National Ambulance Resilience Unit NARU. Service Specification for NHS Ambulance Services Hazardous Area Response Teams

Transcription

1 Service Specifiction for NHS Ambulnce Services Tems

2 This document supersedes the Drft Deprtment of Helth Guidnce for Ambulnce Tems: Mnging nd Sustining HART pbility in NHS Ambulnce Service Trusts Providing Ptient re Within the Inner ordon of Mjor Incidents nd Hzrdous Environments (April 2011). It should be referred to in conjunction with the NHS Stndrd ommissioning ontrct for Ambulnce Services. It detils the requirements in order to mintin current HART cpbility nd cpcity referred to in the NHS Operting Frmework Responsibility for ssuring delivery of DH Policy for Emergency Prepredness, Resilience nd Response in NHS Ambulnce Trusts in Englnd is delegted to West Midlnds Ambulnce Service NHS Trust, through Service Level Agreement (SLA), nd these services re provided by the Ntionl Ambulnce (). Within the terms of the SLA re the requirements for delivery of Hzrdous Are Response Tems in ech of the mbulnce trusts s prt of ntionl cpbility. ontents Section A Foreword 3 Section B Bckground/ Introduction 4 B.1. Roles nd responsibilities 5 Figures in this specifiction document re dpted from those kindly provided by GWAS HART. Section 8.1. Purpose 8.2. Aims nd objectives 8.3. Definition nd scope 8 1. Requirements 8 2. Loction of HART units 9 3. pbilities Types of Incidents Attended The HART Model Introduction Recruitment & Selection Model Unit Deployment Trining Stndrd Operting Procedures Vehicles nd Equipment HART Estte Mutul Aid Monitoring nd Evlution Outcomes Qulity Assurnce 24 This mteril should be red in conjunction with the NHS Emergency Plnning Guidnce. All mteril forming tht guidnce is web bsed nd prepred to be used primrily in tht formt. The web-bsed versions of the guidnce including underpinning mterils hve links to complementry mteril from other orgnistions nd to exmples of the prctice of nd pproch to emergency plnning in the NHS in Englnd. The web version of the guidnce is vilble t 2

3 Foreword hve been estblished to enble mbulnce services to sve lives in environments where previously, our stff hve been unble to sfely operte. The development nd implementtion of HART begn in 2005 nd hs been funded nd initilly mnged centrlly by the Deprtment of Helth (DH). This ws to ensure the concept ws set up to stndrd model cross ech of the mbulnce trusts involved. A key fctor is tht HART is ntionl cpbility nd there is therefore requirement for these tems to be ble to provide mutul id support to nywhere within the UK. The effectiveness of this relies upon sfe systems of working being pplied in consistent wy wherever they my be deployed. These rrngements re in plce in order to protect stff in ll of the responding gencies, s well s the public, nd will enble us to sve the lives of ptients tht might otherwise be lost. Since June 2011, responsibility for delivery of emergency prepredness policy in mbulnce services in Englnd hs been delegted to the Ntionl Ambulnce (), hosted by West Midlnds Ambulnce Trust (WMAS) through Service Level Agreement with DH. This includes completion of the roll-out of HART units nd the ongoing coordintion, monitoring nd ssurnce of the ntionl HART cpbility. Foreword A Throughout the development nd estblishment of these specilist ssets, ll spects of the concept nd the opertion of HART hve been monitored nd evluted. This lerning process is ongoing in order to build robust evidence bse for HART ctivity nd requirements in respect of new nd emerging threts nd risks to public helth. It is importnt tht this specifiction is dhered to, by Trusts nd ommissioning Bodies, so tht the ntionl HART cpbility remins resilient nd prepred cross the whole of Englnd. The purpose of this specifiction is to ensure tht this model is delivered consistently nd mintined ppropritely cross the country to provide ssurnce in the systems in plce nd ese for mutul id in the event of complex or mss csulty incidents. Keith Prior MSc MPr Director Ntionl Ambulnce Rtified on the 29th Mrch By the WMAS SLA Delivery Progrmme Bord. Dte for Review: 1st Jnury

4 Bckground The NHS needs the cpbility to respond to unconventionl incidents. The UK fces serious nd sustined thret from interntionl terrorism, the level nd source of which is continully monitored nd djusted s required by the Joint Terrorism Anlysis entre (JTA). The DH is supporting the PREPARE nd PROTET strnds of the Government s ounter-terrorism Strtegy (ONTEST 2) by providing helth policy input nd coordinting NHS emergency plnning to respond to terrorism. DH hs committed to implementing certin spects of this strtegy, including deliverbles round improving the response of the emergency services to incidents involving hemicl, Biologicl, Rdiologicl, Nucler nd Enhnced onventionl Wepons (BRNE) mterils. The HART cpbility plys leding role in this response nd s result, HART is specificlly referred to in ONTEST 2, nd the UK Strtegy for ountering the BRNE terrorism thret. In ddition, the olition Government published the Ntionl Security Strtegy in October HART provides clinicl response to priority risks identified t Tiers 1, 2 nd 3 within this strtegy. The HART cpbility lso forms mjor element of the helth response within the Home Office Ntionl pbilities Progrmme to increse UK resilience. In ddition incidents which HART re trined nd expected to respond to remin s High Impct on the binet Office Ntionl Risk Register. Such incidents might include industril ccidents with HAZMAT component such s the Buncefield explosion; nd nturl dissters or incidents tht require n Urbn Serch And Rescue (USAR) response, such s building or trench collpses, or Inlnd Wter Opertions (IWO) such s in nd round flooding, lkes or wterwys; or other incidents tht rise in res of difficult ccess, such s working t height, in confined spces or underground. The primry im of HART in ll such incidents is to be ble to rech ptients s quickly s possible (by being ble to sfely enter hzrdous environments) to perform immedite trige, provide life-sving tretment nd improve helth outcomes for ll csulties. Bckground/Introduction B There is continul effort in HART to improve nd increse levels of cpbility in responding to ll types of hzrdous incident, whether instigted delibertely s cts of terrorism, or ccidentlly or by course of nture, to ensure lives re sved nd helth outcomes for csulties re gretly improved. Throughout the development nd introduction of HART gret emphsis hs been plced on the importnce of building close working reltionships with collegues in the other emergency services nd specilist rescue gencies nd this includes regulr exercising nd trining together nd shring lessons lerned. It is essentil tht this continues nd ll policies nd procedures re regulrly tested in this wy. Throughout this underpinning document, the term emergency is used s within the spirit of the ivil ontingencies Act 2004, i.e. to describe n event or sitution tht thretens serious dmge to humn welfre in plce in the UK or to the environment of plce in the UK, or wr or terrorism, which thretens serious dmge to the security of the UK. To constitute n emergency this event or sitution must require the implementtion of specil rrngements by one or more tegory One responders. This specifiction is built on best prctice nd shred knowledge, while lso cknowledging tht in certin extreme circumstnces restrictions or limittions of norml stndrds of cre will be inevitble. It is intended to provide pltform for 4

