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SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer abcdefghij SCOTTISH EXECUTIVE HEALTH DIRECTORATES ARRANGEMENTS FOR RESPONDING TO MAJOR EMERGENCIES

SEHD-INTERNET VERSION-Major Emergency Response Arrangement

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Page 1: SEHD-INTERNET VERSION-Major Emergency Response Arrangement

SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

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SCOTTISH EXECUTIVE HEALTH DIRECTORATES

ARRANGEMENTS FOR RESPONDING TO MAJOR EMERGENCIES

Page 2: SEHD-INTERNET VERSION-Major Emergency Response Arrangement

SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

PREFACE Major emergencies, whilst infrequent, do occur and NHS Scotland must be ready to respond to them. Factors such as climate change, international terrorism, health risks posed by greater global mobility all need to be considered. The aims of emergency planning within NHS Scotland are to ensure that essential health care needs are met effectively when normal services become overloaded, restricted or non-operational for whatever reason, and protect our health when risks are identified. The procedures outlined in this document are aimed at ensuring: - a) NHS Scotland receives adequate support in managing the response to

any emergency; b) Ministers receive briefing on the situation as it develops and advice on

lines to take; c) any action required of the Scottish Executive Health Directorates is clear,

co-ordinated and timely; d) Ministers’ decisions are disseminated and implemented quickly. To ensure flexibility the plan outlines a management and communications structure that can be adopted in full or in a modified form to meet the needs of a particular event or situation. Scottish Executive Health Directorate personnel will need to be prepared to interpret and apply the procedures as circumstances dictate. Kevin Woods Director-General Health Chief Executive NHSScotland

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SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

SEHDs ARRANGEMENTS FOR RESPONDING TO EMERGENCIES CONTENTS SECTION RECORD OF PLAN REVIEW AND AMENDMENT 1 RECORD OF TRAINING AND EXERCISES 2 TABLE OF ACTION CARDS, ANNEXES & ABBREVIATIONS 3 INTRODUCTION 4 RECEIPT OF MAJOR EMERGENCY/INCIDENT ALERTS 5 Definition of Scale of Emergency 5.3 Routine Emergencies 5.4 Major Emergencies 5.5 Major Incidents 5.7 Health Impacts 5.9 MANAGEMENT AND COORDINATION OF THE HEALTH RESPONSE 6 Health Coordination at the scene 6.1 Strategic coordination of the local multi-agency response 6.2 Local/regional health coordination 6.8 National/UK health coordination 6.11 ROLES AND RESPONSIBILITIES 7 Scottish Executive 7.1 Overview of Arrangements 7.2 Civil Contingencies Division 7.5 Generic Structure for Responding to Emergencies in Scotland 7.6 Scottish Executive Emergency Action Team (EAT) 7.7 Scottish Executive Emergency Support Team (EST) 7.9 Scottish Executive Health Directorates 7.11 Health Directorates Board 7.12 Scottish Health Emergency Response Team (SHERT) 7.13 Chief Medical Officer (CMO) 7.19 Scottish Ambulance Service 7.25 NHS Boards 7.26 Health Protection Scotland 7.27 Reporting to the Scottish Executive Emergency Room (SEER) 7.28 Staffing Scottish Health Emergency Response Team (SHERT) 7.29 Chief Medical Officer - Representation on EAT and SHERT 7.32 BACK UP ARRANGEMENTS FOR SEHDs’ ON-CALL OFFICER 8 PHYSICAL SECURITY/ SECURITY OF INFORMATION 9

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SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

SECTION 1 RECORD OF PLAN REVIEW AND AMENDMENT

Date Reviewed by Nature of Amendment/Review July 06 H Scott To take into account revisions in JD

emergency response arrangements

July 07 H Scott • Following Ex Winter Willow • Preface added to document • Establishment of SHERT

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SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

SECTION 2 RECORD OF TRAINING AND EXERCISES

Date Location Organised by Nature of Event 17 May 06 Dunfermline HPS/SEHD Ex Big Chill - pandemic

15/16 June 06 SAH SEHD/ HPA Ex Shared Goal - pandemic

10 Aug 06 SAH SEHD EPB Training for EAT, EST, and

SEHD on call staff, including CMO staff and Performance Management - 1

6 Sept 06 SAH SEHD Training & table top exercise for HD Board.

28 Nov 06 SAH SEHD Training for EAT, EST, and SEHD on call staff, including CMO staff and Performance Management - 2

30 Jan/16>20 Feb 07

SAH SEHD/ DoH Exercise Winter Willow – pandemic influenza

17 & 24 July 07

SAH SEHDs Training sessions for SHERT

25 July 07 SAH SEHDs Ex ‘Whittle’ – exercise of emergency call out procedures

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SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

SECTION 3 TABLE OF ACTION CARDS ACTION CARD 1: SEHDs’ DUTY OFFICER OR OFFICIAL RECEIVING INITIAL

ALERT ACTION CARD 2: SEHDs - EMERGENCY ACTION TEAM REPRESENTATIVE ACTION CARD 3: SEHDs - TEAM LEADER ACTION CARD 4: SEHDs - EAT SUPPORT OFFICER ACTION CARD 5: SEHDs - LIAISON OFFICERS (TO OTHER DIRECTORATES

OR AGENCIES AS REQUIRED) ACTION CARD 6: SEHDs - SEER LIAISON OFFICER ACTION CARD 7: SEHDs - TEAM MEMBERS TO COVER MINISTERIAL AND

MEDIA BRIEFING REQUESTS ACTION CARD 8: SEHDs - ADMINISTRATION SUPPORT ACTION CARD 9: CMO’s PROFESSIONAL STAFF TABLE OF ANNEXES ANNEX ‘A’: EMERGENCY ALERTS ANNEX ‘B’: SCOTTISH EXECUTIVE HEALTH DIRECTORATES -

