MAJOR INCIDENT PLAN Appendix and Action Cards

Transcription

1 MAJOR INCIDENT PLAN Appendix and Action Cards July 2012 A B Switchboard Record of Alert Call Control Centres - Site Specific Personnel C Distribution of Action Cards 1-54 D Action Cards

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3 APPENDIX A SWITCHBOARD RECORD FIRST MESSAGE HAND TO SITE PRACTIONER AS SOON AS POSSIBLE 1. Date & Time of call 2. Caller's initials? 3. Caller's position? 4. Caller s tel no? 5. Which hospital is designated? CMH NPSM BOTH 6. Status of call? STANDBY DECLARED 7. Location of incident? 8. Nature of incident? 9. Estimated total number of casualties? (number) 10. What types and numbers of casualties? Adult Adult Children under 16 Children under Is a decontamination unit required? SEE CBRN RESPONSE PLAN 12. Which other hospitals are alerted? YES (type) (type) (type) (type) NO (number) (number) (number) (number) 13. Any other important information? SECOND MESSAGE PASS TO CONTROL CENTRE MANAGER AS SOON AS POSSIBLE 14. Time of call 16. Caller's initials? 17. Caller's position? 18. Caller s tel. no,? 15. MESSAGE (exact words if possible):....

4 THIRD MESSAGE PASS TO CONTROL CENTRE MANAGER AS SOON AS POSSIBLE 16. Time of call 21. Caller's initials? 22. Caller's position? 23. Contact number? 17. MESSAGE (exact words if possible): STANDDOWN PASS TO CONTROL CENTRE MANAGER AS SOON AS POSSIBLE 18. Time of call 26. Caller's initials? 27. Caller's position? 28. Contact number? 19. MESSAGE (exact words if possible): CONTROL CENTRES: NPSM xxxx CMH xxxx

5 Appendix E SITE SPECIFIC PERSONNEL Silver Control Centre A&E Major Incident room NPH A&E Major Incident room CMH Gold Control Centre Meeting Room 1, Trust Offices, NPH Meeting Room 1, ACAD, CMH Attendees: Control Centre Manager (allocated by CEO or Deputy) Emergency Planning Officer Loggist (nominated by control centre manager) Director of Operations Director of Corporate Services Site Practitioner Medical Director Director of Nursing Attendees: Chief Executive Officer Brent PCT rep Harrow PCT rep Head of Communications NHS London rep Commissioning Partnership rep Communication link with Silver Control Loggist Divisional General Managers Heads of Nursing Support Services Manager A&E Consultant ITU Rep / theatre coordinator IT rep Security rep Duty Clinical Hematologist Duty Pediatrician Fire Officer / Health and Safety officer (as required) Maternity rep if required Mental Health rep if required LAS rep Police rep HPA rep if required

6 APPENDIX F DISTRIBUTION OF ACTION CARDS Silver Control to distribute Action Cards Gold Control to have a copy of the Action Cards

7 Action Card Number Action Card Index Role in Major Incident Page Number 1 Silver Control Centre Manager 8 2 Hospital Gold Commander 9 3 Gold Control Centre Manager 10 4 Medical Director of the Incident 11 5 Senior Surgeon On-call 12 6 Operating Team 13 7 Consultant Radiologist 14 8 Director of Nursing (or Deputy) 15 9 Senior Nurse ITU Press Officer Consultant Paediatrician A&E Consultant Clinical Site Practitioner Assistant Clinical Site Practitioner On-call Consultant Physician On-call Consultant Orthopaedic Surgeon Information Officer A&E Nurse in Charge A&E Lead Receptionist Triage Officer Triage Nurse Triage Clerk Resuscitation (RED) Area Lead Nurse Resuscitation (YELLOW) Area Lead Nurse Resuscitation (GREEN) Area Lead Nurse Terminal Care Doctor Terminal Care Nurse AAU Physician of the week AAU Nurse in Charge Discharge Clinician Discharge Coordinator Facilities Manager (Under review Yvonne Smith) Head of Security (Under review Yvonne Smith) 40

8 34 Ambulance Liaison Officer Switchboard Operator Stand-by Officer Relatives Officer Chaplin Mental Health Liaison Nurse (on duty) Senior / On-call Resuscitation Officer All Ward Areas Head of Midwifery Blood Transfusion Department CMH Blood Transfusion Department NPH Bereavement Officer (Under review Pat Duckett) Loggist Porters (Under review Yvonne Smith) Harrow UCC/CAU EBME (Under review Yvonne Smith) Senior Emergency Hazards Physician (CBRN) Chemical Assessment Team (CBRN) Casualty Decontamination and Treatment Team (CBRN) 53 Catering (Under review Yvonne Smith) Linen (Under review Yvonne Smith) Communications Officer 63 59

9 MAJOR INCIDENT ACTION CARD 1 Silver Control Centre Manager Head of Site Operations or DGM Surgery Division (in hours) (On Call Manager Out of Hours) Alerted by: Switchboard Site Practitioner Report to: Silver Control Centre Alerts: Ensure Gold Control Centre alerts have commenced. The role of the Silver Control Centre Manager is to lead the initial response to a major incident and act as the Incident Control Team Leader. (out of hours) The general manager for both A&E sites will take this lead when delegated to the On Call Manager. 1. Take handover from clinical site practitioner to assure overall command of the incident. 2. Ensure Executive Director on call is aware of major incident and has set up the Gold Control Centre 3. Allocate appropriate action cards to each member of the team and assign 2 way radios to each of the Incident Control team from the supply held by Switchboard. 4. Ensure key wards/departments are informed and have activated their own departmental plans, principally ITU, Imaging, Pathology, Theatres, Pharmacy, Security, Chaplains, Bereavement Councillor, and Support Services. 5. Work as a team with the Medical Director to run the incident. 6. In conjunction with the site practitioner clear AAU Dickens Ward 7. Ensure a record log is kept showing times, events and action taken. 8. Make an assessment of the implications of the incident for planned activity and inform Gold Control Commander who will make the final decision. 9. If further security required inform Gold Control Centre. 10. Consider the need to set up a Relatives Centre in Himsworth Hall. for families of casualties. If required, identify a member of staff to act as Relatives Centre Coordinator. 11. Set up an initial briefing session for Incident Control team members and appropriate senior staff. Follow this with regular briefings at approximately 1-2 hour intervals. 12. Liaise with Gold Control Centre hourly informing them of capacity in A&E, and what bed availability is coming up on wards etc.

