DOCUMENT TITLE: MAJOR INCIDENT PLAN. Version: V2.2. Date of Final Ratification: 15 th May 2017 Name of Ratifying Committee: Review Date: November 2019

Transcription

1 MAJOR INCIDENT PLAN DOCUMENT TITLE: MAJOR INCIDENT PLAN Originator/Author /Designation & Specialty: Sharon Walford - Emergency Planning & Capacity manager Director Lead: Paul Bytheway Chief Operating Officer Target Audience: All staff Version: V2.2 Date of Final Ratification: 15 th May 2017 Name of Ratifying Committee: Review Date: November 2019 Registration Requirements Outcome Number(s) (CQC) Relevant Documents /Legislation/Standards Contributors: Clinical Quality Safety and Patient Experience Committee Safe Caring Effective Well Led Responsive Civil Contingencies Act 2004, Operational resilience and capacity planning for 2014/2015, Local authorities preparedness for civil emergencies: A good practice guide, Planning for operational resilience in health and social care during 2014/2015 Designation: Emergency planning & capacity manager, The electronic version of this document is the definitive version CHANGE HISTORY Version Date Reason 2.0 May 2017 This document replaces the previous Major Incident Plan Feb June 2017 Revised and updated amendments to bronze control 2.2 October 2017 Addition of Annex 6 A translation service is available for this document. The Interpretation/Translation Policy, Guidance for Staff is located on the intranet under Trust-wide Policies. Major Incident Plan V2.2 October 2017 Page 1 of 114

2 Contents Section Page No. Contents page & 2 Introduction, Statement of intent, purpose Trust responsibility for emergency preparedness 6 5 Definition of a Major Incident Types of incident 7 6 Risk assessment 8 7 Command and control structure Trust command and control structure Gold (strategic) command Silver (tactical) command Bronze (operational) command Recovery team Major incident situation assessment (METHANE) 11 8 Initiation of major incident policy Communication The hospital plan The hospital Coordination plan Receipt of casualties Access to ED Wards & OPD Discharges None Emergency Patient Transport Diagnostics Critical care Pathology/blood bank Pharmacy HSDU Procurement Catering Relatives Press and media Volunteers G.P s and UCC Security and car parking Capacity management Information about casualties Debriefing Post traumatic counselling Birmingham, Solihull & Black Country Incident Response 22 plan 18 Training/support References Equality & Diversity Process for monitoring compliance 23 Annex 1 Chemical incident plan Annex 2 Biological incident plan Annex 3 Radiation contamination plan Annex 4 Paediatric major incidents 32 Annex 5 Action cards index Annex 6 Mass casualty Plan Major Incident Plan V2.2 October 2017 Page 2 of 114

3 Contents Section Page Number Action cards Action cards Appendix A METHANE report 96 Appendix B SBAR meeting 97 Appendix C Silver command incident meetings (prompt sheet) 98 Appendix D Log booklet link general loggist 99 Appendix E Major Incident radio instructions 100 Appendix F Bronze command incident meetings (prompt sheet) 102 Appendix G SBAR debrief 103 Appendix H Switchboard callout procedure 104 Appendix I Road access Merry Hill Centre 107 Appendix J Hospital Coordination team 108 Appendix K Teleconference 109 Appendix L Site map 113 Major Incident Plan V2.2 October 2017 Page 3 of 114

4 THE DUDLEY GROUP NHS FOUNDATION TRUST MAJOR INCIDENT PLAN 1. INTRODUCTION 2. STATEMENT OF INTENT/PURPOSE The objective of the Major Incident plan is to facilitate a rapid and efficient mobilisation of services in the event of a Major Incident being declared. Within the policy there are action cards for all key staff that would be involved, ALL other staff must be aware of the role of their department and how it fits in with the Major Incident plan The Major Incident plan does not deal with incidents covered by the National Arrangements for Incidents involving Radioactivity (NAIR scheme) or with other major radiation emergencies. Those incidents are managed via sub regional and national plans. There is a link in emergency planning on the hub - National Arrangements for Incidents involving Radioactivity (NAIR) 2.2. An Acute Trust is defined as a Category 1 Responder under the Civil Contingencies Act (2004) Category 1 responders are those emergency services that are likely to be in the forefront of the response to a major incident - such as health and police This places a statutory duty on the Trust to undertake certain additional functions:- To undertake the risk assessment relevant to the area served. To maintain plans that ensure that if an emergency occurs, the Trust can continue to perform its essential functions (Business Continuity Plan) To arrange for the publication of all / part of the plans made. To maintain arrangements to warn the public and to provide information and advice to the public if an emergency occurs This plan should be read in conjunction with Trust arrangements for Pandemic Flu, CBRN Incidents, Fuel Shortage, Industrial Action, Evacuation, Security Lock Down, Adverse Weather and plans to respond to incidents identified on local, regional and national Risk Registers. This information is available in Emergency Planning on the Trust intranet. 3. ABBREVIATIONS / DEFINITIONS AEO BCP BMS CAD Capacity CSC CBRN CCA CCG CDU CEO COO CSC DGNHSFT DIC Accountable Emergency Officer Business Continuity Plan (Internal Incident) Bio Medical Scientist Computer Aided Dispatch Manages capacity Chemical Biological Radiological Nuclear (deliberate) Civil Contingencies Act Clinical Commissioning Group Clinical Decision Unit Chief Executive Officer Chief Operating Officer Clinical Site Coordinator Dudley Group NHS Foundation Trust Doctor in charge Major Incident Plan V2.2 October 2017 Page 4 of 114

5 DRF Dudley Resilience Forum DSU Day Surgery Unit ED Emergency department Emergency Preparedness The extent to which emergency planning enables the effective and efficient prevention, reduction, control, mitigation of and response to emergencies EMS Escalation Management System EP&CM Emergency Planning & Capacity Manager EPRR Emergency Preparedness Resilience and Response ERT Emergency Response Team FP10 Prescription sheet that will require an external pharmacy to dispense HALO Hospital Ambulance Liaison Officer HAZMAT Hazardous Materials (accidental) HDA High dependency area (ED) HEPA filter High Efficiency Particulate Filter Hospital Control Centre Silver (tactical) command/capacity hub HSDU Hospital Sterilisation and Disinfectant Unit ITU Intensive Therapy Unit JESIP Joint Emergency Services Interoperability Programme LHRF Local Health Resilience Forum LHRP Local Health Resilience Partnership METHANE report M Major Incident declared E Exact location T Type of incident (RTA, Fire, and explosion) H Hazards at the scene (chemicals) A Access which roads are accessible N Number of casualties E Emergency services required MHDU Medical High Dependency Unit MIP Major Incident Plan NAIR National Arrangements for Incidents involving radioactivity Nervecentre Task allocation system used out of hours managed by CSC NILO National Inter-agency Liaison Officer NHSBT NHS Blood and Transplant NEPT Non-Emergency Patient Transport NIC Nurse in charge OCD On call Director OCM On call manager OOH Out of hours PAU Paediatric Assessment Unit QEH Queen Elizabeth Hospital (Birmingham) RAM GENE A radiation contamination meter which detects surface radiation RCMT Regional Capacity Management Team Response Decisions and actions taken in accordance with the strategic, tactical and operational objectives defined by emergency responders RHH Russells Hall Hospital SBAR Situation Background Assessment Recommendations SHDU Surgical High Dependency Unit T&O Trauma and Orthopaedics Major Incident Plan V2.2 October 2017 Page 5 of 114

