medical Management and Support (2011)

Commanders must ensure that they have command and control of theincident. This is achieved through the implementation of the commandstructure.

JESIP Principles for Joint Working

Co-locate

Communicate

Co-ordinate

Jointlyunderstand risk

Shared SituationalAwareness

C

Safety

Commanders must ensure the safety of all responders, patients andmembers of the public. This is achieved through risk assessment andthe identification and use of control measures.

S

Triage

In order that casualties are treated in the most appropriate manner atriage process will be used. This will consist of an initial triage sieve,with a further triage sort. During CBRNE or other types of terroristincidents the triage process may have to be modified due to theenvironment and the levels of PPE required for responders.Initial clinical care (such as Catastrophic Haemorrhage control andbasic airway manoeuvres) may be undertaken at this stage.

T

Treatment

Once casualty triage has taken place, patient care and treatment cancommence and continue through to definitive care.T

Transport

The availability of transport may vary so careful consideration must begiven to the capability and suitability of transport types.T

Communication

Commanders must ensure effective communications at incidents,internally and externally, using plain English which is free of technicaljargon and acronyms. The use of interoperable communication devicesis a key part of this. Commanders must also provide information toinform the development of a Joint Doctrine.

C

Assessment

Using information, intelligence, risk assessments and available policies,plans and procedures, Commanders must make a full assessment ofthe incident. From this Commanders will develop the strategy and tacticsfor dealing with the incident. During the assessment phase Commanderswill identify the level and types of resources required to manage theincident. This will include specialist resources such as HART and alsothe requirement for mutual aid.

A


3

Command and Control

DECISION MAKINGEffective Command and Control canonly be achieved by Commanderswho can make reasoned, lawful andjustifiable decisions.

To support decision making The JointDecision Model (JDM) is to be appliedto decision making at any emergencyincident and it is suitable for use byCommanders at all levels, regardlessof role.

In the context of the Joint DecisionModel, shared situational awarenessbecomes critically important.Shared situational awareness isachieved by sharing informationand understanding between theorganisations involved, to build astronger, multi-dimensionalawareness of events, theirimplications, associated risks andpotential outcomes.

3.9

3.10

Decision making in the context of anemergency, including decisionsinvolving the sharing of information,does not remove the statutoryobligations of agencies or individuals,but it is recognised that such decisionsare made against an overridingpriority to save life and reduce harm.

The sharing of personal data andsensitive personal data (includingPolice intelligence) requires furtherconsideration before sharing acrossagencies and the JDM can be usedas a tool to guide decision making onwhat to release and to whom. Inconsidering the legal and policyimplications, the following arerelevant:

A legal framework to shareinformation is required – in an‘emergency’ situation this willgenerally come from Common

Figure 3 - Joint Decision Model (JDM)

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Law (save life/property), theCrime and Disorder Act 1998 orthe Civil Contingencies Act 2004.

Formal Information SharingAgreements (ISA) may existbetween some or all respondingagencies, but such existencedoes not prohibit sharing ofinformation outside of these ISAs.

There should be a specificpurpose for sharing information.

Information shared needs to beproportionate to the purpose andno more than necessary.

The need to inform the recipientif any of the information ispotentially unreliable orinaccurate.

The need to ensure that theinformation is shared safely andsecurely – it must comply withthe Government SecurityClassifications (2018) ifappropriate.

What information is shared,when, with whom and why,should be recorded.

Joint decisions must be madewith reference to the overarchingor primary aim of any responseto an emergency: to save livesand reduce harm. This is achievedthrough a coordinated,multi-agency response. Decisionmakers should have thisuppermost in their mindsthroughout the decision makingprocess.

Gather and share informationand intelligenceThe following mnemonic should beused when passing informationbetween emergency responders andControl Rooms to enable theestablishment of shared situationalawareness:

3.11

Jointly assess risks, developa working strategy Understanding risk is central toemergency response. The CivilContingencies Act places arequirement on all Category 1responders to have an accurate andshared understanding of the riskswhich would or may affect thegeographical area for which they areresponsible.

The joint assessment of risk is theprocess by which commanders worktowards a common understanding ofthreats, hazards and the likelihood ofthem being realised, in order to informdecisions on deployments and the riskcontrol measures that are required.

Risk mitigation measures to beemployed by individual services alsoneed to be understood by the otherresponding organisations in order toensure any potential for unintendedconsequences are identified inadvance of activity commencing.A joint assessment of the prevailingrisks also limits the likelihood of anyservice following a course of actionin which the other services areunable to participate.

3.12

Major incident declaredor standby?M

Exact location;EType of incident e.g. explosion,building collapse;THazards present, potentialor suspected;HAccess – routes that aresafe to use;ANumber, type, severityof casualties;NEmergency services nowpresent and those required.E


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This therefore, increases theoperational effectiveness andefficiency of the response as wellas the probability of a successfulresolution of the incident.

It is rare for a complete picture toexist and therefore a workingstrategy, for a rapid onsetemergency, should be based onthe information available at thetime. The following should beconsidered when developing aworking strategy:

Identification of hazards – thiswill begin from the initial callreceived by a Control Room andwill continue as first respondersarrive on scene. Informationgathered by individual agenciesmust be disseminated to all firstresponders and control roomseffectively. The use of themnemonic METHANE will assistin a common approach.

Dynamic Risk Assessment –undertaken by individualagencies, reflecting the tasks /objectives to be achieved, thehazards that have been identifiedand the likelihood of harm fromthose hazards.

Identification of the tasks – eachindividual agency should identifyand consider the specific tasksto be achieved according to itsown role and responsibilities.

Apply control measures – eachagency should consider andapply appropriate controlmeasures to ensure any risk isas low as reasonably practicable.

Integrated multi-agencyoperational response plan – thedevelopment of this plan shouldconsider the outcomes of thehazard assessment and servicerisk assessments, within thecontext of the agreed prioritiesfor the incident.

Recording of decision – theoutcomes of the joint assessmentof risk should be recorded,together with the identified priorities and the agreedmulti-agency response planwhen resources permit.

It is acknowledged that in the earlystages of the incident this may notbe possible, but it should be notedthat post-incident scrutiny inevitablyfocuses on the earliest decisionmaking.

THE COMMAND AND CONTROLSTRUCTURE The efficiency of the Command andControl System relies on thediscipline and effectiveness of eachCommander within the Chain ofCommand; good discipline promotescohesion within the system.

It is important that all those whohave a role within the commandstructure are appropriately trainedand exercised to understand whatthey have to do, how they have todo it and when.

Chain of Command

3.13

3.14

3.15

StrategicCommander

Strategic Advisor

Loggist

Strategic Medical Advisor

CHAIN OF COMMAND COMMAND SUPPORT

TacticalCommander

OperationalCommander

Ambulance ServiceFunctional Roles

NILO/Tactical Advisor

Loggist

Medical Advisor

Forward Doctor

Loggist

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STRATEGIC COMMANDER Personnel discharging the StrategicCommander role must be capableof directly representing the interestsof the Trust Board. They must becapable of committing the Trust toa course or action without the needfor further authority during anemergency situation (i.e. withoutmaking a phone call). Whilst thisrole and function may be supportedby several people, the StrategicCommander must be a singleindividual that is easily identifiableas the person with overall Executiveresponsibility for the organisationat any point in time.

The Strategic Commander hasoverall responsibility for thecommand of the response andrecovery of an incident or appropriatepre-planned event. The StrategicCommander will set the AmbulanceService Providers strategic aims(the Strategy) for the incident,providing a framework for the TacticalCommander(s) to work within.

To ensure multi-agencycommunication and coordinationduring a major incident or event,the Strategic Commander (orrepresentative) will attend and effectcommand from the multi-agencyStrategic Coordinating Group (SCG),and Health Coordination Groups ifformed. However, where an incidentaffects only the Health Service thenthe Strategic Commander may decideto manage the incident from anAmbulance Service Provider location.

Whilst the Strategic Commandermust not make tactical decisions,they maintain responsibility forensuring that the tactics which arebeing employed are proportionate,appropriate and effective.

The Strategic Commander’sresponsibilities in line with theirNational Occupational Standardperformance criteria can be found

3.16

3.17

3.18

3.19

3.20

in ANNEX 1 Strategic Commander:Command and Control Roles,Performance Criteria andResponsibilities.

The key channels of communicationfor the Strategic Commander areas follows:

Strategic level representativesof multi-agency partnerse.g. Police, Fire, Military, Health,Maritime Coastal Agency,national and local governmentTactical CommanderOrganisational CoordinatingCentre or intelligence cell*Emergency Operations Centre(EOC)Strategic Medical Advisor*Executive on call*Media Liaison Officer*Command Loggist*Strategic Advisor or otherspecialist roles*Scientific Technical Advisory Cell(STAC) *

*Denotes where applicable

TACTICAL COMMANDER Personnel discharging the TacticalCommander role must have athorough working knowledge ofNHS Ambulance Service operations.They must have sufficient knowledgeand experience to manageoperational assets, including bothgeneral and specialist assets. It iscritical that the Tactical Commanderhas a comprehensive knowledge ofall tactical options available to themand the extent of the capabilitiesunder their command. That willinclude an understanding of howto effectively balance the risksassociated with deploying thefollowing capabilities:

General frontline AmbulanceassetsAir Operations and Helicopter Emergency Medical Services(HEMS)

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Command and Control

Critical Care / AdvancedParamedicsCasualty Clearing StationsCBRN DecontaminationCapabilities (SORT)

Hazardous Area Response Teams(HART) including:

CBRN responseHazardous MaterialsSafe Working at HeightConfined SpaceUnstable TerrainWater Operations and FloodingTactical Medicine Operations(in addition to MTA)Marauding Terrorist Attack(MTA)National Mass CasualtyCapabilities

The Tactical Commander does notneed to be operationally trained orqualified as an operative in eachof these capabilities, but they doneed to be competent in their roleas a Commander to overseetheir deployment.

Tactical Commanders must providecomprehensive briefings to theStrategic Commander on the risksand benefits of all practices detailedin the National Ambulance ServiceCommand and Control Guidance. It is not sufficient for the TacticalCommander to be reliant on theNILO / Tactical Advisor to covergaps in their competence or toplace the advisor in command ofthe incident. The NILO / TacticalAdvisor should be able to provide(or facilitate access to) very detailedinformation on specific operationalcapabilities including those ofother agencies to their TacticalCommander but the Commanderis responsible for the decisionsthey make based on the advice theyreceive. They must be credible andcompetent to accurately interpretthis information and make thenecessary decisions.

The Tactical Commander hasresponsibility for developing theTactical Plan and the CasualtyManagement Plan. The TacticalPlan will be developed within theframework of the Strategy andany available intelligence andassociated risks.

Due to the dynamics of a majorincident the Tactical Commandermay put a Tactical Plan into placebefore the Strategy has been set.Where this is the case, the TacticalPlan should be reviewed against theStrategy once it becomes available.

The Tactical Commander will providea framework and parameters for theOperational Commander to operatewithin (Tactical Plan). The TacticalCommander must support theOperational Commander to achievetheir objectives and manage theincident effectively; however, theyshould not get involved in the directoperational management of theincident.