10 MAJOR INCIDENT ACTION CARD 2 Altered by: Switchboard Report to: Gold Control Alerts: Hospital Gold Commander CEO or Deputy Director 1. Ensure that the Gold Control room is set up. You will remain in control of the recovery team until relived or the incident is over 2. Establish contact with the Central Middlesex Control room 3. Receive situation briefing from Silver Commanders as to the scale and nature of the incident 4. Based on your assessment of the situation, decide who you require to form your recovery team. Inform the Silver Commander and ask them to nominate appropriate people to work with you. 5. Liaise with the Trust Chief Executive and provide a situation briefing 6. Liaise with other agencies re Mutual Aid moving into the recovery phase 7. Provide advice, guidance and support to Silver Commander 8. Ensure that once Silver Commander has declared the incident as stood down plans for returning to normal functioning are implemented 9. Working with the Hospital Coordination Teams, you are responsible for directing and planning the Trust recovery phase. 10.You will provide strategic leadership to the Trust whilst the plan is in operation. 11. Establishing what is going on and visualizing the best, worst and most probable outcomes. 12.Establish strategic aims and health objectives in conjunction with other components of the Health Community 13.Deliver action plans for the recovery phase 14.Manage potential harm to the Trust s reputation 15.Ensure resources are used to best effect between the two sites 16.Ensure that adequate and appropriate information is available to the two Hospital Control Teams 17.Continually review events. You will be supported in your role by a team of specialist advisors from key services and disciplines from across the Trust. These advisors will have the authority to make on the day strategic decisions and contribute to the recovery plan. As a team you will determine and promulgate a clear recovery plan, with supporting objectives which are to be reviewed as the incident progresses.

11 MAJOR INCIDENT ACTION CARD 3 Gold Control Centre Manager (On Call Executive Director, Director of Operations) Alerted by: Switchboard or Page One text Report to: Gold Control Centre Alerts: Control Centre (other site if declared); Trust Office. Report ALL Actual or Potential major incidents to NHS England London pager NHS01 NWL CCG/CSU To contact the Director On- Call please call and request pager NWLCP01 1. On arrival, set up and take handover from clinical site practitioner in control centre and assume overall command of the incident. If appropriate, review senior management staff presence to ensure both Control Centres are adequately staffed. 2. Remain in Gold Control Centre to ensure: Silver Control Room is set up and opened by A&E Nurse in Charge Make an immediate assessment of which staff to notify Silver Control and convene the major incident management team. Allocate appropriate action cards to each member of team and distribute two way radios to each of the incident control rooms from the supply held by switchboard and Silver Control. Key staff report in and are issued with Action Cards Staff and resources are deployed (or put on stand by) as necessary, designating key staff where necessary following information from Silver Control Relevant hospital activity, information and communications are co-ordinated Rest of hospital activity continues, depending on severity of the incident. 3. Liaise with Police Family Liaison Officers and Ambulance Liaison Officer (based in Control Centre) and the Press Office/Trust Office for any VIP visits and Silver Control. 4. Receive updates from Switchboard and Silver Control. 5. With Resource Coordinator monitor and respond to HPA/other s via e-info system. 6. Inform Central Ambulance Control (CAC) of all incidents. 7. For advice/assistance or specialist advice on ALL incidents call the Health Protection Agency London and ask for the on call HPA. For additional support or resources contact LAS CAC and inform Silver Control. 8. In the event of a CBRN incident, inform Security Officer and ask police for assistance to close off all hospital entry points to minimise risk of contamination. Entry to the hospital will be via A&E Reception only unless advised otherwise (ref 1.7) and inform Silver Control. Once notification of Stand Down is received, manage the Stand Down procedure with the A&E Consultant, including Wembley MATS if used, and ACAD/Willesden (CMH incidents only) and the local PCT.

12 MAJOR INCIDENT ACTION CARD 4 Medical Director for the Incident (Senior Physician who is in overall control of the Hospital Response) Altered by: Switchboard Report to: Silver Control Alerts: Terminal Care Doctor 1. Ensure on arrival that A&E staff are organised into treatment teams. These teams will initially treat Priority 1 and Priority 2 patients. 2. Nominate a Senior Medical Liaison Service Office who will take responsibility for the preparation and provision of laboratory services. Ensure that Haematology and Transfusion services are available. 3. Nominate a Senior Surgeon and distribute his/her Action Card. 4. Nominate a Senior Physician. 5. Allocate a Medical and Surgical Consultant to act as discharge clinicians in all areas. 6. Review extra roles and ensure nominated lead in (see list on page 46/49) 7. Meet with discharge clinicians on a regular basis, ensure all processes and systems are in place to safely discharge patients and give regular feedback to Silver Control. 8. Ensure Gold Control are regularly briefed. 9. Agreed a business continuity plan with Gold Control and act as Medical Advisor for the running of the rest of the sites. 10. Allocate a Terminal Care Doctor to Silver Control. 11. Ensure all Clinical Directors review their medical staffing for hours of the incident.