6 TTO s UCC VascU WMAS Tablets to Take Out (prescription dispensed internally) Urgent care centre (24hr service) Vascular Unit (high dependency) West Midlands Ambulance Service 4. TRUST RESPONSIBILITIES FOR EMERGENCY PREPAREDNESS 4.1 Chief Executive The Chief Executive must ensure that the Trust has a Major Incident plan that meets the requirements of current Department of Health and National Resilience statutory requirements. 4.2 Accountable Emergency Officer (AEO) The NHS Act (2006) places a duty of care on relevant service providers to appoint an individual to be responsible for discharging their duties under section 252A. This individual is known as the AEO, Chief executives will be able to delegate this responsibility to a named director. At the DGNHSFT the Chief Operating Officer (COO) is the Board level director responsible (AEO) for Emergency Preparedness Resilience and Response (EPRR) 4.3 Emergency Planning Manager The Emergency Planning Manager will have delegated responsibility for emergency preparedness in support of the AEO. This manager will plan and coordinate training to ensure the Trust adheres to current legislation. They will also represent the Trust at Regional EPRR meetings and Local Resilience Forums to ensure information and good practice is shared. 4.4 Trust Directors Executive and Clinical Directors are responsible for ensuring that all staff and services within their area of responsibility are included in the emergency planning process. They will ensure training has been planned and carried out for appropriate staff. 4.5 All Staff All staff should familiarise themselves with the content of this document and how it may involve them and their colleagues in the event of a major incident. Key roles that are required during a Major Incident are segregated into Action cards (Annex 5). The action cards have been produced with input from the teams that will be using them to ensure they are reflective of the practices that would be required under extreme pressure for that team. It is imperative that all staff know and understand their specific role in the event of a major incident. Ward areas would be required to identify patients that could be discharged quickly to provide acute beds. 5. DEFINITION OF AN INCIDENT - incidents are classed as either: Business Continuity incidents one that disrupts normal service delivery. Critical incident a localised incident where the level of disruption results in the organisation temporarily or permanently losing its ability to deliver critical services, patients may have been harmed or the environment is not safe and requires special measures and support from other agencies, to restore normal operating functions. Major incident an event or situation, with a range of serious consequences, which requires special arrangements to be implemented by one or more emergency responder agencies. Emergency responder agencies are all Category one and two responders as defined in the Civil Major Incident Plan V2.2 October 2017 Page 6 of 114

7 Contingencies Act (2004) and associated guidance. A Major Incident is beyond the scope of business as usual, and is likely to involve serious harm, damage, disruption or risk to human life or welfare, essential services, the environment or National security. 5.1 Incident levels As an event evolves it may be described in terms of its level as shown. For clarity these levels must be used by all organisations across the NHS when referring to incidents. Incident level Level 1 Level 2 Level 3 Level 4 An incident that can be responded to and managed by a local health provider organisation within their respective business as usual capabilities and business continuity plans in liaison with local commissioners. An incident that requires the response of a number of health providers within a defined health economy and will require NHS coordination by the local commissioner(s) in liaison with the NHS England local office. An incident that requires the response of a number of health organisations across geographical areas within a NHS England region. NHS England to coordinate the NHS response in collaboration with local commissioners at the tactical level. An incident that requires NHS England National Command and Control to support the NHS response. NHS England to coordinate the NHS response in collaboration with local commissioners at the tactical level. 5.2 TYPES OF INCIDENT Business continuity/internal incident fire, loss of power or IT, adverse weather. Big bang a serious transport accident or explosion Rising tide a developing infectious disease (e.g. pandemic flu) Cloud on the horizon a serious threat developing elsewhere such as a significant chemical release Headline news public or media alarm Chemical, Biological, Radiological and nuclear (CBRN) actual or threatened dispersal CBRN materials with deliberate criminal, malicious or murderous intent Hazardous Materials (HAZMAT) accidental incident involving hazardous materials Cyber-attacks attacks on systems to cause disruption and reputational or financial damage. Attacks may be on infrastructure or data confidentiality Mass casualty typical events with casualties in the 100s where the normal incident response must be augmented with extraordinary measures Major Incident Plan V2.2 October 2017 Page 7 of 114

8 6. RISK ASSESSMENT The Trust has a duty to assess the various risks and hazards that are likely to trigger a major incident response and these risks form part of the Trust Risk Register. In addition, there are risks that are common to all emergency services and supporting agencies and those form part of the Community Risk Register, which is maintained by the Local Health Resilience Partnership (LHRP) Examples of the highest risks at the time of writing this policy are mass casualty event, prolonged severe pressure creating capacity issues, pandemic influenza, cyber-attack and environmental health incident (CBRN) 7. COMMAND AND CONTROL STRUCTURE One of the keys to the successful management of an incident is the early establishment of command and control, which is maintained throughout the incident. Command - is the direction of the members and resources of an organisation in the performance of its roles and tasks and operates vertically within the organisation. Control - is the authority to direct strategic and tactical operations in order to complete an assigned function. Co-ordination - is the harmonious integration of the expertise of all agencies involved with the objective of effectively and efficiently bringing the incident to a successful conclusion Trust Command and Control structure Gold (Strategic) Command Trust HQ, Chief Executives office Medical Bronze Command (Operational) EAU 3136 or 3139 Silver (Tactical) Command Capacity Hub behind Main reception ext 3163, 1359 or 1360 Surgical Bronze command (Operational) First Floor clinical offices ext 4269 Major Incident Plan V2.2 October 2017 Page 8 of 114

9 7.2. Gold (strategic) command This is the senior tier of management with good communication facilities based away from the front line. Gold Command will be managed either by the Chief Executive or an Executive Director. This level would have overall executive command of the Trust during a major incident, making strategic decisions about the deployment of resources, maintaining the normal functioning of core services across the Trust, as far as possible, communications with external agencies /media/vip s, and restoring normality as soon as possible. The gold (strategic) commander will identify a recovery team to feed into silver meetings any impact on normal activity and what recovery plan is required to return to normal following this incident. Gold Command will be located in the Chief Executive s office in South Block and the Gold Commander will be supported by a Communications Manager and Decision Loggist. In this office on the right hand side cupboard there is a resource folder for the Gold Commander which is regularly updated. On the Hub in departments - Emergency planning there is also information that would be useful in a Major incident West Midlands Major Incident response plan - activation algorithm, NHS England - on call rota, contact numbers etc Silver (tactical) command Silver Command will be prepared as soon as a Major Incident is reported by the Ambulance service for either Standby or Declared The Silver Commander will provide tactical leadership whilst implementing and using the Major Incident Plan. They will lead the Silver command team to provide a co-ordinated hospital wide response and will report up to Gold (Strategic) command The Clinical Site Coordinator will be the Silver Commander until a more senior manager or director arrives on site (OOH). When the Clinical Site Coordinator (CSC) hands over to a more senior Silver commander they will explain the Situation, Background, Assessment and Recommendations (SBAR appendix B) this is not a replacement for the METHANE report, it is used to provide a structured handover. There is also a flowchart that will be used throughout the incident to ensure all options have been considered (Appendix C) Silver Command will be based in the Capacity Hub office, this is behind main reception. The Silver Commander will be supported by the CSC, Medical Coordinating Officer, Nurse Coordinating Officer, Decision Loggist and if possible a General Loggist who will record all other activity. During normal working hours they will also be supported by Capacity Manager & Capacity Matron. If this room cannot be used the backup silver is the ED seminar room but in a decontamination incident this is allocated to the Police Documentation Team. This team would need to be re-located by the medical secretaries (action card 20) All decisions made before a loggist arrives must be logged by the Silver Commander in the green Major Incident Log book. This book will be kept for 25 years for future use in court if required. Follow this link for a printed Incident Log-Book for general logging (Appendix D) Major Incident Plan V2.2 October 2017 Page 9 of 114