5 ll NHS orgnistions to undertke mjor incident nd emergency plnning in respect to HART resources nd to provide informtion on ssocited ctivities tht my lso be required. In the context of this Specifiction, the terms NHS orgnistion nd NHS Trust includes NHS Foundtion Trusts. HART is referenced in the NHS Operting Frmework 2012/13 prgrph 2.45 stting tht Primry re Trusts (PTs) must ensure tht they mintin the current cpbility nd cpcity of the existing HARTs in Ambulnce Trusts. This service specifiction should be referred to by Ambulnce Trusts nd ommissioning bodies during the commissioning process to ensure this requirement is met. will undertke udits of mbulnce trusts using n ssurnce frmework bsed on this service specifiction. B.1. Roles nd Responsibilities In ddition to the generl roles nd responsibilities set out for the DH, the HPA nd for NHS orgnistions in the NHS Emergency Plnning Guidnce (2005), the following roles nd responsibilities re specific to the development nd deployment of HART tems : Deprtment of Helth to continue to liise cross Government deprtments to ensure the DH contributes ppropritely towrds ntionl objectives, for exmple, in reltion to the Ntionl Security Strtegy, Ntionl pbility Progrmme, ONTEST-2 (ounter-terrorism strtegy) nd the Home Office Model Response Progrmme (MR), in the provision of helthcre to ensure centrl functions in respect of ntionl trining, procurement, policy, procedures, reserch nd development nd qulity ssurnce re provided by the Ntionl Ambulnce to ensure the ntionl cpbility is mintined, vi service delivery contrct with the host mbulnce trust Bckground/Introduction B NHS Ambulnce Trusts, including Foundtion Trusts to dhere to the specifiction within this document to ensure HART cpbilities re mnged nd mintined in consistent mnner to prticipte within the HART governnce structure of working groups, contributing to the ongoing monitoring nd development of the cpbility to ensure sufficient funding is llocted to cover deprecition costs ssocited with HART ssets nd tht these re replced in line with ntionl specifictions within greed replcement schedules ommissioning Bodies re to ensure tht HART cpbility will be commissioned to this specifiction in ccordnce with the requirements within the NHS Stndrd ontrct for Ambulnce Services nd the NHS Operting Frmework where ny dditionl requirements re identified by the mbulnce trusts in support of this specifiction, these will be considered fter tking dvice in conjunction with the 5

6 Strtegic Helth Authorities SHAs re ccountble for ensuring tht effective rrngements re in plce for the provision nd mintennce of HART tems in line with this specifiction SHAs will seek ssurnce from in respect of complince of Trusts with this specifiction. NHS Acute Trusts including NHS Foundtion Trusts Acute trusts will need to liise closely with mbulnce trusts to ensure they mintin n pproprite level of wreness nd understnding of HART cpbilities such tht the cre pthwy for ptients between mbulnce trusts nd cute trusts opertes sfely nd semlessly. Relevnt deprtments nd personnel within cute trusts will need to prticipte in trining exercises nd emergency plnning in conjunction with HART dhering to the Emergency Prepredness Guidelines. Not For Profit, Non-Government Orgnistions, registered chrities nd the voluntry sector Locl Authorities nd other rescue orgnistions (sttutory nd nonsttutory) tht fll within this ctegory will need to mintin level of wreness nd understnding of HART cpbilities nd how they contribute to emergency plns which my include undertking joint exercising nd trining. Specilist rescue gencies will need to liise nd work closely with HART in the development of relevnt Stndrd Opertion Procedures, to ensure coordinted service delivery to ptients Bckground/Introduction B 6

7 Figure 1: Overview of the Ntionl Strtegic Mndte for HART Ntionl HART Service Specificiton Ntionl HART Stndrd Operting Procedures p.21 of the 2012/13 frmework emergency prepredness section mndtes PT commissioners to mintin the current cpbility nd cpcity of HART units. NHS Operting Frmework Strtegic Ambulnce ontrct Guidnce for ommissioners UK ontest Strtegy Ntionl Mndte for HART p Prepre strnd of the ontest strtegy HART provides key prt of the DH / NHS contribution to ontest work strems. HART specificlly referenced in strtegy. Pitt Review Model Response (Home Office) p.10 section on being rescued nd cred for in n emergency (flooding) Government ccepted the need to extend rescue nd cre cpbilities in flooding HART IWO progrmme now contributes to this strtegy [ Restricted - BRNE Ntionl Plnning Assumptions ] ivil ontingencies Act 2004 Ntionl pbilities Progrmme The Act designtes the mbulnce service s tegory 1 responder nd cretes series of sttutory duties in reltion to responding to emergencies. The HART cpbilities support complince with number of these sttutory duties. binet Office coordinted progrmme. 22 cpbility work strems combine to support the resilience of the UK. HART is fundmentl spect of the NHS contribution to number of these priority work strems. The work strems re outlined t: Bckground/Introduction B 7