Co-location of multi-agencycommanders is essential and allowsthose commanders to perform thefunctions of command, control andcoordination, face to face, at a singleand easily identified location. It isalso desirable for more complexincidents at Tactical and Strategiclevels.

The actual location of the TacticalCommander will be determined bythe location of the TacticalCoordinating Group (TCG)/JointCommand Facility (JCF), which willusually be held at a pre-identifiedlocation or near the incident scene.

Some agencies with differentcommand structures will send arepresentative to the TCG in aliaison capacity with the IncidentCommander remaining at the scene.In cases of doubt over the locationof the multi-agency TCG, the

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Ambulance Tactical Commandershould where possible locatethemselves alongside the leadcoordinating agency TacticalCommander (this is often the Police).

In circumstances where the TacticalCommander is delayed in gettingto the TCG, consideration shouldbe given to a request for aninteroperability talk-group to beinitiated. Such a request should notsubstitute the requirement for theTactical Commander to attend a TCGand liaise with colleagues from otherresponding agencies in person.

If the Tactical Commander attendsthe incident scene without engagingwith the multi-agency TCG, they riskoperating in isolation, which wouldinvariably complicate and prolongthe incident unnecessarily. Whereresponders are able to rapidlyco-locate, communicate andcoordinate their activities, situationalawareness is shared, risks jointlyunderstood and pragmatic solutionsdeveloped to mitigate severe andtime critical challenges.

The Tactical Commanders’responsibilities in line with theirNational Occupational Standardperformance criteria can be foundin ANNEX 2 Tactical Commander:Command and Control Roles,Performance Criteria andResponsibilities.

The key channels of communicationfor the Tactical Commander areas follows:

Strategic CommanderMedical Advisor*NILO or Tactical Advisor*Tactical level representatives ofmulti-agency partners eg Police,Fire, Military, Health, MaritimeCoastguard Agency, nationaland local governmentOperational Commander*Emergency Operations Centre(EOC)

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Incident Coordinating Centre*Command Loggist*


OPERATIONAL COMMANDERThis role has responsibility for theactivities undertaken at the scene.As such they will be located at theincident scene and ideally collocatedwith the Incident Commanders of theother responding agencies at aForward Command Point. Where thisis not possible, the OperationalCommander must ensure regularmulti-agency face to face briefingstake place.

The Operational Commanderensures that the TacticalCommander’s Plan is carried out andthat they understand the Strategy.Importantly they must understandand be able to discharge theirresponsibilities within these.

As the Operational Commanderthey will provide leadership andmanagement to the Functional RoleOfficers and any other direct reports.

Key responsibilities for theOperational Commander can befound in ANNEX 3 OperationalCommander: Command and ControlRoles, Performance Criteria andResponsibilities.

The key channels of communicationand partnerships for the OperationalCommander are:

Operational Commanders frommulti-agency partners e.g. Police,Fire, Military and Local AuthorityTactical CommanderEmergency Operations Centre(EOC)Casualty Clearing StationMedical LeadForward Doctors*Command Loggist* Other Functional Roles *


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It is imperative that each part ofthe incident is afforded appropriateattention. To assist with this,Commanders may assign key roles to other appropriately trainedindividuals. These are referred toas the Functional Roles.; for examplean Ambulance Parking Officer.

COMMAND FUNCTIONS WITHINEMERGENCY OPERATIONS CENTRE(EOC)Control rooms play a vital role inmanaging the early stages of a multi-agency incident, they are key tobuilding a coordinated, effectivemulti-agency response. In the initialstages of all incidents, somecommand and control willneed to be provided by NHSAmbulance Service’s EOC. In theevent of a significant or majorincident the command and controlstructure that would be expected tomanage these incidents in Operationswill need to be implemented in theEOC with the same command levelsthat would be expected in theoperational environment.

These roles should be maintaineduntil they are relieved by theirOperational equivalent at the scene.If these operational roles are notfulfilled, then the responsibility tomaintain this command and controllevel or position will remain with therelevant EOC Commander.

Operations Commander EOC:

Initial response and resourceallocation decisions based on theneed and available capabilitiesbalanced against demand.Single point of contact forOperational Commander for onscene updates and the agreedmodel for incident informationsharing e.g. ‘M/ETHANE’.

Tactical Commander EOC:

Supports incident response

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with resource.Link between organisationCommand and Control structure: Operations and EOC.Responsible for internal and external escalation andcommunications with partneragencies.Ensures adequate resourcesare available to manage theimpact of the incident on corebusiness.

SPAN OF CONTROL The span of control refers to thenumber of communication linesor direct reports an individual isexpected to manage. Five reportinglines are commonly recognised to bethe optimum number for one person.It is possible however that givenconsideration to the environment,type of incident and the level ofresource, a Commander couldmanage up to seven lines, althoughdue to the same factors this maybe as low as two or three due tothe nature, scale and complexityof the incident.

COMMAND SUPPORT ROLES

Strategic Advisor

Strategic Advisors are appointed bythe Strategic Commander accordingto their field of expertise and therequirements of an event oremergency. The Strategic Advisor isnot necessarily the same as a NILOor Tactical Advisor. Whilst the NILOor Tactical Advisor may provide directadvice to the Strategic Commanderon certain matters such as mutualaid (as described in the Commandand Control Guidance) their advicewill usually be focused at theOperational and Tactical levels.

The Strategic Advisor will be selectedby the Strategic Commander basedon their expertise relevant to thestrategic challenges of the incident.

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For example, if public messagingis a key aspect, a CommunicationsDirector may fulfil this role. For thisreason and to maintain flexibility forthis role, a specific set of competencesare not specified for this role.

Tactical Advisor

A Tactical Advisor is a member ofstaff who has the relevant depthof subject knowledge regardingTrust specialist and non-specialistcapabilities and associated risks andthe benefits of deploying / utilisingsuch capabilities. The TacticalAdvisor must be able to utilise thatknowledge and provide conciseadvice to commanders regardingthe risk and benefit of deployingTrust specialist and non-specialistcapabilities during an incidentresponse.

The Tactical Advisor is not aCommander or a decision maker.The responsibility for the decisionsand course of action taken restswith the relevant Commander.However, the Tactical Advisor is bothresponsible and liable for the advicethey provide. They must be credibleand competent individuals.

They must have an in depth, currentknowledge of specialist capabilitiesincluding; CBRN, HART (IRU, SWAH,Confined Space, Water Rescue andSupport to Security Operations) andMTA. The Tactical Advisor must havein depth knowledge of the Trustsmajor incident response plan, andother relevant doctrine, policies andprocedures. They must also have agood working knowledge of localpartner agencies capabilities andthat of the NHS.

National Interagency Liaison Officer(NILO)

A NILO should have a similar skill setto the Tactical Advisor but theseindividuals have undertaken

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additional training to liaise withother responding agencies.

NILO’s must maintain an up-to-dateunderstanding of the responsearrangements for other specialistagencies, particularly Police, Fireand Rescue, Military, Coastguard andthe Security Services. NILO’s willprovide advice to various levels of theCommand Structure on how to workeffectively with the other agenciesand help other agencies to interfaceeffectively with the NHS aims andobjectives. That means that NHSAmbulance NILOs may be deployedand imbedded within anotheragencies structure as required.

The NILO is not a Commander or adecision maker. The responsibilityfor the decisions and course ofaction taken rests with the relevantCommander. However, the NILO isboth responsible and liable for theadvice they provide. They must becredible and competent individualswith a recognised multi-agencyNILO qualification and maintain theirsecurity clearance.

MEDICAL SUPPORT ROLESThe medical support roles (StrategicMedical Advisor, Medical Advisorand Forward Doctor) are notcommand roles. They are advisoryroles and carry no commandauthority. Nevertheless, their advicewill directly influence the commanddecisions taken so personneldischarging these functions musthave the relevant skills andexperience commensurate to theadvisory role. Those providingmedical advice are both responsibleand liable for the advice they provide.

At the Strategic level, the StrategicMedical Advisor is principallyresponsible for monitoring overallhospital capacity and ensuring thetactical level has access to theclinical resources it requires,

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particularly if national mutual aidis required from other sectors ofthe NHS.

At the Tactical level, the MedicalAdvisor is principally responsiblefor casualty distribution from theincident(s). They will support theTactical and Strategic AmbulanceCommanders to transfer patientsfrom the scene into the appropriatemedical facilities.

At the Operational level, the ForwardDoctor(s) will coordinate and directthe clinical care provided at theCasualty Clearing Station (CCS) orequivalent. Where multiple Doctorsare deployed at an incident, oneDoctor will be appointed to theprinciple Forward Doctor role by theMedical Advisor to be their singlepoint of contact.

No Doctor will deploy into the innercordon or into the hot / warm zonesof incidents without the expressapproval of the Tactical Commanderand without passing through theentry control system (if established).

The Medical Director of each NHSAmbulance Service provider isresponsible for ensuring that theStrategic Medical Advisor, MedicalAdvisor and Forward Doctor rolesare available at all times and thatthe personnel occupying theseroles are credible and competent.This competence must includespecific knowledge and training incomplex pre-hospital emergenciesand the management of largecasualty numbers (i.e. more than20 patients).

The Medical Advisor attached to theTactical Commander and the ForwardDoctor(s) must have pre-hospitalemergency experience. Further tothat, both must have a goodunderstanding of the followingprovisions (though they do not needto be qualified in them):

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JESIPNHS HART operations NHS MTA operations NHS CBRN operations NHS Mass Casualty capabilityand logisticsHelicopter Emergency MedicalServices (HEMS)NHS Ambulance Service criticalcare and advance ParamedicpracticeToxic triageCBRN countermeasuresCasualty decontaminationproceduresPre-hospital analgesiaManagement of high velocitywounds and explosive injuriesSubmersion and hypothermiaeventsSuspension trauma andcrush injuriesRecognition of life extinct in theforensic settingManagement and onwarddistribution of over 200 casualtiesinto the wider NHSNHS Ambulance CasualtyClearing Station (CasCS) logisticsand capabilities

Personnel discharging the MedicalAdvisor role (attached to the TacticalCommander) and the Forward Doctorrole must practice their functionalrole as ‘player’ during a relevantexercise every 12 months. Thisrequirement can be substituted forreflective practice followingattendance at a real emergency oroperational incident.

LOGGISTThe maintenance of comprehensivedecision logs is a critical part ofIncident Management. Commandersare responsible for ensuring thatall the decisions that they makeare captured and recorded in anappropriate manner. This shouldinclude the actual decision taken,the rationale for such decisions andany actions outstanding as a result.

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Where they are available, trainedloggist’s should be used to undertakethis role.

OPERATIONAL COMMUNICATIONSADVISOR Where they exist, OperationalCommunications Advisors canprovide reliable and consistent adviceregarding the use of the emergencyservices digital radio system, andtheir advice should be sought.

They can facilitate the needs of themulti-agency responders during theinitial planning phase of any event oroperation, and during a spontaneousincident by providing operational andtechnical knowledge of all mannerof communication systems includingassisting in the development of acommunications plan to ensureoptimal use is made of available talkgroups whilst remaining cognisantof coverage and capacity; they shouldbe included in the response at theearliest opportunity.