13 MAJOR INCIDENT ACTION CARD 5 Senior Surgeon On-Call Altered by: Switchboard registrar acts up till consultant arrives Report to: Silver Control Centre Alerts: On Call Surgical Team 1. Control of the surgical response 2. Setting priorities for treatment and surgery for surgical casualties 3. Liaising with the Senior Physician regarding the surgical aspects of casualty priorities 4. Advising Treatment Teams on management 5. Appoint a Senior Surgeon pre-op and Senior Surgeon post-op and a Senior Surgeon Theatres as staff become available. If not yet available assume the responsibility of these staff in addition to your own. 6. Liaison with the Senior Surgeon pre-op and Senior Surgeon post-op regarding changing surgical priorities of casualties in pre-op 7. Liaison with the Senior Surgeon Theatres regarding theatre availability and usage, and the formation of operating teams 8. Liaison with the Senior Anaesthetist regarding provision for surgery 9. Liaise with Specialist Surgeon as required. 10. Operating debriefing of senior surgical staff involved in the Major Incident Response

14 MAJOR INCIDENT ACTION CARD 6 Operating Team Altered by: Switchboard Report to: Silver Control Centre Alerts: as indicated Team will consist of: Surgeons, Anaesthetists, Nurse/ODP 1. On formation proceed to the theatre indicated by the Senior Surgeon Theatres 2. Check equipment as necessary 3. Liaise with the Senior Nurse Theatres regarding equipment required for the procedures contemplated (some equipment may not be available) 4. Operate as agreed with the Senior Surgeon Theatres 5. Ensure any fragments of extrinsic material removed at operation are labelled with the Major Incident Casualty Number, and saved for forensic examination 6. Inform the Senior Surgeon Theatres if there is any change in projected operating time 7. Inform the Senior Surgeon Theatres once the time the operation will end is known

15 MAJOR INCIDENT ACTION CARD 7 Altered by: Switchboard Report to: Silver Control Centre Alerts: as indicated Consultant Radiologist 1. Liaise with the Senior Radiographer with regard to staffing within the x-ray departments 2. On being informed of a Major Incident proceed to the main x-ray department 3. Ensure that the departmental call in for relevant staff has been implemented 4. Ensure that the departments are cleared of all by the most urgent of non Major Incident cases 5. Liaise with the Medical Co-ordinator (Silver Control Room) with regard to the likely nature and duration of the hospital response. 6. Consider the need to institute a shift system for senior radiological staff later in the incident 7. Liaise with the Medical Co-ordinator and the Consultant Pathologist regarding the provision of forensic radiological investigations

16 MAJOR INCIDENT ACTION CARD 8 Altered by: Switchboard Report to: Silver Control Centre Alerts: as indicated Director of Nursing Or Deputy 1. Liaise with the Team Co-ordinator on duty, regarding action already taken 2. Liaise with Senior Nurse in A&E regarding the current state of the reception area 3. Ensure that the following posts are filled: Senior Nurse Pre-op/Post-op, Senior Nurse Theatres, Senior nurse ITU, Senior Nurse Wards, Senior Nurse Discharge Area 4. Liaise with the Medical Co-ordinator regarding current staffing levels 5. Assess the preparedness of key clinical areas by phoning: pre-op Post-op, ITU, Theatres, Admissions and establish any immediate requirements for additional sterile and non-sterile supplies, and laundry. 6. Continually liaise with the following key personnel: Senior Emergency physician, Senior Manager, Senior Nurse A&E, Senior Nurse pre-op, Senior Nurse Post-op, Senior Nurse Theatres, Senior Nurse ITU, Senior Nurse Admissions, Senior Nurse Discharge Area to ensure adequate nurse staffing, and to supervise. Advise key personnel on necessary staffing levels, and likely duration of the response once this becomes clear. Ensure that shift systems at adequate staffing levels and skills are instituted as soon as possible so that staff get maximum rest. 7. Consider the need for deployment of psychiatric nursing staff to key areas, and approach the psychiatric incident team nurse if necessary. 8. Report any difficulty in maintaining services in any areas to the Medical Coordinator 9. If necessary set up a receiving ward (depending which is already in use as pre-op/ post-op) to become post-op overflow. Ensure staff on this ward are fully briefed to carry out their tasks and issue appropriate action card to the Senior Nurse in the area.

17 MAJOR INCIDENT ACTION CARD 9 Altered by: Switchboard Report to: Silver Control Centre Alerts: as indicated Senior Nurse ITU 1. On being informed of a Major Incident inform all staff in ITU 2. Appoint one nurse to institute ITU call-in (including non duty consultants and technicians) 3. Assume the role of Senior Nurse ITU until relieved by a more senior ITU nurse 4. Assess the current ITU staffing and bed state. 5. Liaise with the Senior Intensivist regarding the predicted ITU bed availability 6. Liaise with the Senior Intensivist regarding the possibility of transferring current patients 7. Preparation of the maximum number of ITU beds for use by Major Incident casualties 8. Control of nursing in ITU, including liaison with the Senior Nurse for 24 hour shift cover at the necessary staffing levels and skills 9. Report by phone to the Senior Nurse once the predicted ITU bed availability is known. 10. Monitoring of ITU stores 11. Provision of hourly casualty statements to the Medical Co-ordinator 12. Operational debriefing of all ITU nursing staff involved in the Major Incident Response.