8 .1. Purpose The primry purpose of HART response is to provide life-sving clinicl intervention, if necessry within the inner cordon, t rnge of emergency incidents involving hzrdous mterils nd/or environments..2. Aims nd Objectives Key ims of HART re to: hve tems of highly trined NHS mbulnce personnel who cn respond rpidly into n incident involving hzrdous mterils nd/or environments, or in res where there is difficult ccess nd egress, in order to sve life nd improve helth outcomes for ll csulties provide erly intelligence to the wider helth communities, ssist in the rescue opertion if required nd hve the bility to provide rpid medicl ssistnce to other first responder personnel should the need rise The progrmme hs estblished HART s ntionl 1 model delivered by NHS mbulnce trusts in order to support ny mutul id requirements in the event of mss csulty incidents or multiple, concurrent lrge-scle incidents. To this end the development of the selection processes, trining courses, stndrd operting procedures, clinicl protocols nd vehicle nd equipment specifictions re being tken forwrd on ntionl bsis. This will ensure tht HART personnel will be ble to sfely operte nywhere in the country, longside collegues from other HART tems nd the other emergency services..3. Definition nd scope 1 Whilst this policy nd progrmme hs been instigted nd led by the DH in Englnd, close liison with the devolved dministrtions nd rown Dependencies hs been mintined. Scotlnd, Wles nd Northern Irelnd re introducing vritions of these cpbilities to llow redy provision of mutul id cross borders it is therefore importnt tht the sme or similr model nd specifictions be dhered to Requirements Responding within the inner cordon of scene, prticulrly t mjor, hzrdous incident, requires different working prctices, equipment nd systems of work to conventionl mbulnce response where usully single responders or two person crews re deployed. HART provides tem-bsed response tht needs high level of multi-gency coopertion nd understnding. HART personnel need rnge of Personl Protective Equipment (PPE) nd clinicl equipment suitble for use in these conditions, nd the skills nd knowledge necessry to operte sfely within these environments. Specific behviourl competencies nd personl ttributes tht promote confidence nd resilience for working within tems nd in very difficult circumstnces re required to ensure sfety nd optiml performnce, so the recruitment nd selection processes re tilored to ensure this hppens. Becuse HART needs to hve 24/7, 365 dy cpbility, ech prticipting mbulnce trust is effectively deploying 42 WTE (or more if the trust hs multiple HART units) ppropritely qulified nd experienced mbulnce personnel, in ddition to those performing conventionl frontline duties. Trusts therefore hve hd to bckfill these roles to cover this move, in order to mintin performnce for conventionl responses. DH funding hs been provided to support this. 8

9 Ech HART will hve specific nd specilised vehicles nd equipment to enble the tems to deploy effectively nd sfely. There is requirement therefore, for the provision of suitble fcilities to ccommodte them. There re specific recommendtions for ccommodtion tht include sttutory mesures for equipment storge, clening nd mintennce, security mesures to protect ssets, nd n pproprite environment to support ongoing trining nd stff welfre. Becuse of the nture of the work, high level of inter-gency wreness nd coopertion is essentil. There is therefore need for regulr multi-gency trining nd exercising both loclly nd ntionlly. The HART progrmme initilly concentrted on introducing specific cpbilities within the service: Incident Response Unit (BRNE/HAZMAT incidents), Urbn Serch & Rescue nd Inlnd Wter Opertions. The rnge of cpbilities hs since expnded to cover response to certin firerms incidents. Decisions to expnd or chnge the rnge of cpbilities within HART will be ssessed by nd will be risk nd evidence bsed in response to chnging threts nd risks. Introduction of dditionl cpbility will necessrily depend on resources nd cpcity vilble Loction of HART Units The originl progrmme tht begn in 2005 sought to estblish twelve HARTs cross Englnd. These were to be locted in line with the Home Office Model Response Progrmme which looks t emergency services response to BRNE type ttck in the UK. Three dditionl tems hve been dded to the originl objective in 2011/12. There re 15 HARTs bsed strtegiclly to enble 45 minute response to high risk loctions identified within the Home Office Model Response Progrmme. These re locted in the following Ambulnce Trusts (unless otherwise specified ech Trust currently hs one HART): Est Midlnds Est of Englnd (two tems) Gret Western London (two tems) North Est North West (two tems) South entrl South Est ost (two tems) South West West Midlnds Yorkshire Further HARTs my be required in response to the emerging evidence bse, the Ntionl Risk Register, incresing threts to ntionl security, nd reviews of the Home Office Model Response. 9

10 .3.3. pbilities Incident Response Unit pbility (IRU) IRU cpbility forms the bsis for improved response in the event of potentil or ctul contmintion or presence of hzrdous substnces or environments, including in the Hot Zone or Inner ordon. This mens tht mbulnce personnel cn ssess, trige nd tret csulties quicker thn they previously could, by ccessing them erlier. All HART personnel re trined nd equipped to provide IRU cpbilities. Beyond the conventionl or BRNE decontmintion mbulnce response within the wrm zone, the IRU cpbility cn work on scene nd within the inner cordon to: Undertke scene risk ssessment mking use of specilist knowledge gined in trining nd liising with other experts on scene nd online/remotely Work longside FRS personnel to deploy forwrd into the inner cordon or hot zone of n incident to provide emergency medicl ssistnce Fcilitte rescue, in conjunction with FRS, of mss csulties t hzrdous mterils incident Operte in vrying levels of PPE, bsed on dynmic risk ssessment, including Gs Tight hemicl Protection Suit (GTPS) nd use of Extended or Single Durtion Brething Apprtus (E/SDBA) Identify indictors which my determine ny mterils involved/present t n incident Undertke rpid clinicl reconnissnce to determine: Scle of incident ommencement of (Toxic) Trige Number & distribution of live csulties linicl toxidromes using clinicl dignostic lgorithms in conjunction, if possible, with ny vilble scientific dt, for exmple from FRS Detection, Identifiction nd Monitoring (DIM) tems linicl resources required within the inner cordon to sve life Provide bsic life sving tretment mesures, (trgeted principlly t P1 nd P2 ptients who re cliniclly t most risk): Toxic Trige (Hot Zone) Rescue (evcute) using ny possible mens tstrophic hemorrhge control (tourniquets/compression dressings) Nerve Agent Antidotes (vi combo-pens) Inter-Osseous ccess Assist ventiltion vi Bg, Vlve Msk (BVM) + BRNE filter Oxygen (multiple delivery system where necessry) Provide rpid feedbck to mbulnce nd other Incident ommnders regrding scene ssessment, clinicl resources required nd potentil wider helth requirements Provide clinicl detils on rescued ptients for effective hndover in wrm zone to BRNE decontmintion tems Provide clinicl bckup nd support for collegues nd personnel working within the inner cordon / hot zone 10