FUNCTIONAL ROLES In the early stages of a major incidentthe functional roles will need to beassigned to personnel (Trustemployed) that are available at thescene to discharge them. However,their relative skills and experiencemust be considered by theOperational Commander beforeassigning those roles. The nationalaction cards must be used bythose appointed to these roles (orequivalent local action cards that areconsistent with this specification).As soon as is reasonably practicable,the functional roles should be filledby personnel that have been trainedto discharge them. This does notapply to the Decontamination Officerfunctional role which must only bedischarged by trained and competentstaff in the respective discipline.

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The HART Team Leader functionalrole can only be discharged by aHART current and competent TeamLeader who has previously qualifiedas a HART Operative.

Further roles are described inANNEX 4, however this list Is notexhaustive and other FunctionalRoles may be necessary dependenton the type and scale of the incident.

RECORD KEEPING AND LOGGING There has been much emphasison recording decisions followingcriticism directed at emergencyservices during high profile cases.

The incident log book is a recordof the management and decision-making process for the specificcommand role from the onset ofinvolvement of the incident, eventor operation until its conclusion.This log will record the evolvingprocess and provide a clear recordof the causes and effects of anycourses of action taken andcommunicated by the post holders.

The incident log book will form adefinitive record of the post holder’srole which they might have causeto rely on at a later date to justifytheir actions.

At the end of any incident, event oroperation, the incident log book willbe retained securely along with allother log books and associatedrecords relating to the incident,event or operation in the appropriateAmbulance Service Archive store fora minimum of 25 years.

Commanders are responsible for therecording of all decisions that theymake in relation to an incident in an appropriate command decision log.Logging is essential to facilitateoperational debriefing, provideevidence for inquiries and identifylessons for the future.

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Comprehensive logging should bemade of all events, decisions(including those deferred and nottaken) and the reasoning behindkey decisions and actions taken.

Each organisation is responsiblefor maintaining and storing its ownrecords and should be considerate oflogging best practice when deliveringor purchasing training in this skill.

Further guidance relating to recordkeeping can be found in:

NHS England EPRR Framework NARU Incident Log Book Emergency Preparedness Emergency Response andRecovery, paragraphs4.6.1 – 4.6.4 Government SecurityClassifications April 2014

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NO ELBOW

ErasuresE

Leaves torn out of the logL

Blank spacesB

OverwritingO

Writing above or belowthe lined areaW

As soon as is reasonablypracticable, the functionalroles should be filled bypersonnel that have beentrained to discharge them.

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AMBULANCE SERVICE STRATEGYAll major incidents that involve amulti-agency response and where anSCG is formed will have strategy inplace. This will be developed by theChair of the group but will be agreedby all partners. The multi-agencystrategy will rarely offer specificorganisational guidance to singleagency Commanders. It will usuallydetail how the partners will worktogether to manage the incident inline with the JESIP Joint Doctrine.

The Ambulance StrategicCommander should produce aspecific strategy for the AmbulanceService providing the guidance,parameters and justification for theAmbulance command structure torespond to the incident. An examplecan be found at ANNEX 9.

The strategy should be specific toa given incident and not generic,although some common themes willrun through every strategy, such asthe need to ensure the health, safetyand welfare of responders.

The Strategic Commander may beginthe development of the strategy onnotification of the incident and theywill build on it once furtherinformation and intelligencebecomes available. The strategyshould not be considered ‘final’until the incident has closed.The strategy should be regularlyreviewed throughout the incident,as a minimum at every meeting ofthe SCG.

In the development phase, theCommander should continually referto the JDM (see Figure 3 on page 15)which will guide them through thepoints for consideration during thedevelopment of the strategy. Thestrategy must take account of the

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identified and anticipated risksidentified during the threat and riskassessment process. Other driversinclude the limitations andconstraints of their own and othersorganisational and national policy,as well as the individual capabilityof the Commanders and otherAmbulance resources, ensuringeveryone remains within their scopeof practice.

Whilst the strategy will provideobjectives for the Incident Commandand parameters for the TacticalCommander to work within, it shouldnot be too constraining and preventthem from performing their role.The Tactical Commander should infact be consulted on the developmentof the strategy, as they will add to theintelligence picture and can offeradvice on the type of tactics whichmay be used.

The Strategic Commander sets thestrategic intent and strategy and isultimately accountable andresponsible for its content anddelivery. It is important that thisstrategy and associated decisions,including rationale, are written inthe Commander’s decision log.

The strategy should be in plainEnglish to ensure it can beunderstood by all the relevant people(internally and externally). The use ofoverly technical terms and acronymsshould be avoided wherever possible.The use of such terminology by theEmergency Services in their planningand management has been thesubject of much criticism at publicinquiries and inquests.

When issuing the strategy, a full andinformative (though concise) briefingshould be provided to the TacticalCommander to ensure the strategy

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is understood, along with theparameters you are setting them towork within.

An example strategy can be foundat ANNEX 1 Ambulance ServiceStrategy and Health Service Strategy.

TACTICAL OPTIONS The Tactical Plan will ideally bedeveloped following receipt of thestrategy from the StrategicCommander. However, due to thenature of incidents, it is unlikely thatthe Strategic Commander will be inplace before the Tactical Commander.

Through the use of the JDM, theTactical Commander will be able toidentify the appropriate tactics to usein the management of the incident.This is a critical element of the cycleand the selection of the tactics will bereinforced by the fact due diligenceshould have been paid to thepreceding factors of information,intelligence, threats, risks, policiesand procedures.

Options and considerations willbe dependent on the type andscale of incident presented. Otherconsiderations will be existingpre-determined attendances, theenvironment within which theincident occurs, the number andtypes of casualties, and the capacityand capability of the resourcesavailable. Examples of tacticaloptions include:

The deployment of MTA(Marauding Terrorist Attack)responders wearing fulltactical dress and ballisticprotection into an activeshooter incident.

Where possible, the identification and use of separate hospitalsfor casualties from public orderincidents.

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Deployment of CBRNE assetsprior to an incident or eventwhere there is an increasedrisk or evidence of a CBRNEoccurrence.

A dedicated command structurewith appropriate supportfunctions.

The available Personal ProtectiveEquipment (PPE) capabilities ofthe Ambulance Service can befound at ANNEX 8 AmbulanceService Personal ProtectiveEquipment Capabilities.

Communication of the Tactical Planto the Operational Commander isessential. Briefings should follow asystematic method, such as theIIMARCH. An entry should be made inboth the Operational and TacticalCommanders’ logs that this briefinghas taken place.

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Figure 4 - IIMARCH Briefing Model

INFORMATION – where/what/how many? History(if applicable) use METHANEI

INTENT – why are we here? Strategy, tactical &operational planI

METHOD – how are we going to do it? Tactical plan,policy, plansM

ADMINISTRATION – Command /media /dress code / decision logs / welfare / food / Individualtasking / timing

A

RISK ASSESSMENT – specific threat areas /PPE / filter changesR

COMMUNICATIONS – confirm radio callsigns /indicate other means of communication if required /ensure staff understand inter agency communications

C

HUMANITARIAN ISSUES – disclosure detailsH

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The Tactical Plan objectives shouldbe recorded in a written commanddecision log. It is the TacticalCommander’s responsibility toensure that this takes place.

RISK IDENTIFICATION ANDMANAGEMENTCommanders need to identify andmanage all the risks and hazardsthat pose a direct or indirect threat tothe people under their command andthose who may be affected by their

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action or inaction (co-responders,patients and public). This isachieved through the applicationof recognised and documentedrisk assessments and theimplementation of appropriatecontrol measures. Not until thisprocess has been completed cana decision be made on the tacticsto be used.

The Dynamic Risk Assessment (DRA)(Figure 5) allows for a structuredapproach to risk management.

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Analyse the situationor task

Review Hierarchy of Control(ERICPD)

Yes - Carry out taskDynamically assessthe system of work

If No, reassess safesystems of work

Are the controlmeasures employedadequate to managethe identified risks?

ELIMINATE

REDUCE

ISOLATE

CONTROL

PPE

DISCIPLINE

by complete removal of the hazard -

get rid of the hazard; replace it with

something less hazardous.

the level of risk by reducing the

nature of the hazard eg use small

quantities, lower voltage.

the hazard from people or the

people from the hazard.

exposure to the hazard by controlling

who has access or use procedure/

protocols limiting exposure time.

Issue Personal Protective Equipment.

Personal Protective Equipment

should always be seen as the last

resort in order to control a hazard.

Ensuring that employees follow safe

systems of work and procedures.

Ensure all control measures are

monitored, subject to review

and enforced.

Select a safesystem of work

Figure 5 – Dynamic Risk Assessment / Hierarchy of Control


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‘ERICPD’ continues as a hierarchy ofrisk control used by the emergencyservices in line with JESIP doctrine.However, the Health & SafetyExecutive and industry have movedto a variant called ‘ESEAP’ (Eliminate,Subsistution, Engineering Controls,Administartion Controls, PPE), anda combined emergency servicemigration across to this model willfollow in the future.

DYNAMIC RISK ASSESSMENT Analyse the TaskStep one of the risk assessmentis to analyse the situation or task.Commanders will commence thisprocess from the moment they areinformed of the incident. This willtake the form of analysing theinformation or intelligence, anyidentified hazards reported andknowledge of existing plans andprocedures.

The intelligence picture will befurther enhanced on arrival at themobilisation point. Commanders willneed to enhance their situationalawareness. This will be achieved byconsidering the following:

i. Available intelligence and information.

ii. The type and nature of theincident and available resources(PDAs).

iii. Incident specific plans andprocedures (COMAH, CBRNE,Terrorist Attack).

iv. Any significant hazards arisingfrom the incident.

v. The risks presented to:The Ambulance ServiceProvider and NHS respondersCo-respondersThe public

Select a safe system of workIn order that Commanders can selecta safe system of work they mustreview the available optionsin line with existing plans and

procedures. Selection of theappropriate course of action willbe dependent on the availability oftrained and competent resourcesand personnel. For example, tofacilitate a decontaminationresponse, a Commander must haveavailable adequately trained CBRNEresponders, PPE and individualscapable of erecting and operatingdecontamination showers.

Dynamically assess the safesystem of workOnce a Commander decides on acourse of action they need to makejudgement and assess whetheror not the risks involved areadequately mitigated by the controlmeasures employed.

Are the control measuresemployed adequate to managethe identified risks?The elimination or reduction of risksis the Commander’s primary aim inthe step towards ensuring respondersafety. Where elimination orreduction are not possible thenfurther control measures will needto be introduced.

Yes, carry out taskWhere appropriate mitigationand control measures exist then responders may be directed to carryout the identified task, but onlythrough employment of the identifiedsafe systems of work. This can onlyoccur when:

Appropriate command andoperative briefings havetaken placeThe identified control measuresare in placeKey roles have been allocated toappropriately trained individuals

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Review and shareThe DRA is only effective if constantlyreviewed. The incident will changeand therefore so will the risks.Control measures may need to beincreased or decreased; areas whichwere considered defensive tactically,may become offensive as theincident progresses and vice versa.The review also allows Commandersto reassess the systems of workand their appropriateness for thetasks in hand.