EMERGENCY RESPONSE GROUPS ANNEX ‘C’: SCOTTISH EXECUTIVE CORPORATE RESPONSE FLOW CHART ANNEX ‘D’: NHS BOARD SITUATION REPORTS ANNEX ‘E’: MODEL AGENDA FOR SEHDs’ SENIOR MANAGEMENT TEAM ANNEX ‘F’: LOG OF EVENTS ABBREVIATIONS CCS – Civil Contingences Secretariat CMO – Chief Medical Officer EAT – Emergency Action Team EST – Emergency Support Team HPA – Health Protection Agency HPS – Health Protection Scotland CSCCC – Cabinet Sub-Committee on Civil Contingencies NHS – National Health Service SAS – Scottish Ambulance Service SCG – Strategic Coordinating Group SE – Scottish Executive SECC – Scottish Emergency Coordinating Committee SEER – Scottish Executive Emergency Room SEHDs – Scottish Executive Health Directorates SHERT – Scottish Health Emergency Response Team STAC – Scientific & Technical Advice Cell

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SECTION 4 INTRODUCTION 1. This document aims to provide guidance to Scottish Executive Health Directorates (SEHDs) staff responding to emergencies that might affect the health of people in Scotland or might threaten the integrity of the healthcare that can be provided by the Scottish NHS Boards. 2. This document should be read in conjunction with:

a) “The National Health Service in Scotland Manual of Guidance: Responding to Emergencies” http://www.SEHDs.scot.nhs.uk/emergencyplanning/guidance.htm

3. Guidance is provided on:

a) The initial actions to be taken when alerted to large scale major incidents or emergencies, requiring implementation of national/UK co-ordination and support arrangements;

b) responsibilities of SEHDs in the event of such incidents; c) arrangements for co-ordination and management of the health

response. 4. During such emergencies health-reporting arrangements will be established which seek to ensure that the health response is co-ordinated and supported at national level.

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SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

SECTION 5 RECEIPT OF MAJOR EMERGENCY/ INCIDENT ALERTS 1. The SEHDs provide 24-hour contact arrangements through a rota of on call staff for the receipt of major emergency/ incident alerts. NHS Boards also provide 24-hour major incident contact numbers. (ACTION CARD NO. 1) 2. Major health emergency/ incident alerts to the SEHDs may come from a variety of sources. NHS Boards may also alert the SEHDs’ Performance Management Division or the CMO’s office using routine links. Major public health alerts are likely to be notified to the CMO’s Office via Health Protection Scotland (HPS), the Health Protection Agency (HPA), NHS Boards, or NHS 24. (ANNEX ‘A’) Definition of Scale of Emergency 3. The following paragraphs provide standard definitions of scale applied to health emergencies within NHS Scotland. Emergencies may be spontaneous in nature e.g. train, air or road accidents, or ‘rising tide’ such as pandemic influenza or major outbreaks of communicable disease where the effects are not immediately apparent. Routine Emergencies 4. The NHS is accustomed to normal fluctuations in daily demand for services. A routine emergency is defined as one which can be met within the normal capacity and procedures of those faced with it. It is one which places no abnormal demand upon health care services. Major Emergencies 5. A major emergency is defined as a situation, either arising or threatened, which requires the special mobilisation and/or redeployment of staff or other resources with consequent interruption to routine activities. 6. Major emergencies are much larger scale events affecting potentially hundreds rather than tens of people, possibly also involving the closure or evacuation of a major hospital or persistent disruption over many days. These events will require a collective response by a number of NHS organisations and may require joint working between two or more NHS Boards, and/or other UK Health Directorates. Major Incidents 7. This is a widely accepted term used by the emergency services to describe any emergency that requires (and triggers) the implementation of special arrangements by one or more of the emergency services, the NHS or the local authority.

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8. Major incidents are events of potentially catastrophic proportions that severely disrupt health and social care and other functions (power, water etc) and that exceed even collective capability within the NHS. These events may require the implementation of emergency powers and mobilisation of health countermeasures. Health Impacts 9. The health impacts of routine emergencies are generally localised and can be absorbed by the NHS. Major emergencies and incidents have wider consequences that might impact upon healthcare in three main ways:

• overwhelm health service capacity • threaten the continuity of service provision • threaten the wider health of the community – either immediately

or at some subsequent stage.

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SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

SECTION 6 MANAGEMENT AND CO-ORDINATION OF THE HEALTH RESPONSE Health co-ordination at the scene 1. When a Major Incident is declared by the emergency services, the Scottish Ambulance Service and local NHS Board will ensure that the NHS response at the scene is co-ordinated, that adequate resources are deployed, and that communication channels are established. Strategic coordination of the local multi-agency response 2. The Police will establish arrangements to co-ordinate the multi-agency strategic, tactical and operational response within their force boundary, and if necessary between Police force areas. 3. At strategic level health services will be represented by the Scottish Ambulance Service and an Executive Officer from a NHS Board. Health services will be represented at tactical and operational levels by the Scottish Ambulance Service and a Medical Incident Officer appointed by the local NHS Board. 4. For incidents where there is significant continuing threat to public health such as the release of toxic agents, NHS Boards will be represented on the Strategic Coordinating Group by a Director of Public Health or Consultant in Public Health Medicine. 5. If the threat to public health results from the deliberate release of a hazardous substance the Police may request the NHS Board to establish a Scientific and Technical Advice Cell (STAC) at the Police strategic command centre, to advise on the health consequences relating to management of the incident. 6. In situations where the management of an incident is being coordinated by the police, but it is decided not to implement the SCG or the STAC option, there might still be a need for a defined group to provide health advice to the strategic police command level. In such circumstances, flexibility will be required to create a grouping best suited to the needs of the particular event. 7. Some emergencies such as animal disease outbreaks, flooding or supply of essential services might not trigger emergency services major emergency/ incident arrangements. In these circumstances strategic multi-agency co-ordination arrangements will be determined locally, with local authorities possibly assuming responsibility for coordination in place of the Police.