11 Urbn Serch nd Rescue pbility (USAR) USAR cpbility extends the res or environments in which prmedics cn operte sfely nd provide clinicl intervention to include those where ccess nd egress is difficult, my involve protrcted entrpments, nd requires specilist equipment nd trining. urrently hlf of the personnel in ech HART unit re trined nd equipped for USAR response. A USAR Prmedic will be trined nd equipped to operte in: Any incident where csulty requires cre in confined spce environment nd/or where there my be prolonged entrpment Any incident to which the Helth nd Sfety Legisltion Sfe Working t Height pplies nd csulty requires cre Any incident involving difficult ccess / egress where USAR skills nd equipment cn overcome these difficulties to rech, tret nd help extrct ptients Any incident to which the Fire nd Rescue Service (FRS) requires or hs deployed their USAR resources USAR Prmedics re trined to ccess ptients, perform trige, deliver ptient cre, nd dvise on extriction. They re not responsible for serch, rigging sfety lines or csulty recovery systems, removl of rubble or debris, plcing structurl supports, nd operting technicl serch nd rescue equipment; tht is the role of the FRS USAR tem The role of the USAR Prmedic is to provide: Helth input to the initil scene ssessment Scene ssessment including dynmic risk ssessments directly relted to the needs of the mbulnce nd other helth services Joint identifiction of the Inner ordon nd, if required, the Hot Zone Initil trige nd immedite life sving tretment Hzrd identifiction Estimtion of the mbulnce/clinicl resources required nd ongoing resource needs ommnd & ontrol in the inner cordon overseeing Ambulnce / Helth resource mngement sulty mngement sulty extriction Inlnd Wter Opertions (IWO) This extends the cpbilities of these mbulnce personnel, from bsic wter wreness skills, to working more extensively, longside Fire & Rescue Services, on inlnd wterwys nd in incidents such s flooding. IWO opertives re trined to ccess ptients, trige nd provide clinicl interventions s necessry nd dvise on csulty extriction s prt of the multi gency response. This will include ny centrlly coordinted deployment to widespred flooding s prt of Deprtment for Environment, Food nd Rurl Affirs (DEFRA) tem typed response. HART Opertives re not responsible for serch, rigging sfety lines, csulty recovery systems, wter crft hnding nd operting technicl serch nd rescue equipment. 11

12 Tcticl Medicine Opertions (TMO) This llows HART to work closely with the police nd other specilist gencies to deliver tcticl medicine cpbility. Opertions under this cpbility my include certin firerms incidents. HART opertives re trined to operte longside Authorised Firerms Officers (AFOs) inside bllistic cordon. The tcticl options include ccess, ssessment, tretment nd extriction of ptients cught within the inner cordon of specilist security opertions. The tctics used by HART under this cpbility group re protected under restricted mrking. Further cpbilities will be considered within HART using n evidence-bsed pproch, nd then only where cpcity nd resourcing is sufficient to provide n pproprite level of response. Future developments will be considered longside commissioning rrngements Types of Incidents Attended In generl the types of clls tht my indicte the need for HART response will include: HAZMAT/BRNE: ny incidents involving ctul or suspected HAZMAT / BRNE, including gs leks, white powder incidents nd fires involving HAZMAT Fires & explosions: All lrge fires nd explosions, including fires involving unsfe structures, persons reported trpped, recovery situtions Trnsport-relted: complex incidents involving trnsport systems, including ril, rod nd ir (e.g. multi-vehicle, multi-csulty, hzrdous contents, fuel spillges etc) Suspect pckges nd explosive devices: Incidents involving suspect pckges, bgs, vehicles nd envelopes s well s explosive devices such s bombs or WWII Ordnnce Unsfe structures: Incidents involving unsfe structures such s building collpses, scffolding collpses, demolition sites Unconscious: Incidents involving unconscious ptients with unknown cuse (such incidents require the STEP 1,2,3 protocol to be used by emergency responders) Working t height: Up on scffolding, gntries, crnes, trees, tops of buildings Difficult ccess / confined spces: Trench collpse, under mchinery, wells Mountin/ve/Mines Rescues: In support of the relevnt specilist rescue tems Other USAR: Incidents where response is instigted by the Ntionl Fire USAR coordintion centre Inlnd Wter: on or ner dringe chnnels; where ptients re in or within 3 meters of wter body; where vehicle hs gone into wter body; where csulties re locted in n re where wter needs to be crossed to ccess the csulty; river/wter wy serches; where flooded res need to ccessed by HART opertives; unstble surfces such s mud nd ice Incidents requiring TMO cpbilities 12