To assist in the risk identification andmanagement process an AmbulanceSafety Officer should be appointed.This should be an individual who hasbeen given specific training toundertake this role. They will haveresponsibility for all Ambulance andNHS resources on site.

OPERATIONS AND RESOURCEMANAGEMENT Initial identification of the incidentand communication of this and theresource requirements will assistin mitigating the impact of theincident on the affected AmbulanceService Provider.

A universally accepted way ofachieving this structuredcommunication is through the useof a Sit-Rep (Situation Report).The mnemonic M/ETHANE is usedthroughout the Emergency Services.

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The message should contain thefollowing information:

MAJOR INCIDENTDECLARED OR STANDBY.The person making the reportshould be explicit whetherthis is a major incidentdeclaration or a standby inanticipation of the occurrenceof a major incident.

M

EXACT LOCATION OFTHE INCIDENT. Where possible the gridreference or GPS coordinatesshould be included, along withany landmarks or iconic sites.

E

TYPE OF INCIDENT.What is the exact nature ofthe incident? For example, aCBRNE incident, active shooteror road traffic collision?

T

HAZARDS.What hazards are known tobe present or those thatcould potentially manifestthemselves?

H

ACCESS AND EGRESS.What are the agreed or bestroutes to and from the scene,including any agreed blueroutes and those which needto be avoided, including anypre-identified RVPs? Forexample, where a gas plumeis present, information onavoiding this will be required.

A

NUMBER OF CASUALTIES.How many casualties arethere and if possible, whatare the level and severityof injuries?

N

EMERGENCY SERVICES.Which Emergency Servicesare present, and which arerequired? Include specialistresource request if known.

E


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All incidents will offer their ownchallenges in terms of availableresources; some will require largedegrees of specialist resources,(for example CBRNE incidents mayrequire significant numbers ofdecontamination practitioners, allof whom will probably come fromthe Ambulance Service Provider’score resource). Ambulance ServiceProviders will still be expected tomaintain an appropriate responseto core business as usual.

Early identification of the incidenttype, any hazards, numbers ofcasualties and resourcerequirements will assist theTACTICAL COMMANDER in planningfor the resourcing of the incident.This is prevalent with the IORoperating model which emphasisesearly identification of potentialhigh-risk incident. They will alsoensure that a system is in place forthe management of the resources.

The decision to request mutual aidshould be taken by the Host Service’sStrategic Commander, with supportfrom the NILO / Tactical Advisor. Theinitial activation of Mutual Aid may,in extremis, be decided directly bythe Strategic Commanders of therequesting (Host) Service and theAssisting Service(s), but furtheractivity will be co-ordinated throughthe National Ambulance CoordinatingCentre (NACC). All requests formutual aid must include specificinformation pertaining to the leveland types of resources required.For further information, please referto Mutual Aid Memorandum ofUnderstanding.

The Strategic Commander facilitatesany requests for external agencyassistance through the SCG wherepossible. Where a StrategicCommander decides to managean incident from within AmbulanceService, then a Strategic LiaisonManager will attend the SCG as

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the Strategic Commander’snominated deputy with specificdelegated authority.

The Tactical Commander willmake requests to the StrategicCommander for additional orspecialist resources; where morethan one scene exists (multi-sitedincident) then the StrategicCommander will make the decisionas to where to best use the availableresources. In the absence ofthe Strategic Commander thedecision will be taken by the Tactical Commander.

Ambulance Services employ a varietyof resources in response to incidents.Some are specialists such as clinicaldecontamination. These all workalongside core Ambulance resources.

COMMUNICATIONSINTEROPERABILITY Interoperability voicecommunications is the ability tooperate and communicate with otheragencies in the event of a multi-sitedincident or in the absence of a TCG.

Interoperability will improvecommunications betweenEmergency Services and appropriatepartners helping to informdecision-making through greaterunderstanding of the incident andimproved situational awareness.

The use of interoperability voicecommunications through the digitalradio system should not replaceface to face meetings betweenCommanders but complement them.

The request for interoperable voicecommunications will be made inline with locally agreed plans andSOPs for requesting Multi-AgencyInteroperability.

Suitable qualified communicationsadvisors should be consulted to

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develop a communicationsplan for the incident at theearliest opportunity.

The Interoperability voicecommunication can be found inANNEX 7 CommunicationsInteroperability Flowchart.

COMMAND BRIEFING Briefing of the command team andstaff is an important aspect ofcommand. The IIMARCH model canbe used for this, it is the firstopportunity that the Commanderwill have to deliver their plan withsubsequent rationale and decisionsto those who are expected to carryout the orders.

The briefing should be a two-wayprocess where Commanderswelcome questions and feedback;this will allow the Commander toensure that the plan has not onlybeen received, but also understoodand assimilated by those that havereceived it.

Where necessary, Commandersshould ensure specialists orindividuals who can add value tothe briefing are included within it.

If a face to face briefing is notpossible then additional methodscan be employed. For example,written briefs, telephone or radiocommunication, or videoconferencing. Commanders shouldbe cognisant of relevant protectivemarkings or sensitivity of informationwhen choosing a briefing route andthat all notes and logs made before,during and after briefings maybe disclosable.

Regardless of the method used,a full and accurate record of thebrief should be made and retainedas part of the command decision log;including who delivered the brief,who received it, the date, time and

4.31

4.32

4.33

4.34

4.35

location. This should be repeatedfor all subsequent briefings andupdates.

INFORMATION SHARINGInformation sharing is a crucialelement of civil protection work thatunderpins all forms of cooperation.Information should be sharedformally and as part of a culture.Ambulance Service Providersshould consider it good practiceas well as their duty to shareinformation with other responders.Procedures are set out in theregulations to formally requestinformation from other responders.The use of interoperability talkgroups and agreed critical messagestructures in the form of preagreed situation reports (SITREPS)given at regular intervals will aidthe information sharing processand assist in the joint understandingof risk and shared situationalawareness.

The initial presumption is that allinformation should be shared, withthe exception of sensitive informationwhich includes:

Information prejudicial tonational securityInformation prejudicial topublic safetyCommercially sensitiveinformation

Ambulance Service Providers shouldhave arrangements in place to mark,store, handle and transfer sensitiveinformation (including transfer byelectronic means). AmbulanceService Providers shall have regardto Government SecurityClassifications and any informationsharing protocols of their LRFs.

Effective information sharing canonly take place if partnershipsbetween responders are embraced.This underlines the importance of

4.36

4.37

4.38


4

Incident Management

Ambulance Commanders ensuringthat they are fully engaged with theirpartner responders at all the relevantlevels through the Strategic andTactical Coordinating Groups, and atthe operational front end.

AMBULANCE SERVICE COMMANDAND CONTROL IN RESPONSE TOA TERRORIST ATTACKThe threat of a Terrorist Attackwithin the UK is determined by thesecurity services.

Threat levels are produced by thesecurity services, the currentthreat level is available at thefollowing:https://www.mi5.gov.uk/threat-levels

Threat levels are designed to givea broad indication of the likelihoodof a terrorist attack.

Commanders must be aware of thecurrent threat level and its meaning,including any special measures to beimplemented by the Trust.

4.39

The Ambulance Service Response toa terrorist attack will be determinedby the attack methodology andthreat. A terrorist attack may involvethe following attack methodologies;

Bladed weaponsVehicle as a weaponDeliberate use of fire asa weaponUse of Improvised ExplosiveDevices (IED’s) / grenades –vehicle or person borneFirearms (including a MaraudingTerrorist Firearms Attack)Siege; including the taking ofhostages to prolong an attackor impede rescue operations.The use of chemicals, e.g. acidor alkali, to cause death or injuryChemical Biological RadiologicalNuclear

The above examples are notexhaustive, and an attack mayinvolve more than one attackmethodology.

Specific Emergency Service JointOperating Principles (JOPS) havebeen developed to enable theemergency services to respond toa terrorist attack. These documentsare available via individual Trustemergency preparednessdepartments. They are all builtaround the foundation of theJESIP principles.

Ambulance commanders, advisorsand NILOs must have a thoroughknowledge of the Joint OperatingPrinciples and the capabilities ofspecialist and non-specialistambulance responders.

Command and control arrangementsfor the Ambulance Service inresponse to a terrorist attack will bebased upon the Command Guidance,JESIP and the JOPs. It is essentialthat the Ambulance Commandersat all levels of command are flexible,adaptable and demonstrate clear

4.40

4.41

UK THREAT LEVEL

SEVERE An attack ishighly likely.

CRITICALAn attack isexpectedimminently.

SUBSTANTIAL An attack isa strongpossibility.

MODERATE An attack ispossible, butnot likely.

LOW An attackis unlikely.

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leadership in response to a TerroristAttack. An attack may be simple orcomplex in nature, however allattacks will require effectivecommand and control to ensure thatlives are saved and staff deployedappropriately and safely. Some attackmethodologies will require commandand control and decision making tobe implemented in a greater capacityby on scene commanders, with afocus upon rapid deployment ofresponders in order to save life.Dependent on attack methodologythere will be significant pressureplaced upon commanders to assessinformation rapidly in order to makeeffective decisions, which must becommunicated clearly and concisely.

POST INCIDENT PROCEDURESA post incident debrief is a criticalpart of the incident life-cycle.It is normally the only recognisedand structured opportunity theorganisation will have to learn froman incident in respect of how theiremployees responded and acted,and how their policies andprocedures stood up to the task.

The debriefing process can beginas soon as the first resources beginto leave the incident (the hot debriefphase); although dependent onthe scale of the incident and theresources allocated, there may be a formal debrief at a later stage.

The debrief process will allow theorganisation to:

Address any identified healthand safety issuesEvaluate the effectivenessof policies and proceduresEvaluate organisation, team andindividual performanceIdentify training needs andimprove training accordinglyDemonstrate an auditableapproach to incident management

4.42

4.43

4.44

Tactical Commanders must ensurethat debriefs take place for allAmbulance personnel directlyinvolved in the incident. Althoughthey may not physically be able todo this themselves, they mustensure a process is in place forthe capture of all lessons fromAmbulance and, where appropriate,NHS staff; this may include debriefsby external facilitators.

In addition to an operational debrief,there should be a process forpsychological debriefing, as the postincident debrief process is not initself a welfare tool for managingstaff welfare issues; however, thesemay become apparent throughoutthe debrief process. Where this isthe case, then welfare arrangementsneed to be put in place. Support mayalso be required for staff not involveddirectly with the incident but who areaffected psychologically by its impact(injury or death of a colleague).

All information recorded during thepost incident process may also bedisclosable.

Joint Organisational Learning (JOL)Online platform should be used torecord any multi-agency lessonsidentified as part of the debriefingprocess.

4.45

4.46

4.47

4.48


5

Competencies

and Training

5.0 COMPETENCIES AND TRAINING

NATIONAL OCCUPATIONALSTANDARDS (NOS) National Occupational Standardsare the mandatory system used todefine what is expected of competentindividuals. Ambulance ServiceProviders must provide those peoplewho are expected to undertake acommand role, with the trainingand exercise opportunities thatare relevant to the role they willbe performing.