10 7.3.6 There is a resource cupboard in Silver Command that holds:- - Major Incident plan (MIP), Tabards - Laminated action cards - Business Continuity plan (BCP) - Local area BCPs - Large screen T.V to show Sky news (through EMS link) & capacity screen - A Z - Green incident log book - Teleconference phone, standard phone - Pens, white board, flip charts etc. - Major incident radio (see Appendix E for instructions) The purpose of the tactical level is to ensure that all actions taken in an incident are coordinated, coherent and integrated in order to achieve maximum effectiveness, efficiency and desired outcomes. The silver (tactical) commander will determine priorities for allocating resources, plan tasks to be undertaken and allocate jobs or roles, pull additional resources and assess risks The NHS England Incident Response Rota provides the contact details for NHS England West Midlands and the Tactical Advisor who will support the Trust (or Trusts) in an incident Surgical Bronze (operational) command Surgical Bronze is the Operational Manager for Surgery, Trauma and Orthopaedics (T&O), Maternity and Paediatrics. The role of Surgical Bronze commander will be undertaken by a manager or senior nurse in Surgery or T&O Surgical Bronze is based in the First Floor Clinical Offices which are adjacent to ward B4 ext During an incident this will be signposted The Surgical Bronze Commander will be supported by a Surgical bed manager, Anaesthetist on call, on call Surgical, Gynaecology, Paediatrics, ENT (if on site) and T&O Consultants and Theatres Manager/Lead nurse Information required by the Silver commander from these areas will be collected by the Bronze Commander and reported to Silver Surgical Bronze MUST have a decision loggist (using a green Major Incident log book) but would also benefit from an additional general loggist using a printed log booklet. All decisions made before a loggist arrives must be logged by the Surgical Bronze Commander. There is a flowchart that will be used throughout the incident to ensure all options have been considered There is a red resource box in Surgical Bronze Command that holds the Major Incident policy, laminated action cards, Business Continuity plan (BCP), green incident log book, general loggist booklets, tabards, pens, white board, flip charts etc Elective Activity - it may be necessary to suspend elective activity in order to accommodate patients from the incident. This will be dependent on the number and type of patients from the incident. Major Incident Plan V2.2 October 2017 Page 10 of 114

11 The reduction of elective activity will commence as follows; with the lowest priority identified first. Patients undergoing routine procedures / appointments / investigations Patients with long waiting times Clinically urgent patients This will apply to all elective activity including inpatients, day cases, outpatients, diagnostic procedures. A record will be kept in the decision log for Surgical bronze so that patients can be contacted after the Trust has recovered to normal working Medical bronze (operational) command will be based in EAU doctor s office ext or The medical Registrar will be based here initially and will be supported by a medical manager (in hours) Medical bronze will report ED/EAU position to silver (tactical) command Recovery team At the earliest opportunity the Gold (strategic) or Silver (tactical) commander will identify a Recovery team to plan the return to normal working. This team will consider planned activity in the days to come, see action card This team will not be based in the capacity hub and will not be involved in capacity management The Recovery team will be led by a senior manager from the Trust who is able coordinate teleconferences, liaise with local authorities, community managers re: allocation of community nurses, CCG s, Care Home Select, Discharge facilitators and the capacity team to expedite discharges to bring the Trust to a position where normality will resume following the incident The Recovery team will report into silver (tactical) command meetings to understand the Trust position in order to communicate with colleagues in the teleconference meetings (Appendix K) A declared state or the impact of the incident could last for days. The Recovery team will look at planning for the next 1 7 days. This will require senior decision makers to input elective activity, staffing and additional contingency areas. This will also be discussed at silver (tactical meetings) Major incident situation assessment tool It is recognised that each of the emergency services have their own well defined role and operating procedures. Under the Joint Emergency Services Interoperability Programme (JESIP) the police, fire and ambulance service use generic guidance on what actions they should undertake when responding to a Major Incident. They will use METHANE which is the same Shared Situational Tool that we use in this Trust to understand the Incident (Appendix A) The emergency services under JESIP will locate the Bronze Commanders at the Site of the incident. Communication with the Trust from the incident will be via the major incident radio or direct with the Silver (tactical) commander on ext. 3163, 1359 or INITIATION OF THE MAJOR INCIDENT POLICY 8.1 This may occur in two ways: Major Incident Plan V2.2 October 2017 Page 11 of 114

12 The Ambulance Incident Officer will declare a Major Incident following talks with the Fire Incident officer and a senior police officer (JESIP) Ambulance control will identify and establish the receiving and supporting hospitals and notify them accordingly. There may be a sudden influx of casualties in the Emergency Department, in which case the On-call emergency consultant or ED registrar on site may declare a Major Incident. This may happen at the Hospital even though the Police and Ambulance Services are able to cope with the situation at the scene Ambulance and Police Services will be informed by the COO (Or Director on call) immediately if the Trust declares a Major Incident to allow re-direction of any further patients to other local designated hospitals if this is possible. The Director will discuss this with CCG or CCG on call who will liaise with NHS England - See the West Midlands Major Incident response plan - activation algorithm (MASS CASUALTIES) pages 12 to In the event that a chemical contamination is identified at the site of an incident a Senior Police Officer, the Fire Incident Officer or the Ambulance Incident Officer may declare a Chemical Incident. Annex 1 of the Trust's Major Incident Plan will then be activated and switchboard will call staff using (Appendix H) following confirmation of who requires a call by the Silver (tactical) commander or a member of the hospital coordinating team In the event that a biological contamination is identified at the site of an incident a Senior Police Officer, the Fire Incident Officer or the Ambulance Incident Officer may declare a Biological Incident. Annex 2 of Trust's Major Incident Plan will then be activated and switchboard will call staff using (Appendix H) following confirmation of who requires a call by the Silver (tactical) commander or a member of the hospital coordinating team In the event that a radiation contamination is identified at the site of an incident a Senior Police Officer, the Fire Incident Officer or the Ambulance Incident Officer may declare a Radiation Incident. Annex 3 of Trust's Major Incident Plan will then be activated and switchboard will call staff using (Appendix H) following confirmation of who requires a call by the Silver (tactical) commander or a member of the hospital coordinating team. 8.2 Major incident STANDBY (correct terminology is essential) The message MAJOR INCIDENT STANDBY - should originate from ambulance control and will be received by ED on the red alert phone. The ED nurse in charge will document the information given and inform switchboard (METHANE paperwork (Appendix A) The message gives advance warning of the possibility of the need to initiate the Trust's Major Incident Procedure, on a phased or limited basis. For a Major Incident Standby, switchboard will use call list 1 (Appendix H) All staff on call list 1 are required to come to the hospital as soon as possible unless they receive a call to say Major incident standby cancelled The staff on call list 1 will prepare the areas under their control so that the Trust is ready to receive large numbers of casualties in the event of a Major Incident Declared message being received If the Major Incident location is the Merry Hill Centre the call from Switchboard must state Major Incident standby Merry Hill Centre, traffic restrictions will be in place (Appendix I) Major Incident Plan V2.2 October 2017 Page 12 of 114