18 MAJOR INCIDENT ACTION CARD 10 Head of Communications Altered by: Switchboard Report to: Gold Control Centre Alerts: On call press office Mark Jonathan Street PR page: NHS England London Press on call leads ask for LON Attend Gold Control Centre. 2. Contact Mark Purcell at Jonathan Street PR if not done so already ( ). Out of hours - all media calls can be directed to this number if a press officer is not on site. 3. Establish the PRESS OFFICE and be prepared to receive all media enquiries assess need for external/agency support. At Northwick Park Hospital this should be the media and communications office (4b011). At Central Middlesex Hospital this should be the hot desking room in the Park Royal Suite. 4. Identify an area for members of the press to base themselves when/if on site (the PRESS RECEPTION/WAITING AREA). Encourage responsible behaviour within the hospital, working with security/police if necessary. 5. Liaise with Gold Command, Police (or other lead agency) in relation to the release of all press and public statements. 6. Ensure PCT and NHS London communications leads are advised and updated, (and DH Media Centre in relation to CBRN incidents) of all media communications. 7. Prepare statements on behalf of Gold Command, Chief Executive and A&E Consultant. Identify key spokespeople. 8. Advise and make appropriate arrangements for patients and relatives who agree to give media interviews. 9. Produce regular updates for all staff, patients and visitors as required in liaison with Gold Command. 10. Co -ordinate any VIP visits (liaising with the chief executive and director on call). KEEP A LOG OF ALL ACTIONS AND DECISIONS TAKEN DATE AND TIME

19 MAJOR INCIDENT ACTION CARD 11 Consultant Paediatrician Altered by: Switchboard registrar acts up till consultant arrives Report to: Silver Control Centre Alerts: On Call Paediatric and Neonatal Teams 1. Assume the role of Senior Paediatrician 2. Determine available paediatric facilities 3. Liaise with Senior Nurse Paediatrics 4. Locate Senior Physician and Senior Emergency Physician and determine the need for Paediatric Assessment Team. 5. Identify a suitable Paediatric Triage Officer 6. Proceed to the A&E department and advise on the management of children 7. Liaise and task PAT on arrival (with Medical Co-ordinator)

20 MAJOR INCIDENT ACTION CARD 12 Altered by: Switchboard Report to: Silver Control Alerts: Triage Officer, Mobile Team(s) A & E Consultant 1. Allocate, deploy Clinical Teams. Assume Clinical responsibility for departments. 2. Allocate medical staff resources including key posts listed on Manpower Board. 3. Liaise with on call medical staff with regard to scale of incident and need for additional medical manpower, including paediatric and psychiatric support. For Ophthalmic services: CMH call switchboard and ask for Consultant on call. NPH call ask for on-call consultant. 4. Be prepared to liaise with the Press Office & Police Documentation Team re: press and public statements and press briefings. 5. For advice/guidance or specialist advice on ALL incidents, call the Health Protection Agency London and request the on-call HPA. 6. For additional support or resources call the LAS CAC CMH only. If it seems likely that the ACAD Centre will be required for patients following A&E triage, the ACCIDENT CONSULTANT or DIRECTOR OF NURSING/DEPUTY will brief the ACAD Manager, who will then activate the departmental procedure. 8. Once notification of Stand Down has been received and after consultation with the Control Centre Manager make the decision on when normal working arrangements can be re-instated. 9. Debrief staff.

21 MAJOR INCIDENT ACTION CARD 13 Clinical Site Practitioner Altered by: Switchboard Report to: Switchboard to collect Major Incident Form then goes to Silver Control Centre Alerts: On Call Manager 1. Collect incident call log from switchboard. (CMH ONLY collect control centre keys) 2. Assume overall command of the incident until the arrival of the Control Centre Manager (Action Card 2) and Director of Nursing/Deputy (Action Card 3). Follow Action Cards 1 & 2 until relieved On Call Manager/On Call Executive. 3. Having assessed the detail of the incident, call out Head of Clinical Site Practitioners/Senior Site Practitioner (CMH only), off duty clinical site practitioners if required. 4. Provide most recent Bed State to update Silver Control Centre Status Board, liaising with the Assistant Clinical Site Practitioner. 5. If possible (eg delegate to Assistant Clinical Site Practitioner) advise all wards by phone of the incident; ask them to prepare for emergency ward rounds. 6. Liaise with Assistant Clinical Site Practitioner, Receiving Ward Nurse and Critical Care Co-Ordinator re Bed State and allocation of patients. 7. Maintain a record in the Control Centre of all patients discharged and/or transferred to other wards/sites. 8. Keep the Control Centre appraised of the bed situation on the Receiving Ward, and vacant beds in the hospital. 12. CMH only. If it seems that bed capacity will be insufficient additional in-patient beds may be sought from ACAD/Willesden hospital or Pine Ward via the resource co-ordinator. (References )

22 MAJOR INCIDENT ACTION CARD 14 Assistant Clinical Site Practitioner Altered by: Clinical Site Practitioner Report to: Control Centre Alerts: Ward managers on duty and calls out off duty site practitioners if required 1. Advise all wards of the incident and ask them to initiate staff call out procedures and prepare for emergency ward rounds and transfer of patients. 2. Inform Clinical Site Practitioner in Control Centre of Bed Status and advise of efficient bed allocation. 3. Liaise with Director of Nursing/Deputy to determine need for additional staff on wards. 4. Work with Discharge Clinician to identify suitable patients for discharge. 5. Liaise with Receiving Ward Nurse to place patients being cleared. 6. CMH Only if requested by the Control Centre or Clinical Site Manager - identify patients suitable for transfer to ACAD and/or Willesden Centre for Health & Care. Assist with transfer arrangements.

23 MAJOR INCIDENT ACTION CARD 15 On-Call Consultant Physician Altered by: Switchboard registrar acts up till consultant arrives Report to: Silver Control Centre Alerts: On Call Medical Team, Emergency Physicians, Care of the Elderly Physicians 1. Assist A&E Consultant, Surgical & Orthopaedic Consultants to determine whether additional medical staff are required to be called out in addition to on-call teams. 2. Arrange for staff to be contacted and if necessary, for continuing cover to relieve staff. 3. Ensure that sufficient medical staff are deployed to cover the areas where patients have been admitted. 4. Assist in clearing A&E of existing patients to home, GP s, UTC or other A&E. 5. Conduct ward rounds (or delegate to medical team) to identify patients fit for discharge. 6. Take responsibility for medical Major Incident admissions. At CMH Liaise with nominated Clinical Coordinator from ITU to assist with creating ITU capacity.

