Major Incident Plan. Version: 3.0

Transcription

1 Major Incident Plan Version: 3.0 Previous version Author Jane Miller Current Author/ Jane Miller Approval/Ratification body Care Plus Group Board Date Reviewed/ratified: 18 th December 2014 Subsequent Review date: 18 th December 2015

2 Contents 1 Scope and Purpose Background Definition of a Major Incident Key Risks Structure of Command and Control Summary of the role of Care Plus Group in the event of a major incident Control Liaison Alerting mechanisms 7 3 Procedure/ Action Cards Senior Manager on Call (First Senior Manager Contacted) Chief Operating Officer/ Chief Executive Operational Managers CPG Clinical staff responding to a major incident Clinical staff deployed to an evacuation/rest centre Administration staff at CPG Command and Control centres Loggist staff at CPG Command and Control centres Bomb Threats CPG Emergency Contact Numbers Media Management Communications Public Information Situation Reporting CBRN/HazMat

3 1 Scope and Purpose This plan applies to all employees of the Care Plus Group (CPG), with particular reference to key individuals who have specific responsibilities in relation to responding to Major Incidents as detailed below. This plan is a generic plan and can be applied to all major incidents. It reflects an integrated emergency response with other agencies e.g. Ambulance Service, Fire Service, Police, Public Health England, Local Authority etc. This plan is the framework that CPG is required to work to in response to a major incident. This plan defines what constitutes a major incident and identifies the command and control structure at strategic, tactical and operational levels. 2 Background 2.1 Definition of a Major Incident A major incident is any event whose impact cannot be handled within routine service arrangements and consequently it requires the implementation of special procedures. The response will differ depending on whether one or more organisations are required to respond. For the purposes of Emergency Preparedness and Resilience responses including responding to major incidents Care Plus Group (CPG) has a responsibility as a provider of NHS services to respond within the NHS framework. A big bang major incident is normally declared by the Ambulance Service (for health). Other slow burn incidents can be declared by other elements of the NHS. It would usually only be in exceptional circumstances that the CPG would declare a major incident due to the nature of our business. A major incident may arise in a variety of ways: Big bang for example, a serious transport accident, explosion or a series of smaller incidents Rising tide for example a developing infectious disease epidemic, adverse weather such as snow or flooding Cloud on the horizon for example a serious threat such as a major chemical or nuclear release developing elsewhere and needing preparatory action Headline news for example public or media alarm about a personal threat Internal incidents for example fire, breakdown of utilities, major equipment failure, hospital acquired infections, violent crime Deliberate release of chemical, biological or nuclear materials Mass casualties For the NHS a major incident is defined as: Any occurrence that presents 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 hospitals, ambulance trusts or primary care organisations. This plan is underpinned by key guidance including: 2

4 The Civil Contingencies Act (2004) and supporting guidance Preparing for Emergencies and Responding to Emergencies NHS England Emergency EPRR (Emergency Preparedness, Resilience and Response) documents The Civil Contingencies Act 2004 (CCA) delivers a single, framework for the provision of civil protection in the UK. The principal objectives of the Act are to ensure consistency of planning across all government departments and its agencies, whilst setting clear responsibilities for frontline responders at a local level. The Act divides responder organisations into two categories, depending on the extent of their involvement in civil protection work, and places a proportionate set of duties on each. Category 1 responders are those organisations at the core of emergency response. CPG is a Category 1 Responder. Category 1 responders are subject to the full set of civil protection duties. Category 1 responders are required to: Risk Assessment - assess the risk of emergencies occurring within their area and use this to inform contingency planning Collaborate with other organisations to compile community, local or national risk registers Ensure internal corporate risk management processes to include risk to continuation of services Emergency Planning - organisations are required to: o ensure emergency plans are in place in order to respond to emergencies linked with relevant risk registers o ensure validation and exercising of emergency plans o ensure appropriate senior level command and decision making 24/7 o ensure appropriate Emergency Operations Centre (EOC) facilities to control and coordinate the response to an emergency o ensure relevant response staff are trained to an appropriate level for their role in response o ensure robust communication mechanisms Business Continuity Planning - organisations are required to: o undertake risk management processes to identify risks and take mitigating action where appropriate o maintain appropriate arrangements to maintain essential services through disruptive events Warning and informing - organisations are required to: o maintain arrangements to make available information on emergency preparedness matters to the public o maintain arrangements to warn, inform and advise the public in the event of an emergency Information Sharing - organisations are required to: o share information with other local responder organisations to enhance coordination both ahead of and during an emergency Co-operation - organisations are required to: o co-operate with other responder organisations to enhance co-ordination and efficiency when planning for an emergency o co-operate with other responder organisations to enhance co-ordination and efficiency when responding to and recovering from an emergency 3