13 8.3 If a call is received to state MAJOR INCIDENT - DECLARED then switchboard will also ring all of the staff on call list - 2 (Appendix H) Major incident DECLARED (correct terminology is essential) The message MAJOR INCIDENT DECLARED is likely to originate from Ambulance Control. It may or may not have been preceded by the message 'Major Incident Standby' On receipt of the message MAJOR INCIDENT DECLARED ED will inform switchboard who will immediately implement the Major Incident callout plan (Appendix H) On receipt of the message 'Major Incident Declared' staff should proceed as directed on their individual 'Action Cards' (See Annexe 1). It will then be the responsibility of the key officers to contact the other relevant personnel in their discipline or department, using a cascade system of communication. Staff not called in for the incident should not come in to help unless they have confirmed that they are needed. The incident may have impact on the Trust for several days or even weeks so staff will also be required for recovery and a return to normal. Staff should wear their identification badge at all times and tabards if they hold a key role. 8.4 MAJOR INCIDENT TERMINATION/STAND DOWN ARRANGEMENTS At the termination of a Major Incident a message will be received either: 'MAJOR INCIDENT - Casualties cleared' Or 'MAJOR INCIDENT - Cancelled' This signifies the stand down for the Major Incident, however stand down at the site may invariably occur before the hospital has finished treating patients If this message is received by Switchboard it should be immediately relayed to Silver (tactical) command on ext. 3163, 1359 or The Hospital Co-ordinating Team will then agree stand down arrangements in collaboration with the ED Consultant and NIC. Stand down within the Trust may be several hours after stand down at the site. Once the Trust gives stand down this message will be communicated via Silver (tactical) command. 9 COMMUNICATION 9.1 Good communication is essential during a Major Incident. The switchboard is likely to be overloaded with calls. It is therefore important that staff do not add to the communication problems by unnecessarily telephoning through the hospital switchboard. Priority will be given to all Major Incident Calls over routine calls. 9.2 During a Major Incident, non-urgent communication by phone should be limited to Major Incident communication or urgent matters only. Communication with the command rooms will be via:- emergency.planning@dgh.nhs.uk for silver command (capacity hub, behind main reception) This will be non-urgent only. Gold via switchboard Silver ext. 3163, 1359 or Medical bronze ext (office hours only) Major Incident Plan V2.2 October 2017 Page 13 of 114

14 Surgical bronze ext For important communication, runners must be sent if the lines are continuously busy. Switchboard or security will provide radios for the HALO to communicate with silver (tactical) command and any other staff the coordinating team deem necessary to improve communication. 9.3 The communications team will support the Trust with external messages to the public and other agencies. This will be via the Trust web site, Facebook, twitter and local media. Internal messages will also go out on the hub and to Trust executives. 10 THE HOSPITAL PLAN 10.1 Hospital Co-ordinating Team The Major Incident will be co-ordinated and managed from Silver (tactical) command in the capacity hub behind main reception The silver (tactical) commander will be supported by the Clinical Site coordinator and the three co-ordinating officers. These Co-ordinating officers are:- The Medical Co-ordinating Officer The Nursing Co-ordinating Officer The Operations Director or deputy (in hours). On call manager (OOH) The roles of the medical and Nursing Co-ordinating officers are described on Action Cards (see Annexe 1) Key tasks for this team will be:- To co-ordinate the Trust Move resources (including staff) as appropriate to support areas of high pressure Liaise with other organisations involved in the incident, particularly the Ambulance Service Communicate with departments and key staff within the Trust using Bronze (operational) commanders to feedback from their areas. Liaise with the Hospital Ambulance Liaison Officer (HALO) who will be based in the emergency department. The HALO will communicate between ED, Silver (tactical) command and WMAS (base and scene of incident) 10.2 Receipt of casualties Emergency Department (ED) Casualties will be received in the Emergency Department at Russells Hall Hospital. The Emergency Department will be cleared of all patients who do not require immediate treatment. They will be requested to visit their General Practitioner for advice. All casualties will enter the triage stream at the resus entrance of ED. Casualties arriving in ED will be given pre-prepared wrist bands and paper notes. The unique Major Incident number will be used for all X-rays, blood samples or paperwork for that patient. These are available via the Emergency Department Nurse in Charge and are stored in the ED Major Incident Store Room. Patients will be identified by this although name and date of birth can also be added if known. Major Incident Plan V2.2 October 2017 Page 14 of 114

15 10.3 Access to ED Access for all patients will arrive via the resus entry where they will be triaged. Self-presenters will also be directed to the resus door for triage, no-one will enter via the usual ED entrance In previous mass casualty incidents (London, Paris); casualties have made their own way to hospital on buses, taxis and own transport. There is a potential that self-presenters could arrive at main reception and the Silver (tactical) Command team will need to consider allocating staff here to direct self-presenters back outside and round to the ED resus entrance where patients will be triaged Patients will arrive with triage cards from the incident if they were triaged on site. Patients will be triaged again on arrival by the triage teams. Triage categories Description Triage colour Triage team ED entrance Area assigned to 1 Immediate Red Primary Resus door Resus or HDA if resus 2 Urgent Yellow Primary Resus door Minors area 3 Walking wounded Green Primary Resus door Main waiting room after triage 4 Expectant Blue Resus door CDU (end of life) 5 Dead White Mortuary Category 1 Immediate (red) will be treated in the resus area of ED and any overflow will be managed in the HDA area of ED (cubicles 1 8) Category 2 Urgent (yellow) will be treated in the HDA area of ED and overflow will be treated in new patients (cubicles 11 19) any Category 3 Walking wounded (green) will be treated in the main waiting room where the Green Team will be based. The paediatric area will be used for assessments and treatments. Patients with minor or no physical injury may need psychological care following the incident. These patients will be streamed to UCC. Category 4 Expectant/end of life (blue) will be managed in the Clinical Decision Unit (CDU) Category 5 Dead (white): Patients declared dead at the incident site will be labelled appropriately and may only be removed with the authority of the HM Coroner who, if numbers demand, will require the Local Authority to provide premises for use as a temporary mortuary. Patients who died en-route to the hospital will be certified by the triage doctor and taken to the hospital mortuary. Patients who die in the department will be certified by the attending doctor. Any bodies brought in dead or who died in the department must be placed into a body bag complete with their effects. Children Where possible, children will be kept with their families (if cat 2 or 3) a place of safety may be required see paediatric action card 26. Major Incident Plan V2.2 October 2017 Page 15 of 114

16 Following initial triage and treatment, patients from these areas will then move to one of the following destinations: Admit for surgery Surgical/T&O/Gynae admission Vascular admissions Critical patients Medical admissions Patients requiring psycho-social support Overflow contingency if there are too many P3 s to remain in ED for final treatments (i.e. plaster, suturing) Transfer Discharges Dead Direct to theatre (East Wing) or SAU SAU on B5 (West wing) Direct to B3 Intensive Care Unit (East Wing) EAU UCC (Mallin Health) OPD following approval by ED shop floor Consultant and Silver Command Team Specialist Centre Discharge lounge Mortuary, Russells Hall Hospital 10.4 WARDS The following medical and support staff will play a key role in the management of beds at Russells Hall Hospital: Orthopaedics - The Registrar (or junior doctor carrying that responsibility) until the arrival of the on-call Consultant Orthopaedic Surgeon Surgery - The Registrar (or junior doctor carrying that responsibility) until the arrival of the on-call Consultant Surgeon Medicine - The Registrar (or junior doctor carrying that responsibility) until the arrival of the on-call Consultant Physician Paediatrics The Consultant or Registrar Capacity Team- Members of the Capacity Team will support the medical staff in ensuring the prompt and safe discharge of appropriate patients to increase bed availability for incoming casualties Arrangements should be made to discharge all non-urgent patients and the appropriate follow-up arrangements made for them. This responsibility rests with the medical staff identified in paragraph unless the incident happens in hours when the parent teams can identify discharges from their areas The Silver (tactical) team will discuss all non-urgent elective activity and cancel if appropriate to release theatres, recovery capacity & staff to redeploy The OPD team are on the callout list for a major incident. This will provide the Green team with nursing resources who are able to assist with treatments i.e. dressings, slings, plastering after X-ray etc. The plan will be to contain all P3 patients from the incident until they can be discharged from ED. However, the OPD team have an internal plan to open up areas should the volume of P3 casualties overwhelm ED. If this occurs then overflow to OPD will be approved by the ED Shop Floor Consultant (action card 9) following consultation with the Silver Command Team. Support will be required depending on the types of injuries moved to OPD - for example:- Maxilla facial for facial injuries & facial suturing Plaster technicians (to include measuring for crutches) Major Incident Plan V2.2 October 2017 Page 16 of 114

