Number here HMIP/01 HOSPITAL MAJOR INCIDENT PLAN YSBYTY GWYNEDD

Transcription

1 Version: 0.1 Number here HMIP/01 HOSPITAL MAJOR INCIDENT PLAN YSBYTY GWYNEDD Date to be reviewed: July 2013 No of pages: 98 Author(s): Emma Binns Author(s) title: Business Continuity Manager Responsible dept / director: Neil Bradshaw Planning Approved by: BCU Civil Contingencies Group / HMT Date approved: May 2012 Date activated (live): July 2012 Documents to be read Major Emergency Plan alongside this policy: Purpose of Issue/Description of current changes: This is the new operational Major Incident Plan for the Ysbyty Gwynedd site. This replaces the North West Wales Trust Major Incident Procedure. First operational: July 2012 Previously reviewed: Changes made yes/no: PROPRIETARY INFORMATION This document contains proprietary information belonging to the Betsi Cadwaladr University Health Board. Do not produce all or any part of this document without written permission from the BCUHB

2 INTRODUCTION The threat posed by modern environmental emergencies, terrorism, infectious diseases or major industrial accidents are likely to be the greatest challenge faced by the NHS in recent times. With a potential impact of increased demand, a reduced or compromised workforce and the challenges associated with remodelling the service to meet the needs of patients. Emergencies of this scale and nature would in themselves be unprecedented in nature and scale and thus requiring a whole systems approach to the problem. Following a major transition programme Betsi Cadwaladr University Health Board created a Major Emergency Plan that sets out how the BCUHB will react to such an emergency and how it will contribute to the overarching and co-ordinated multi-agency response. Furthermore, the plan will identify safe, workable systems that can be delivered to ensure that the public continues to receive a professional health service irrespective of whether their needs are as a result of the emergency or an underlying medical condition. The aim of the following plan is to outline how each District General Hospital site will respond to and manage a co-ordinated response to deal with a potential event. Not all aspects of the plan will be relevant to everyone, however, you should ensure that you read the sections pertinent to you and your department (including any departmental Major Incident Plans), so you are prepared should the Health Board be faced with the challenge of a Major Incident. 2

3 DOCUMENT CONTROL POLICY PROCEDURE PROTOCOL GUIDELINE Yes Yes No No Classification of document: Area for Circulation: Reference number: Corporate Health Board Wide HMIP/01 Version Number: 1 Original/previous Ref number: 0 Author Name and Job Title: Responsible Officer: Details of lead/responsible: Group/ Committee: Consulted Via: Ratified by: Ms Emma Binns, Emergency Planning Officer Mrs. Mary Burrows, Chief Executive Mr. Neil Bradshaw, Director of Planning Civil Contingencies Group BCU Civil Contingencies Group / HMT Board Date issued: July 2012 Review details: July

4 TITLE PAGE NO. INTRODUCTION 2 DOCUMENT CONTROL 4 PART 1 - DEFINITION OF AN EMERGENCY 5 PART 2 - ALERT LEVELS & TRIGGERS 8 PART 3 - ROLE OF THE ACUTE HOSPITALS 10 PART 4 - CO-ORDINATION AND MULTI AGENCY INTEGRATION 11 PART 5 PATIENT FLOW DIAGRAMS 12 PART 6 S 15 4

5 PART 1 DEFINITIONS & TRIGGER LEVELS Definition of an Emergency BCUHB defines a major emergency or a major incident as:- Any occurrence that presents a serious threat to the health of the community, disruption to the service or causes, or is likely to cause, such numbers or types of casualties as to require special arrangements to be implemented by a hospital(s), ambulance trusts or primary care organisation. BCUHB also recognises the wider Civil Contingencies Act definition as:- An event or a situation which threatens serious damage to human welfare in a place in the UK, to the environment of a place in the UK, or war or terrorism which threatens serious damage to the security of the UK. BCUHB also recognises certain events have the potential to rapidly overwhelm the local capacity respond, even with the implementation of major emergency plans. Therefore this plan takes account of mass casualty incidents and defines them as: A disastrous single or simultaneous event(s) or other circumstances where the normal major incident response of several NHS organisations must be augmented by extraordinary measures in order to maintain an effective, suitable and sustainable response. Declaration of an Emergency BCUHB can collectively declare a major emergency or individual hospitals and community or primary care responders can declare a major emergency when their own facilities and/or resources are overwhelmed. BCUHB recognises that other partner agencies may declare a major emergency which may not meet the above health definition and that the health definition might not result in a major emergency for others. BCUHB will activate an appropriate level of response to support other civil protection partners should they declare a major emergency. 5

6 Prioritisation Categories of Patients P1 (Red) immediate intervention within one hour life threatening P2 (Yellow) admission and early intervention within four hours P3 (Green) can wait for treatment usually the walking wounded All casualties will be triaged and labelled on site in accordance with the agreed casualty priority sorting code/labelling system Hospital Declaration In the majority of cases the alerting message will come from the Welsh Ambulance Service Trust and will be received by the Hospital Switchboard. The alert may also come via the Welsh Assembly Government, internally from a hospital, community or primary care area, any other NHS organisation such as the NPHS or via any of the emergency or statutory services. If a call is received directly by the Emergency Department then the ED staff member receiving the call must immediately inform switchboard. Scale of Emergency Beyond a Major Incident (DOH 2004) sets guidance and policy to assist the NHS to plan for a major incident of very serious proportions involving potentially large numbers of casualties. This Guidance defines the scale of a major incident in the NHS. Whilst many major incidents are triggered by big bang incidents such as traffic accidents, explosions etc, there are other potential circumstances where a major incident is triggered by a rising tide or non-acute traumatic event, eg, infectious disease outbreak, power cuts, covert radiation leakage. In such cases, the ambulance services may be involved but may not be the natural alerting organisation. The levels of incidents for which NHS organisations are required to develop emergency preparedness arrangements are: MAJOR for example multi vehicle motorway crashes. More patients will be dealt with, probably faster and with fewer resources than usual but it is possible to maintain the usual levels of service. MASS much larger scale events affecting potentially hundreds rather than tens of people, possibly involving the closure or evacuation of a major facility or persistent disruption over many days. These will require a collective response by several or many neighbouring authorities. CATASTROPHIC events that severely disrupt health and social care and other functions, for example mass casualties, power, water etc and that exceed even collective local capability within the NHS. 6