24 MAJOR INCIDENT ACTION CARD 16 On Call Consultant Orthopaedic Surgeon Altered by: Switchboard registrar acts up till consultant arrives Report to: Silver Control Centre Alerts: On Call Orthopaedics Team 1. Assist A&E Consultant and Medical & Surgical Consultants to determine whether additional medical staff are required to be called out in addition to on-call teams. 2. Arrange for staff to be contacted and if necessary, for continuing cover to relieve staff. 3. Assist in clearing A&E of existing patients to home i.e. GP s. 4. Conduct ward rounds (or delegate to team) to identify patients fit for discharge. 5. Work closely with Theatres to ensure these are open, staffed and ready to accept patients. Liaise with consultant surgeons to ensure adequate staffing. 6. Take responsibility for orthopaedic Major Incident admissions.

25 MAJOR INCIDENT ACTION CARD 17 Information Officer Altered by: Control Centre Manager Report to: Incident Control Centre Alerts: This role will be delegated by the Silver Control Manager to a manager or senior nurse whose main role is to provide an accurate record all the activity occurring in the Silver Control Centre to Gold and Vice versa. 1. Collect and wear tabard from Control Centre. 2. Assist Incident Control Centre Commander with the passing of information to ED, and Gold Control as required. 3. Work with the A&E Lead Receptionist and clinical site practitioner to maintain the Status Board up-to-date with all Major Incident patients and their treatments status by: Liaising with the Triage point; Liaising with all treatment areas; and Liaising with radiology and Critical Care Co-Ordinator, Receiving Ward Nurse and Assistant Clinical Site Practitioner 4. Work closely with the Police Family Liaison Team and Ambulance Liaison Officer so that all parties are working from consistent, up-to-date and accurate information, subject to the normal rules on confidentiality.

26 MAJOR INCIDENT ACTION CARD 18 A & E Nurse-in-Charge Altered by: Switchboard Report to: A&E Alerts: A&E staff & Reception; Mental Health Liaison Team/Nurse, off duty A&E staff 1. Collect and wear tabard from Control Centre. Ensure this Action Card is displayed by the LAS Hotline in the Majors Area at all times. 2. Inform UCC of Trust s Major Incident Status and ask them to commence rapid discharge procedures. 3. Allocate a member of staff to commence A&E staff call-in procedure on instruction from the Director of Nursing/Deputy. 4. Open up Major Incident Equipment Store and initiate setting up the Control Centre pending arrival of Clinical Site Practitioner. 5. Designate Nurses to take charge of areas within the department Triage, Resuscitation (RED) Majors (YELLOW) Minors (GREEN). Ensure all areas within department have sufficient equipment and consumables. 6. With A&E staff clear the department by directing non-urgent patients to the appropriate alternative area. 7. Ensure A&E receptionists use major incident documentation for ALL patients treated in A&E from the onset until Stand Down. 8. Allocate and re-deploy staff to A&E areas as appropriate request extra staff via Director of Nursing/Deputy 9. If Decontamination Shelter is requested by LAS, liaise with Emergency planning team regarding deployment and staffing. CBRN RESPONSE PLAN TO BE INITIATED WITH SPECIFIC ACTION CARDS. 10. After Stand Down ensure Major Incident Equipment Store is replenished as quickly as possible.

27 MAJOR INCIDENT ACTION CARD 19 Altered by: A&E Nurse-in-Charge Report to: A&E Alerts: Call in off-duty reception staff A & E LEAD Receptionist 1. Collect and wear tabard from Control Centre. 2. Call in off duty reception staff. 3. Ensure all patients arriving at Triage Point, and all patients arriving in the department during the incident (i.e. prior to Stand Down) utilize Major Incident Patient Documentation ONLY. 4. Ensure: each patient is numbered and documented accordingly using pre-prepared Major Incident Patient Folders. identity bracelet is placed on each patient; and patient notes remain with the patient while in the A&E. 5. Collect information on the location of the major incident casualties within the department and hospital and ensure the Information Officer is updated at least every fifteen minutes.

28 MAJOR INCIDENT ACTION CARD 20 Medical Triage Officer Altered by: A&E Consultant when present; at other times this will be the most experienced A&E doctor on duty Report to: A&E Alerts: 1. Collect and wear tabard from Control Centre. 2. Establish the Triage Point at the ambulance entrance and manage this area. 3. Ensure area is equipped with necessary diagnostic equipment and medical supplies that will be required for the Triage (TRTS) of patients. 4. Casualties will have been triaged by medical staff at the scene of the incident. Retriage these casualties on arrival and classify patients in accordance with the Major Incident procedure using Cruciform Triage Cards. 5. Direct patients to the appropriate receiving area within the department. Patients who have died en route will need to be confirmed as DOA (dead on arrival).

29 MAJOR INCIDENT ACTION CARD 21 Altered by: A&E Nurse-in-Charge Report to: A&E Alerts: Triage Nurse 1. Collect and wear tabard from Control Centre. 2. Collect Cruciform Triage cards from Control Centre. 3. Ensure area is equipped with necessary diagnostic equipment and medical supplies that will be required for the Triage (TRTS) of patients. (e g. swabs, gloves, BP ophthalmoscope, otoscope, clinical waste bin). 4. Work with Triage Officer at Triage Point at Ambulance Entrance, following Major Incident procedure for triage coding of patients and directing them to the appropriate receiving area within the department. Re-triage these casualties on arrival and classify patients in accordance with the Major Incident procedure using Cruciform Triage Cards..