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Local/regional health coordination 8. Coordination between health organisations at local/regional level will be through establishment of a NHS Board emergency control centre staffed by senior NHS personnel from the NHS Board principally involved. All health organisations involved in the response will be directly represented within the health emergency control centre or will maintain regular communications links. 9. A key responsibility of the health emergency control centre will be to ensure information is passed effectively between the local health response organisations and their representatives at the Police Strategic Command Centre, and the SEHDs. 10. For any emergency where the immediate impact is likely to be mainly on public health, rather than the day to day operation of the NHS, responsibility for overall public health management and co-ordination will rest with the NHS Board(s) concerned. National/UK health co-ordination 11. Strategic coordination arrangements for major emergencies that necessitate the involvement of the Scottish Executive include provisions for the establishment of an Emergency Action Team (EAT) and an Emergency Support Team (EST). The SEHDs representative on the EAT will be a senior manager who has been trained and exercised in EAT procedures 12. SEHDs staff will liaise with the EST and will establish initial contact with NHS Board’s emergency control team, health representatives at the SCG, or individual services as appropriate. SEHDs staff might also link to the Department of Health in London and other UK health agencies, Health Protection Scotland, and other organisations as necessary, to support national and UK co-ordination of the health response (ANNEX ‘C’).

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SECTION 7 ROLES AND RESPONSIBILITIES Scottish Executive 1. The objectives of the SE’s corporate response arrangements are to ensure that: a) local responders receive adequate support in managing the response to

the emergency and its consequences; b) Ministers receive briefing on the situation as it develops and advice on

lines to take; c) any action required of the SE is clear, co-ordinated and timely; d) Ministers’ decisions are disseminated and implemented quickly; e) The SE and Whitehall Departments work together to achieve the best

possible resolution of the crisis. Overview of Arrangements 2. In the event of an emergency, central co-ordination will be achieved through co-working by the following groups: a) The Scottish Cabinet – the ultimate authority for policy. b) The Cabinet Sub-Committee on Civil Contingencies (CSCCC) – a small

group of Ministers, tasked by Cabinet to give political direction to Scotland’s response to an emergency on a day to day basis.

c) The Scottish Emergencies Co-ordinating Committee (SECC) – a group of top level managers from the Scottish Executive and members drawn from local responders who will develop the strategy for Scotland’s response within the political parameters set by Ministers.

d) The Emergency Action Team (EAT) - a team of senior civil servants (usually Heads of Division) from affected SE Directorates that will take the lead in making sure the SE delivers on the strategic agenda set by Ministers and top management.

e) The Emergency Support Team (EST) – which will gather process and share information about the emergency so as to facilitate an informed response by central government.

3. These groups form the SE’s corporate response, coordinating the work of SE Directorates and where necessary external organisations. Individual Directorates and organisations will of course have some discretion in deciding how best to respond to a crisis. 4. During an emergency, there is a clear expectation that each Directorate will work according to the overall corporate priorities.

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5. The Civil Contingencies Division will: - a) Establish the EAT and the EST b) Through the EST act as focal point for communications between SE

Directorates, between the SE and UK Government (Civil Contingencies Secretariat) and between the SE and the local SCGs;

c) Through the EST produce situation reports for the Cabinet Sub-Committee on Civil Contingencies (CSCCC) and SEEC if established.

d) Coordinate support from and request for assistance to other SE Directorates and other agencies

Generic Structure for Responding to Emergencies in Scotland 6. A diagram showing the generic structure for responding to major emergencies in Scotland is shown at ANNEX ‘C’. Scottish Executive Emergency Action Team (EAT) 7. The Emergency Action Team will:- a) analyse information received through the EST and provide advice to the

CSCCC and the SECC on options for handling the consequences of the emergency;

b) oversee implementation of decisions taken by Ministers and SECC; c) ensure co-ordination of SE activity. d) ensure that the activities of each SE Directorate are coordinated to support

priorities of the SE as a whole, and that each Directorate mobilises the necessary resources as required.

8. Each EAT member will activate the resources of those directorates within their Director-General’s overall area of line management at the start of an emergency and ensure that:- a) their Directorate is briefed as the emergency evolves; b) their Directorate provides briefing to support the SECC and the CSCCC; c) their Directorate’s interests are considered by the EAT, SECC and

Ministers when cross cutting policy decisions are to be made; d) their Directorate implements Ministerial instructions on responding to the

emergency; e) any information being given out externally by their Directorate is consistent

with corporate information; and f) their Directorate engages as necessary with Whitehall and external

partners.

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SEHDs Major Emergency Response Arrangements v6 – July 07 Internet Version Harry Scott National Emergencies Planning Officer

Scottish Executive Emergency Support Team (EST) 9. The Emergency Support Team’s function is to gather process and share information about the emergency so as to facilitate an informed response by central government. 10. The objectives of the Emergency Support Team are to: a) analyse and collate information into situation reports (sitreps); b) forward sitreps to Scottish Ministers (Cabinet Sub-Committee on Civil

Contingencies), Scottish Executive Coordinating Committee and the Emergency Action Team to support informed decision making by senior officials and Ministers;

c) share the sitreps with appropriate SE and Whitehall Departments; d) in consultation with the EAT, disseminate information and decisions from

senior officials and Ministers; and e) make sure that responders are kept informed of the national picture and

central government’s strategic direction. f) Support SEER operations in line with the SE priorities as defined for the

EST by the Chair of the EAT. 11. Scottish Executive Health Directorates a) Provide management, and co-ordination of the health response to major

incidents and national emergencies b) Supply SEHDs staff for the EAT, and Scottish Health Emergency

Response Team (SHERT) c) Liaison Officers for the Scottish Executive Emergency Room (SEER) or

other organisations or agencies as appropriate to the circumstances. (ANNEX ‘B’) Health Directorates Board 12. If the incident causes major disruption to the provision of service by the NHS in Scotland, the Director-General Health and Chief Executive NHS Scotland may convene a meeting of the Health Directorates Board made up of SEHDs’ Directors or their representatives. Its main functions will be to:- a) oversee strategic coordination of the health service response in Scotland b) liaise with the Department of Health in London c) liaise closely with SEHDs EAT representative and the affected NHS

Boards, normally by contact with the Boards’ Senior Emergency Management Team. (See ANNEX ‘E’ for model agenda)