5 Category 2 responder organisations are "co-operating bodies" that are placed under lesser obligations beneath the Civil Contingencies Act than Category 1 responders. Primarily their role is cooperating and sharing relevant information with Category 1 responders. They should be engaged in discussions where they can add value. Furthermore, they must respond to reasonable requests. From April 2013 CCGs are Category 2 responders, Area Teams are Category 1 responders. 2.2 Key Risks For the Humber area the key risks likely to lead to a major incident have been identified on the Community Risk Register as follows: Very High Risks Pandemic influenza Fluvial flooding Low temperature/snow Coastal flooding Toxic chemical release High Risks Fire/explosion at an oil refinery Water pollution Air quality incident Accident involving transportation of fuel/explosives Storms Heatwave/ drought Epidemic Offshore incident disruption to supplies Telecommunications failure Electrical network failure Medium Risks Gas terminal explosion/fire Gas pipeline explosion/fire Fuel distribution site explosion/fire Offshore gas/oil platform explosion/fire Industrial accidental toxic release (e.g. chlorine) Accidental release of radioactive material Industrial explosion Passenger vessel sinking in UK waters Accident involving transportation of hazardous chemicals Aircraft ditching in the sea or inland water Passenger vessel fire Bridge collapse SARS type disease Legionella/meningitis type outbreak Animal disease (Foot and Mouth, etc.) Public protest Low Risks Food chain contamination 4

6 Deliberate blockage of port Tremor/landslide Building collapse Failure at water treatment works 2.3 Structure of Command and Control CPG s formal role in the event of a major incident is to act as a health responder because of its provision of NHS community services. In order to ensure any response is proportionate and effectively coordinated, the following structure of command will be adhered to. It is as important for an organisation to know the extent of their responsibilities as much as to fulfil those within its remit. NB The key coordinating role for Health is now held by the NHS England Area Team for North Yorkshire and The Humber as a Category 1 Responder following NHS changes in April The CCG are now a Category 2 Responder. CPG are not a blue light service and therefore should not attempt to undertake a broader coordination role. Operational (bronze) response - represents CPG health command of the incident. The role of the CPG Command and Control centre which is headed up by the Senior Manager on call is to undertake the following: Co-ordinates the health services business at an operational level Co-ordinates a situation reporting mechanism with health services and partner agencies at all command levels and with participating agencies Manage demands on resources Advise responders on operational issues Communicates regularly and systematically with the Chief Operating Officer/ Chief Executive Ensure communication networks are set up Contact tactical command when resources are required Activate distribution of items Relocation of health / social care service workers as appropriate Tactical (silver) response Chief Executive/ Chief Operating Officer/Director of Finance. At this level and depending on the incident: Attend as required in the local multi agency Silver Command usually led by the Local Authority or Police Support to and general oversight of Operational Command progress Decision making and review of the incident Communication with Non Executives if required Prioritisation and accessing resources including finances Communications with the CCG and Area Team and others as needed including where needed at strategic gold command Respond to media enquiries Seek mutual aid if required Overview of progress of incident and response Ensure operation of rest of organisation during incident and recovery from incident Strategic (gold) response - is the strategic, multi-agency command level. It is normally led by the Senior Police Commander and the NHS will be represented by the NHS England Area Team for North 5