13 Figure 2: Overview of the HART Service Specifiction ommissioned Service Output ore Services: Incident Response Unit (IRU) pbility Urbn Serch nd Rescue (USAR) pbility Inlnd Wter Opertions (IWO) pbility Tcticl Medicine Opertions (Firerms) Delivered loclly nd ntionlly ccording to the specified mutul id specifictions. Mintin notice to move ntionlly. omplince fctors: Support NHS mjor incident nd BRN plnning ONTEST centrl strtegy Model Response centrl strtegy Ntionl pbilities Progrmme NHS Operting Frmework DH Emergency Prepredness Guidnce Pitt Review (flooding) Ntionl Qulity Assurnce Audit Including Key Performnce Indictors (KPI s) Non-commissioned Locl Added Benefit Outputs My Include: Locl corporte complince with ntionl strtegic mndte Extend trust provision of Prmedic level cre to hzrdous situtions loclly Ptient outcome improvements (clinicl indictors for hzrdous re ptients) Wider opertionl support (nerest nd quickest support to opertionl performnce) Relese of opertionl ssets from incidents (further opertionl performnce support) Provision of Specil Opertions Disptch Desk within Trust Trining support (emergency prepredness nd BRN decontmintion) Estte co-loction Income genertion ost Reduction nd Efficiency Sving Support (strengthen locl finncil performnce) QUIPP gend pilots nd reserch TRIMM (post incident stress debriefing) support to wider Trust 13

14 The HART Model Introduction During the development of HART there hs been n emphsis on the need to implement nd operte HART units to consistent model. The hs coordinted the development with significnt multi-disciplinry nd multi-gency input nd in consulttion with the trusts involved. A consistent pproch to the mintennce of this best prctice model, in line with this specifiction is criticl for: the resilience nd cpbility of the individuls nd the tems s whole ensuring dherence to sttutory requirements, sfe working prctices nd ontinuing Professionl Development interoperbility with other emergency services nd specilist gencies (such s the Helth Protection Agency) redy provision of mutul id cross ll NHS mbulnce services To this end, ll HART personnel hve been recruited nd selected, trined nd equipped to the sme specifiction. All HARTs work to Stndrd Operting Procedures (SOPS) nd re required to meet sttutory nd mndtory trining requirements. This model will be regulrly reviewed using the evidence gthered through ongoing monitoring of ctivity nd fctors tht influence the resilience nd prepredness of HART personnel Recruitment & Selection 2 A different model for trining ledership within HARTs is being implemented in couple of trusts involving 7 tem eductors (ie one per tem), with one led eductor. The ongoing evlution process will compre these different models nd seek to build on the strengths of ech. All HART personnel re to be recruited nd selected in ccordnce with specifiction in the ltest version of the HART Recruitment & Selection Mnul. This sttes the relevnt criteri for eligibility to be member of HART nd includes use of the evidence bsed ompetency Frmework for HART Mngers, Tem Leders nd Opertives. It lso includes the requirement for pplicnts to pss n Occuptionl Helth medicl ssessment, nd lso Physicl ompetence Assessment (PA). Once in post, HART personnel re required to undertke regulr Ongoing Physicl ompetence Assessments (OPA) The HART Unit A HART Unit currently consists of minimum of: ) HART Mnger x 1wte b) HART Triner x 1wte 2 c) HART Admin support x 1wte d) HART Opertives x 35wte e) HART Tem Leders x 7wte Of these, d. nd e. bove form 7 tems of 6 (5 opertives nd tem leder) within the unit, in generl working 7 week rot, with one tem on duty nd one tem on trining week t ny one time. Locl vritions my be in plce (e.g. some units 14

15 operte effectively with 5 tems of 8), however the requirement to hve protected trining week is prmount (due to the sttutory requirements surrounding the protective equipment used by HART), plus to llow for bsences nd relief. HART Opertives nd Tem Leders re required to hold Registered Prmedic sttus 3 nd be ble to work to the most recent version of the Joint Royl olleges Ambulnce Liison ommittee (JRAL) stndrds. The ongoing monitoring nd lerning s HART hs become opertionl hs led to considertion of the need for other supporting skill levels to be introduced within the tem. This work is under development. In order to support clinicl decision mking in unusul circumstnces, mbulnce trusts with HART re required to identify up to four doctors who will be vilble to provide dvice, specificlly to HART clinicins, either remotely or on scene if necessry. These doctors will be required to undertke level of wreness trining which will be provided to fmilirise themselves with HART cpbilities Deployment 3 This is the recommendtion of the linicl sub-group supporting the DH HART project tem nd hs lwys been the intended model. In setting up HART however, some Trusts hve not hd sufficient prmedic resources to relese into their tems, within the timefrme, nd some opertive posts hve been ppointed to Emergency Technicins (EMTs). There is n understnding nd requirement therefore tht these EMT opertives should preferbly lredy be on the prmedic pthwy nd ttin prmedic sttus s soon s is prcticble. Funding hs been provided to llow bckfill of ll HART posts. HART forms centrl strnd to mbulnce service bility to contribute to the BRNE nd Mss sulty elements of the Ntionl pbility frmework nd ONTEST. This is its primry purpose s well s responding dy-to-dy to incidents involving hzrdous substnces nd environments tht they re specificlly trined nd equipped to do. HART provides 24 hours dy, 365 dys per yer response. Minimum stffing level on duty t ny time should be one tem of 6 (5 opertives nd 1 tem leder). The HART requires full tem of 6 for n optimum IRU response cpbility. Priority must be given to HART clls nd prepredness to respond to these t ll times, prticulrly for the identified MR loction. In line with the Model Response Progrmme HART response is expected to be on scene nd redy to respond s full tem within the MR loction in 45 minutes. In order to mintin clinicl competence nd skills, s well s responding to HART specific clls no more thn 2 opertives on duty my, on occsions, be vilble to respond to other clls using HART RRVs, but must NOT be included s prt of core opertions resourcing s their priority is to be vilble for HART responses t ll times. There should be loclly greed criteri in plce for how nd where HART RRV responders cn be deployed within the region whilst mintining the bility to immeditely meet the MR response requirement (s full opertionl tem) whenever the need for this rises. This requirement will not prevent ny HART opertive or tem from being deployed to ny incident s the "nerest nd quickest" resource in extreme circumstnces where this is the most ethicl course of ction, however this initil response should be relieved s mtter of priority so tht the MR response requirements re not compromised. 15