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Scottish Health Emergency Response Team (SHERT) 13. The role of SHERT as a health coordinating mechanism is intended to be fully integrated into the Health Directorates’ contribution to the SE emergency response machinery i.e. the support given to the Cabinet Sub-Committee on Civil Contingencies by the Scottish Emergencies Coordinating Committee, Scottish Executive Emergency Action Team and Scottish Executive Emergency Support Team in any emergency. SHERT will establish a coordinating centre for those arrangements. 14. SHERT co-ordinates the SEHDs’ input into the SE's overall emergency response. All SEHDs officers providing an emergency response are members of SHERT, including the SEHDs’ members of the Emergency Action Team. 15. SHERT will also provide liaison officers to advise the SE’s corporate response arrangements via a SEHDs Liaison Officer based in the SEER, and/or through contact with the Emergency Support Team. Depending upon the circumstances it may not be necessary for a health liaison officer to maintain a permanent presence in SEER, but report and operate from there as and when appropriate. 16. SHERT provides additional support to the SEHDs by acting as the “health emergency room”. This will allow efficient co-ordination of the SEHDs’ response, providing more detailed health information to the Cabinet Secretary for Health & Wellbeing and/or the Minister for Public Health, the Director-General Health, and SEHDs’ senior management and a mechanism to action requests flowing from the Emergency Action Team. 17. SHERT will work in conjunction with the Emergency Action Team and Emergency Support Team. Collection of information via sit reps for circulation to the wider Scottish Executive, Strategic Coordinating Groups, and other Government and non-Government agencies will done via the EST. 18. The SEHDs’ Liaison Officer in the SEER will be the main conduit for gathering and disseminating health specific information to and from NHS Boards in Scotland and other health agencies. Whilst this does not debar SEHDs from communicating directly with NHS Boards and agencies it is vital for the SEHDs Liaison Officer in SEER is copied into and apprised of those communications so that central coordination of all health communications is maintained. Chief Medical Officer (CMO) 19. Within the Office of the Chief Medical Officer, the two professional groups for Public Health and NHS Issues operate weekly on-call rotas and each provide a 24 hour contact point. All NHS Boards are aware of the relevant contact numbers.

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20. As a back-up, the security control room staff at Victoria Quay who operate the SE’s general out-of-hours contact system have a confidential list of contact details for these professional staff members. 21. The CMO will be responsible for: a) coordinating the SEHDs’ response to public health emergencies; b) providing professional and medical advice to the Cabinet Secretary for

Health & Wellbeing, the Minister for Public Health, the First Minister and other members of the Scottish Cabinet;

c) providing advice to the Scottish Executive and the NHS on issues relating to Medical, Scientific, and Environmental Health matters;

d) liaising with other UK CMOs, other health departments, and other external agencies, as required

22. Where necessary, a Professional Issues Group will be established and chaired by the CMO or someone on his behalf to consider, analyse and advise on the possible medical, scientific and environmental consequences. 23. Membership will be invited from within and outwith SEHDs and other agencies and departments as appropriate. 24. Advice from this group will normally be input via the SEHDs’ representative on the EAT, but will also be available to all other SE groups involved in the emergency response. 25. Scottish Ambulance Service: a) Deploying appropriate healthcare resources to care for casualties at the

scene b) Mobilising local resources flexibly and to the maximum extent consistent

with maintaining essential care c) Ensuring arrangements are in place to access the national stock of health

countermeasures for CBRN incidents (Ambulance Service)

26. NHS Boards: a) Ensuring health representation at multi-agency strategic and tactical level

meetings b) Ensuring co-ordination/support arrangements are in place between all

health services involved in emergency response within the NHS Board/ Strategic Coordinating Group area //

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c) Ensuring that the NHS within its area has clear command and control

structures and facilities d) Ensuring that direct healthcare resources can be mobilised quickly to

support local hospitals or to sustain patients in the community should hospital services be reduced or compromised for a period

e) Having agreed systems in place to enable them to work with other NHS Boards as the ‘lead’ NHS Board, or to act in support of a nominated ‘lead’ Local Health Board

f) With support from SEHDs/ HPS, taking steps to monitor and safeguard the health of the local population for the duration of an incident

g) Having systems in place rapidly to disseminate health advice to the public if required

h) Liaising with and providing situation reports to the Emergency Support, and Emergency Action Teams, or SEHDs’ Performance Management Division

Health Protection Scotland 27. HPS has a remit to co-ordinate health protection activity in Scotland especially that carried out by NHS Boards. The functions of HPS fall into the following broad areas: a) Providing specialist health advice to the SEHDs and NHS Boards. b) Participating in HPA-led UK arrangements to ensure as far as possible a

consistent UK-wide public health response c) Coordinating the public health response by NHS Boards in Scotland at a

tactical level and monitoring of the level and impact of the measures they put in place.

d) Providing scientific operational and logistical support to NHS Boards and

SCGs (in particular advice and support to the JHAC) on public health management and the health protection response.

e) Communicating surveillance information through professional

communications, official press statements, regular updates in the HPS Weekly Report and HPS website, and responding to press enquiries in collaboration with SEHDs and the HPA.

f) In addition HPS and Scottish NHS Laboratories will provide Scottish data

to the HPA for the overall UK figures, and will provide or make a contribution to regular sitreps for SEHDs, SECC, and CSCCC as appropriate.

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Reporting to the Scottish Executive Emergency Room (SEER) 28. The Civil Contingencies Division will establish this facility at a location appropriate to the circumstances prevailing at the time. The SEHDs’ on-call Officer will be informed of its location by Civil Contingencies Division personnel at the time of contact. This location should be passed on to other responding SEHDs personnel. Staffing Scottish Health Emergency Response Team (SHERT) 29. Initial staffing for the SHERT will be drawn from the list of on call and other SEHDs staff from a list maintained by the SEHDs’ Emergency Planning Team. The following list of core staff will be required with others being co-opted as required and depending upon the nature of the emergency: - a) SEHDs’ Emergency Action Team representative: (ACTION CARD 2) b) Team Leader: (experience in supporting Ministers is essential, and

preferably also with policy or performance management experience) Functions are to manage the SHERT, ensure EAT requests placed on SEHDs are actioned, and liaise with the Directorate (ACTION CARD 3)

c) EAT Support Officer: to provide appropriate support the SEHDs’ member on the EAT (ACTION CARD 4)

d) Liaison Officers: to other Directorates/agencies as required (ACTION CARD 5)

e) SEER Liaison Officer(s): (ACTION CARD 6) f) Team members: to cover ministerial and media briefing requests

(ACTION CARD 7) g) Team members: to provide administrative support (ACTION CARD 8) h) CMO’s Directorate: (ACTION CARD 9) i) Heath Protection Scotland staff or other if required j) Communications Health & Wellbeing: (marketing and/or press) 30. The National Emergencies Planning Officer (NEPO) or a Deputy (DNEPO) will contact key advisory and support staff and co-ordinate the SEHDs’ membership of the SHERT. 31. In the absence of these officers the most senior SEHDs officer available at the time must arrange for the SHERT to be appropriately staffed and ensure co-ordination of the health team.