7 Yorkshire and The Humber. CPG may be required to attend dependant on the issue and attendance would be by the Chief Operating officer or Chief Executive of CPG. The role of Gold Command is as follows: Make strategic decisions in respect of resources within the Humber area Prioritise resources in the event of multiple incidents or an incident which has a wide ranging impact Prioritise requests for resources Have the authority to seek the mutual aid of other agencies in support of their NHS role Co-ordinate the overall health response to a major incident Ensure effective command and control arrangements are established across health services Report regularly to the Department of Health Prioritise services to ensure the least amount of disruption to normal services Public Health England Health Consultant advise the police incident commander of public health issues pertaining to the incident Liaise with the military re health needs STAC (Scientific and Technical Advisory Cell) The Police may request Public Health England (formerly Health Protection Unit) set up and chair a Scientific and Technical Advisory Cell (STAC). This is a strategic group that consists of individuals who have expertise in managing the health impacts of an incident. The role is to give specialist technical advice at Gold level and may include Consultants in Communicable Diseases. Incidents to advise on could for example include chemical incident, outbreak of infectious disease, radiation incident. Public Health England will liaise with regional and national Public Health colleagues as appropriate including for example Chemical Hazards and Poisons, epidemiologists and microbiologists experts, where necessary. Public Health England has wide experience of planning for major incidents and may be the key joint partner in dealing with an incident from a health perspective. The North Yorkshire and the Humber Public Health England team which responds to incidents is located in York and they operate a call out 24/7 contactable via Yorkshire Ambulance Service. The CPG Senior Manager on Call has access to their contact details. 2.4 Summary of the role of CPG in the event of a major incident: CPG s role in a major incident is very specific and is as follows: Liaise with all responding agencies to ensure an integrated response to the incident Meet health care needs in evacuation/rest centres Provide health support for vulnerable people affected directly by the major incident, including minor injury treatment Oversee the replacement of missing medication to the displaced population Utilise psychological support where needed (via local provider Navigo) Meet demands in workload arising from the discharge of patients from responding Acute NHS trusts due to the admission of mass casualties Provide mass treatment/immunisation for adults in conjunction with Public Health England Support Public Health England in implementing health protection measures Organize location and relocation of staff and equipment at a local level Ensure the continued provision of essential routine health care of the general population 6

8 Because CPG do not deliver children s health services it is important that in the even of an incident with health implications that close liaison is in place with the children s health provider (children s community nurses; health visitors and school nurses) i.e. North East Lincolnshire Council. It is important that in the event of a major incident occurring the principles of strategic management are kept in clear focus. The following provide a useful guide (taken from Department of Health Strategic Leadership in a crisis2): Leader stands back (mostly thinking not doing) Look upwards, outwards, forwards (situational awareness ie. so what, what if, what then?) Direction and Position (position for effective future action and outcome; create a framework for effective operations) Information is managed (CRIP Common recognised information picture) Always share situational awareness and strategic aim Stay in role 2.5 Control Liaison In the event of a major incident CPG may need to liaise with: Public Health England Local Authority CCG NLAG (acute trust) All emergency services Police media manager Local Authority Communications Manager NHS 111 General Practitioners NHS England Area Team for Yorkshire and the Humber Other related agencies, e.g. Port Authority, Environment Agency 2.6 Alerting Mechanisms As responders or communicators (CPG could be involved in the notifying of an incident) in an incident it is essential that the alerting mechanism or trigger mechanisms are standardised by all responders. The health services communication cascade is undertaken by the Ambulance Service. Health Service staff declaring a major incident do so through the Ambulance Service. The following alerting messages are used to identify the stages of response: Major Incident Stand By communicate to staff Major Incident Activate implement this plan fully NB Major Care Incident Plus Group Stand will Down normally major only incident be involved response in coordinating is no longer a major required incident although for health recovery in the post-blue phase may light commence phase. 7

9 3 Procedure/ Action Cards 3.1 Actions to be taken by the Senior Manager on Call (First Senior Manager Contacted/ Incident Control Manager) The Senior Manager on Call is CPG s first point of contact available 24/7 on telephone number ACTION CARD 1 The Senior Manager on Call will: 1 Gather as much information as possible. 2 Inform a CPG Director (Chief Operating Officer or Chief Executive) and where required seek their support/ attendance to support the management of the incident. 3 Make contact with the NHS England Local Area Team Director on call. 4 Contact CPG Heads of Service and other managers as appropriate and place on standby for support with the Incident Control centre. 5 Coordinate staffing to attend at Rest centres if rest centres are established. 6 If appropriate alert Navigo Senior Manager on Call that their services will be required as part of the incident e.g. for the provision of psychological support 7 Contact CPG communication lead to alert them to possible need to liaise with NHS England Local Area Team communications lead. 8 Contact and secure the support of the CPG on call administrator and on call loggist and coordinate and lead the incident response and this team ie the Incident Control Team. Brief the individuals before they start on how you will work together. 9 If the incident dictates, in agreement with the Chief Operating Officer or Chief Executive open the Incident Control centre at 1 st Floor Freeman Street Resource Centre, Kent St, Grimsby DN32 7DH. 10 Begin a log. 11 Commence action. 12 If the incident is prolonged, shift work needs to be established with other Senior Managers within CPG. 8