30 MAJOR INCIDENT ACTION CARD 22 Altered by: A&E Receptionist Report to: A&E Alerts: Triage Clerk 1. Collect and wear tabard from Control Centre. 2. Collect Major Incident Patient documentation from Major Incident Store. DO NOT USE ICS SYSTEM. 3. Remain at Triage Point. Work with the Triage Officer and Triage Nurse at Triage Point at ambulance entrance. 4. Follow Major Incident procedures for triage coding of patients and directing them to the appropriate receiving area within the department. 5. Using Major Incident Patient information ensure: each patient is numbered and documented accordingly ONLY using preprepared Major Incident Patient Folders and Numbers Identity bracelet is placed on each patient & notes remain with the patient at all times keep the lead receptionist informed of attendance

31 MAJOR INCIDENT ACTION CARD 23 Altered by: A&E Nurse-in-Charge Report to: A&E Resuscitation Alerts: Resuscitation (RED) Area Lead Nurse(s) 1. Collect and wear tabard from Control Centre. 2. Manage the Resuscitation Area allocating staff where appropriate. 3. Manage non A&E staff 4. Inform Nurse in Charge of staff shortfalls or equipment deficits

32 MAJOR INCIDENT ACTION CARD 24 Altered by: A&E Nurse-in-Charge Report to: A&E Majors Alerts: Majors (YELLOW) Team Lead Nurse Area 1. Collect and wear tabard from Control Centre. 2. Manage the Majors Area, allocating staff where appropriate. 3. Inform Nurse in Charge of staff shortfalls or equipment deficits.

33 MAJOR INCIDENT ACTION CARD 25 Altered by: A&E Nurse-in-Charge Report to: A&E Minors Alerts: Minors (GREEN) Area Lead Nurse 1. Collect and wear tabard from Control Centre. 2. Manage the Minors Area, allocating staff where appropriate 3. Facilitate the discharge of A&E patients present prior to the major incident being declared, inform the nurse in charge when area is clear. 4. Direct new arrivals to the single Major Incident Triage Point. 5. Inform Nurse in Charge or Control Centre of shortfalls of staff, supplies and/or equipment.

34 MAJOR INCIDENT ACTION CARD 26 Altered by: Medical Director Report to: Silver Control Centre Alerts: Terminal Care Doctor 1. If a Terminal Care area is required as instructed by the Control Centre, ensure that the area identified is cleared and prepared to receive patients by making best use of available resources. 2. Work with the Terminal Care Nurse to provide appropriate care and facilities for these patients and their carers. 3. Liaise with chaplains or other pastoral/religious leaders. 4. Requests for additional staff and resources should be made the major incident control centre. Inform Gold Control Centre of activity at least every 30 minutes.

35 MAJOR INCIDENT ACTION CARD 27 Altered by: Director of Nursing/Deputy Report to: Silver Control Centre Alerts: Terminal Care Nurse 1. If a Terminal Care area is required as instructed by the Control Centre, ensure that the area identified is cleared and prepared to receive terminally ill patients by making best use of available resources. 2. Work with the Terminal Care Doctor to provide appropriate care for these patients and their carers. 3. Liaise with chaplains or other pastoral/religious leaders. 4. Requests for additional staff and resources should be made the major incident control centre.

36 MAJOR INCIDENT ACTION CARD 28 Altered by: Gold Control Centre Report to: Silver Control Centre Alerts: AAU Physician of the week 1. As receiving ward clinician on AAU, liaise with other medical staff in order to maximize bed availability on the receiving ward by discharging/transferring patients as appropriate. 2. Liaise with CCT/HART as required to mobilize support packages for those patients who require assistance from social services and other agencies. 3. Prepare receiving ward to receive major incident casualties and take clinical care of patients admitted. 4. If further beds are required, liaise with the Assistant Clinical Site Practitioner in order for additional beds to be vacated from wards. 5. Liaise with pathology/chemistry and highlight all discharge dependant patients awaiting blood results 6. Alert Pharmacy

37 MAJOR INCIDENT ACTION CARD 29 Altered by: On Duty Report to: Alerts: Call in off duty nursing staff AAU Nurse in Charge 1. Assist Receiving Ward Clinician in preparing Receiving Ward to receive major incident casualties and to take care of patients admitted. 2. Work with the discharge clinician to discharge patients or transfer patients to other wards (or hospitals). 3. Liaise with Assistant Clinical Site Practitioner and Silver Control Centre regarding Number of beds available for admissions Availability of staff. Stand down procedure Take records to the Control Centre when incident is over.

38 MAJOR INCIDENT ACTION CARD 30 Discharge Clinician (Delegated by the Medical Physician of Receiving Ward) Altered by: Silver Control Centre Report to: Silver Control Centre Alerts: 1. Report to the Discharge Point and ensure all patients leaving the hospital are checked and are physically suitable to be discharged. 2. Ensure TTA s and follow up arrangements (if required) are made. Record relevant information in the patients notes. You will work with the Discharge Coordinator (29) 3. Refer any cases where queries arise regarding return appointments, home support packages etc to the Discharge Coordinator.