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Chief Medical Officer (CMO) Representation - SEHDs Senior Management Team, EAT or SHERT 32. The nature of the emergency will determine the requirement for specialist representation from the Office of the Chief Medical Officer within the Health Directorates Board, EAT or SHERT. The Chief Medical Officer will be responsible for provision of any necessary specialist input. The Chief Medical Officer will also convene the Professional Issues Group and will invite the appropriate membership.

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SECTION 8 BACK UP ARRANGEMENTS FOR SEHDs’ ON-CALL OFFICER 1. There may be occasions when for some reason the SEHDs’ On-Call Officer cannot be reached. To cater for this eventuality a second member of staff also carries an emergency pager which is alerted using the same number as the one carried by the On-Call Officer. This staff member also has access to the SEHDs’ call out arrangements. 2. As an additional safeguard the Scottish Executive Security Staff at Victoria Quay keep a confidential list contact details of SEHDs personnel who may be called out in the event of a major emergency occurring and for some reason the SEHDs’ On-Call and back up member of staff cannot be reached.

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SECTION 9 – PHYSICAL SECURITY/ SECURITY OF INFORMATION 1. In an emergency situation, all staff reporting to the Scottish Executive Emergency Room (SEER) must make themselves familiar with physical security arrangements. It is the responsibility of all staff to assist the Receptionist in SEER in ensuring only properly authorised individuals gain access to the Emergency Room. 2. All staff must be fully aware of Scottish Executive policy on the protective marking of documents. They must also understand the correct procedures for the sharing of protectively marked information electronically and in hard copy. Staff must also make themselves familiar with the arrangements for storing protectively marked material.

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ACTION CARD 1

SEHDs ON CALL OFFICER OR HEALTH DIRECTORATE OFFICIAL RECEIVING INITIAL ALERT

The officer receiving an initial alert call must ensure the following steps are taken: 1. Establish information about the incident including:

a) What time were you informed? b) Who informed you? c) What has happened? d) Where did it happen? e) When did it happen? f) Which NHS Board(s) is involved? g) What action has been taken? h) Who is the contact in the NHS Board?

2. Start and maintain an incident log of actions and decisions (ANNEX ‘F’) 3. Contact and consult as appropriate (see SEHDs Emergency Contact List):

a) National Emergencies Planning Officer or Deputy, if available b) Any available SEHDs Emergency Action Team member c) Any available SHERT member d) Where a major incident/emergency has been declared inform

Director-General Health personally or via PA

4. Report to the SEER (location will be advised by the Civil Contingencies Division)

5. Respond to any requests from NHS Boards for immediate assistance or

advice, passing on such requests, where appropriate. 6. Consider the need to:

a) Alert Directors/Deputy Directors (SEHDs and CMO) and seek support;

b) If not already alerted notify the Civil Contingencies Division of potential implications for other Directorates;

c) Establish who is acting as SE lead Directorate for the emergency; d) Activate arrangements for establishment of a SEHDs Liaison Officer

in the SEER or with another agency if required. e) Undertake any other actions appropriate to the situation

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7. Assume SEHDs Liaison Officer duties upon arrival at the SEER (ACTION CARD 6)

(continued)

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ACTION CARD 1 (cont.)

Guidance for SEHDs’ on–call Officer or Senior SEHDs Official receiving initial alert

Notification of emergency situation received from NHS Board/Ambulance/ Civil Contingencies Division/ CMO’s Office, HPS, or SE Security Staff at VQ

Contact member of SEHDs Emergency Action Team, and National Emergencies Planning Officer or Deputy (if available)

Assess and discuss the situation

Further action required or significant threat to

service delivery

No further action required

1. Maintain contact with NHS Board and continue to monitor situation. 2. Inform Performance Manager for NHS Board concerned

No further action required

Stand down. Prepare report for Ministers/ Health Directorate Board as appropriate.

Convene meeting of SHERT at St Andrew’s House

First SEHDs official or member of CMO’s Directorate to arrive

contacts NHS Board concerned and supplies contact name, email and

telephone number

Begin a written log of events

Contact Civil Contingencies Division and ask if SEER is to be

activated

SEER not activated

Ensure SEER Liaison Officer is appointed

SEER activated

At conclusion of incident stand down staff as appropriate Prepare report for Ministers/ Health Directorate Board as appropriate.

Inform other NHS Boards’ out of hours contacts (only if required)

and brief them

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ACTION CARD 2

SEHDs - EMERGENCY ACTION TEAM MEMBER

The SEHDs EAT representative (Senior Civil Service grade) will be supported in this role by a SEHDs member of SHERT

The SEHDs member of the EAT must ensure the following steps are taken: 1. Report to the SEER (location will be advised Civil Contingencies Division or

staff cascading alert) 2. Ensure the SEHDs Liaison Officer in the SEER has adequate support 3. Ensure the SEHDs Liaison Officer in the SEER has established contact with

NHS Board(s) concerned and other SE Directorates as appropriate 4. Identify and assess the implications of the incident for health services in

Scotland 5. Promote and encourage mutual aid between NHS Boards if required 6. Ensure Cabinet Secretary for Health & Wellbeing and/or Minister for Public

Health, Director-General Health, and Senior SEHDs officials receive regular briefings