StrategicStrategic Commanders are tomaintain their competencies asdescribed in this framework. They must ensure that throughpersonal development reviews,commanders under theirresponsibility are maintaining theircompetence portfolios and areattending learning events/trainingas described in the framework andStandards for NHS AmbulanceService Command & Control, and asappropriate providing release fromnormal duties to attend such events.

All Commanders Accountable for ensuring their owncontinued professional development. As detailed in the framework,attending national, regional and localcourses as required and supportinglearning with practical experience ofcommand e.g. exercises.

NOS are used as tools to assist inrecruitment, appraisal, jobevaluation and development ofindividuals, teams and organisations,they ensure that all personnel areaware of their own role and whatthey need to be able to perform it ina competent manner. They allow foreasy reference for team composition,task allocation and can provideorganisations with defence whencompetence is questioned. Tactical,

5.1

5.2

Operational and Functional roleswhere appropriate can use theircompliance with NOS usefully ifcalled to account for their skills.

Increasingly, in a litigious society,it might prove useful to be able toclaim compliance with nationallyrecognised standards. NOS providea framework for development andassessment.

There are three main types oftraining within the workplacedesigned to meet an individual’sdevelopment needs:

Continual ProfessionalDevelopment (CPD)Progression New Roles: expansion or change

In all these cases, NationalOccupational Standards accuratelydefine and underpin roles and theirdesired outcomes.

AMBULANCE COMMANDERSCONTINUAL PROFESSIONALDEVELOPMENTSkills for Justice have provided thefirst rung to a consistent approachto Ambulance Service CommandDevelopment. In 2011 theAssociation of Ambulance ChiefExecutives (AACE) approved thatthese should be formalised intoan Ambulance Commander NOSto be adopted by each AmbulanceService Provider. It wasrecommended Ambulance Servicesagree the principles of CPD, utilisingthe evidence record developed byNWAS (ANNEX 10) which allowsindividuals to maintain a personalportfolio of evidence against eachof the NOS applicable to theircommand level. Evidence is onlyvalid on the last two years.

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Every Ambulance Commander mustbe given the opportunity to undertakethe NOS through their organisationembedding a consistent approachto the management of incidents thatrequire a command structure.

In complement to the NationalCommander Guidance there is aNational Commander ContinualProfessional Development Portfolio.The CPD Portfolio will be issued toOperational, Tactical and StrategicCommanders, together with theTactical Advisor.

Following initial completion of thePortfolio evidence requirements, eachCommander will have responsibilityfor undertaking continuing educationwithin the command field, enough todemonstrate their knowledge on arecurring 24-month cycle.

A cycle of ongoing education willhelp Commanders to develop abetter understanding of incident

5.7

5.8

5.9

5.10

management and enhance skillsrequired to meet the challenges ofspecial or major incidents. NHSAmbulance Trusts supported byNARU, should undertake an auditannually to ensure compliance withthe Ambulance Commander NOS;this monitoring process will provideopportunities for sharing of bestpractice, skill practice and critique.

An additional benefit of the NOSlies with succession planning. Thoseindividuals who aspire to take oncommand roles will, for the first time,have a set of standards to worktowards in order to be prepared whenthe opportunity to progress arises.

Both the NOS and CPD sectionsabove imply improvement inresilience of both organisationalcommand and national structureswhen an organisation carries outtheir responsibility for providingdevelopment opportunities requiredby individuals.

5.11

5.12


5

Competencies

and Training

THE SUITE OF STANDARDSStrategic CommanderThe following represents the suiteof standards that a StrategicCommander is required to achieve.There are 9 mandatory standardsand 6 optional ones:

Strategic Commander MandatorySuite of Standards

5.13

Figure 6 – Strategic Commander Mandatory Suite of Standards

CCAA2 - Shareinformationwith other

organisations

CCAA1 - Work incooperationwith other

organisations

CCAB1-Anticipate andassess the riskof emergencies

CCAE3 -Conduct debriefingafter an emergency,exercise or other

activity

CCAA3 – Manageinformation tosupport civil

protection decisionmaking

E10 – Takeeffectivedecisions

D11 – LeadMeetings

CCAG1 - Respondto emergenciesat the strategic

level

CCAF2 - Warn,inform and advisethe communityin the event ofemergencies

Strategic

Figure 7 – Strategic Commander Optional Standards

CCAD1 -Develop,

maintain andevaluate businesscontinuity plansand arrangements

CCAG4 -Address theneeds ofindividuals

during the initialresponse toemergencies

CCAH2 -Managecommunityrecovery fromemergencies

CCAH1 -Provide on-goingsupport to meetthe needs ofindividualsaffected byemergencies

CCAF1 - Raiseawareness of therisk, potentialimpact and

arrangementsin place foremergencies

CCAC1 -Develop,

maintain andevaluateemergencyplans and

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Tactical Commander Working at the tactical level, theTactical Commander suite contains8 mandatory and 6 optionalstandards. The Tactical Commandermust demonstrate competenceagainst the standards through thecompletion of their CPD.

Tactical Commander MandatorySuite of Standards

5.14

Figure 8 – Tactical Commander Mandatory Suite of Standards

Figure 9 – Tactical Commander Optional Standards

E10 –Take effectivedecisions

CCAB1-Anticipate and assess

the risk ofemergencies

CCAA2 -Share information

with otherorganisations

CCAG2 -Respond toemergenciesat the tactical

level

D11 – Leadmeetings

CCAA3 – Manage information

to support civilprotection decision

making

CCAE3 -Conduct debriefingafter an emergency,

exercise orother activity

CCAA1 -Work in cooperation


Tactical

CCAD1 -Develop,

maintain andevaluate businesscontinuity plansand arrangements



CCAF2 -Warn, informand advise

the communityin the event ofemergencies

CCAH1 -Provide on-goingsupport to meetthe needs ofindividualsaffected byemergencies

CCAF1 - Raiseawareness of therisk, potentialimpact and

arrangementsin place foremergencies

CCAC1 -Develop,

maintain andevaluateemergencyplans and

arrangements


5

Competencies

and Training

Operational CommanderThe Operational Commander suitecontains 7 mandatory standards and4 optional ones. The OperationalCommander must demonstratecompetence against the standardsthrough the completion of their CPD.

Operational Commander MandatorySuite of Standards

5.15

Figure 10 – Operational Commander Mandatory Suite of Standards

Figure 11 – Operational Commander Optional Standards

E10 –Take effectivedecisions

CCAA3 – Manage information

to support civilprotection decision

making

CCAA2 -Share information


CCAE3 -Conduct debriefingafter an emergency,

exercise orother activity

CCAA1 -Work in cooperation


CCAB1-Anticipate and

assess the risk ofemergencies

CCAG3 -Respond toemergencies

at theoperational

level



D11 -Lead

meetings

CCAF2 -Warn, informand advise

the communityin the event ofemergencies

CCAD1 -Develop, maintainand evaluatebusiness

continuity plansand arrangements

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COMMAND ASSESSMENT TOOLSA suite of Command AssessmentTools have been developed andmaintained by NARU. Current andup to date versions are available onwww.Naru.org/Resources/Online

Resources and documents/NARUpublications:

https://naru.org.uk/document-category/naru-publications/

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Descriptor Initials

Strategic Assessment Tool

COMMAND AND CONTROL STRUCTURE

Have they established a C2 structureappropriate for incident

Have they resourced C2 structureappropriately

Have they referenced initial strategyC2 guidance

Has the tempo and battle rhythm ofmeetings been established

Has the Strategy been reviewed and isit pertinent to incident

Have parameters been set for Tacticalcommanders

Have they liaised with NHS England andacute Trusts implications across region

Has the NACC been requested andNARU informed

Have they informed NHS Region

Consider immediate forward look for6 – 12 hours

Has the continuity of core businessbeen ensured

Have they ensured long term resourcingnext 24 hours

Have they appropriately resourced atscene activities – mutual aid

Have they requested tactical plans andoperational updates

Assessment ToolNARU EDUCAT ION CENTRE

Comments

NARU Education Centre Command Strategic Assessment Tool - Version 1.0@NARU_Education www.narueducationcentre.org.uk

Strategic As

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NARU EDUCAT ION CENTRE

NARU Education Centre Command Strategic Assessment Tool - Version 1.0@NARU_Education www.narueducationcentre.org.uk

Descriptor Initials

JESIP

Have they ensured co location ofsubordinate commanders and adherenceto JESIP

Has appropriate support been requested to SCG advisors, PHE dependent onincident type

Have the appropriate questions beenasked at SCG

Are they able to chair the SCG if required

ORGANISATIONAL ISSUES

Have legal liabilities (including the dutyof care and potential negligence) beensufficiently covered

Have the Financial implications been considered and agreed

Has there been positive engagement with the media – modern outlook

Have they considered recovery focusing on PIP welfare

Comments

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Com

man

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Tact

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Com

man

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Descriptor Initials

Commander Assessment Tool- Tactical Commander

PREPAREDNESS

Appropriate PPE used

Appropriate tabard used

Log book started

JESIP

Did the Commander?

Co-locate

Communicate

Co-ordinate

Jointly assess risk

Share situational awareness

Use METHANE

Use JDM

NARU C2 Performance Criteria

Obtain sufficient information todetermine the current status of theresponse, this should include:

Detailed and formal handoverfrom the acting ICEnsuring that command chainis aware of the handoverLogging the handover

Formulate a tactical plan to includepredetermined emergency plans andanticipated risks

Implement tactics in a timely manner,this should include:

Confirming roles & responsibilitiesAllocating tasksConfirming communicationchannels

Assessment ToolN A R U E D U CAT I O N C E N T R E

Y P N Comments

TAC

TIC

AL


Com

man

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t Too

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Tact

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Com

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TAC

TIC

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Descriptor Initials

Conduct on-going risk assessmentand management in response to thedynamic nature of emergencies

Review tactics with relevant othersincluding key personnel involved incommand, control and coordination

Ensure actions to implement tacticsare carried out, taking into accountthe impact on individuals,communities and the environment

Determine priorities for allocatingresources

Anticipate likely future resourceneeds, taking account of the possibleescalation of emergencies

Work in cooperation andcommunicate effectively withother responders

Liaise with relevant organisations toaddress the long-term priorities ofrestoring services and the recoveryof affected communities

Obtain and provide technical andprofessional advice from suitablesources to inform decision-makingwhere required

Provide accurate and timelyinformation to inform and protectcommunities

Work effectively with the mediawhen required

Monitor and maintain the health,safety and welfare of individualsduring the response

Review actions at Operational level

Identify where circumstanceswarrant a strategic level ofmanagement and engage with theStrategic level as required

Ensure that any individuals undertheir area of authority are fullybriefed and debriefed

Evaluate the effectiveness of tacticsand use this information to informfuture practice

Y P N Comments

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Comments

Assessment ToolN A R U E D U CAT I O N C E N T R E

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Tactical Commander

Name: Signature: Date:

Commander Assessor


The assessor must ensure they fully discuss the assessment with the commander concerned and alllearning points are identified for their future command development.