17 Impact team to assist with admission avoidance, this may include Occupational Therapists, Physiotherapists, Impact sister, social worker, ERT team. Ophthalmic team to review eye injuries if on site DISCHARGES All discharges should be sent to the discharge lounge if safe to do so, patients that would be excluded are infected, confused, neutropenic and stretcher discharges The Silver command and Coordinating team will identify areas for bedded discharges: Surgery Day Surgery Unit if capacity allows. Use ward staff to look after bedded discharges to release DSU to support in theatre. Medicine medical day case unit or GI unit ED outpatients in liaison with OPD lead nurse bleep NON-EMERGENCY PATIENT TRANSPORT (NEPT) WMAS provide Dudley Group with emergency and non-emergency patient transport but it cannot be assumed that the NEPT team are aware of the Major Incident. The silver command team will nominate a member of the team to liaise with the NEPT team The NEPT team who also support New Cross will be asked to pull support into the Dudley contract if they are not affected by the incident although this is very unlikely St John, if on site, will be allocated journeys by the nominated transport person in point Discharges from ED, EAU and wards will be prioritised over the discharge lounge patients The Trust has a contract with a local taxi company that will take patients and claim payment at a later date following invoicing. Any patients safe to travel by bus or taxi should go via these methods to avoid use of ambulances Diagnostics (radiology, MDCU, cardiac catheter lab, GI unit) All non-urgent diagnostics will be discussed in silver (tactical) command, cancellation of elective diagnostics will be considered to release slots and staff for emergency activity. All patients not requiring immediate attention will be sent home or returned to their ward The radiology lead will assess if lead aprons are required in ED The radiology lead will consider activity at Guest and Corbett and will discuss with the silver team if this activity needs to be cancelled to pull resources to RHH Patients seen in the Emergency Department will be X-rayed if necessary, prior to admission to the hospital Minor injuries will be X-rayed at the discretion of medical staff and seen in the Radiology Department that day or subsequently In the event of major injuries the on-call Radiologist may be called to the Emergency Department at the discretion of the Emergency Consultant or radiology lead Critical Care Units To maximise the critical care resources available, patients already in the Critical Care Units will be assessed for their needs by the on-call Intensive Care Consultant and moved to the appropriate environment. The Critical Care Units encompass ICU, Surgical HDU, Medical HDU and VascU (Vascular High Dependency Unit) Major Incident Plan V2.2 October 2017 Page 17 of 114

18 Patients requiring level 2 or 3 care in ICU or SHDU following planned but urgent surgery will be discussed in surgical (operational) bronze and decisions made will be reported to the silver (tactical) command team NHS England will require regular situations reports from the Trust, critical care unit capacity is information that will be required Pathology/blood bank On receipt of the call, Haematology BMSs should staff the laboratory, reporting on arrival to the most senior BMS Any contact with the NHSBT will be via the Blood Bank at RHH The laboratory will be prepared as far as is possible for basic tests & investigations Pharmacy The pharmacist in charge at Russells Hall/on call pharmacist will ensure that there are sufficient intravenous solutions and controlled drugs available If extra pharmacy support is required, this will be via the Pharmacist in charge at Russells Hall or on call pharmacist A supply chain to the Emergency Department, Theatres, Critical Care Units and wards will need to be established by the pharmacist in charge at Russells Hall/On Call Pharmacist utilising the portering service The pharmacist in charge will liaise with silver (tactical) command to provide updates re: prioritising workload. This will include supporting ED who will use FP10 s where appropriate and provision of TTO s to expedite discharges. Pharmacy support to clinics will be discontinued and any clinics continuing to run will require FP10 (outside pharmacy) prescriptions HSDU Senior staff will ensure that there is sufficient equipment and sterile stocks available to support Emergency department and Theatres Autoclaves and other sterilising equipment will be prepared to ensure a rapid turnaround of equipment Technical support will be provided by Estates staff to maintain autoclaves and sterilising equipment Procurement Senior staff will liaise with the Silver (tactical) command team to prepare to meet any immediate requests for additional goods and services Catering Catering will be reviewed for additional support to ED or for staff staying longer due to the incident. The catering team will be required to report to silver (tactical) command what additional support can be provided Relatives Despite the activation of a Police Incident Information Centre, relatives and friends are likely to make early contact with the hospital in attempts to locate and obtain information about casualties If relatives and friends arrive at the Hospital they should be directed to the Dining Room on the 1st Floor of South Block, which will be opened up or cleared on the instruction of the Zonal Manager (Interserve) Relatives and friends will be asked to wait in the Dining Room under the control of the Zonal Manager (Interserve) and catering staff will bring appropriate refreshments General information on casualties will be given to them by the Duty Manager, (Interserve) but detailed or sensitive information will be given by clinical staff or via the police. Major Incident Plan V2.2 October 2017 Page 18 of 114

19 When relatives are allowed to visit the patient they will be escorted by a member of the clerical, portering, security staff or volunteers Distressed or bereaved relatives and friends will be taken to the Tutor Rooms (EDU 015, 016 and 017 on the 1st Floor of South Block), where they may be comforted by the Hospital Chaplains and other support agencies who will be directed to this area If relatives and friends telephone the hospital they will be given the number of the Police Incident Information Centre PRESS AND MEDIA ARRANGEMENTS In order to minimise disruption, a constructive and positive relationship should be established with the press and media as quickly as possible Members of the Press or other media are to be directed to the Main hospital Entrance at Russells Hall Hospital. They will then be escorted to room 6 in the Clinical Education Centre, South Block, first floor by a member of the communications team, clerical, portering, security staff or volunteers as available The control of the Press and media will be the responsibility of the Head of Customer Relations and/or the Communications Manager and in their absence, a senior manager designated by the Gold (strategic) commander, who will be responsible for issuing up-to-date information and picture opportunities. Press statements will need to be co-ordinated with the Emergency Services and the on-call Public Health Consultant The Press and media must not be allowed out of room 6 unless escorted by a member of staff and they will not be free to make direct and unwelcome contact with casualties or their relatives. Press or media enquiries by telephone are to be directed to the Communications Manager IN THE EVENT THAT THE MAJOR INCIDENT IS A CHEMICAL OR BIOLOGICAL INCIDENT, MEMBERS OF THE PRESS OR OTHER MEDIA WILL NOT BE ALLOWED ON THE RUSSELLS HALL HOSPITAL SITE VOLUNTEERS In the event of volunteers attending or telephoning the Hospital, they are to be referred to the Main Reception Desk where the receptionist will take their name, address and telephone number, thank them for their offer and explain that in the event of their being required, they will be sent for. They will then be asked to leave the hospital grounds. If the volunteer coordinator or a deputy they will assess which staff are required to stay on site Out of hours this will be managed by the Zone Co-ordinator designated by the Zone Manager The Trust volunteer team, who are familiar with the hospital, may assist in escort duties and help to provide refreshments to patients and waiting relatives The Zone Manager (Interserve), supported by the Trust Volunteers Co-ordinator is responsible for the deployment of volunteers The Trust volunteer team expected to be on site (or those called in) are to report to the first floor reception South Block with their security ID badges. The volunteer team will help with specific tasks and their deployment will be managed by the Volunteers Co-ordinator and the Zone Manager (Interserve). Major Incident Plan V2.2 October 2017 Page 19 of 114