10 3.2 Actions to be taken by Care Plus Group Chief Executive/Chief Operating Officer ACTION CARD 2 The Chief Operating Officer/ Chief Executive will: 1 Respond as requested by the Senior Manager on call. 2 Proceed to the CPG Incident Control Room (if requested) 1 st Floor Freeman Street Resource Centre, Kent St, Grimsby DN32 7DH 3 Inform the Local Authority/ Police Duty Officer of availability to attend Tactical or Strategic Command if appropriate/ required. 4 Maintain liaison with the NHS England Area Team providing regular updates as appropriate. 5 Liaise with the CCG to ensure they are aware of the incident and in case any funding/ resources are required. 6 Ensure all actions on Action Card 1 are completed. 7. Coordinate a de-brief involving all relevant staff following the conclusion of the incident to learn lessons. 8. Ensure access to relevant support for any member of staff who requires it as a result of their involvement in the incident e.g. access to counselling etc. 9

11 3.3 Actions to be taken by Operational Managers ACTION CARD 3 Operational Managers will: During Office Hours Work from your normal base unless requested to do otherwise. Out of Office Hours Stay near to a telephone. Assist from home unless requested to do otherwise. Utilise the Senior Manager on Call/ Heads of Service, and keep them informed of developments or risks as they develop. Provide increased capacity to assess and meet early discharges from hospital utilising Rapid Response/ Intermediate Care at Home and Community nursing / the Beacon where possible. Provide assessment and treatment of evacuated patients including meeting chronic healthcare needs and arranging medication stocks (liaising with pharmacies and GPs) Consider the need for mental health provision (via Navigo). Support mass treatment or vaccination centres and rest centres if required once these have been set up by the Local Authority if requested to do so. Other tasks/service provision as required upon request. Keep a log of action taken. 10

12 3.4 Actions to be taken by CPG Clinical Staff responding to a major incident ACTION CARD 4 Clinicians required to respond to major incidents across CPG will include Rapid Response, Community Nurses, Specialist Nurses etc. and will be identified and contacted via the Incident Management Team. Most commonly the initial clinical response is likely to be from Rapid Response who operate 24/7. The Incident Management Team will contact Rapid Response on the 24/7 contact number and Nurse Managers via the Head of Service and there should be an exchange of information, including confirmation of relevant telephone numbers. Outline responsibilities: Meet health needs in rest centres Assist in mass treatment, e.g. vaccinations Depending upon the nature of the incident staff may also be requested assist with the following: Provide minor injury service Provide first aid Provide triage Staff may be asked to assist at the scene of an incident to provide first aid, triage and minor injury treatment. If attending the scene the Practitioners should report to the Ambulance Controller and ensure they have the appropriate personal protective equipment (PPE). Practitioners may be asked to staff a minor injury unit (either existing or adapted within a building). Practitioners may be asked to attend rest/evacuation centres (see Action Card 5). Their role will be to: Provide medical screening to ensure evacuees who have or develop medical problems receive necessary health care Assess any health needs of evacuated people Arrange for the replacement of lost prescribed medicines Provide medical advice and information on the consequences of the incident Provide a health contribution to the welfare support of evacuees NB the Local authority is responsible for the setting up, staffing and overall management of rest centres. Maintenance of Records From the outset there will be a need to maintain records of: All information received and action taken All liaison with GPs, Local Authority, the receiving hospital(s), etc. The personal details of all those in receipt of specific advice or care Reporting The Incident Control Manager (Senior Manager on Call) will be provided with situation reports covering all significant events, assessments and action taken or proposed by Practitioners. 11