16 In wht should be exceptionl circumstnces, the following should pply in reltion to stffing levels tht re below the minimum with respect to subsequent deployment of HART RRV response to other types of clls: 6 on duty = 2 RRVs = full HART cpbility 5 on duty = 1 RRV 4 on duty = 0 RRV 3 on duty = 0 RRV 2 on duty = 0 RRV limited HART response nd provision of specilist dvice vilble depending on nture of incident nd skill mix on duty - HART Mnger will dvise on wht level of cpbility is vilble NB. Stff bsences nd vcncies will normlly be covered by relief stff nd/or overtime nd occsions when stffing drops below six should be rre. In the event of n incident requiring dditionl personnel, potentil bck up my be vilble from the trining tem, depending on their loction nd commitment t the time. The HART response cpbility is dditionl to core opertionl resourcing nd hs been funded specificlly by the Deprtment of Helth to meet the requirements in points the bove. All stff initilly recruited to the HART unit from the existing Opertions pool re expected to hve been bckfilled with fully qulified prmedics (funded by DH) so no resource or cost pressure hs occurred within the trust s result of the HART estblishment. ommissioners will recognise tht HART ctivity should be treted s dditionl to the funding for core, conventionl A&E opertions. 16

17 .4.5. Trining Trining is criticl element of ensuring HART sfety, resilience nd cpbility, nd knowledge nd skill levels must be mintined t ll times. ertin elements, (e.g. Brething Apprtus, Sfe Working t Height) require sttutory re-certifiction trining nd ll HART personnel re expected to undertke continuity trining nd pproprite levels of ontinuing Professionl Development (PD). Skills, cpbilities nd physicl competencies which re ssessed or developed during the ppointment nd initil trining phse will need to be mintined nd provider orgnistions must be ble to demonstrte this. HART initil trining nd eduction involves extensive theory nd prcticl scenrio exercises delivered by subject mtter experts. In ddition to the HART Trining Fculty, ech HART unit hs HART Triner. In some trusts there my be number of HART Tem Eductors insted, with nominted Led Triner. Trust HART Triners re expected to tke prt in the HART Triners Forum to shre lerning, best opertionl prctice nd identify core trining needs. HART Trining Requirements (see Figure 3): ore Trining All core trining elements re ssessed in ccordnce with stndrd competency bsed ssessment process. The current courses required on initil recruitment tht re funded nd provided centrlly by the HART trining fculty re: 4 At the current time, 50% of ech HART unit will receive USAR trining. This position will be under review nd ny decision to extend this cpbility will be risk nd evidence bsed. IRU course = 15 dys USAR course = 15 dys 4 Inlnd Wter Working = 4 dys (delivered through loclly selected providers) As cpbilities develop, nd in response to ny chnges in risks identified, the course content nd course lengths will be subject to review. Personl Protective Equipment Trining (PPE) Pre-requisite trining in PPE hs to be pssed prior to ttending IRU trining. HART personnel re required to undertke trining, sourced loclly wherever possible, in the use nd mintennce of the following PPE: ivil Responder 1 suits (R1) trining provided either by Trust R1 instructors or by locl Police R1 Instructors (3 dys) Powered Respirtor Protective Suits (PRPS) trining provided in-house (2 dys) Gs Tight hemicl Protection Suits (GTPS) nd Extended Durtion Brething Apprtus (EDBA) trining provided by the Fire & Rescue Service (10 dys) HART PPE trining hs been developed together with the relevnt gencies involved to ensure pproprite content for mbulnce use nd tht minimum stndrd is met. 17

18 ontinuity Trining Exercises Orpheus 1 nd 2 reports (2008) document the rpid fde of certin HART skills, Exercises Sxon Shore nd len re reports (2009) document the cler dvntge of tems mintining such skills through regulr trining. It is essentil for ptient cre nd sfety of personnel tht HART relted skills re mintined to high stndrd. Mny res such s PPE nd incident response procedures require regulr continuity trining, this must involve both theory nd prcticl sessions nd trining with other gencies. To ensure skill levels re mintined nd exercised HART personnel need to hve protected trining week within their rot system, 1 week in 7. HART triners re expected to develop n ongoing trining pln which ensures skills re regulrly updted nd tested s well s keeping ll personnel up to dte with developments in knowledge res nd informtion on ntionl security threts. Regulr trining nd exercising with other tegory 1 responders, specilist rescue gencies nd other orgnistions is essentil nd expected to be undertken on regulr bsis. Sttutory Re-ertifiction Trining nd Assessment In ddition to the usul sttutory trining requirements for Helth & Sfety, HART specificlly require re-certifiction nd/or ssessment in the following: Brething Apprtus (undertke wer t lest once month, ssessed re-certifiction exercise for competence nnully) R1 suit (nnul ssessment) PRPS (nnul ssessment) Sfe Working t Height (bi-nnul ssessment) onfined Spce Working (bi-nnul ssessment) Ongoing Physicl ompetence Assessment (6 monthly nd on Return to Work fter illness or injury) 18