7 There are also events which occur on a national scale e.g. fuel strikes terrorist attacks, pandemic or multiple events that require the collective capability of the NHS nationally. A major incident may arise in a variety of ways: Big Bang: a serious transport accident, explosion or a series of smaller incidents. Rising tide: a developing infectious disease epidemic or a capacity/staffing crisis pandemic. Cloud on the horizon: a serious threat such as a major chemical or nuclear release developing elsewhere and needing preparatory action. Headline news: public or media alarm about a personal threat. Internal incidents: fire, breakdown of utilities, major equipment failure, hospital acquired infections; violent crime Deliberate release of chemical, biological or nuclear materials Mass casualties TRIGGERS The exact trigger point for initiating a major emergency will depend on the nature and the extent of the incident. Therefore the following situations may trigger a major emergency response: A significant incident that threatens to overwhelm the resources of a hospital site, community or primary care area. A significant incident that requires co-ordination of more than one hospital site, community or primary care area. An incident that crosses into the area covered by another Welsh Health Board or English Strategic Health Authority. An incident where greater mutual aid is required, such as on a regional or national basis. A significant internal incident within any hospital or community hospital whereby the daily running of the service is adversely affected necessitating special arrangements to be instigated. 7

8 PART 2 ALERT LEVELS BCUHB will operate at five levels of alert. These levels are described in detail on page 13 of the BCUHB Major Emergency Plan under Part 2 Alert Levels, Triggers and Activation. Alert Terminology The following Terminology will be used as Standard Messages used by the Ambulance Service: Notification The Hospital Switchboard will usually receive notification of a Major Incident (either as a 'standby' alert or a full declaration of a Major Incident) from Ambulance Control. Switchboard will verify the calling of a Major Incident with the declarer before implementing the Hospital s Major Incident Procedure. A Major Incident for the Hospital may also be declared by a Consultant/Senior Nurse in the Emergency Department or a Clinical Site Manager in consultation with the Senior Manager on duty/bronze on call in respect of an internal Major Incident. In an extreme situation, e.g. immediate risk, the Clinical Site Manager can declare a Major Incident. MAJOR INCIDENT STANDBY This alerts the hospital that a major incident may need to be declared at any of the 3 District General Hospital sites within North Wales. In the event of advance notice being received of a potential Major Incident (e.g. an aeroplane that has engine trouble or an incident in an adjoining hospital s locality, or an incident which has not yet been assessed by the emergency services but which sounds likely to be declared as a Major Incident), the Hospital Switchboard will receive notification from Ambulance Control, who will use the agreed term "Major Incident - standby". On receiving notification the Hospital Switchboard will notify key individuals via the Call Cascade, again using the phrase Major Incident, standby. The specific actions to be taken at this point are detailed within the individual/ departmental action cards. However the key elements to the response at this stage will be: 1. Alerting of relevant key staff 2. Setting up of Hospital Control Centre 3. Setting up of Major Incident signposting and marshalling around the Hospital site. 4. Holding back all non-urgent theatre patients 5. Establishing bed-state information 8

9 MAJOR INCIDENT DECLARED ACTIVATE PLAN The hospital needs to activate its plan and mobilise extra resources. A full Major Incident will be notified to Switchboard by Ambulance Control using the agreed term Major Incident declared. On receiving notification, the Hospital Switchboard will notify key individuals via the Major Incident Call Cascade to inform all relevant departments of the Major Incident, again using phrase Major Incident declared. The specific actions to be taken at this point are detailed within the individual/ departmental action cards. Many of the actions that are to be taken under standby are re-listed in this section to ensure that they are carried out if the Hospital is taken straight to full activation. They do not need to be repeated if a standby alert is upgraded to a full declaration. MAJOR INCIDENT CANCELLED This message rescinds at any time, either Major Incident Standby or Major Incident Declared. If a standby alert is cancelled, Switchboard will be advised and will then cascade this to all departments using the term "Major Incident - cancelled". The closing of a Major Incident from the Incident Site occurs with the receipt of the message Major Incident - casualty evacuation complete from Ambulance Control. In both cases the message should be passed to the Hospital Control Centre, who will then stand down individual departments within the Hospital, once it is appropriate to do so. In the event of an actual Major Incident, departments will only be stood down after the last patients to be evacuated from the Incident Site have arrived at the Hospital and passed through the particular department. Thus it can be expected that the Emergency Department will be the first department to be stood down, followed by others once they have finished treating all incident patients. MAJOR INCIDENT SCENE EVACUATION COMPLETE All receiving hospitals are alerted as soon as all casualties have been removed from the site. The Ambulance Incident Officer (AIO) will make it clear whether any casualties are still en route. HOSPITAL MAJOR INCIDENT This message would be used if a situation involving casualties, which does not affect other Emergency Services (except Ambulance) or Local Authorities, but does require special arrangements within the hospital. The alert message would be given by either the Consultant in Emergency Department Medicine, Associate Specialist in Emergency Department Medicine or Clinical Site Manager. An example would be the simultaneous arrival of a number of seriously injured casualties from two separate road traffic accidents. 9