20 This volunteers will be offered support following the incident as with other staff groups employed by the Trust. 11 GENERAL PRACTITIONERS/UCC 11.1 Gold (strategic) command will work with the communications team to liaise with the Dudley CCG and the CCG communications team. A request will go out to ask that emergency admission requests from GPs or domiciliary visits are to be referred, wherever possible to 'non receiving' Hospitals for the duration of the Major Incident The Urgent Care Centre (UCC) is located adjacent to the Outpatient department at Russells Hall Hospital. UCC is open 24 hours per day, 7 days per week and is staffed by G.P s, reception staff and nurse practitioners The UCC will be notified of the incident during the call out process (Appendix H) and will send home all patients not requiring urgent attention. These patients will be advised to see their own g.p s or return when the incident is stood down. This information will be available on the Trust web site or local radio. Casualties from the incident with minor or no physical injuries may require psycho-social support as they are too traumatised to send home. These patients will be streamed to UCC. 12 SECURITY AND CAR PARKING FACILITIES 12.1 Tight security will be enforced throughout the duration of the Major Incident and staff will be required to wear their identification badges The security lead at the time of the incident will escalate to the senior manager or manager on call if more staff are required. Staff will be pulled from other sites at Dudley Group (i.e. Corbett or Guest) or other contracts If police resources are not immediately available, hospital security staff will assume responsibility for access, parking and security until police assistance arrives At an early stage, the site will be controlled by security and police and vehicular access to the Emergency Department will only be granted to emergency vehicles Relatives, friends, media and volunteers will be directed to the main visitor car park and then to the Main Entrance (see Site Plan Appendix L) Staff must comply with parking restrictions imposed by police or security staff at the time. Staff will park in the staff car parks but must access via North block or main entrance (Maternity entrance if the incident is CBRN) 12.7 During a Major Incident, security staff will be stationed at the Main Entrance (East Wing), the Maternity Entrance (East Wing) and the Emergency Department (West Wing) to control access into the hospital In the event the Major Incident is a chemical, biological or radiation incident the deployment of security staff and lock down arrangements set out on Action Card 24 will apply. 13 CAPACITY MANAGEMENT 13.1 The capacity team will continue to manage bed capacity getting regular updates from surgery, T&O, paediatrics and maternity Regular capacity planners will be prepared for the Silver (tactical) command team to enable decisions to be made for the management of the incident The CSC will regularly update the Regional Capacity Management Team via the Escalation Management System (EMS) so that they are able to evaluate the region. The RCMT will send regular updates via to the CSC inbox at site.coordinator@dgh.nhs.uk or emergency.planning@dgh.nhs.uk Using the EMS level, the Capacity team will communicate the EMS level and key staff will use the escalation policy to follow the action cards. Major Incident Plan V2.2 October 2017 Page 20 of 114

21 13.5 The CSC will regularly monitor the WMAS CAD (Computer Aided Dispatch) which will indicate the number of ambulances here, number en-route and handover times The HALO will also support the Ambulance Triage team to cohort patients when safe to do so to release crews out of the hospital. The Silver (tactical) command team will provide staff to support this area Teams based in the capacity hub will support the recovery team. These are: The Discharge coordinators and discharge facilitators who will review all known delays to assist with discharge planning. If required to, this team could re-locate some of the team to release computers and phone lines. The Care Home Select team who will assist with placement of patients awaiting long term 24hr care. Red Cross will support vulnerable patients on discharge for up to 6 weeks. This service will be considered to enable some patients to go home. The recovery team will liaise with the capacity team to report any known discharges and any delays waiting for TTO s The CSC, capacity manager & capacity matron (in hours) will liaise with each other to ensure all available beds are declared early, patients sent to the discharge lounge (where possible) and all areas have had a senior review. Out of hours the Clinical CSC managing Nervecentre will liaise with the Capacity CSC to ensure an up-to-date bed state is available The therapies dept. can support discharges or release staff from wards to assist in ED. This team could assess specific types of casualties such as respiratory or orthopaedic and support assessments to facilitate discharges. 14 INFORMATION ABOUT CASUALTIES 14.1 As soon as possible after the occurrence of a major incident the police will establish an Information Centre. This will usually be located at the Lloyd House and staffed by police officers The telephone number of the Information Centre will be released to all the news media as quickly as possible and enquirers will be instructed to use this number and not to contact local hospitals Any enquirers ringing hospitals for information concerning casualties should be referred to the Police Incident Information Centre Number Information about casualties taken to hospital will be gathered and transmitted to the Police Incident Information Centre by Police Documentation teams which will be based at the hospital The Police Documentation Team will pass only general information to the Police Incident Information Centre, giving patient's name and whether they are: Dead Injured and detained for treatment or observation Injured but not detained No physical injuries 14.6 Information concerning the death of a casualty will be given to relatives on a personal visit by a Police Officer and not passed to them by telephone The Police Documentation team will need access to a telephone and fax line and they will be housed in the medical secretaries office ext (Room AED 099) in Emergency Department (See Plan Appendix L) In the event of a CBRN incident this team will be based in the ED seminar room behind the paediatric area of ED if it is safe for them to come on site. They will enter the hospital via the maternity entrance as all other doors will be in lock down Documentation on casualties will be obtained by the Police Documentation Team, supported by the Emergency Department Administration Team. Major Incident Plan V2.2 October 2017 Page 21 of 114

22 15 DEBRIEFING 15.1 Following a Major Incident there will be a hot debrief following Trust standdown to enable staff involved to discuss the incident and communicate what went well, not well and lessons learned. This will be documented on an SBAR debrief document (Appendix G) 15.2 The Accountable Emergency Officer or delegated deputy will be responsible for arranging a cold debrief within 72hrs of stand-down. This internal debriefing will be open to staff involved on the day and those involved in the recovery process in the days to follow. A report will follow to identify lessons to be learnt and actions required following this review. CCG, Local Authority, NHS England, RCMT & Public Health will be invited to this debrief Lessons will be shared with the Local Health Resilience Partnership (LHRP), Local Health Resilience Forum (LHRF) and the Dudley Resilience Forum (DRF). 16 POST TRAUMATIC COUNSELLING 16.1 A number of agencies will be available to provide for the Counselling and support of staff involved in a Major Incident in the period following the incident Counselling will be arranged, as appropriate, by the Director of Human Resources supported by the Hospital Chaplain. 17 BIRMINGHAM, SOLIHULL AND THE BLACK COUNTRY INCIDENT RESPONSE PLAN (IRP) In the event of a Major Incident (of whatever type) threatening to overwhelm any individual part of the NHS in the West Midlands conurbation, there is the provision to co-ordinate the response through the NHS England Area Team. This will be via the West Midlands Major Incident response plan - activation algorithm IRP Role The IRP supports the local NHS in planning and responding to major incidents through a defined system of command and control at four levels of response: Level 1 - Managed locally by individual Trusts. Level 2 - Response co-ordinated by NHS England Area Team Level 3 - Regional Lead is with NHS England Regional Team Level 4 - Nationally led Responsibilities - Incident Directors at Level 2 or 3:- mobilise NHS Resources across the area in support of the affected Trusts manage the wide-area response co-ordinate all media/public information Level 2 - Location NHS England Area Team Incident Co-ordination Centre NHS England West Midlands St Chads Court 213 Hagley Rd, Birmingham, West Midlands, B16 9RG england.bsbc-icc@nhs.net) Birmingham, Solihull & Black Country Incident Manager (1 st On-call) NHS England West Midlands Incident Director (2nd On-Call) NHS England Incident Response Rota. This also containers the contact details and rota for the tactical advisor for acute providers. Major Incident Plan V2.2 October 2017 Page 22 of 114