39 MAJOR INCIDENT ACTION CARD 31 Discharge Coordinator Altered by: Clinical Nurse Practitioner Report to: Silver Control Centre Alerts: CCT/DRT/HART staff in line with departmental procedure 1. Ensure area identified for use as the Discharge Point is cleared of existing patients. 2. Ensure all patients leaving the hospital are checked by the Discharge Clinician. 3. Maintain a record of patients exiting via the discharge point. When the incident is stood down take list to control centre together with medical notes/x-rays. 4. Liase, via the Gold control centre with the PCT control centre if community resources/care is required for patients. 5. Check that patients leaving do so in possession of all Prescriptions Aids Possessions (including keys) Valuables Follow-up appointment 6. Ensure all ambulance and volunteer drivers collecting patients follow the designated route off the hospital site

40 MAJOR INCIDENT ACTION CARD 32 Altered by: Gold Control Centre Report to: Gold Control Centre Alerts: Own call out procedures Facilities Manager 1. Activate own departmental procedure, and inform Control Centre of current mobile phone number. 2. Ensure additional staff and frequencies are maintained in A&E and receiving areas, including trolleys and chairs. 3. Ensure additional porters and security are called in and deployed to A&E, Imaging and Theatres as required. 4. Ensure top-up supplies are made available via Exel. 5. Ensure CSSD & TSSU supplies/services are available as soon as required. 6. Ensure catering services provide support to Control Centres, A&E Staff Room, Theatres, discharge point and relatives waiting area 7. Procure additional transport and PTS resources to Discharge Point including volunteer car services. 8. Additional Medical supplies are available from LAS Central Ambulance Control via the control centre. 9. Brent PCT may request mattresses in the event Wembley Centre for Health and Care needing to open a temporary ward. These are stored at NPH level 2 and are clearly marked for Major Incident use facilitate their transfer to Wembley Centre for Health and Care.

41 MAJOR INCIDENT ACTION CARD 33 Altered by: Switchboard Report to: Gold Control Centre Alerts: Own Plan Head of Security 1. Open Gold Control Centre on designated site as instructed by clinical site practitioner. 2. Activate departmental procedure. 3. Ensure warning signs are placed at A & E and main hospital entrances which advise staff, visitors and non-urgent patients that a Major Incident is in progress. 4. Direct relatives/carers to the Relatives Area 5. Ensure designated areas are unlocked out of hours for Discharge Point, Terminal Care and Relatives Area 6. Ensure the appropriate levels of security are maintained in the rest of the hospital. 7. Liaise with Police officers on all appropriate issues. 8. In the event of a CBRN incident to minimise the risk of contamination the SILVER CONTROL CENTRE MANAGER will advise that all hospital entry points are to be closed and signed NO ENTRY with instruction of where to gain access to the hospital. Police assistance may be available to assist. Entry to the hospital will be via A&E only unless advised otherwise. 9. Take ALL Original Security incident log sheets immediately to the Control Centre when incident is over.

42 MAJOR INCIDENT ACTION CARD 34 Altered by: LAS Report to: Silver Control Centre Alerts: Ambulance Liaison Officer 1. Appointed by the LAS and is based in the Silver Control Centre in the A & E Department. Liaise with the Control Centre Personnel and senior key A&E staff. 2. Appraise the Control Centre of updates from the incident site, and passes on the Stand Down message when advised. 3. Adheres to LAS Ambulance Liaison Officer action card/role. 4. Liaise with Gold Control Centre for regular updates of incident. A Job profile for this role will be provided by LAS

43 MAJOR INCIDENT ACTION CARD 35 Switchboard Operator Altered by: LAS Report to: Switchboard Alerts: Staff identified in the Major Incident Call out procedure 1. On receiving a Major Incident Declared message, verify the caller s identity as being from the LAS, EBS or PCT (name). 2. Take down details on Major Incident Report Form A and read back details before exchanging name/initials at the end of the call. A copy of this is to be collected by clinical site practitioner. (CMH only the clinical site practitioner will also collect control centre key) 3. Immediately initiate Hospital wide Call-Out procedure in accordance with Major Incident Plan. 4. Seek additional operator support in accordance with local departmental procedure. 5. Liaise with the Gold Control Centre Manager, providing any additional information on the incident that is received. 6. Carry out any communications work requested by the Gold Control Centre Manager and other senior key staff. 7. Pass on ALL incident updates and enquiry details to the Control Centre.

44 MAJOR INCIDENT ACTION CARD 36 Altered by: Control Centre Manager Report to: Control Centre Alerts: Stand-by Officer 1. Set up a stand-by area for volunteering staff if requested by Control Centre Manager, and following discussion of options for size and location of facility required. 2. Pass on instruction and information from the Control Centre to volunteers, including escalation and Stand Down. 3. Record/track staff who prefer to stand-by in their own department (Take telephone contact number) 4. Record area to where staff have been allocated 5. When the incident is over take records to Control Centre

45 MAJOR INCIDENT ACTION CARD 37 Relatives Officer Altered by: Director of Nursing/Head of Nursing Report to: Control Centre Alerts: 1. Liaise with Support Services Manager to ensure that area is available and catering support is provided. 2. Exclude members of the press from the relatives area. 3. Correlate details of relatives waiting with details of next-of-kin held by Police Family Liaison Team in the control centre. 4. Liaise with Control Centre regarding release of information updates to relatives. 5. Liaise with Chaplain, Bereavement Councillor, social services and other personnel providing counselling and support to relatives 6. Prevent relatives from going to A&E. 7. Facilitate access to payphones. 8. Via Control Centre, access additional staff, or security and police support, as required.

46 MAJOR INCIDENT ACTION CARD 38 Chaplain Altered by: Switchboard Report to: Control Centre Alerts: Appropriate colleagues and religious leaders as necessary 1. Work closely with the Receiving Ward, Terminal Care, A&E, ITU and Relatives Area. Review the cultural and spiritual needs of patients and their immediate carers, and summon appropriate support from other faiths as necessary. 2. Liaise closely with Information Officer. 3. Liaise with the Bereavement Councillor 4. With reference to the London Churches Church Major Incident Multi-faith Plan (May 2003) you may be contacted to ensure pastoral arrangements are working correctly/check need for Chaplain back-up. (Copy held in control centre) 5. Arrange for ongoing support and advice to staff members, liaising with Occupational Health department as appropriate. 6. Ensure appropriate pastoral care for patients admitted, their carers and those returned to the community.