10 PART 3 ROLE OF THE ACUTE HOSPITALS WHAT IS THE ROLE OF the acute site? The key roles and responsibilities of the hospital sites are to: - Provide the hospital s clinical response. Receive and triage casualties in the Emergency Department. Liaise with the WAST, other hospitals and partner agencies to manage the impact of the incident. Provide support to any designated receiving hospital that is substantially affected and in return, rely on mutual support if required. Maintain communications with relatives and friends of existing casualties and those from the incident, the local community, the media and VIP s. Provide on-site medical care and advice. Provide counselling advice and support in partnership with other agencies. Ensure the Health Board continues all of its essential functions and the maintenance, as far as possible, of normal acute health services. Ysbyty Gwynedd, Ysbyty Glan Clwyd and the Wrexham Maelor Hospital are the three receiving hospitals within North Wales in the event of a major incident. This means that depending on the geographical area of the incident, either site will receive the first casualties from any Major Incident occurring within North Wales. If all of the injured patients cannot be treated at one specific site, some will be directed to other hospitals; this will be determined by the Ambulance Service according to the nature and location of the incident. Whilst a Major Incident is in progress, in addition to being designated the receiving hospital, the site will still receive emergency medical and surgical admissions from it s catchment area. It may therefore be necessary to divert such admissions to neighbouring hospitals. 10

11 PART 4 CO-ORDINATION AND MULTI AGENCY INTEGRATION The command and control of major emergencies by BCUHB will be in accordance with the Strategic (Gold), Tactical (Silver and Operational (Bronze) Command Structure as follows below :- COMMAND DEFINITION ACTION Gold Silver Bronze Strategic Command of the Incident Tactical Command of the Incident Operational Command of Response Provide the strategic management and co-ordination of BCUHB resources during the emergency by ensuring secondary, community and primary care service delivery for both the incident and for normal operational delivery. Establishes and communicates policy and determines priorities for the tactical command to implement. Allocate resources to ensure appropriate tactical and operational response. Establish strategies for the return to normality. Communicates with the Welsh Assembly Government and the public. Actively or passively represents the BCUHB at the Strategic Co-ordination Centre. At BCUHB level provide the tactical management and coordination of resources during the emergency by directing secondary, community and primary care services. Implement the strategic policy and priorities. Prioritise the allocation of resources. Liaison with other agencies and ensuring effective coordination of the tactical response. Direct Bronze commander(s) according to the requirements of the incident. Co-ordinate multiple hospital responses and deliver a primary care response Operationally manage all resources in line with strategic direction and established priorities to provide an acute response. 11

12 PART 5 MAJOR INCIDENT PROCEDURE PATIENT FLOW WEST INCIDENT SITE EMERGENCY DEPARTMENT OR MAIN WAITING AREA P1 P2 P3 EMERGENCY DEPT RESUSCITATION AREA MAIN EMERGENCY DEPT TREATMENT AREA MINORS AREA BEUNO WARD STAFF DINING ROOM TRAUMA OPERATING THEATRES 2, 6 OR 7 TUDNO WARD OR CYBI WARD OR TRYFAN WARD HOME THROUGHOUT A MAJOR INCIDENT, THE ROUTINE EMERGENCY WORK OF THE HOSPITAL MUST BE ACCOMMODATED AS FAR AS POSSIBLE. 12

13 MAJOR INCIDENT PROCEDURE PATIENT FLOW CENTRAL Triage Area Ambulance Entrance Accident Department P1 P2 P3 Resuscitation Area A/E Department Rooms Area A/E Department Fracture Clinic and adjacent Minor Injuries Area Accident Department 1 st four Only P1 Surgical cases Subsequent P1 Surgical Cases All P2 Surgical Cases All P1 and P2 Medical Cases P3 requiring admission P3 Cases Not requiring admission Walking Wounded Imminent Surgical Holding Area Theatre 7 and 8 Acute Surgical and Medical Receiving Wards: Surgical Ward 4 Medical AMU / designated medical ward Pre Discharge Holding Area Physiotherapy Department General Theatres 1-8 Acute General Medical/ Surgical Wards Ward 4 Intensive care Coronary Care 13

14 MAJOR INCIDENT PROCEDURE PATIENT FLOW EAST INCIDENT SITE EMERGENCY DEPARTMENT P1 P2 P3 1. EMERGENCY DEPARTMENT RESUSCITATION AREA 2. FRACTURE CLINIC OUT PATIENTS DEPARTMENT STAFF DINING ROOM MAIN THEATRES ADMISSION WARD HOME THROUGHOUT A MAJOR INCIDENT, THE ROUTINE EMERGENCY WORK OF THE HOSPITAL MUST BE ACCOMMODATED AS FAR AS POSSIBLE. 14

15 PART 6 HOSPITAL S PAGE NO. Switchboard 16 Clinical Site Manager (CSM) 19 Hospital Incident Commander (HIC) 21 Nursing Incident Commander (NIC) 24 Medical Incident Commander (MIC) 28 Hospital Control Centre (HCC) 29 ED Consultant 32 Senior Clinical Site Manager / Clinical Site Manager B 34 Estates Facilities Cell 35 Information Management Cell 36 Non Acute Services Cell 37 Staffing Cell 38 Support Services Cell 39 Ambulance Liaison Officer 40 Police Liaison Officer 41 Discharge Support Team 42 Nursing Staff Co-Coordinator 44 Pharmacy 45 Catering 46 Mobile Medical Team 47 HSDU/CSSD 51 Junior Doctor 52 Consultant On Call Orthopaedics 54 Consultant On Call Surgery 55 Consultant On Call Paediatrics 56 Pathology Blood Transfusion 58 Pathology Shift Biomedical Scientist (BMS) Clinical Biochemistry 59 Pathology Mortuary Manager 60 Chaplaincy 61 Traffic Controller 63 Senior Porter 64 Medical Records Officer 65 Volunteer Co-Coordinator 66 Relatives Officer 67 Media Liaison Manager 68 Clinical Nurse Manager / Acute Matron (PCSM CPG) 69 Locality Matron 70 Hospital Social Work Service Procedure 71 Radiology Action Card 1 72 Radiology Action Card 2 73 Anaesthetics Department Theatres ITU