7. Provide advice to Ministers and Senior Officials on the health response 8. Facilitate provision of information and advice to NHS Scotland 9. Prioritise responses to internal/external requests 10. Represent SEHDs at EAT meetings chaired by the Civil Contingencies

Division 11. Prepare and approve press briefings in consultation with Communications

Directorate 12. Ensure that a log of key actions and decisions is maintained (ANNEX ‘F’)

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ACTION CARD 3

TEAM LEADER 1. Overall direct management of SHERT 2. Ensure the SEHDs’ SEER liaison officer is adequately supported 3. Confirm SEHDs’ SEER Liaison Officer has established contact with NHS

Board(s) concerned and other SE Directorates as appropriate 4. Ensure SEHDs’ Liaison Officers are sent as appropriate to other

departments and agencies 5. Where a major incident/ emergency has been declared inform the Director-

General Health personally or via PA 6. Ensure daily briefings are coordinated for the Cabinet Secretary for Health

& Wellbeing and/or Minister for Public Health covering:

a) Progress of the emergency (more detailed information than that provided to Cabinet Sub-Committee on Civil Contingencies)

b) Reports on Health Protection Scotland led activity c) NHS Boards response d) Action to be taken e) Communications issues

7. Facilitate provision of information and advice to NHS Scotland 8. Prioritise responses to internal/external requests 9. Update colleagues in SEHDs as required, on behalf of senior management 10. Where it is involved, liaise with Health Protection Scotland regarding control of the incident and communication with Boards. 11. Supervise and assist SEHDs’ SEER Liaison Officer with liaison with NHS Boards as required. 12. Action requests by senior management to communicate SE decisions to NHS Boards and others.

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ACTION CARD 4

SEHDs EAT SUPPORT OFFICER 1. Assist and support the SEHDs EAT member in the carrying out all of their

duties 2. Act as liaison between SEHDs EAT member and SEHDs SEER Liaison

Officer 3. Note EAT policy decisions and actions placed by EAT on SEHDs

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ACTION CARD 5

SEHDs LIAISON OFFICERS (TO OTHER DIRECTORATES OR AGENCIES AS REQUIRED) 1. Represent the interests of SEHDs 2. Maintain regular contact with SHERT Team Leader 3. Develop situation reports for inclusion in situation reports to Ministers, and

for distribution within SEHDs and to NHS Scotland 4. Screen out information that is not required by SEHDs 5. Provide initial focal point for SEHDs 6. Maintain an up to date summary of the situation 7. Establish/maintain a database of essential contacts 8. Maintain a log of incoming and outgoing messages, and key actions 9. Establish and maintain a filing system for all incoming/outgoing information

actions, including e-mail

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ACTION CARD 6

SEHDS SEER LIAISON OFFICER Summary 1. The function of staff in the Scottish Executive Emergency Room is to ensure the smooth flow of information between responders, the SE’s central response organisation, SE Directorates and Ministers and the UK Government. As SEHDs Liaison Officer, you are responsible for gathering information from the NHS and SEHDs. 2. Objectives

a) Ensure that information concerning the interests of SEHDs is integrated with the corporate SE response to the emergency.

b) Ensure that the actions of SEHDs and the NHS Boards/agencies/Directorates with which it works are informed by the decisions taken by Ministers, SECC and other SE Directorates.

Specific Tasks 3. On arrival at SEER agree with Civil Contingencies Division EST leader:

a) Which information flows you will be responsible for (normally all detailed health aspects from NHS Boards and related organisations.

b) How they will be integrated with EST processes (e.g. timelines for providing health information input to sitreps).

4. This will require you to be clear about both the needs of the EST and the interests of SEHDs. In particular the SEHDs’ EAT representative will need to be involved in these discussions. 5. Once this has been agreed communicate this to relevant organisations through Directorate colleagues, as necessary. Primary functions then will be to: a) Develop situation reports from NHS for inclusion in Civil Contingencies

Division situation reports to Ministers, and for distribution within SEHDs and to NHS Scotland

b) Screen out information that is not required by the SE (where possible you

should reduce the burden on responders by making sure they are clear about what information is needed).

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c) Record useful information in agreed format that will enable it to be collated

into the EST’s information system. d) Keep NHS Boards and other NHS organisations informed of strategic

SEHDs’ policy/decisions e) Maintain regular contact with your Directorate’s EAT rep and co-ordinate

activity between the two of you. 6. Be mindful that on occasion verbal feedback will be required for SEHDs

contacts.

7. The SEHDs’ Liaison Officer must ensure the additional steps are taken: b) Provide initial focal point for NHS Boards – pass e-mail, telephone and fax

details to NHS Board(s) concerned. c) Ensure situation reports are received from all responding health services

See (ANNEX ‘D’) d) Maintain an up to date summary of the situation e) Establish/maintain a database of essential contacts f) Maintain a log of incoming and outgoing messages, and key actions

(ANNEX ‘F’) g) Establish and maintain a filing system for all incoming/outgoing information

actions, including e-mail

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ACTION CARD 7 TEAM MEMBERS TO COVER MINISTERIAL AND MEDIA BRIEFING REQUESTS 1. Draft ad hoc briefing in consultation with Team Leader

2. Circulate requests for briefing material and pull together

3. Maintain lines to take in liaison with communications representative

4. Co-ordination of daily briefings for Cabinet Secretary and/or Minister for Public

Health

5. Liaison with communications representative and press desks

6. Assist team leader in actioning requests from SEER

7. Management and delegation to admin staff

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ACTION CARD 8

ADMINISTRATION SUPPORT

1. Work under direction of SHERT Team Leader 2. Ensure sufficient stationary equipment is available for SHERT 3. Arrange for meals/ refreshments at direction of SHERT Team Leader 4. Assist in the preparation of Ministerial and other briefings as required 5. Maintain filing system of messages and actions received and initiated by SHERT

members

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ACTION CARD 9

CMO’s PROFESSIONAL STAFF

1. Report to the SEER (location will be advised by Civil Contingencies Division/

SEHDs’ on call officer or other staff cascading alert) 2. Coordinate provision of advice to the SE generally and to the CSCCC and SECC,

and EAT on:

a) the medical, scientific and environmental health implication of the emergency b) the potential impact on health and health services c) the health implications of proposed response strategies