13 3.5 Actions to be taken by Care Plus Group clinical staff deployed to evacuation/rest centres ACTION CARD 5 The role of CPG staff within an evacuation/rest centre is summarised as follows: Provide medical screening to ensure evacuees who have or develop medical problems receive necessary health care Assess any health needs of evacuated people Arrange for the replacement of lost prescribed medicines Provide medical advice and information on the consequences of the incident Provide a health contribution to the welfare support of evacuees If required to attend an evacuation/rest centre: 1 Confirm the exact location of the centre and attend. 2 At the Rest Centre: Make yourself known to the manager/coordinator of the rest centre. Confirm an allocated working area, i.e. an area with privacy with the Rest Centre Manager. Gather as much information as possible to accurately assess heath needs of evacuated individuals. Prepare documentation, and maintain accurate records including: o All information received and action taken o All liaison with GPs, Local Authority, the receiving hospital(s), etc. o The personal details of all those in receipt of specific advice or care 3 Treatment: Identify anyone requiring clinical help and treat where possible e.g. chronic health problems. Give health information and advice. Arrange for replacement medication. Normally request the patient s GP to prescribe. If out of hours contact Out of Hours GP service. Medication will normally be obtained through a retail pharmacy. If this is not possible contact the hospital on call pharmacist through the switchboard. Ensure chronic conditions are treated. 4 Update: Update the Incident Control Manager (Senior Manager on Call) with situation reports Maintain good communication with the Rest Centre Manager on duty 5 Be alert to any adult or children s safeguarding issues and follow adult and children s safeguarding procedures where appropriate 6 Health Visitors, School Nurses and Nursery Nurses should be accessed via N.E. Lincsolnshire Council and utilised where needed/ appropriate. 7 For people requiring mental health support/ services this should be accessed via local health provider Navigo. 12

14 3.6 Actions to be taken by Administration staff at CPG Command and Control centre ACTION CARD 6 1 Report to the Incident Control Room, 1 st Floor Freeman Street Resource Centre, Kent St, Grimsby DN32 7DH. Access to the room is available 24/7 via designated swipe card access or via the security guard within the building. Staff occupying the room will be re-located as appropriate. 2 Ensure the telephones are working, and clearly marked with numbers. 3 Prepare a whiteboard with key telephone numbers including for example: Ambulance Control Police Control Fire Control Local Area Team CCG Local Authority others as the incident dictates 4 Prepare log sheets. 5 Set up internet, and fax, where possible 6 Follow instructions as required by the Incident Manager e.g. log maintenance, obtaining supplies, cascading information by fax. 13

15 3.7 Actions to be taken by the Loggist at CPG Command and Control centre ACTION CARD 7 The function is to capture information for decision making during an incident following best practice. 1 Attend the CPG Incident Control Room. 2 Open the major incident stationery box(es) and obtain log book(s). 3 Liaise with the Incident Control Manager to ascertain which logging requirements you will undertake, i.e. allocated to one role/manager or loggist for the control centre activities. 4 Await further messages/instructions from the Incident Control Manager and seek clarification on instructions if required. 5 Commence recording information and actions taken in the approved Emergency Log Book. Initial each entry and at the end of your duty period when you hand over. 6 Use any available administrative staff to assist with answering telephones, photocopying, etc. and focus only on your allocated role. 7 Post incident action: Collate ALL documentation, drawings, maps, trigger notes, audio-visual material pertaining to the incident for debrief/lessons to be learnt and future enquiries 14

16 3.8 Bomb Threats - Procedure for Telephone Warnings ACTION CARD 8 In the event of a bomb threat being received the receiver must: 1 Write down as much detail as possible. Stay calm. 2 If a code is given the code word must be noted exactly as passed by the caller. This will assist Government officials in confirming the nature and identity of the caller. 3 Keep the line open even if the caller has put his telephone down DO NOT REPLACE YOUR TELEPHONE HANDSET. 4 Inform the police (using 999) on another line. They will give further instructions. 5 If the threat affects your building sound the alarm and take steps to secure the evacuation of the building. 6 Inform a Senior Manager or the Senior Manager on Call if not available. 15