23 Activation Follow the instructions and guidelines in the West Midlands Major Incident response plan - activation algorithm pages 12 to 13. Page 71 shows the agreed patient distribution for Priority 1 & 2 patients in an incident. 18 TRAINING/SUPPORT All wards and departments will have a resource folder for emergency planning to ensure their teams are aware of specific policies and plans. There is also a page on the hub for Emergency Planning which is accessible via departments which also provides access to this policy and those needed for emergency planning. Staff on the hospital management on call rota will attend on call training before going onto the on call rota. This will include capacity, 12 hour breach protocol and reporting, emergency planning, command and control and management of an incident. On call/emergency planning training is a 2 hour session talking about the theory & expectation of on call staff. There will also be a walk round to understand the involvement of UCC, OPD, ED, decontamination and Silver (tactical) command. What to do in a Major Incident (staff awareness leaflet) is available in the red emergency planning awareness folders in all wards and departments and on the emergency planning page on the hub. This is also given to new starters with the Trust. 19 PROCESS FOR MONITORING COMPLIANCE Lead Tool Frequency Reporting arrangements Emergency planning manager Emergency planning manager Core Standards Best practice peer review Yearly Reported to LHRF & LHRP Yearly Reported to LHRF & LHRP Acting on recommendations and Lead(s) Reviewed via Trust EPRR group Reviewed via Trust EPRR group Change in practice and lessons to be shared Shared via EPRR group Shared via EPRR group 20 EQUALITY The Dudley Group NHS Foundation Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds. This document has been assessed appropriately. 21 REFERENCES Command paper (including green and white) NHS England (2016). NHS Standard Contract 2016/ /05/2017] [Accessed The Workplace (Health, Safety and Welfare) Regulations Major Incident Plan V2.2 October 2017 Page 23 of 114

24 Health and Safety Executive (HSE) (2013) Workplace, health, safety and welfare. Workplace (Health, Safety and Welfare) Regulations Approved Code of Practice and guidance. Second edition. Health and Safety Executive: [Accessed 26/05/2017] NHS England (2015) NHS England Emergency Preparedness, Resilience and Response Framework [Accessed 26/05/2017] NHS England (2015) NHS England Core Standards for Emergency Preparedness, Resilience and Response. [Accessed 26/05/2017] NHS England Command & Control Framework 2013 NHS Resilience PAS 2015: Guidance for NHS-funded organisations 2010 Department of Health(2007) Mass Casualties Incidents A framework for planning. Emergency Preparedness Division. Health and Social Care Act 2012 Act of parliament Civil Contingencies Act 2004 Civil Contingencies Act 2004 (Contingency Planning) Regulations 2005 National Health Services Act 2006 Major Incident Plan V2.2 October 2017 Page 24 of 114

25 ANNEX 1 CHEMICAL INCIDENT PLAN 1. INTRODUCTION 1.1 Recently there has been a surge in planning and resources for the management of a chemical incident. This is largely due to world-wide terrorist activity, however, the largest threat within this region comes from our local industry, and the transport of hazardous chemicals on the roads and rail. 1.2 Currently this Trust has twenty three sets of NHS approved Yellow Personal Protective Equipment (PPE) and a static decontamination shower unit. The PPE sets will be used by the Decontamination Team and are located in the major incident room. 1.3 Decontamination of patients would normally be undertaken at the scene and then transported to ED. Only rarely would the ambulance service transport a patient prior to decontamination. The ED nurse in charge will alert the fire brigade as soon as a patient self presents at the Trust with an unknown contaminant, once on site the fire brigade will take charge of the incident which will release ED staff back into the department. 1.4 In a chemical incident, we can expect an influx of affected walking wounded. Some industrial chemicals have a rapid effect, such as acids and alkali. Other chemicals have a slow onset, with general malaise etc. However chemicals such as phenols have a carcinogenic association, which can cause much public concern, with many well patients attending medical services for check-ups. 1.5 Terrorist actions are designed to cause mass panic. The nature and type of incident, and the chemical involved will ultimately dictate the pattern of attendance to the Emergency Department. 1.6 Additional supplies of equipment are available Equipment Pods 100 people supply, 80 adult + 20 paediatric. From West Midlands Ambulance Service, Emergency Operations Centre, Millennium Point Nerve agent antidote Duodote single injection pens From West Midlands Ambulance Service, Emergency Operations Centre, Millennium Point Biological Cipro Pod Decision to deploy from WMAS Biological Doxy Pod Decision to deploy from WMAS Major Incident Plan V2.2 October 2017 Page 25 of 114

26 2 SECURE ALL ACCESS TO THE HOSPITAL 2.1 All points of entry to the hospital building must be secured Maternity entrance at the East wing of the hospital will be the only entrance that visitors can enter; this will be controlled by security. North block staff entrance will be the designated staff entrance. Only staff, with appropriate hospital ID badges will be allowed entrance here All other routes of access to the hospital building will be closed, allowing no access The Emergency Department Ambulance, and walk in entrances will all be in lock down until it has been confirmed that the cordon has been lifted by the fire brigade who will take charge of the incident The ED nurse in charge will clear ED of patients and relatives. Wards to pull those requiring admission, those to stay in ED will need additional staff pulled to support. Any patients who may have been contaminated in the waiting room will need to stay in ED until the contaminant has been identified. 2.3 The Security and Decontamination teams will set up: Hot Zone - a mustering point for all arriving contaminated people / patients. (Grass verge opposite Decontamination Unit if delivered by ambulances, grass by the peripatetic car park if patients self-present in the ED waiting room) Warm Zone - where decontamination takes place. This is the hot zone for dry decontamination or the purpose built static decontamination unit for wet decontamination Cold Zone, post decontamination mustering. This is via the EAU external entrance to be directed as appropriate to ED, if P1 or 2, and the ED waiting room if P Decontamination of patients Decontamination team leader. An ED trained nurse who is trained to take the Initial Operational Response (IOR) will coordinate dry decontamination. Click here to view the Dry decontamination DVD. The ED nurse in charge will liaise with the IOR nurse and the NILO to assess if dry decontamination is sufficient or if wet decontamination is required Decontamination team The initial team will be from ED staff until the arrival of the Fire service CBRN team who will take over to release staff back to ED. The Nurse in charge of ED will liaise with the estates team to switch off the ventilation system by the Decontainer, the time must be documented. ED decontamination lead to ensure all windows in hospital facing decontamination area are to be closed 2.5 Decontamination of internal hospital areas Cleaning will be supported by Interserve following identification of the contaminant. Major Incident Plan V2.2 October 2017 Page 26 of 114