16 SWITCHBOARD Notification The Switchboard will usually receive first notification of a Major Incident from the Ambulance Service, however, a Major Incident could be declared by a member of the senior medical/nursing team in the Emergency Department and/or the Clinical Site Manager. The words Major Incident, standby or Major Incident declared should be used. Standby notification will be given when a potential Major Incident has been notified to the Ambulance Service but they have not yet reached the incident site to assess its scale, or when an incident is thought likely to escalate to a scale that would require activation of the Major Incident Procedure within the Hospital. Call Received from Ambulance The telephonist should then call back Ambulance Control to verify the authenticity of the Incident alert. Call Received from Emergency Department Take the callers name and number ask them to leave the line free and tell them you will call them back immediately to verify the call. METHANE Report The telephonist will then ask for the following information this should be noted on the correct pro-forma attached to the Call Cascade. Identity of caller Major Incident Exact location of incident Type of incident Hazards present at the site Access to the incident site Approximate Number of casualties Emergency Services currently at the site On receiving notification the Hospital Switchboard will notify key individuals via the Crash/Fire Bleep System, using the phrase Major Incident, Standby. The telephonists should then immediately start to alert key members of staff, according to the call cascades at the end of this document. There are two lists - one for use during normal working hours, the other for out of hours, weekends and bank holidays. 16

17 SWITCHBOARD - CONTINUED Staff and departments should be contacted in the order they appear on the list (but if an individual cannot be located quickly the switchboard operator should continue down the list before trying again to contact those individuals who could not be reached the first time). Each individual should be given the same message: "The Hospital has been placed on Major Incident Standby. Please activate the standby phase of your Major Incident response." As each individual is contacted a note should be made on the call-out list of their name and the time they were contacted. It is essential that these people are contacted as quickly as possible - for this reason the switchboard operators should make all of these calls without answering any incoming calls to the main switchboard. If on-call staff have to be paged, the message should be for them to ring in to line ( ). This will enable switchboard staff to identify incoming calls that need to be answered as part of the response. If more than one switchboard operator is present the individual receiving the notification should make these calls whilst the other can continue to deal with incoming calls. The Clinical Site Manager will identify a member of staff to assist switchboard with incoming calls of a complex nature. The Hospital Switchboard need to complete the telephone call cascades. If the alert is then confirmed (by receiving a Major Incident declared message from Ambulance Control) the call out process should then be followed according to the procedure described in INCIDENT DECLARED below. The switchboard operator should then re-contact those members of staff who have been placed on standby notification, informing them that the alert is declared. MAJOR INCIDENT CANCELLED If you receive a message stating that the Major Incident has been cancelled ring Ambulance Control to check the message and then notify key individuals via the crash/fire bleep system using the phrase Major Incident Cancelled then re-contact those members of staff who have been placed on standby/declared informing them that the Major Incident is cancelled. MAJOR INCIDENT STAND DOWN When you receive confirmation from the Hospital Control Centre that the incident has been stood down notify key individuals via the crash/fire bleep system using the phrase Major Incident Stand Down then re-contact those members of staff who have been placed on standby/declared stating that the Major Incident has been stood down. 17

18 MAJOR INCIDENT NOTIFICATION YSBYTY GWYNEDD Please complete all details this will be collected by the Clinical Site Manager MAJOR INCIDENT STANDBY / DECLARED IDENTITY OF THE CALLER AND ORGANISATION CALLING FROM E.G. WAST MAJOR INCIDENT STANDBY OR DECLARED EXACT LOCATION OF INCIDENT. TYPE OF INCIDENT (EG FIRE, RTC). HAZARDS PRESENT AT THE SITE. ACCESS TO THE INCIDENT SCENE. APPROXIMATE NUMBER OF CASUALTIES. EMERGENCY SERVICES AT THE SCENE. DATE : TIME : NAME OF PERSON TAKING CALL : TITLE OF PERSON TAKING CALL : SIGNED : 18

19 CLINICAL SITE MANAGER The Clinical Site Manager (CSM) will initially carry out the role of the Nursing Incident Commander (NIC). The CSM will contact the NIC, HIC, ED Consultant and the Physician on-call to determine the appropriate hospital response having considered the METHANE Report received from WAST. MAJOR INCIDENT STANDBY 1. Proceed to the switchboard and collect the METHANE Report to take to the Hospital Control Centre (HCC). 2. Identify a suitable individual (a loggist could be used) to proceed to switchboard and assist with telephone calls of a complex nature. A list of trained loggists and their contact details (both in and out of hours) can be found on the On-Call website. 2. Establish Hospital Control Centre, in the Executive Seminar Room (Major Incident Briefcase is stored in the cupboard in the boardroom, telephones are stored in the cupboard in the Seminar Room ensure tables and chairs are in position and install telephone handsets. 3. Ensure that up to date bed information on bed states across all wards is available. 4. Start recording all telephone calls and decisions in the Major Incident Log Books. 5. Contact the Senior Clinical Site Manager or if unavailable a second Clinical Site Manager who can perform the role of Clinical Site Manager B. 6. When the Senior Clinical Site Manager / CSM (B) arrives at the HCC, proceed to the Emergency Department. 7. Notify the HCC of his/her arrival in the ED. 8. Liaise with the HCC to establish anticipated numbers of patients and the time before arrival to determine whether existing inpatients could be moved to enable a dedicated ward to be allocated for the admission of patients. 9. Assist ED in clearing the Department by identifying beds for the rapid admission of patients currently within the Department. 10. Liaise with the Discharge Support Team about the discharge and transfer of patients and the resulting bed availability. MAJOR INCIDENT DECLARED 19