3. Act as a SEHDs point of contact for NHS staff on health, medical, scientific and

environmental health matters, as appropriate 4. In cooperation with HPS respond to national enquiries on health, medical, scientific

and environmental matters, as appropriate 5. Liaise with internal and external health experts as appropriate 6. Formulate and disseminate guidance on the health aspects of the response, as

appropriate 7. Ensure that a log of key actions and decisions is maintained (ANNEX ‘F’) 8. Provide professional advice to the SE Senior Officials, SECC, EAT or EST as

required 9. Devise a staff rota to ensure that appropriate professional staff are continually available throughout the emergency and operate within a single system of working

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ANNEX ‘A’ EMERGENCY ALERTS

The alert to an emergency affecting NHS Scotland and/or the SEHDs could be received by the following:

Type Reported by Could be reported to: Initial actions by official receiving

report Notes

Routine emergency e.g. NHS service hampered by poor weather/ incident involving multiple casualties/ outbreak of communicable disease, but NHS Board is coping.

1. NHS Board 2. Scottish Ambulance Service 3. DPH 4. HPS 5. NHS 24 6. Media

Office hours: 1. Performance

Management Division

2. CMO’s Office 3. Health Emergency

Planning Team Outwith office hours: 1. On call SEHDs staff 2. Performance

Management Division

3. CMO’s Office

1. Maintain contact with NHS Board 2. Monitor situation 3. Support and advise where necessary 4. Contact and advise Perf Man/

CMO’s Office/ Emergency Planning Team as appropriate

5. Inform/ confirm that Comms. Health & Wellbeing has been informed

6. Brief Minister if required

Although some incidents may have small beginnings they may escalate into major emergencies/ incidents. SEHDS staff must monitor and be alert to any worsening of the situation.

Major emergency e.g. NHS service badly affected by prolonged severe weather/ incident involving large numbers of casualties. Emergency services may have declared a ‘major incident’/ major outbreak of communicable disease which, prompts NHS Board to request mutual aid from neighbouring NHS Board(s).

1. Scottish Ambulance Service 2. NHS Board Emergency Planning

Officer 3. NHS Board 4. Justice Directorate 5. DPH 6. HPS 7. NHS 24 8. Media

Office Hours: 1. Health Emergency

Planning Team 2. Performance

Management Division

3. CMO’s office Outwith office hours: 1. On call SEHDS staff 2. Performance

Management Division

3. CMO’s office

1. Maintain contact with NHS Board 2. Monitor situation 3. Support and advise where

necessary 4. Contact Civil Contingencies Division

to ascertain if SEER will be activated 5. If SEER not activated contact senior

SEHDs officer and discuss need for preliminary health meeting at SAH

6. If SEER activated contact staff (on duty or off) for SHERT and EAT

7. Inform/ confirm that Comms. Health & Wellbeing has been informed

8. Contact and advise Perf Man/ CMO’s office/ Emergency Planning Team as appropriate

9. Prepare briefing for Minister

Incidents in this class may escalate as explained above, or they may be scaled down as the NHS and the emergency services get on top of the situation and begin to manage the incident.

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ANNEX ‘a’ (continued)

EMERGENCY ALERTS

The alert to an emergency affecting NHS Scotland and/or the SEHDs could be received by the following:

Type Reported by Could be reported to: Initial actions by official receiving report

Notes

Major incident e.g. NHS service under severe pressure or overwhelmed by incident involving large numbers of casualties. Emergency services have declared a ‘major incident’/ widespread outbreak of communicable disease affecting one or more NHS Boards.

1. Scottish Ambulance Service 2. Justice Directorate 3. NHS Board Emergency Planning

Officer 4. NHS Board 5. DPH 6. HPS 7. NHS 24 8. Media

Office Hours: 1. Health Emergency

Planning Team 2. Performance

Management Division

3. CMO’s office Outwith office hours: 1. On call SEHDs staff 2. Performance

Management Division

3. CMO’s office

1. Maintain contact with NHS Board 2. Monitor situation 3. Support and advise where necessary 4. Contact Civil Contingencies Division

to ascertain where SEER will be activated

5. Contact senior SEHDs staff (on duty or off) for EST and EAT

6. Inform/ confirm that Comms. Health & Wellbeing has been informed

7. Contact and advise Perf Man/ CMO’s office/ Emergency Planning Team as appropriate

8. Prepare briefing for Minister

Incidents in this class are likely to be prolonged and severe in their affect on the community. It is likely to be some time before the NHS and emergency services begin to cope and get on top of the situation.

The above are only illustrative of what might happen, and are listed only as examples. Major emergencies/ incidents can occur at the most unexpected times, and from the most unlikely of circumstances. A fair degree of adaptability is required from those who assess and respond to incidents so they are prepared for any event which might unfold

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ANNEX ‘B’

SCOTTISH EXECUTIVE HEALTH DIRECTORATE EMERGENCY RESPONSE GROUPS

Committee or Team SEHDS Representative

Scottish Emergency Co-ordinating Committee (Chaired by Director General Justice & Communities ) Top level managers from the Scottish Executive and non-executive members drawn from local responders who will develop the strategy for Scotland’s response within the political parameters set by Ministers.

Director - Public Health & Wellbeing Directorate (or other nominated Director) National Emergencies Planning Officer for NHS Scotland (or Deputy)

Emergency Action Team (Chaired by Deputy Director, Civil Contingencies Division) Team of senior civil servants from affected SE Directorates that will take the lead in making sure the Executive delivers on the strategic agenda set by Ministers and top management.

Primary: Deputy Director - Public Health & Substance Misuse Division Deputies: 1. Deputy Director - Patients & Quality & Support 2. Associate Director for Workforce 3. Deputy Director - Healthcare Planning

Emergency Support Team (Chaired by Head of Civil Contingencies Unit) Gather process and share information about the emergency so as to facilitate an informed response by central government.