47 MAJOR INCIDENT ACTION CARD 39 Mental Health Liaison Nurse (on duty) Altered by: A&E Sister Report to: Control Centre Alerts: Senior Mental Health Manager bleep holder 1. Inform the senior mental Health Manager bleep holder of the incident. 2. Arrange for ongoing support and advice to staff and patients in A&E. 3. Assess and treat mental health patients in the Accident and Emergency Department and those who are triaged by the major incident triage team.

48 MAJOR INCIDENT ACTION CARD 40 Altered by: Switchboard Report to: Silver Control Alerts: Resuscitation Officer Senior/On-call Resuscitation Officer 1. Take over the Site Practitioners role of providing physical response to clinical emergencies in wards and departments. For example cardiac arrest calls paediatric and adult. 2. When required provide support and assistance to the Medical Registrar. This may include acting as Arrest Team Leader. 3. Assist with critical care emergencies in the A&E Department. 4. Work closely with the resource co-ordinator to ensure resuscitation facilities are provided in areas were deficits are identified 5.

49 MAJOR INCIDENT ACTION CARD 41 All Ward Areas Altered by: Clinical Site Practitioner/Director of Nursing Report to: Remain in ward area Alerts: 1. On receipt of information regarding major incident standby on alert the nurse in charge on each ward will Undertake an assessment of bed state Make an assessment of the likely availability of beds due to patient admissions/discharges over the next five hours in liaison with the relevant medical team Ensure all staff on duty are aware of incident 2. This information should be passed to the clinical site practitioner covering beds. 3. The nurse in charge will make arrangements for the curtailment of routine admissions and clinical activity to be put into action if instructed to do so by the Silver Control Centre Manager. 4. The nurse in charge will liaise with relatives of current inpatients regarding their ability to accept a discharge at short notice. 5. The nurse in charge will initiate the calling in off duty staff if requested to do so by the Silver Control Room. 6. Consideration will be given to the adequacy of stock levels, particularly medical and surgical items, plasma substitutes and pharmacy stock levels and action when accordingly. 7. Make an announcement on ward to all patients and relatives: Inform them that there has been a major incident and explain that we expect a high level of activity and therefore request that relatives/visitors leave the ward, and the hospital. Explain that some relatives will remain to help take home their loved ones. 8. Prepare to take patients from high dependency wards/beds.

50 MAJOR INCIDENT ACTION CARD 42 Altered by: Switchboard or Control Centre Report to: Silver Control Centre Alerts: Head of Midwifery 1. Attend silver control centre if required and called by control centre manager/ Director of Nursing if incident involves pregnant casualties. 2. Act as advisory role if pregnant casualties and inform on call obstetric teams. 3. Review bed situation in all maternity wards and update control centre. 4. Assess staffing levels in all maternity wards and review if assistance required in A&E or receiving wards for surgical trained recovery nurses. 5. Report staffing levels to Director of Nursing or Deputy 6. Be available to control centre if required and instructed by Director of Nursing.

51 MAJOR INCIDENT ACTION CARD 43 Altered by: Switchboard Report to: Silver Control Centre Alerts: as indicated Blood Transfusion Department CMH 1. Ensure that you can contact the Clinical Haematologist and tell him/her your contact details 2. Ensure that can contact the Haematology Lab Technician (BMS) and tell him/her your contact details. Ask for a quick assessment of current blood stocks 3. Prepare the MI clipboard for accurate transfusion log 4. Ensure that every patient is logged with MI number 5. Ensure that all clinicians are aware that blood requests are organised through you alone. A Group and Save sample should be sent early. Note the gender on the transfusion request form. 6. Ensure that every request for blood products and contact with Haematology Lab Technician (BMS) is recorded 7. Ensure that appropriate red cell transfusion requests are made according to the urgency: Immediate- O neg minutes- uncross matched Group specific red cells 60 minutes- fully cross matched red cells 8. Ensure that all pregnant women who need Anti-D are recorded for later follow up (to confirm Anti-D is given). 9. Ensure that all pre-operative patients are screened for sickle cell disease 10. Ensure that Lab is aware of any potential transfers out and that blood is packed correctly for transfer Ensure that the receiving hospital transfusion Lab is contacted re transfer

52 MAJOR INCIDENT ACTION CARD 44 Altered by: Switchboard Report to: Silver Control Centre Alerts: as indicated Blood Transfusion Department NPH 1. Ensure that you can contact the Clinical Haematologist and tell him/her your contact details 2. Ensure that can contact the Haematology Lab Technician (BMS) and tell him/her your contact details. Ask for a quick assessment of current blood stocks 3. Prepare the MI clipboard for accurate transfusion log 4. Ensure that every patient is logged with MI number 5. Ensure that all clinicians are aware that blood requests are organised through you alone. A Group and Save sample should be sent early. Note the gender on the transfusion request form. 6. Ensure that every request for blood products and contact with Haematology Lab Technician (BMS) is recorded 7. Ensure that appropriate red cell transfusion requests are made according to the urgency: Immediate- O neg minutes- uncross matched Group specific red cells 60 minutes- fully cross matched red cells 8. Ensure that all pregnant women who need Anti-D are recorded for later follow up (to confirm Anti-D is given). 9. Ensure that all pre-operative patients are screened for sickle cell disease 10. Ensure that Lab is aware of any potential transfers out and that blood is packed correctly for transfer 11. Ensure that the receiving hospital transfusion Lab is contacted re transfer

53 MAJOR INCIDENT ACTION CARD 45 Altered by: Switchboard Report to: Silver Control Centre Alerts: as indicated 1. Bereavement Officer

54 MAJOR INCIDENT ACTION CARD 46 Altered by: Switchboard Report to: Silver /Gold Control Centre Alerts: as indicated Loggist 1. Using the loggist book capture decisions made in the command control centre. 2. Use the Best Practice method 3. Attend the debrief meeting