20 1. Ensure that all the steps above at Major Incident Standby have been carried out. 2. Liaise with the HCC to establish anticipated numbers of patients and the time before arrival to determine whether existing inpatients should be moved to enable a dedicated ward to be allocated for the admission of patients. 3. At the direction of the HCC, liaise with wards, junior medical staff and Portering staff to relocate existing patients within the Hospital. DURING THE INCIDENT 4. The CSM will identify the ward to which the patient will be admitted once decision to admit has been made. 5. If necessary the CSM will work with Junior Medical Staff and wards to co-ordinate the transfer of existing inpatients between wards to ensure that appropriate ward accommodation is provided for patients with specific needs. 6. The CSM will ensure that up to date information on bed states is relayed to the Ambulance Liaison Officer for onward transmission to the Medical Incident Officer at the incident site. 7. If insufficient beds are available for the expected number of patients the CSM must inform the HCC of this. The HCC will decide whether to seek patients for transfer to other hospitals or discharge home. 8. Throughout the incident the CSM will communication and liaise closely with the Senior CSM / CSM (B) and ensure that up to date information on bed states and patient flow is available in the HCC. 20

21 HOSPITAL INCIDENT COMMANDER (HIC) The Hospital Incident Commander will initially be the Bronze On Call and will have responsibility for co-ordinating the hospital s response to the incident if the Bronze on Call does not feel suitably experienced to act as the Hospital Incident Commander they can delegate this role to a more operationally experienced member of the on-call team such as an Associate Chief Of Staff for Medicine, Surgery, Anaesthetics, Women & Families. The HIC will co-ordinate the arrangements for the reception of patients, will liaise with supporting hospitals, make arrangements for the provision of extra staffing and determine the priorities for the treatment of patients. The CSM will be responsible for contacting the HIC, ED Consultant and the Physician on Call to determine the appropriate hospital response having considered the METHANE Report received from WAST. MAJOR INCIDENT STANDBY Ensure Hospital Control Centre is appropriately staffed and the following are identified and availability is confirmed to attend if necessary:- On Call Silver Duty Manager Five members of the On-Call Management Team (In hours Executive PAs will have contacted five members of the Bronze On Call (Out of hours Bronze on call will be responsible for doing this). Four Loggists details available on the On Call website. 1. Consider the SITREP (METHANE) in terms of the short, medium and long term consequence. 2. Identify the bed status/ staffing for ED, Medical, Surgery, Theatres, Critical Care, Admissions Ward, Community Hospitals. 3. Consider the cancellation of non-urgent elective, inpatient day case and outpatient activity taking advice from the NIC and MIC. 4. Determine staffing status:- Facilities Diagnostics Nursing Catering Pharmacy 5. Ensure that a detailed log is maintained throughout the incident (log books available in HCC). 21

22 MAJOR INCIDENT DECLARED 1. Activate arrangements outlined at Major Incident Standby. 2. Task the NIC to oversee patient flow, ambulance liaison, patient discharge, outpatients, ED, Surgery, Medicine, Women Services and Children Services. 3. Task the Physician to liaise with medical colleagues and support effective clinical management. 4. Task the five members of the On-Call Management Team to oversee the following cells:- i. Information Management Cell including media liaison, public enquiries, switchboard, administrative support. ii. iii. iv. Estates/Facilities Cell Portering, Hotel Services, Laundry, Traffic, Utilities, Equipment, Security. Support Services Cell Police Documentation Team, Relatives, Medical Records, Pathology, Mortuaries, HSDU/CSSD, Pharmacy and Physiotherapy, IM&T, Radiology, Theatres. Non Acute Services Cell Community Care, Primary Care and Mental Health Liaison, Hospital Social Worker, Voluntary Aid Societies. v. Staffing Cell Medical Staffing, Nurse Bank, Occupational Therapy?, Staff side Liaison, Human Resources. 6. Action Cards to be issued and signed and appraisal of the situation provided. 7. Acknowledge and act where appropriate on any site/incident specific plans i.e. decontamination plans. 7. Ensure hospital communications are implemented i.e. two way radios or other systems used within the hospital. 8. Admissions Ward to be identified and made ready to receive patients:- YG Tudno Ward. YGC Ward 4. Wrexham Awaiting identification 9. Identify a suitable Senior Registrar (incident dependant) to be placed in charge of patients admitted from the incident to the dedicated ward. 10. Other medical staff to be deployed appropriately in accordance with action cards. 22

23 11. Specialist Units to be alerted (depending on the incident). 12. Co-ordinate the allocation of manpower, equipment, blood products, oxygen etc at the hospital site/major incident site) if requested. 13. Determine when it is appropriate to stand the hospital down in its entirety or component parts, ensuring that all records are secured and that an appropriate debrief is scheduled to take place at the earliest opportunity. 14. Write a summary report for the Chief Executive. 23