Descriptor Initials

Fully record all decisions, actions,options and rationale accordance withcurrent information, policyand legislation

Ensure engagement with multi-agencyresponders, providing a joined up andproportionate response

Request digital radio interoperabilitywhere appropriate

Ensure appropriate control measuresare employed to manage all identifiedrisks, reviewing and updating logsand risk assessments as appropriate

Follow any action cards specific tothe Tactical Command role as issuedby the Host Service Provider

Y P N Comments


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Command As

sessmen

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– Op

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ommander

Descriptor Initials

Commander Assessment Tool- Operational Commander

PREPAREDNESS

Appropriate PPE used

Appropriate tabard used

Log book started

JESIP

Did the Commander?

Co-locate

Communicate

Co-ordinate

Jointly assess risk

Share situational awareness

Use METHANE

Use JDM

NARU C2 Performance Criteria

Make an initial assessment of thesituation

Report the assessment to otherresponders in accordance withestablished procedures?

Ensure a METHANE message iscommunicated to the relevantcontrol Hub

Prepare and implement an initialplan of action

Ensure actions are carried out,taking into account the impact onindividuals, communities and theenvironment

Conduct ongoing risk assessmentand management in response tothe dynamic nature of emergencies

Assessment ToolNARU EDUCAT ION CENTRE

Y P N Comments

OPERATIONAL


Com

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Oper

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Descriptor Initials

Work in cooperation andcommunicate effectively withother responders

Request digital radio interoperabilitywhere appropriate

Confirm the availability and locationof relevant services and facilities

Identify the resources required anddeploy them to meet the demands ofthe response

Ensure the establishment of thefunctional roles required to managethe incident

Ensure that appropriately trainedindividuals undertake eachfunctional role

Ensure that individuals are effectivelybriefed to carry out functional roles

Communicate any resourceconstraints to the relevant personor find suitable alternatives

Monitor and protect the health,safety and welfare of individualsduring the response

Deal with individuals in a mannerwhich is supportive and sensitive totheir needs

Liaise with organisations as requiredfor an effective response

Identify where circumstanceswarrant a tactical level ofmanagement and engage with thetactical level as required

Implement the Tactical Plan whereapplicable within a geographical areaor functional area of responsibility

Ensure that any individuals undertheir area of authority are fullybriefed and debriefed

Fully record their decisions, actions,options and rationale in accordancewith current information, policy andlegislation

Follow any action cards specific tothe Operational role as issued by thehost Ambulance Service Provider

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Operational Commander


Commander Assessor


The assessor must ensure they fully discuss the assessment with the commander concerned and alllearning points are identified for their future command development.


Strategic Commander Assessment Tool

Tactical Commander Assessment Tool

Operational Commander Assessment Tool


ANNEX 1STRATEGIC COMMANDER:COMMAND AND CONTROL ROLES, PERFORMANCE CRITERIA AND RESPONSIBILITIES

The Strategic Commanders’responsibilities in line with theirNational Occupational Standardperformance criteria are:

Obtain and analyse the availablerelevant information to informdecision making.

Make effective decisions based onthe best available information.

Agree the policy and strategicframework within which the tacticallevel will work and ensure effectivetwo-way communication with thetactical level.

Work effectively in cooperationwith partner organisations at astrategic level.

Confirm strategic decisions agreedwith responders and how these willbe implemented.

Take action to review the strategy,updating or varying the strategyin response to changing situationsor information.

Obtain and provide technical/professional advice from suitablesources to inform decision-makingwhere required.

Ensure the strategy reflects anyrelevant policy, legal frameworkor protocols.

Ensure the strategy takes accountof the impact on individuals,communities and the environment.

Engage effectively in the politicaldecision-making process.

a)

b)

c)

d)

e)

f)

g)

h)

i)

j)

Review the scale of requiredresources and ensure theiravailability.

Ensure that all relevantorganisations have sufficient andaccurate information with a suitabledegree of urgency to enable effectivecoordination of response.

Ensure the development andimplementation of an effectivecommunications strategy.

Address medium and long-termpriorities to facilitate the recoveryof affected communities.

Ensure provision of continuedsupport for individuals affectedby emergencies.

Ensure effective delegation to thetactical level.

Evaluate the effectiveness of thestrategy and use this informationto inform future practice.

Fully record your decisions, actions,options and rationale in accordancewith current information, policy andlegislation.

Ensure all Tactical Commandersare subject to a hot debrief.

Provide a public relations link withthe wider community.

Follow any action cards specificto the Tactical Commander roleas issued by the host AmbulanceService Provider.

k)

l)

m)

n)

o)

p)

q)

r)

s)

t)

u)

A1

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ANNEX 2TACTICAL COMMANDER:COMMAND AND CONTROL ROLES, PERFORMANCE CRITERIA AND RESPONSIBILITIES

The Tactical Commanders’responsibilities in line with theirNational Occupational Standardperformance criteria are:

Obtain sufficient information todetermine the current status of theresponse. This should includeensuring that a detailed and formalhandover is received from the actingTactical Commander, and that thewhole command chain is aware thatsuch a handover has taken place andappropriate log entries are made.

Formulate a Tactical Plan andCasualty Management Plan whichtakes account of all availableinformation, including any pre-determined emergency plans, andanticipated risks.

Implement tactics in a timely manner,confirming roles, responsibilities,tasks, and communication channels.

Conduct on-going risk assessmentand management in response to thedynamic nature of emergencies.

Review tactics with relevant othersincluding key personnel involved incommand, control and coordination.

Ensure actions to implement tacticsare carried out, taking into accountthe impact on individuals,communities and the environment.

Determine priorities for allocatingavailable resources.

Anticipate likely future resourceneeds, taking account of the possibleescalation of emergencies.

Work in cooperation andcommunicate effectively with otherresponders.

a)

b)

c)

d)

e)

f)

g)

h)

i)

Liaise with relevant organisationsto address the longer-term prioritiesof restoring essential services andhelping to facilitate the recovery ofaffected communities.

Obtain and provide technical andprofessional advice from suitablesources to inform decision-makingwhere required.

Provide accurate and timelyinformation to inform and protectcommunities, working with themedia where relevant.

Monitor and maintain the health,safety and welfare of individualsduring the response.

Review actions taken at operationallevel.

Identify where circumstanceswarrant a strategic level ofmanagement and engage with thestrategic level as required.

Ensure that any individuals underyour area of authority are fully briefedand debriefed.

Evaluate the effectiveness of tacticsand use this information to informfuture practice.

Fully record your decisions, actions,options and rationale in accordancewith current information, policyand legislation.

Ensure engagement withmulti-agency responders, providinga joined up and proportionateresponse.

Request digital radio interoperabilitywhere appropriate.

j)

k)

l)

m)

n)

o)

p)

q)

r)

s)

t)

A2

ANNEX 2


Ensure appropriate controlmeasures are employed to manageall identified risks, reviewing andupdating logs and risk assessmentsas appropriate.

Follow any action cards specificto the Tactical Commander role asissued by the host AmbulanceService Provider.

u)

v)

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ANNEX 3OPERATIONAL COMMANDER:COMMAND AND CONTROL ROLES, PERFORMANCE CRITERIA AND RESPONSIBILITIES

The Operational Commanders’responsibilities in line with theirNational Occupational Standardperformance criteria are:

Make an initial assessment of thesituation and report this to otherresponders in accordance withestablished procedures.

Ensure a METHANE message iscommunicated to the relevantEmergency Operations Centre (EOC).

Prepare and implement an initial planof action.

Ensure actions are carried out,considering the impact on individuals,communities and the environment.

Conduct on-going risk assessmentand management in response to thedynamic nature of emergencies.

Work in cooperation andcommunicate effectively with otherresponders.

Confirm the availability and locationof relevant services and facilities.

Identify any resources required anddeploy them to meet the demands ofthe response.

Ensure the establishment ofthe functional roles required tomanage the incident and thatappropriately trained individualsundertake each role.

Communicate any resourceconstraints to the relevant personor find suitable alternatives.

Monitor and protect the health,safety and welfare of individualsduring the response.

a)

b)

c)

d)

e)

f)

g)

h)

i)

j)

k)

Deal with individuals in a mannerwhich is supportive and sensitive totheir needs.

Liaise with relevant organisations asrequired for an effective response.

Identify where circumstanceswarrant a tactical level ofmanagement and engage with thetactical level as required.

Implement the Tactical Plan andCasualty Management Plan whereapplicable, within a geographical areaor functional area of responsibility.

Ensure that any individuals underyour area of authority are fully briefedand debriefed.

Fully record your decisions, actions,options and rationale in accordancewith current information, policyand legislation.

Follow any action cards specific tothe Operational role as issued by thehost Ambulance Service Provider.

l)

m)

n)

o)

p)

q)

r)A3

ANNEX 3


A4

ANNEX 4

ANNEX 4FUNCTIONAL ROLES

Ambulance - Safety OfficerResponsible for the health and safetyof all NHS responders entering andworking within the cordons of theincident. The Ambulance Safety Officerwill work closely with the OperationalCommander ensuring appropriatecontrol measures are employed tomitigate against identified risksthrough the risk assessment process.The Safety Officer should, wherepossible, work alongside the SafetyOfficers of the other agencies.

Ambulance - Primary Triage OfficerResponsible for coordinating theinitial (SIEVE) triage of all casualtiesat the incident. The Triage Officershould work closely with theCasualty Clearing Officer (CCO).Dependent on the size of theincident, there may be a requirementto allocate an Officer for Primaryand Secondary triage. The TriageOfficer is responsible for maintaininga record of the number andcategories of casualties triaged.

Ambulance - Casualty ClearingOfficer (CCO)Responsible for the management ofthe Casualty Clearing Station (CCS),they work closely with the Triage,Parking and Loading Officers andthe Forward Medical Advisor (FMA)to ensure an efficient triage andtreatment of all casualties, and theappropriate use of availabletransport resources. The CCO isresponsible for keeping a log of thenumber and categories of casualtieswho pass through the CCS.

Ambulance - Secondary TriageOfficerResponsible for coordinating thesecondary (SORT) triage of allcasualties within the CasualtyClearing Station (CCS). The Triage

Officer should work closely with theCasualty Clearing Officer (CCO) andMedical Advisor. The Triage Officeris responsible for maintaining arecord of the number and categoriesof casualties triaged and the regularre-triage of patients (at least every15 minutes).

Casualty Loading OfficerThe Loading Officer works veryclosely with the Casualty ClearingOfficer (CCO) to ensure thatcasualties who requiretransportation from the CCS areaccommodated. The Loading Officeris responsible for keeping a log ofthe number and destinations ofcasualties transported from the CCS.

Ambulance - Equipment OfficerThe Equipment Officer will ensurethe supply and re-supply ofequipment to all respondingNHS resources.

Ambulance – Patient Liaison OfficerResponsible for communicatingagreed messages to groups ofpatients. They will liaise with theAmbulance Command team toensure consistent messages arerelayed.

Hospital Ambulance Liaison Officer(HALO)Assists at A&E Departments tomaintain efficient ambulanceturnaround and re-equipping ofambulances. They will also liaisewith the police documentationteams. An important role is toarrange relief for members of staffsuffering from fatigue or stress onarrival at the hospital. The HospitalAmbulance Liaison Officer (HALO)will liaise with the HospitalManagement Team to ensure it isaware of the hospital’s capability to

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receive casualties and relayinformation back to the EmergencyOperations Centre. This officer’s jobis to also keep RCC updated with thecurrent status of the hospital’s ResusBays, Theatres and ITU.