17 4 CPG Emergency Contact Numbers All relevant emergency contact numbers are stored in the Incident Control Room at Freeman Street Resource Centre and are checked on a monthly basis to ensure they are up to date. They are not included in this document due to the confidential nature of some of these contact numbers. In addition these are also stored on the T drive, within the Emergency Preparedness folder which is accessible to all Senior Managers on Call and Executive Directors. 5 Media Management In an acute incident (unless the incident is a slow burn ongoing health incident) the Police Media Officer co-ordinates the media response. In such instances Health services do not communicate directly to the media unless authorised to do so by the Police Incident Commander at Gold Command. In the event of a slow burn incident where CPG need to communicate direct with the media this must be undertaken in liaison as appropriate with the Local Area Team/ CCG. The lead Communications Officer for CPG operates through a memorandum of understanding with partner agencies. Key elements to remember are: The need to express sorrow and sympathy where this is appropriate Be clear what is being done Be clear what will be done in the future Co-operate with the media (they may be at the scene in vast numbers very quickly, depending on the incident) due to the public interest nature of incidents Open and maintain dialogue Ensure they are talking to the official spokesperson Provide regular bulletins for the press Avoid mixed messages The media can be a force for good; they can be positive and helpful. They can and will publish what is given to them subject to editorial privilege. A good relationship with the press will ensure the accuracy of the information and dispel inaccurate rumour. If the press cannot speak to an official spokesperson they may speak to someone who is hostile to the organisation. The press are opinion formers who have a job to perform which, in the main, they do professionally and in a caring way. The media should be requested to initially communicate with the lead media officer within CPG who will organise an appropriate co-ordinated response. Co-ordinated Communication Response The Communication Officers also have to co-ordinate their response to the media. This is seen as a NHS England Area Team role when: Tactical and Strategic Command are convened 16

18 There is more than one incident taking place 5.1 Communications Public Information Public Information In a health incident it may be necessary to set up an information line for the public. This should be arranged locally through N.E. Lincolnshire Single Point of Access. In an acute incident, e.g. a train crash, the information and helpline will be established through the Police but there may be elements of health that need to be incorporated. Media Broadcast It is important to establish a positive relationship so that public health information can be broadcast on television and radio or information provided in the press. Spokesperson It should be decided in advance on who should speak on behalf of the organisation ie Chief Executive/ Chief Operating Officer or Head of Service. This should be someone who is media trained. 5.2 Situation Reporting In a major incident it is vital that regular communication between the CPG, Local Area Team, CCG, Health Protection Unit, Acute Trusts, Emergency Services, Local Authority and other agencies as appropriate and relevant takes place. Only then is the Incident Management Team able to provide an accurate overview of information to staff working in the field, Gold Command, or to external agencies who require it e.g. NHS England. Particular issues for reporting by the Incident Management Team may include: Available staffing resources Relocation of staffing Other resources Cancelled services (when, where, why) Disrupted services (when, where why) Assistance required 6 CBRN (CHEMICAL; BIOLOGICAL; RADIOLOGICAL AND NUCLEAR)/ HazMat (HAZARDOUS MATERIALS) In 2005 there were, nationally, 1040 reported chemical incidents affecting over 3 million members of the public. Over 3000 of those affected, presented to local health care providers with symptoms. With the increase in transportation of dangerous chemicals by road, the potential for terrorism and the number of chemical companies in the region there is an increased risk that incidents involving such substances could occur. Biological hazardous materials may be found stored in hospitals, universities, medical research establishments, industry etc. throughout the country. At times, it is necessary to transport quantities of these types of materials. A very small quantity of such material can be extremely dangerous. 17

19 Biological hazards can be serious if the substance is ingested, inhaled or injected. Biological release of a bacterial or viral agent, as with naturally occurring infection, is likely to become a major public health issue. Usually biological incidents will be hard to detect or identify. Individual cases will be identified by health care organisations as part of normal patient care. The consequences will only become apparent as increasing casualties present with similar symptoms. Ionising radiation is a form of energy that is invisible, odourless and tasteless. Natural radiation is all around us: in air, earth, food and water and all of this makes up the background radiation to which we are all continuously exposed. Manmade sources of radiation and radioactive materials are used in medicine (diagnostic imaging, radiotherapy), research and industry. Casualties may present who have received high radiation doses from being close to a radiation source and/or have been contaminated with radioactive materials. A warning may be received locally from an emergency service, local industrial site, or other source, informing of a CBRN or HazMat incident, release or explosion and most incidents of this nature are as a matter of course dealt with by the acute sector the ambulance service and other emergency providers working in conjunction with local hospitals. However, experience from hazardous or potentially hazardous situations such as the London bombings of 2005 demonstrate that large numbers of people may self evacuate if they can and leave the scene of an incident without first coming into contact with the responding emergency service. Later, once symptoms have developed, or as a result of widespread media coverage, they may then self present to a primary or community health care facility in search of treatment, advice and reassurance. A proportion of these people will be worried well who have not been contaminated, but are concerned about their possible exposure to toxic substances. However, some will have been exposed and may need treatment and may retain a degree of contamination on their bodies or clothing, posing a risk to healthcare staff that they come in to contact with. There is therefore the need in the event of such instances to care for self presenters; to maintain staff safety; to recognise the role of front line receivers of such individuals; to maintain essential services; to return to normal business as soon as possible. Key principles for the management of such incidents are as follows: Recognise unusual circumstances and be aware of the risks Manage the incident and limit the spread of contamination Give priority to minimising exposure and safety risks to staff Provide care and information to patients Communicate and obtain guidance from external agencies Maintain business continuity and recover to normal business as early as possible 18