SEHDs SEER Liaison Officer

Health Directorates Board (Chaired by Director-General Health & Chief Executive NHS Scotland, or nominated Deputy) Senior SEHDs staff that monitor day to day running of NHS (not the emergency response) during major emergency. Provide advice and guidance to Cabinet Secretary for Health & Wellbeing and/or Minister for Public Health

SEHDs Directors or their nominated deputies

Scottish Health Emergency Response Team (SHERT) SEHDs personnel charged with co-ordinating the SEHDs’ input into the SE's overall emergency response and providing additional support to the Directorate by acting as the “health emergency room”.

1. SEHDs EAT representative 2. Team Leader 3. EAT Support Officer 4. Liaison Officers -other Directorates/agencies as

required) 5. SEER Liaison Officer(s) 6. 1-2 Team members to cover ministerial and media

briefing requests 7. 1-2 team members to provide administrative support 8. Comms expert (marketing and/or press) 9. Medical expert

Office of Chief Medical Officer Groups/committees convened by or on behalf of CMO according to nature of emergency e.g. pandemic influenza, smallpox or other major public health emergency

Membership decided by Office of CMO

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ANNEX ‘C’

SE generic primary response structure for national emergencies

UK Cabinet

Civil Contingencies Committee

(Lead UK Ministerial Committee – a Scottish

Minister attends but is not member)

Emergency Action Team (EAT) (senior SE officials co-ordinate media communications and the

delivery of the strategic response across SE Directorates and

Strategic Co-ordinating Group)

Emergency Support Team (EST)

(gathers, collates and shares information to advise the EAT

and instruct the SCGs)

Civil Contingencies Committee (Official) (lead UK official level

committee)

Civil Contingencies Secretariat

(co-ordinates action across the UK government)

Press Office

Sitreps etc

Scottish Police Information and Co-ordination Centre

(S-PICC) (collates info from individual forces into a national picture)

Scottish Executive Directorates

Liaison mainly with police forces

Normal or enhanced governance arrangements.

Strategic Co-ordinating Groups (SCGs)

(collate information and co-ordinate regional response)

Scottish Emergencies Co-ordinating Committee (SECC) (top management from SE and affected responders advise the

CSCCC on strategy development and advise the EAT on strategy delivery. May or may not be convened depending upon nature and

scale of emergency)

Responder Organisations (including the emergency services, NHS Boards, HPS, and SEPA etc.)

Scottish Ministers brief UK colleagues on Scottish situation

UK decisions passed to Scottish Ministers for

consideration

Scottish Cabinet

Cabinet Sub-Committee on Civil Contingencies (CSCCC)

(sub-committee of Cabinet, responsible to Cabinet for strategic direction of the emergency response)

Reporting & direction Advice & guidance

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ANNEX ‘C’ (Continued)

SEHDs primary response structure

Reporting & direction

Advice & guidance

Emergency Action Team (EAT) (senior SE officials co-ordinate media

communications and the delivery of the strategic response across SE Directorates and Strategic

Co-ordinating Group)

Emergency Support Team (EST) (gathers, collates and shares information to advise

the EAT and instruct the SCGs, including NHS Boards)

Scottish Emergencies Co-ordinating Committee (SECC)

(top management from SE and affected responders advise the CSCCC on strategy

development and advise the EAT on strategy delivery. May or may not be convened depending

upon nature and scale of emergency)

Cabinet Sub-Committee on Civil Contingencies (CSCCC)

(sub-committee of Cabinet, responsible to Cabinet for strategic direction of the emergency response)

Health Directorates Board Senior SEHDs staff that monitor day to day running of NHS (not the emergency response) during major emergency. Provide advice and guidance to Minister for Health and Community Care

Scottish Health Emergency Response Team SEHDs personnel charged with co-ordinating the HDs’ input into the SE's overall emergency response and providing additional support to the Directorate by acting as the “health emergency room”.

Health Protection Scotland Health Protection Agency UK Directorate of Health

Other Directorates and agencies (as required)

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ANNEX D

NHS BOARD SITUATION REPORT

The nature of the emergency will dictate the information required from NHS Boards, however the following should be considered during the initial stages of any emergency: 1. NHS Pressures

• Number of Emergency Admissions • Nature of injuries • Decontamination issues (if any) • ITU bed occupancy • Bed states (availability might be limited) • Staffing shortages (availability might be limited) • Public Health issues affecting capability or capacity of NHS Board(s) • Ambulance Service Demand (999 & GP Urgent calls) • NHS 24 Call Volumes

2. Consequences of Pressures

• A&E waits >12 hours (availability might be limited) • Operations cancelled by hospital < 24 hours before admission (availability might be

limited) • Ambulances diverted from usual hospital (availability might be limited) • Hospitals closed to admissions • Additional resources required • Media Interest

3. Look Ahead

• Actions to be pursued locally to protect services • Actions to be pursued nationally to support local services • Any future developments expected

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ANNEX E

SCOTTISH EXECUTIVE HEALTH DIRECTORATE HEALTH DIRECTORATES BOARD

MODEL AGENDA

1. Initial meeting

• What has happened? • Where did it happen? • When did it happen? • Which NHS Board(s) is/are involved? • Who is the lead officer for the NHS Board concerned? • Has mutual aid been requested if required? • Additional resources required • Media Interest • Public Health issues • Actions being pursued locally to protect services • Actions to be pursued nationally to support local services • Developments expected between now and next meeting of this group

2. Summary of Actions and Policy Decisions

The following items may be discussed at the initial meeting of the group or at subsequent meetings as the information comes to hand

3. NHS Pressures

• NHS 24 Call Volumes • Ambulance Service Demand (999 & GP Urgent calls) • Number of Emergency Admissions • ITU bed occupancy

4. Consequences of Pressures

• A&E waits >12 hours (availability might be limited) • Operations cancelled by hospital < 24 hours before admission (availability might be

limited) • Hospitals closed to admissions

Note: This agenda should be viewed as an initial guide to start a meeting off. Items may be added or deleted from the agenda as the incident progresses.

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ANNEX ‘f’ LOG OF EVENTS

DATE_______________ LOG KEEPER(S)_______________________

SERIAL No

TIME TO FROM EVENT ACTION/REMARKS SIGNED

PAGE NO. _________OF __________ PAGES