24 NURSING INCIDENT COMMANDER (NIC) The Nursing Incident Commander (NIC) will initially be the Clinical Site Manager and will have responsibility for working with the HIC and the MIC to support the operational response. The CSM will be responsible for contacting the HIC, ED Consultant and the Physician on Call to determine the appropriate hospital response having considered the METHANE Report received from WAST. MAJOR INCIDENT STANDBY Support Bronze On-call, the MIC and ED Consultant in determine the appropriate hospital response having considered the METHANE Report received from WAST. If appropriate: - 1. Establish Hospital Control Centre in the Executive Seminar Room (Major Incident Briefcase is stored in the cupboard in the boardroom; phones are stored in the cupboard in the Seminar Room. 2. Ensure that up to date bed information on bed states across all wards is available. 3. Designate a Nurse to take over the CSM role (patient flow) until relieved by a senior member of the CSM Team. 4. Develop a plan to optimise capacity to admit and discharge patients taking account of patient flow in site specific diagrams and staffing demand. 5. Ensure that processes are in place to bring in additional nursing staff and equipment. MAJOR INCIDENT DECLARED 1. Activate arrangements outlined at Major Incident Standby. 2. Oversee patient flow, discharge outpatients, ED, Surgery, Medicine and Women and Children s Services. 3. Liaise with the ambulance Maintain up to date information on bed status. 4. Consider redeployment of staff to critical areas. 5. Liaise with the Consultant Anaesthetist on-call (who will attend the ED) and the Hospital Control Centre to identify availability of ITU/ICU beds in neighbouring hospitals. 6. Oversee and support the creation of capacity in ED by expediting discharge. 24

25 MAJOR INCIDENT PROCEDURE PATIENT FLOW WEST INCIDENT SITE EMERGENCY DEPARTMENT OR MAIN WAITING AREA P1 P2 P3 EMERGENCY DEPT RESUSCITATION AREA MAIN EMERGENCY DEPT TREATMENT AREA MINORS AREA BEUNO WARD STAFF DINING ROOM TRAUMA OPERATING THEATRES 2, 6 OR 7 TUDNO WARD OR CYBI WARD OR TRYFAN WARD HOME THROUGHOUT A MAJOR INCIDENT, THE ROUTINE EMERGENCY WORK OF THE HOSPITAL MUST BE ACCOMMODATED AS FAR AS POSSIBLE. 25

26 MAJOR INCIDENT PROCEDURE PATIENT FLOW CENTRAL Triage Area Ambulance Entrance Accident Department P1 P2 P3 Resuscitation Area A/E Department Rooms Area A/E Department Fracture Clinic and adjacent Minor Injuries Area Accident Department 1 st four Only P1 Surgical cases Subsequent P1 Surgical Cases All P2 Surgical Cases All P1 and P2 Medical Cases P3 requiring admission P3 Cases Not requiring admission Walking Wounded Imminent Surgical Holding Area Theatre 7 and 8 Acute Surgical and Medical Receiving Wards: Surgical Ward 4 Medical AMU / designated medical ward Pre Discharge Holding Area Physiotherapy Department General Theatres 1-8 Acute General Medical/ Surgical Wards Ward 4 Intensive care Coronary Care 26

27 MAJOR INCIDENT PROCEDURE PATIENT FLOW EAST INCIDENT SITE EMERGENCY DEPARTMENT P1 P2 P3 1. EMERGENCY DEPARTMENT RESUSCITATION AREA 2. FRACTURE CLINIC OUT PATIENTS DEPARTMENT STAFF DINING ROOM MAIN THEATRES ADMISSION WARD HOME THROUGHOUT A MAJOR INCIDENT, THE ROUTINE EMERGENCY WORK OF THE HOSPITAL MUST BE ACCOMMODATED AS FAR AS POSSIBLE. 27

28 MEDICAL INCIDENT COMMANDER (MIC) The Medical Incident Commander will be the Duty Physician On Call/Anaesthetist On Call until relieved by the Assistant Medical Director (if available) and will have responsibility for co-ordinating the hospital s response to the incident along with the HIC and the NIC. MAJOR INCIDENT STANDBY Support the CSM, Bronze On-call and ED Consultant in determining the appropriate hospital response having considered the METHANE Report received from WAST. MAJOR INCIDENT DECLARED 1. Ensure that a detailed log is maintained throughout the incident. 2. Liaise with the On-Call Consultants and NIC within the HCC to ensure the effective deployment and management of medical staff. 3. Co-ordinate the prioritisation of individual patient management with clinical colleagues in the context of competing priorities. 4. Provide a central point of contact for clinical decision making dealing with organisations and agencies beyond the hospital. 5. Oversee and advise on patient safety matters particularly in regards to capacity and pinch points which might affect maximising patient flow. 6. Liaise with senior clinical colleagues to ensure they have their departmental plans ready to activate and determine whether they require any support. 7. Write a summary report for the Chief Executive. 28

29 HOSPITAL CONTROL CENTRE (HCC) The HCC is a designated area which will be established by the CSM to facilitate coordination of the whole hospital response. The HCC will be managed by the Hospital Control Team consisting of:- Hospital Incident Commander (HIC) Nursing Incident Commander (NIC) Medical Incident Commander (MIC) 5 members of the On-Call Management Team 4 Loggists The rooms are located as follows:- Wrexham Maelor Hospital The Group Quiet Room OT Department Ysbyty Glan Clwyd The Foyer, Post Grad Centre Ysbyty Gwynedd Seminar Room, Executive Corridor the Major Incident Briefcase is stored in the cupboard in the boardroom, telephones for the HCC are stored in the cupboard in the Seminar Room. DEFINITION OF A HOSPITAL MAJOR INCIDENT The number or types of casualties require special arrangements to be implemented by the hospital and jeopardise the delivery of core hospital services. INITIAL ACTIVATION (MAJOR INCIDENT STANDBY) Upon receipt of notification of an incident the HIC, the NIC and the MIC together with the ED Consultant will determine an appropriate level of hospital response. ACTIVATION (MAJOR INCIDENT DECLARED) Upon receipt of notification of a major incident the CSM (NIC) will set up the HCC, the HIC and MIC will attend the HCC and collect and fulfil their action cards. FORMAL HANDOVER PROCESS To ensure an appropriately skilled and experienced Hospital Management Team, the initial responders can formally handover to more senior colleagues using a formal handover process. Switchboard notifies Initial Response On-going Response Role CSM ADNS/ACOS (nursing) NIC (can assume the role of HIC if deemed more appropriate) Handover procedure Bronze On-call ACOS (Ops) / DGM with HIC acute operational experience. Physician On-call AMD MIC 29