The HALO role will be subject tocommand resource availability andmay not be available to all receivinghospitals.

Hazardous Area Response TeamLeader (HART)The HART Team Leader will providedirect line management for all HARTresources; they will report through tothe Operational Commander ensuringthey carry out the objectives of theAmbulance Service response in linewith the Tactical Plan.

Casualty Clearing Station MedicalLead (CCSML)Responsible for coordinating,supporting and advising paramedicsand medical staff in the CasualtyClearing Station (CCS) to maximisethe clinical care of all patientsattending the CCS and appropriateonward journeys to specialistreceiving hospitals.

Ambulance - Forward DoctorResponsible for ensuring the mostappropriate medical management ofpatients is undertaken within the areathey are designated to (CCS orincident ground). Working closely withthe Medical Advisor and OperationalCommander and ensuringappropriate records are maintainedfor patients.

SUPPORT ROLES

Ambulance – LoggistResponsible for capturing keyinformation and decision makingmade by the ambulance commandteam during an incident.

Ambulance - Communications OfficerResponsibilities include the provisionof robust communications at thescene of the incident. This mayinclude the deployment of any mobilecontrol units where available.

Ambulance - Decontamination OfficerWhere casualties requiredecontamination, a DecontaminationOfficer will be nominated to managethat facility. This will also require theappointment of a suitably trainedindividual to undertake the EntryControl Officer role (ECO).

Ambulance - Media Liaison OfficerAll incidents have the ability to attractmedia interest. The Media LiaisonOfficer will develop and coordinatethe release of Ambulance ServiceProvider media statements. This willoften be achieved in a multi-agencysetting; however, it should always bedone in line with the AmbulanceService Provider Strategy.

National Ambulance CoordinationCentre (NACC)The NACC is hosted by West MidlandsAmbulance Service and is facilitatedby NARU Duty Officers. The NACCPlan identifies key objectives andbenefits of this facility. The NACC is toprovide the focal point for thecollection, collation and assessmentof data regarding all AmbulanceService Providers in the UK;specifically, their ability to providemutual aid if called upon to do so.

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ANNEX 5AMBULANCE SERVICE STRATEGY

AMBULANCE SERVICE STRATEGY

It is the intention of the Ambulance Service Provider to respond to and manage theongoing incident in a way which promotes and saves life, reduces humanitarian sufferingand is compatible with the vision and values of the Ambulance Service Provider. Througheffective coordination, sound planning and good leadership the Strategic Commander will:

1. Maintain public confidence and minimise the impact of the incident by ensuring that the Ambulance Service Provider is responding effectively to the incident.

2. Ensure that the Ambulance Service Provider response is coordinated and integrated with the wider health and responding agencies.

3. Maintain effective capacity management within the Emergency and Non-Emergency Service, and the Emergency Control Rooms, by:

a. Assessing and identifying any gaps in the response capability of the organisation for dealing with this incident.

b. Identification and request for mutual aid.

4. So far as is reasonably practicable, take all measures and employ all appropriately identified control measures to safeguard the following people under the terms of Health and Safety Legislation:

Ambulance staff and other responders Local communities

5. Ensure public messages are coordinated with other agencies and partners.

6. Ensure effective Business Continuity and Recovery arrangements are in place across the organisation and review where necessary.

7. Provide support and representation at the sub-regional level where appropriate.

8. Create and maintain a well documented, auditable plan and decision log for the incident at all levels of command.

9. Review this strategy every 4 hours.

Signature (STRATEGIC COMMANDER)

Date: Time:

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ANNEX 5

HEALTH STRATEGY

Aim

To ensure that the NHS in England provides a robust, integrated response to theemerging situation

Objectives

1. Saving and protecting human life

2. Relieving suffering

3. Containing the emergency – limiting its escalation or spread

4. Maintain, where possible, critical services

5. Protecting the health and safety of patients and NHS personnel

6. Providing patients and the public with information

7. Promoting self-help and recovery

8. Restoring normality as soon as possible

9. Facilitating investigations and inquires

10. Evaluating the response and identification of lessons

HEALTH STRATEGY


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ANNEX 6

ANNEX 6COMMAND TABARDS

AMBULANCEINCIDENT

COMMANDER

AMBULANCESAFETYOFFICER

AMBULANCEOPERATIONAL

COMMUNICATIONSADVISOR

AMBULANCETACTICAL

ADVISOR/NILO

AMBULANCELOGGIST

AMBULANCEPressOfficer

AMBULANCEENTRY CONTROL

OFFICER

AMBULANCEOPERATIONALCOMMANDER

AMBULANCEDECONTAMINATION

OFFICER

AMBULANCEMEDICALADVISOR

Tactical Commander (Ambulance Incident

Commander)White lower half with green& white checked shoulders.

Ambulance OperationalCommander and any functional

role not individually listedYellow lower half and green &white checked shoulders.

Insert as per role.

Strategic Advisor, TacticalAdvisor or National Inter-Agency

Liaison Officer (NILO)Green lower half with green &white checked shoulders.

Insert as per role.

Ambulance Safety Officer (ASO)Blue lower half with green &white checked shoulders.

Decontamination OfficerPurple lower half with green& white checked shoulders.

Ambulance Entry ControlOfficer (ECO)

Green & yellow all over check.

OperationalCommunications Advisor Green & white check.

DoctorRed lower half with green &white checked shoulders.

LoggistOrange lower half and green &white checked shoulders. Allorange is any support function.

Leadership is a keyattribute of anAmbulanceCommander.

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ANNEX 7

ANNEX 7AMBULANCE SERVICE PERSONAL PROTECTIVE EQUIPMENT CAPABILITIES

Standard AmbulanceUniform

Standard AmbulancePPE

Quickdon PPE Extended DurationBreathing Apparatus

(EDBA) PPE

Gas Tight Suit & ExtendedDuration Breathing

Apparatus (EDBA) PPETraining suit displayed

Powered RespiratorProtective Suit(PRPS) PPE

Training suit displayed

Safe Working atHeight/ConfinedSpace/UnstableTerrain PPE

Water Operations PPE

Hazardous AreaResponse Team

Incident Ground PPE

Ballistic PPE

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ANNEX 8COMMUNICATIONS INTEROPERABILITY FLOWCHART

Span of command needs to recognisethat whilst numerous individuals willprovide functional command to theOperational Commander, (such asParking Officer and EquipmentOfficer) it is unlikely that all wouldbe required at all incidents but theOperational Commander must notbe overloaded.

Hazardous AreaResponse

Team Leader

LoadingOfficer

ParkingOfficer

SafetyOfficer

POLICE

FIRE

POLICE

FIRE

AMBULANCESAFETYOFFICER

AMBULANCEHART TEAM

LEADER

AMBULANCESECTOR

COMMANDER

AMBULANCELOADINGOFFICER

AMBULANCEPARKINGOFFICER


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ANNEX 8

CCSMedicalLeadDoctor

DecontaminationOfficer

CasualtyClearingOfficer

SecondaryTriageOfficer

OPERATIONALCOMMANDER

TACTICAL COMMANDER

Sector Commanders

Tactical Advisor/NILO

Medical Advisor

ForwardDoctor

AMBULANCEINCIDENT

COMMANDER

AMBULANCETACTICAL

ADVISOR/NILO

AMBULANCECASUALTY

CLEARING OFFICER

PrimaryTriageOfficer

AMBULANCEPRIMARY

TRIAGE OFFICER

AMBULANCESECONDARY

TRIAGE OFFICER

AMBULANCEOPERATIONALCOMMANDER

AMBULANCESECTOR

COMMANDER

AMBULANCEDECONTAMINATION

OFFICER

AMBULANCEFORWARD DOCTOR

AMBULANCECCS MEDICAL

LEAD

AMBULANCEMEDICALADVISOR COMMAND

SUPPORTROLES

COMMANDSUPPORTROLES

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ANNEX 9

ANNEX 9NOS CPD Evidence Record

Screenshot illustrating the ‘Introduction’ tab within the document.

Screenshot illustrating the ‘Evidence’ tab within the document.


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ANNEX 10AMBULANCE TACTICAL PLAN TEMPLATE

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NARU Education Centre Tactical Plan Template, Version 1.1 April 2019@NARU_Education www.narueducationcentre.org.uk

Tactical Plan Template


T E M P L A T ENARU EDUCAT ION CENTRE

TEMPLATE

This tactical plan template has been designed to assist tactical commanders in the development anddelivery of a tactical plan in response to an incident. It is not exhaustive and should be treated as a guide.The plan will be developed and revised as the incident progresses, and will be informed by the JESIPJoint Decision Model (JDM). The tactical plan should be briefed across the command structure and whenhanding over using IIMARCH.

Using CSCATTT will enable the key principles for incident response to be followed in the tactical planand (reference page 14 NARU Command and Control Guidance section 3.8) will aid the development ofthis plan.

This template is a guide and must not restrict commanders in their planning, thinking or decision makingin order to resolve the incident.

Joint Emergency Services Interoperability Principles (JESIP) and the JDM are fundamental to thedevelopment and delivery of the tactical plan.

WHAT IS YOUR KEY OBJECTIVE:

COMMAND ANDCONTROLJESIP

Command structure,chain of command

Assigned roles

Functions

Locations

NILO / Tactical Advisor

(confirmation or implementationof the above)

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TEMPLATE

SAFETYUNDERSTAND RISK

Ensuring safety of respondersand patients with specific

roles and considerations addeddepending on incident type.

eg flooding, MTFA

Confirmation of regularDynamic Risk Assessment (DRA)

using ERICPD

Assigned safety roles

COMMUNICATION

Confirmation or establishment ofInteroperable talk group and / or

Major Incident channel

Confirmation of call signs forcommand

Back up communications

Communication support

Communication chain of command

Confirm communications withAcute Trusts and other key partners

ASSESSMENTSHAREDSITUATIONALAWARENESS

Scene assessmentflooding/MTFA/RTC

METHANE

Information available

Impact assessment

Scale / REAP Level / thinking ahead/ mutual aid

Casualty typing,paediatrics/burn/geriatric/trauma


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TEMPLATE


TRIAGE

Where

Who

How

How often / for how long

Which algorithm

TREATMENT

CCP CCS Locations ofConfirmation of establishment

Use of clinical skills

CBRN antidotes

Advice PHE

Medical Incident AdvisorCoordination of treatment

Resources / consumables

Mass casualty vehicle

What treatment where

TRANSPORT

Routes in and out RVP SHAlocations

Confirm Casualty Loading Point(CLP) established and location

Parking officers (coordination oftransport (lines of communication)

Receiving hospitals

Impact on core business

Voluntary Ambulance Service Private Ambulance Service

Resources

Loss of key routes

Capacity and capability ofreceiving hospital

Assistance from police

Air assets / landing sites

Specialist assets to the scene If required please continue on the next page

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NARU Education Centre Tactical Plan Template, Version 1.0 August 2016@NARU_Education www.narueducationcentre.org.uk