20 CBRN/HAZMAT ACTION CARD A - FIRST RECEIVERS STOP Think through the following steps 1-3 Step 1 One casualty manage using normal protocols Step 2- Two casualties with similar symptoms with no apparent cause manage with caution and consider risk to staff and others Step 3 Three or more casualties with similar symptoms and no apparent cause Manage as an incident involving hazardous materials; risk assess before intervening/ isolate and seek specialist help immediately THINK of your own safety and that of your colleagues. Call for help from the nearest clinical manager available. Isolate your area. Inform patients that help is on the way. 1. Follow steps Alert the Senior Manager on call by ringing and follow any advice provided 3. Agree who calls 999 for emergency services 4. Consider yourself and others close by as contaminated 5. Lock down reception area see Lockdown plan 6. Prevent other staff from entering reception area 7. Direct contaminated patients to isolation area 8. Open response box a. Put on personal protective equipment (PPE if available) b. Put up pre-printed laminated signs 9. Advise all patients that help is on the way 10. Record patient details on the patient contact template 11. Wait for assistance 12. Keep patients informed 13. Follow specialist advice provided by the emergency services or PHE (Public Health England) 19

21 CBRN/HAZMAT ACTION CARD B - SENIOR MANAGER ON CALL 1 Gather as much information as possible. 2 Inform a CPG Director (Chief Operating Officer or Chief Executive) and where required seek their support/ attendance to support the management of the incident. 3 Make contact with the NHS England Local Area Team Director on call. 4 Contact CPG Heads of Service and other managers as appropriate and place on standby for support with the Incident Control centre. 5 Coordinate staffing to attend at Rest centres if rest centres are established. 6 If appropriate alert Navigo Senior Manager on Call that their services will be required as part of the incident e.g. for the provision of psychological support. 7 Contact CPG communication lead to alert them to possible need to liaise with NHS England Local Area Team communications lead. 8 Contact and secure the support of the CPG on call administrator and on call loggist and coordinate and lead the incident response and this team ie the Incident Control Team. Brief the individuals before they start on how you will work together. 9 If the incident dictates, in agreement with the Chief Operating Officer or Chief Executive open the Incident Control centre at 1 st Floor Freeman Street Resource Centre, Kent St, Grimsby DN32 7DH. 10 Begin a log. 11 Commence action. 12 If the incident is prolonged, shift work needs to be established with other Senior Managers within CPG. 20

22 CBRN/HAZMAT ACTION CARD C CHIEF EXECUTIVE/ CHIEF OPERATING OFFICER 1. Respond as requested by the Senior Manager on call. 2. Proceed to the CPG Incident Control Room (if requested) 1 st Floor Freeman Street Resource Centre, Kent St, Grimsby DN32 7DH 3. Maintain liaison with the NHS England Area Team providing regular updates as appropriate. 4 Liaise with the CCG to ensure they are aware of the incident and in case any funding/ resources are required. 5. Coordinate a de-brief involving all relevant staff following the conclusion of the incident to learn lessons. 6. Ensure access to relevant support for any member of staff who requires it as a result of their involvement in the incident e.g. access to counselling etc. 7. Coordinate media responses in conjunction with the Police/ Local Authority/ NHS England as required. 21