19 On-going Sfety riticl Trining (1 week in 7) Initil / Prerequisite Trining Locl Pre-requisite Trining PRPS / Decontmintion ourse (2 dys) Brething Apprtus ourse (10 dys) R1 ourse (2 dys) Ntionl ore Trining Trinee becomes live opertive HART Unit Trining Modules ommnd & ontrol ommunictions equipment & IT Helth & Sfety / Risk Assessment Emergency procedures Site specific plns nd OMAH sites PPE PRPS EDBA LLGTS R1 DIM USAR SWAH IWO/SRT HART linicl considertions/specific tretment Prmedic clinicl cre HART specific stretchers nd specilist extriction Multiple O2 delivery system Forensic Awreness Firerms / Tcticl Medicine Trnsport incidents Prtner responder wreness HART Vehicles Optionl Trining My Include: E xcelerte hmpions ourse (4 dys) BA hmpions ourse (5 dys) R1 Instructors ourse (5 dys) Portcount Opertor (1 dy) VIP Extrction (5 dys) SWH Triners ourse (5 dys) Meti Simultor ourse (2 dys) Figure 3: Overview of the HART Trining Progrmme Incident Response Unit ourse (15 dys) Urbn Serch & Rescue ourse (15 dys) Locl ore Trining Inlnd Wter Opertions ourse (4 dys) Swift Wter Rescue Technicin ourse (4 dys) Tcticl Medicine / Firerms (3 dys) Mnging Wter Incidents ourse (T/Ls) (3 dys) Sfe Working At Height ourse (1 dy) Vehicle Fmiliristion / Driver Trining (2 dys) Off Rod Driver Trining ourse (2 dys) Winch ourse (1 dy) Polris Driver Trining (1 dy) Vehicle Technology / Excelerte ourse (2 dys) Root use Anlysis ourse (T/Ls) (1 dy) TAP / PTTLS Teching ourse (T/Ls) (5 dys) Bronze ommnd ourse (T/Ls) (2 dys) Off Rod Instructors ourse (5 dys) BA Sfety ourse (1 dy) IS ourse (1 dy) TRIMM ourse (2 dys) Illicit Lbs ourse (1 dy) Toxbse ourse (1 dy) 19

20 .4.6. Stndrd Operting Procedures In order to ensure sfe systems of working, prticulrly in the event of providing mutul id, ll HARTs must dhere to the ltest versions of centrlly developed nd greed Stndrd Operting Procedures (SOPs). Locl Trust SOPs re then bsed on the ntionl SOPs. Any locl devition from the SOPs need to be greed t ntionl level, through nd the Ntionl HART oordintion Group (NHG). SOPs will need to be revised in response to risk ssessment, trining needs nd lessons lernt. All HARTs will need to be kept up to dte with revisions nd dditions Vehicles nd Equipment Ech HART hs currently been provided with the following vehicles: 1 x Forwrd ommnd Vehicle (FV) 1 x Forwrd Reconnissnce / Light Equipment Vehicle (LEV) 1 x Hevy Equipment Vehicle (HEV) 2 x USAR 4x4 vehicle 2 x Rpid Response Vehicle (RRV) 1 x Personnel rrier 1 x 6x6 Polris equipment & stretcher crrier 1 x Modulr Trnsporttion Vehicle All vehicles nd equipment must be serviced nd mintined to the minimum specified levels. PPE must be replced in ccordnce with mnufcturers recommendtions. The IT equipment inherent in the FV is subject to Ntionl mintennce nd support contrct for the first three yers fter delivery to the Trust. Trusts will be expected to mintin (nd fund) continued cover fter this period, using the Ntionlly provided frmework greement. Equipment inventories re not to be dded to without greement t ntionl level, through the HART hnge Request Process. This is essentil to ensure sfe working prctices nd tht vehicle weight limits nd wrrnties re not infringed. All HART vehicles hve been deemed to hve 7 yer life, except the RRVs which hve 5 yer life, nd replcement must be built into Trust vehicle replcement progrmmes. In ddition, the Trust re required to provide nd mintin other necessry equipment such s Mobile Dt Terminls (MDTs) nd Airwve systems nd, where pplicble within locl trust policy, vehicles for HART mnger nd triner. It is therefore essentil tht sufficient deprecition costs re funded ech yer to support replcement of the HART fleet nd criticl equipment in line with the ntionl specifictions for these ssets t the time replcement is required. The HART Vehicle & Equipment Group oversee evlution nd review of current nd future ssets nd ensure tht revision of specifictions is bsed on evidence of need, dvnces in technology nd best prctice. 20

21 .4.8. HART Estte Ech HART is set up with considerble ssets, which require secure nd discreet ccommodtion. In order to ensure consistent provision for HART tems nd pproprite logisticl nd technicl support for the vehicles nd equipment, ech trust where HART is being estblished, with ssocited vehicles nd equipment, will need to ensure tht the recommended esttes specifiction is vilble s minimum. Lerning nd best prctice my suggest the need for other requirements over nd bove the recommended specifiction such s inclusion of physicl competence ssessment equipment nd fcilities. The vehicles nd equipment being provided comprise significnt investment nd include sophisticted, stte-of-the rt technology. Security nd pproprite mintennce of these ssets is therefore key considertion. There re lso sttutory requirements round the pproprite fcilities for mintennce nd clening of equipment such s Extended Durtion Brething Apprtus (EDBA). The Estte provision should be physiclly reviewed nd risk ssessed by the HART Mnger nd Trust Risk & Sfety dviser preferbly before occuption nd regulrly therefter in ccordnce with locl trust policy. The rnge of vehicles, equipment nd PPE ssocited with the current cpbilities detiled in this specifiction indicte required building size of pprox 21,000 sqft. Vehicle ccommodtion The grge fcilities will be designed to be ble to securely store indoors the whole fleet of HART vehicles. Ech of the bove vehicles will hve mrked prking by with retrctble electricl shore-line connection of either 110 or 240 volts (dependent upon locl trusts stndrd fitments), terminting with n uto-eject plug instlled to the current electricl instlltion requirements. Additionlly, the by for the Forwrd ommnd Vehicle will hve ccess to; 240 volt supply rted to 5 KV fitted with 32 mp socket; nd locl re network socket. This will enble the connection nd running up of the on bord technology equipment for trining or mintennce without the need to run the genertor indoors. Ech grge will hve ccess on site to vehicle wsh (pressure wsher or equivlent) fcilities with pproprite ssocited dringe. Within (or immeditely outside) the grge re, wter supply, terminting in mle 70mm instntneous fire coupling cpble of delivering wter pressure of 2 br will be provided. Alterntively fire hydrnt within the grounds of the premises will be ccepted subject to it meeting the sme delivery pressure requirements AND the locl trust hving written greement with the locl wter compny to ccess the hydrnt nd bstrct wter for trining purposes. The grge will be fitted with suitble ir extrction/scvenging system to ensure no build up of exhust fumes when the vehicles re running / mnoeuvring. A clen storge re will be provided within (or ccessed vi) the grge re. This re will be minimum of 10 metres X 10 metres floor spce nd be t lest single 21