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TEMPLATE

TRANSPORTContinued

RESOURCES

Consideration ofspecialist resources

HART

SORT

Air Assets

Mutual Aid includingCommand Mutual Aid

NACC

Welfare patients and staff

Mass Casualty

VAS PAS

Drs

Receiving Hospitals

Local Authority

Supporting Information:


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ANNEX 11

Casualty Management Plan:

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Casualty Profiling

Type of Injury/Illness Casualty Numbers Actual/Estimated

Adult Paediatric

Trauma

Medical

Burns

CBRN/HAZMAT

Special Circumstance

Numbers

Casualty Numbers:

Estimated Actual

Personnel Committed

Organisation

Date: Time: Version:

MANAGEMENT PLANCASUALTY

Potential at Risk Casualty Numbers

Adult Paediatric

Resources on Scene Potential Additional Resources Required

Type Call Sign(s)

DCA(s)

HART

Critical Care

Air Ambulance

MCV

SORT

Type Call Sign(s)

DCA(s)

HART

Critical Care

Air Ambulance

MCV

SORT

MTFA

ETA

MTFA

Other (BASICS/MERIT etc) Other

ANNEX 11CASUALTY MANAGEMENT PLAN

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ANNEX 11

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CASUALTY

Transport type& call sign

Distance by Road (KM)& Mins

Priority TypeAllocationLevel Distance by Air (KM)

& Mins

Receiving Hospital:

Hospital

Casualty Care Pathway Schematic Key

Point of Injury (PoI) Number at Risk

Self Aid/Buddy Aid Name(s) & C/S CatastrophicHaemorrhage& AirwayManagementExtrication ifpossible

IncidentHazardSymbol

RendezvousPoint (RvP)

DesignatedReceivingHospital

CasualtyClearingStation

Initial Care Name(s) & C/S CABCExtricate

CCP/Critical Care Name(s) & C/S AdvancedClinical Care

CCS Name(s) & C/S S ContinuedClinicalPackage forTransport

Hospital Name(s) & C/S Definitive Care& SecondaryTransfer

TEXT

P F ARVP

CasCS

DRH


A12

ANNEX 12

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ANNEX 12Standards for NHS Ambulance Service Command & Control available via Ambulance.pro-clus.co.uk / Reference library / National Standards

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GLOSSARY AND

BIBLIOGRAPHY

GLOSSARY AND BIBLIOGRAPHY

Ambulance Safety Officer (ASO) The officer with specific responsibilityfor the safety of personnel at thescene of an incident.

Blue RoutesA dedicated route for emergencyvehicles to access and egress fromthe scene of an emergency or majorincident.

Business Continuity Management(BCM)Holistic management process thatidentifies potential threats to anorganisation and the impacts tobusiness operations that thosethreats, if realised, might cause,and which provides a frameworkfor building organisational resiliencewith the capability for an effectiveresponse.

Business Continuity Plan (BCP)Documented collection of proceduresand information that is developed,compiled and maintained in readinessfor use in an incident to enable anorganisation to continue to deliver itscritical activities at an acceptablepre-defined level.

Casualty Loading OfficerThe Loading Officer is responsible forthe management of vehicles and thecontrolled onward transportation ofpatients from the Casualty ClearingStation to definitive car.

Chemical, Biological, Radiological,Nuclear and Explosives (CBRNE)A term used to describe Chemical,Biological, Radiological, Nuclearand Explosive materials. CBRNEterrorism is the actual or threateneddispersal of CBRNE material (eitheron their own or in combination witheach other or with explosives), withdeliberate criminal, malicious ormurderous intent.

Civil Contingencies Act 2004 (CCA)Act of 2004 which established asingle framework for Civil Protectionin the United Kingdom. Part 1 of theAct establishes a clear set of rolesand responsibilities for LocalResponders; Part 2 of the Actestablishes emergency powers.

Casualty Clearing Officer (CCO)Ambulance officer who, in liaisonwith the Forward Doctor, ensuresan efficient patient throughput atthe Casualty Clearing Station.

Casualty Clearing Station (CCS)Entity set up at the scene of anemergency by the Ambulance Servicein liaison with the Forward Doctor toassess, triage and treat casualtiesand direct their evacuation.

Control of Major Accident Hazards(COMAH)Regulations applying to the chemicalindustry and to some storage siteswhere threshold quantities ofdangerous substances, as identifiedin the Regulations, are kept or used.

Continual ProfessionalDevelopment (CPD)The process by which an individualcontinues to develop theirprofessional skills and knowledge.

DoctorA qualified doctor who will workwith the Operational Commanderto ensure medical resources areavailable and coordinated on theincident ground.

Dynamic Risk Assessment (DRA)Continuing assessment of risk ina rapidly changing environment.


GLOSSARY AND

BIBLIOGRAPHY

Entry Control Officer (ECO)A trained officer who ensures that allNHS resources are logged in and outof an incident through an agreedEntry Control Point. This may be aFire and Rescue Service Officerwhere local agreement is in place.

Entry Control Point (ECP)The point on the incident groundwhere trained responders will enterand exit the inner cordon.

Extended Duration BreathingApparatus (EDBA)Self contained breathing apparatusused by HART staff which providesan extended deployment time overstandard breathing apparatus.

Hospital Ambulance Liaison Officer(HALO)The Hospital Ambulance LiaisonOfficer will liaise with hospitalmedical and nursing staff regardingarrangements for reception/discharge of patients and theavailability of beds for casualtiesand ensure that this information ismade available to the AIC and Policedocumentation team.

Hazardous Area Response Team(HART)Specially recruited and trainedpersonnel who provide theAmbulance response to majorincidents involving hazardousmaterials, or which presenthazardous environments that haveoccurred as a result of an accidentor have been caused deliberately.

Health and Safety at Work Act(HSaW)Primary piece of legislationcovering occupational health andsafety in the United Kingdom.The Health and Safety Executive isresponsible for enforcing the Actand a number of other Acts andStatutory Instruments relevant tothe working environment.

Health and Safety Executive (HSE)The Health and Safety Commission(HSC) and the HSE are responsiblefor the regulation of almost all therisks to health and safety arisingfrom work activity in Great Britain.

Joint Command Facility (JCF)A location (building, mobile unit etc)that all agencies can assemble tomanage an incident with appropriatemethods of communication and ITinfrastructure.

Joint Decision Model (JDM)A tool for Commanders to use inorder that they can have a structuredapproach to the command decisionsthat they make.

Limit(s) Of Exploitation (LOE)A defined area within whichAmbulance and NHS resourcescan be committed into an incident. The LOE may apply to all resources,or specific resources in a defined areaof the incident (for exampleAmbulance Intervention Teamsworking at an active shooter incident).

National Inter-agency Liaison Officer(NILO)A trained and qualified officer whocan advise and support Commanders,Police, medical, Fire, military andgovernment agencies on theoperational capacity and capabilityof their organisation.

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GLOSSARY AND

BIBLIOGRAPHY

National Occupational Standard(NOS) A set (or suite) of standards whichprovide a benchmark forCommanders. They set outperformance and knowledgeand understanding criteria thatCommanders will be measuredagainst.

Pre-Determined Attendance (PDA)A site specific initial resourcerequirement. Generally airportsand chemical plants will have anagreed PDA.

Personal Protective Equipment (PPE)Protective clothing, helmets, gogglesor other garments designed to protectthe wearer’s body from injury.

Situational Awareness (SA)The state of individual and/or collectiveknowledge relating to past andcurrent events, their implicationsand potential future development.A Commander’s awareness of whatis happening around them.

Strategic Coordinating Group (SCG)Multi agency body responsible forcoordinating the joint response to anemergency at the local strategic level.

Strategic, Tactical, Operational(STO) The formal command structureused within the UK emergencyservices.

Tactical Advisor (TA)A trained officer who can provideCommanders with specific knowledgeof special incidents such as CBRNEor HAZMAT.

Tactical Coordinating Group (TCG)A multi agency group of TacticalCommanders that meets todetermine, coordinate and deliver thetactical response to an emergency.


GLOSSARY AND

BIBLIOGRAPHY

Civil Contingencies Act 2004http://www.legislation.gov.uk/ukpga/2004/36/contents

Civil Contingencies Act 2004 (Contingency Planning) Regulations 2005http://www.legislation.gov.uk/uksi/2005/2042/contents/made

Corporate Manslaughter Act and Corporate Homicide Act 2007http://www.legislation.gov.uk/ukpga/2007/19/contents

Data Protection Act (2018)https://www.gov.uk/data-protection

Emergency Preparedness (2011 update)http://www.cabinetoffice.gov.uk/resource-library/emergency-preparedness

Emergency Response and Recovery version 3 (2010)http://www.cabinetoffice.gov.uk/resource-library/emergency-response-and-recovery

Expectations and Indicators of Good Practice Set for Category 1 and 2 Respondershttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/252341/Expectation_and_Indicators_of_Good_Practice_Set_for_category_1_2_Responders.pdf

Fire and Rescue Service: National Operational Guidancehttps://www.ukfrs.com/guidance

Government Security Classifications April 2014https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/251480/Government-Security-Classifications-April-2014.pdf

General Data Protection Regulationhttps://www.gov.uk/government/publications/guide-to-the-general-data-protection-regulation

Health and Safety at Work etc Act 1974http://www.legislation.gov.uk/ukpga/1974/37/contents

Health and Social Care Act 2008 (Regulated Activities) Regulations 2010http://www.legislation.gov.uk/uksi/2010/781/contents/made

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GLOSSARY AND

BIBLIOGRAPHY

HSE Common Topics: Emergency Responsehttps://www.gov.uk/search?q=emergency+response

HSG48 Reducing Error and Influencing Behaviour (1999)http://www.hse.gov.uk/pubns/priced/hsg48.pdf

JESIP: Joint Doctrine – The Interoperability Frameworkhttps://www.jesip.org.uk/uploads/media/pdf/Joint%20Doctrine/JESIP_Joint_Doctrine_Document.pdf

Lexicon of UK civil protection terminology – Version 2.1.1https://www.gov.uk/government/publications/emergency-responder-interoperability-lexicon

Major Incident Medical Management and Support (2013)http://www.alsg.org/uk/node/10

NARU National Ambulance Service CBRNE/HAZMAT Guidance

NARU National Incident Action Cards

National Risk Register of Civil Emergencies (2013 Edition)https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/211867/NationalRiskRegister2013_amended.pdf

NHS England Command and Control Framework for the NHS during significant incidentsand emergencieshttp://www.england.nhs.uk/wp-content/uploads/2013/01/comm-control-frame.pdf

NHS England Emergency Preparedness Frameworkhttp://www.england.nhs.uk/wp-content/uploads/2013/03/eprr-framework.pdf

NHS England Standards for Emergency Preparedness, Resilience and Response (EPRR)http://www.england.nhs.uk/wp-content/uploads/2014/07/eprr-core-standards-0714.pdf

College of Policing Guidance on Command and Controlhttps://www.app.college.police.uk/app-content/operations/command-and-control/

AcknowledgementsThis document is the intellectual property of the National Ambulance Resilience Unit(NARU).


NOTES

NOTES


March 2019Version 3.0

For further information please contact:

National Ambulance Resilience Unit (NARU)

Website: www.naru.org.uk

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