23 CBRN/HAZMAT ACTION CARD D CLINICAL SERVICE MANAGER STOP Think through the following steps 1-3 Step 1 One casualty manage using normal protocols Step 2- Two casualties with similar symptoms with no apparent cause manage with caution and consider risk to staff and others Step 3 Three or more casualties with similar symptoms and no apparent cause Manage as an incident involving hazardous materials; risk assess before intervening/ isolate and seek specialist help immediately You need to be aware that: It may not be obvious that someone has been in contact with a hazardous material Patients may arrive with no prior warning Their symptoms may be non-specific e.g. itching skin, watering eyes, respiratory problems, dizziness or nausea History taking will identify if they patients believes they have been involved in an incident e.g. an explosion, fire, cloud of smoke or gas; covered in dust, powder of liquid The Ambulance service/ PHE will: Identify the hazardous substance Assess impact on health PHE will formulate specific guidance for community providers Issue guidance to GPs, walk in centres etc. Actions to prepare for self presenters: Before self presenters arrive 1. Consider locking down the building 2. Inform and prepare staff 3. Position signage outside of the building requesting presenting patients to contact reception and remain outside the building 4. Inform CPG Senior Manager on call who will contact the PHE 24/7 on call contact and will also inform the Chief Executive/ Chief Operating Officer who will in turn and the CCG Director on call If self presenters have already arrived 1. If contaminated patients have already arrived then the receptionist or person in first contact should now be considered to be contaminated and must not leave the dirty contaminated area 2. Consider introducing clinical triage at reception 3. Lockdown the building; establish clean and dirty segregation areas within the building; put up signage outside; isolate contaminated people (including staff) in previously agreed area/ room; provide primary decontamination; keep patients and staff informed 4. Cancel non urgent appointment s and undertake any other business continuity actions 5. Call 999 if there appears to be a medical emergency 6. Manage self presenters according to specific guidance received from PHE if applicable 7. Establish communications with PHE for further information and guidance 8. Keep in touch with the ambulance service and PHE for updates and any further advice on sending patients home or moving patients for further care 22

24 9. Protect yourself and other patients/ staff and premises by using isolation procedure; PPE (if available); cleaning; lockdown 10. Keep accurate details of any patients seen name, DOB, address, telephone number, GP, next of kin etc., symptoms and any action taken. As part of this identify any high profile patients 11. Your response will be supported by the Emergency services following your call to them 12. Provide hydration and refreshments for the patients if possible 13. Ensure patients have regular medications they may be taking 14. Allow the patients access to a telephone if possible for them to inform relatives and make arrangements for dependents 15. Provide refreshments and breaks for staff where possible and anything they may require e.g. clean clothes, access to regular medication, access to telephones to contact relatives etc. 16. Consider the need for psychological support for staff concerned 17. Post incident take advice from PHE regarding any areas in the building that may require deep cleaning or decontamination including any specialised decontamination that may be required. Also affected areas should not be re-opened until advice has been taken from the Government contamination service 18. Significant contamination incidents will initially be treated as crime scenes so property or documentation should not be discarded until otherwise advised 19. Seek advice about potential contamination of the water supply from PHE or water supplier Note 1 Decontamination: If advised by PHE to commence decontamination the following general guidance may apply: In the absence of any decontamination equipment/ppe etc. isolate the patient and call for assistance Decontamination should begin as soon as possible All outer clothing should be removed, put into a plastic bag and sealed. Clean gowns should be provided if possible Any valuables should be out into a plastic bag and sealed If the contamination is in dust form the skins should be dusted off first to remove as much as possible The person should immediately be offered wipes for face and hands and a tissue to blow their nose. These should be disposed of in a plastic bag If available offer soap and water for the person to begin washing Provide clean gowns/ blankets for the person after washing. Dirty laundry should be placed in a bag and sealed Once washed ensure the person remains in the designated clean area, preventing contamination Reassure the patient and provide any relevant information Clinical need will determine whether any transfer to hospital is required. NB The ambulance service and hospital may be under severe pressure during a large scale incident Once decontaminated ask the patient to stay in the clean area until further information/ advice is available regarding the contaminant. Note 2 Protecting yourself, other patients/ staff and premises: The aim is to minimise the contact that the potentially contaminated patient has with other people and parts of the premises Immediate action isolate the person in a separate room preferably somewhere without soft furnishings. Do not touch them 23

25 Cordon off the part of the premises they have walked through and anything they have touched. If necessary lock the doors and put notices up outside the premises to direct other patients away from the area Those involved in patient contact should wear the following PPE if available o Apron or gown o Gloves o Mask (highest specification available) PPE should be disposed of as contaminated waste Re-route other patients away from the area Staff and patients who have come into contact should be reassured and asked to stay on the premises until further information is received about the contaminant 24