30 MAJOR INCIDENT HIERACHY To ensure effective response which is supportive of the overall multi-agency response BCU adopts a Bronze (Operational); Silver (Tactical) and Gold (Strategic) model. Essentially this means that Bronze will manage the operational response at a hospital or community level, Silver will co-ordinate multiple hospital responses and deliver a primary care response.gold will set strategy and ensure a multi-agency approach. 30

31 HANDOVER PROCEDURE ROLE : NAME : HIC MIC NIC (PLEASE CIRCLE) TITLE : DATE : TIME : SIGNATURE : HANDED OVER TO : NAME : TITLE : DATE : TIME : SIGNATURE : REASON FOR HANDOVER : 31

32 EMERGENCY DEPARTMENT (ED) CONSULTANT The ED Consultant/Associate Specialist on-call will be contacted by the Nursing Incident Commander (NIC) who, together with the Physician on-call, will determine the appropriate hospital response having considered the METHANE Report received from WAST. It is important to recognise that the key responsibilities of the ED consultant on-call lie in the co-ordination, tasking and supervision of medical staff & clinical services and not in the direct provision of hands-on care. MAJOR INCIDENT STANDBY The Consultant On-Call will: 1. Attend the Hospital Control Centre to determine appropriate hospital response. 2. Ensure that the ED has been informed of the standby alert. 3. Inform the Hospital Control Centre of his/her attendance within the ED and continue to exchange current information on the potential incident. 4. Liaise with Consultant in Anaesthetics (+/- other relevant specialities as determined by nature of incident, e.g. paediatrics) and provide current information on the potential incident. MAJOR INCIDENT DECLARED The Consultant On-Call will: 1. Attend the Hospital Control Centre to determine appropriate hospital response if not already done at standby. 2. Inform the Hospital Control Centre of his/her attendance within the Emergency Department and continue to exchange current information on the incident. 3. Ensure that a member of clerical or support staff has commenced calling other ED medical staff by telephone as decided by the ED Consultant 4. Liaise with the Hospital Control Centre if additional nursing or medical staff need to be requested from other departments or wards. 5. Ensure there is a designated Casualty Triage Officer e.g. experienced Emergency Physician or other doctor with appropriate training. 6. Oversee the treatment of Priority 1 patients within the ED. 32

33 EMERGENCY DEPARTMENT (ED) CONSULTANT continued.. 7. Ensure that suitable staff (e.g. ED doctor/nurse or appropriate speciality e.g. medicine) are allocated to ED patients not involved in the major incident and that their transfers/discharge are being expedited. Low-acuity patients should be redirected if possible to their GP or an alternative MIU/ED. 8. Advise the Hospital Control Centre if it looks likely that the ED is at risk of being significantly overwhelmed and the possible need to divert patients to other Emergency Departments. 9. Maintain close contact/liaison with the Hospital Control Centre and the Senior Nurse in the ED, especially in the Resus area. 10. Following stand-down supervise the return to normal function 11. Ensure a debrief takes place within a suitable timeframe (not usually the same day). 33

34 SENIOR CLINICAL SITE MANAGER / CSM B The Senior Clinical Site Manager will support the Hospital Management Team in coordination of the incident within the Hospital Control Centre. The Senior CSM will do this by assisting the Nurse in Charge, liaising with the CSM in relation to patient flow and ensuring clinical staff resources are sufficient to facilitate patient flow. If the Senior Clinical Site Manager is not available this role will be carried out by a Clinical Site Manager (CSM B). MAJOR INCIDENT STANDBY The Senior CSM will be contacted by the on site CSM (or via the Major Incident bleep if during working hours) and will report to the HCC. 1. Take a handover from the Clinical Site Manager on duty (CSM A) and continue to set up the HCC ensuring tables and chairs are in position and installing telephone handsets. 2. Start recording all telephone calls in the Major Incident Log Books. 3. Liaise with the Discharge Support Team about the discharge and transfer of suitable patients and the resulting bed availability. MAJOR INCIDENT DECLARED 1. Proceed to the Hospital Control Centre. 2. Take a handover from the Clinical Site Manager on duty (CSM A) and continue to set up the HCC ensuring tables and chairs are in position and installing telephone handsets. 3. Start recording all telephone calls in the Major Incident Log Books. 4. Oversee patient flow by ensuring sufficient clinical staffing is available in each of the critical areas receiving patients, that bed capacity is made available to meet the anticipated numbers of patients and that specialities are ready to receive critical patients. 5. Liaise with the Discharge Support Team about the discharge and transfer of suitable patients and the resulting bed availability. 6. During a protracted incident the Senior CSM (CSM B) will need to arrange a roster system for the CSM Team and the Discharge Team, this will ensure that effective site management and discharge planning can be maintained throughout the duration of the incident. 34

35 ESTATES & PATIENT SERVICES CELL The role of the Estates & Patient Services Cell is to ensure the efficient management and provision of the services listed below. This role will be carried out by a member of the Bronze On Call Team. Consider an appropriate manager with a knowledge of Estates / Patient Services. MAJOR INCIDENT DECLARED 1. Proceed to the Hospital Control (HCC) to be briefed and tasked by the Hospital Management Team. 2. The Estates & Facilities Manager will then co-ordinate and oversee matters relating to:- Portering Services. Hotel Service provision including catering and laundry. Continuity of utility services. Security if necessary. Provision and distribution of equipment as required. Traffic Management. 3. The Portering Manager will have been contacted as part of the Hospital Call Cascade and will report to the HCC. 35