22 storey in height. Access to the storge re will be step free nd hve width of no less thn 2 metres. A rnge of shelving should be vilble to suit the equipment to be stored. Stff nd ssocited ccommodtion The sttion ccommodtion will hve the following fcilities s minimum: Unisex locker fcilities for 42 stff (of the lrge work wer/ppe storge type, of full height to ensure tht stff will not need to store equipment on top of lockers) Seprte mle nd femle toilet nd shower fcilities with ssocited chnging fcilities ( minimum of two showers per sex is suggested) An office for the HART mnger, with pproprite IT nd telephone connections An office for the tem members to crry out dministrtive tsks nd to ccess IT A rest room for on-duty stff A kitchen for on-duty stff A trining / meeting room tht sets up to 42 personnel nd triners, equipped with suitble IT equipment including AV projectors 5 A dirty sluice re A clen sluice re for BA equipment clening. A medicl gses store A drying room cpble of housing one set of PPE for ech on duty tem member, nd cpble of being heted nd ventilted 24/7 Fcilities required to crry out regulr physicl competence ssessments nd support mintennce of these competencies Generl Environment 5 Whilst it is unlikely tht n entire HART unit of 42 personnel will tke prt in trining or meeting t ny one time on regulr bsis, fcility this size will support other relted trining involving other Trust personnel, plus cn be used s debriefing room following incidents or multigency exercises where others re involved nd required for de-brief. The following criteri should be met with regrds to the generl environment: The sttion will hve fire detection/lrm system to the current British Stndrd The Sttion will be fitted with security lrm system including perimeter protection The sttion will hve TV monitoring nd recording fcilities, covering t the very lest ll vehiculr nd pedestrin ccess points The perimeter of the site will be fenced nd fitted with gted ccess system controlled by key pd or proximity crd/remote control ccess system from the outside nd vehicle sensors from the inside The sttion will hve prking fcilities for on-duty stff, with dditionl spce to llow prking for on-coming stff or outside trining ctivities Externl security nd sfety lighting will be fitted The sttion s overll design nd construction will comply with ll building regultions in force t the time of construction or dpttion, nd ny other generl locl policies for provision t mbulnce sttions 22

23 .4.9. Mutul Aid A fundmentl spect of the estblishment of HART units cross Ambulnce Trusts is their bility to provide mutul id in the event of mjor, concurrent nd/or mss csulty incidents or protrcted events. Provision of HART mutul id is included in the ltest version of the UK Ambulnce Services Ntionl Memorndum of Understnding oncerning the Provision of Mutul Aid produced by the Assocition of Ambulnce hief Executives (AAE) Monitoring nd Evlution As new nd emerging cpbility within mbulnce services nd the helth service in generl, the evidence bse for the effectiveness nd ongoing requirements for HART response is being obtined through the development stges nd s the tems go live opertionlly nd ctivity is monitored nd lernt from. All HART units hve been provided with the PROLUS web-bsed tool to gther evidence of ctivity nd vlue dded to ptient cre in order to contribute to the evlution, monitoring nd lerning processes put in plce centrlly. Trusts re required to hold n nnul licence in order to use this tool nd keep it updted s revisions re mde. The PROLUS tool llows for dynmic monitoring of: Incidents ttended, the response provided nd the vlue of HART for the mbulnce services, emergency plnning nd prepredness in generl Equipment use, effectiveness nd shelf-life Knowledge, skills nd competencies ssocited with the HART response ontinuous professionl development nd other mndtory skill requirements Key performnce indictors ssocited with qulity, innovtion, impct, productivity nd prevention Individul nd collective helth, well-being, resilience nd overll prepredness for HART incident responding Tem cohesion, tem working nd effectiveness HART mngement nd ledership Multi-gency working, stkeholder reltionships nd shred lerning Ech HART unit is required to populte nd mintin performnce dt in ccordnce with the criteri within the PROLUS system, on monthly nd nnul bsis. This is to llow ntionl monitoring of the vilbility nd cpcity of the HART cpbility nd complince with spects of the service specifiction Outcomes The vlue of providing HART cpbilities will be demonstrted through: Lives being sved, from within the inner cordon of incidents, tht my otherwise hve been lost Longer term medicl implictions being reduced for ptients rescued from within the inner cordon due to erlier clinicl ssessment, trige nd tretment 23

24 Ambulnce clinicins hving wider rnge of skills nd knowledge to deliver cre in vriety of unconventionl situtions The overll helth response to hzrdous incidents being mnged more effectively ommnd nd control rrngements for mjor incidents being improved These outcomes re difficult to mesure quntittively, but mesures re in plce to ensure tht ongoing monitoring provides n objective nlysis of both quntittive nd qulittive dt on HART s vilbility, resilience nd cpbility, contribution nd chievements cross incidents. This lso ensures tht lessons re lerned nd shred to llow for the continuous improvement nd development of HART cpbilities Qulity Assurnce nd Policy Review A qulity ssurnce frmework is in plce nd implemented by, estblishing key processes to provide ssurnce round the delivery nd mintennce of HART in line with this specifiction. Trusts will be expected to comply with requirements of this frmework. Any proposed chnges to the HART model, whether relting to personnel, skill mix, vehicles, equipment or SOPs need to be pproved through the governnce structure, vi the hnge Request process nd consulttion with ll HARTs. Any locl vritions tht hve not been greed t ntionl level my pose risk to the Ntionl pbility nd mutul id rrngements, nd, for vehicles & equipment, could ffect ny wrrnties or mintennce contrcts. 24