36 INFORMATION MANAGMENT CELL The role of the Information Management Cell is to ensure efficient management of all information relating to the incident and will be carried out by a member of the Bronze On Call Team. MAJOR INCIDENT DECLARED 1. Proceed to the Hospital Control to be briefed and tasked by the Hospital Management Team. 2. Contact Loggists and request attendance at the HCC and other key areas. The list of names and contact numbers of loggists can be accessed via the On-Call Managers website. 3. The Information Manager will then co-ordinate and oversee matters relating to press and media enquiries. 4. Maintain hospital status whiteboards. 5. Co-ordinate and oversee the communication between Enquiries and Relatives areas. 6. Provide a point of contact for Police Liaison. 7. Provide a point of contact for switchboard and any support required by switchboard. 8. Write situation reports on behalf of the Hospital Management Team. 36

37 NON ACUTE SERVICES CELL The role of the Non Acute Services Cell is to ensure the efficient management and provision of non acute services as listed below. This role will be carried out by a member of the Bronze On Call Team. MAJOR INCIDENT DECLARED 1. Proceed to the Hospital Control to be briefed and tasked by the Hospital Management Team. 2. The Non Acute Services Manager will then co-ordinate and oversee the following:- Community Nursing Teams Community Hospitals, District Nursing, Health Visitors, CPNs as required by the incident. Ensure co-ordination of primary care and mental health services in liaison with the Health Emergency Control Centre. Liaison with social services. Liaison with voluntary services and the third sector 37

38 STAFFING CELL The role of the Staffing Cell is to ensure adequate staffing to maintain a safe working environment both for the immediate period and the longer term. This role will be carried out by a member of the Bronze On Call Team. MAJOR INCIDENT DECLARED 1. Proceed to the Hospital Control to be briefed and tasked by the Hospital Management Team. 2. The Staffing Support Manager will then co-ordinate and oversee matters relating to:- The provision of medical staffing as directed by the Hospital Management Team. Ensure that adequate nursing staff are available throughout the incident in liaison with Nurse Bank. Human Resources ensure compliance with EWTD and sufficient welfare rest periods for staff involved in the incident. Provision of Occupational Health Support. Welfare of staff and provision of suitable hot debriefs. Infection Control. 38

39 SUPPORT SERVICES CELL The role of the Support Services Cell is to ensure efficient management and provision of the services listed below. This role will be carried out by a member of the Bronze On Call Team. MAJOR INCIDENT DECLARED 1. Proceed to the Hospital Control to be briefed and tasked by the Hospital Management Team. 2. The Support Services Manager will then co-ordinate and oversee matters relating to:- Co-ordination with the Police Documentation Team. The Relatives Centre. Medical Records. HSDU/CSSD Pharmacy requirements. Physiotherapy. IM&T issues. Radiology Pathology 39

40 AMBULANCE LIAISON OFFICER The Ambulance Liaison Officer will:- 1. On arrival s/he will confirm their attendance with Ambulance Control and proceed to the Hospital Control Centre. 2. Obtain details on the nature of the incident, the number of casualties and resources required. 3. Provide information to the Ambulance Control Centre on the bed status at the hospital and support hospitals and other relevant information 4. Ensure arrangements are made for the transport of bulk supplies from Pharmacy to the Incident Site. 5. Exchange information with Ambulance Control, the Hospital Control Centre and the Clinical Site Manager throughout the incident, in particular ensuring the Hospital is kept aware of casualty numbers and that Ambulance Control is aware of the Hospital s capacity to take further patients. 4. Facilitate the quick-turn round of ambulances at the hospital and ensure ambulance equipment released by the hospital is returned to stockpile. 5. Co-ordinate with receiving hospital the requests for transport for patients needing transfer, discharge or specialised treatment. 6. Maintain log of all patients bought into hospital. 7. Supervise arrangements for the arrival of helicopters at the hospital. 8. Ensure where possible that outpatient transport services continue to service clinics that continue to run, and to take home patients already brought into the Hospital. 9. Ensure that the Hospital Control Centre is informed once the incident site is clear of casualties. 10. Remain at the Hospital Control Centre after the incident is closed, to deal with the recovery and disposal of ALL Ambulance equipment and any continuing need for ambulance transport for discharges and transfers. 11. Continue liaison with the Hospital Control Centre with regard to revised clinic arrangements. 12. Prepare a report for the Regional Ambulance Officer. 40

41 POLICE LIAISON OFFICER The Police Liaison Officer will report to the Major Incident Officer in the Seminar Room, Executive Offices where you will be given an action card. The Police will establish their own Control room at the Hospital, based in the Education Centre. The team based in there will be led by a Sergeant (the Hospital Documentation Team Supervisor) and their purpose is to ensure the accurate documentation of all patients received at the Hospital, passing information to the Casualty Bureau Controller in Colwyn Bay. They will establish communications between the Hospital, Casualty Bureau, Mortuary and Major Incident Control Room / Site Command Post. Specific Police Officers will be designated as Documentation Officer(s), Liaison Officer, Property Officer and Communications Officer. They will liaise with Hospital staff on matters relating to documentation and identification of patients and ensure that completed casualty record forms are forwarded to the Casualty Bureau. Copies of the information on patients collected by the Hospital's own Medical Records staff for use at the Hospital Information Point will be given to the Police Control Room. The Police may also need to collect their own information from patients. The Police will assume responsibility for all patients who are brought in dead or who die after reaching the Hospital. Scenes of Crime Officers will also attend the Hospital to collect samples etc as appropriate. All Major Incidents are investigated on the basis that some form of criminal proceedings may result and the Police will therefore need to ensure that all relevant items that may be required as evidence are collected. The Police will also assist in maintaining security at the Hospital and ensuring the smooth movement of traffic to the Hospital. 41