27 2.6 Identification of contaminant Contact Public Health (PH) who may be aware of the situation. They may have identified the agent. The pods of extra equipment and specific drugs can be distributed to cater with large numbers of affected patients ED nurse in charge to contact the pharmacist in charge at Russells Hall/On Call if the ventilation unit is switched off which will affect the aseptic suite Clinically identify the signs and symptoms which can lead to the identification of the type of contaminant. The nurse in charge will liaise with the NILO in ambulance control via the red phone. Further information on clinical presentations of the various types of contaminants is on the internet at and both accessible in the ED department. 3 Other participants 3.1 The Police are likely to be involved. They will require the ED seminar room as their base if it is safe for them to come on site. They are to be advised not to use the Main entrance, or the ED entrance. The only entrance in use during a contamination incident will be the maternity entrance in East Wing. 3.2 A Chemical incident is likely to attract media coverage. The importance of isolating both contaminated people and those not contaminated must be stressed to the press, and the usual facilities in the Education rooms will not apply. Arrangements will be made for Press to be accommodated at the Corbett hospital during office hours. There are no OOH arrangements for press, contact numbers will be taken by the silver (tactical) command team to contact should a press release be necessary. 3.3 If it is safe for relatives to come on site they will be escorted to the café in the Clinical Education Centre, South block, 1 st floor. Major Incident Plan V2.2 October 2017 Page 27 of 114

28 ANNEX 2 BIOLOGICAL INCIDENT PLAN 1 The use of a biological weapon would be either overt or covert, depending upon the perpetrator's aims. 1.1 An overt release of a biological weapon (eg explosive device, crop sprayer) would lead to a large number of contaminated casualties, who may be otherwise uninjured ('worried well'), presenting to hospital expecting treatment: The main aim of management would be the immediate closure of all hospital entrances to prevent contamination of the Emergency Department and the rest of the hospital. Security would have to allow entrance only to identified and non-contaminated staff. Stripping and dry decontamination (see Chemical Incident Plan) would eliminate 99.9% of contaminating organisms, and would take place before the patient enters the Emergency Department. Here, the patients would undergo triage, and walking casualties would be directed to the main waiting room for evaluation and treatment. Non-ambulatory patients would be treated in the main Emergency Department. Swabbing of skin and pharyngeal cavities would take place under the advice and guidance of Consultants in Microbiology and Control of Communicable Diseases, who would also advise regarding prophylactic antibiotics and follow-up after discharge. 1.2 A covert release of a biological weapon (e.g. contamination of food, drinking water or ventilation systems, or covert release in an enclosed environment) is more likely if used by an organisation intent on causing disease and death. Given that scenario, patients will not know that they have been exposed to the contaminating organism or toxin, and will only seek medical attention when they develop symptoms, which may be days later. 1.3 Indicators of a biological weapon attack include: Large unprecedented epidemic of high volumes of patients with similar symptoms Disease not endemic e.g. plague, viral haemorrhagic fevers Unusual clinical presentation e.g. pulmonary infection Multiple disease entities indicating release of cocktail of organisms Indications of multiple source-point outbreaks Multiple drug-resistant organisms, indicating military strains Disease present in human and animal species 1.4 Decontamination would be of limited benefit once the disease is established. However, routine isolation and barrier nursing would be advised. Early involvement of Consultants in Microbiology and CDC would be required. 1.5 In the event of local biological contamination the silver (tactical) commander will determine with the Consultant Microbiologist whether to shut down the hospital ventilation and air conditioning systems. If such a decision is made the silver (tactical) commander will authorise the Estates Manager to close the systems down via the BMS Failure to close windows on the front of the hospital (West wing) could result in contaminated air entering the hospital Failure to shut down ventilation units could result in contaminated air being pulled into the hospital and pharmacy aseptic unit, main hospital, cardiac day case etc. Contaminated HEPA filters in the aseptic unit could result in the loss of this facility for up to 6 weeks. Chemotherapy drugs would need to externally source at a high cost to the Trust. Major Incident Plan V2.2 October 2017 Page 28 of 114

29 ANNEX 3 RADIATION CONTAMINATION PLAN 1 INTRODUCTION 1.1 Where a casualty contaminated with radioactive material arrives at the hospital the senior doctor in the Emergency Department must contact the switchboard at Queen Elizabeth Hospital Birmingham (QEH) to obtain advice and assistance on decontamination procedures. Medical physics staff at Sandwell and West Birmingham NHS Trusts should be requested to attend Russells Hall Hospital. 1.2 Any form of accident involving radioactive material may result in individuals being contaminated by the radioactive material, in addition to trauma. A scheme for dealing with such incidents has been drawn up at a national level known as the 'National arrangements for incidents involving radioactivity (NAIR)' and is co-ordinated by the National Radiological Protection Board. 2 TYPES OF CASUALTIES 2.1 Physically injured and known not to have received a significant dose of radiation and known not to be contaminated with radioactive material These patients require no special facilities relating to radiation. They present no hazard to attendants, vehicles and treatment facilities. 2.2 Exposed to a high radiation dose, whether physically injured or not Unless they are also contaminated with radioactive material, they present no hazard to attendants and there is no risk of contamination of vehicles or treatment facilities. 2.3 Uninjured but contaminated or possibly contaminated These individuals will need to be monitored to assess the degree of contamination, if any. Decontamination facilities will be required. It is possible that contamination alone without physical injury or a significant dose of external radiation would be sufficient to cause an acute effect to the patient but not to attendants. Decontamination is required to prevent or reduce further radiation doses to remove the risk of inhalation or ingestion of contaminating material or the transfer of such material to others. 2.4 Physically injured and contaminated or possibly contaminated Contaminated casualties are those who have radioactive material on their skin or clothing or who have inhaled or ingested radioactive material. This material will continue to emit radiation so long as it is active and not removed, thus adding to the radiation dose received by the individual if the contamination persists. Transfer of contaminating material to attendants or to the patient's surroundings can cause a small risk to individuals other than the patient receiving a radiation dose. Facilities are required for radiation monitoring, decontamination and assessment of the consequences. Precautions are necessary to reduce the spread of contamination to attendants, vehicles and treatment facilities. Patient clothing, dressings, swabs etc. and excreta needs to be bagged and retained for analysis. Major Incident Plan V2.2 October 2017 Page 29 of 114

30 3 GENERAL PRECAUTIONS FOLLOWING ARRIVAL OF CONTAMINATED CASUALTIES Protective clothing such as gloves, caps, overshoes, masks and aprons should be worn for handling the casualty or entering the receiving and treatment areas. These should be removed before handling anything else. The number of staff who come into contact with the casualty must be kept to a minimum. Movement of staff or equipment from the area where the patient is being treated must be avoided. Once contaminated casualties have arrived, staff should only leave the designated area via one exit and should discard protective clothing and be monitored there. Staff should not eat, drink, smoke, or apply cosmetics until monitoring and decontamination has been carried out. Once the radioactive casualties have been decontaminated medical physics staff will check all other personnel and areas used. If necessary they will give instructions on decontamination. 4 ASSESSMENT OF CASUALTY Senior Sister, Emergency Department, is to obtain the Ram Gene radiation assessment monitor kept in the ED Major Incident Store Room. The Triage Officer should assess the needs of the casualties and direct them to the appropriate area. (a) a casualty with multiple injuries or one who is seriously ill should be taken straight to the treatment area. (b) Other casualties and contaminated personnel (including ambulance staff) should remain in the receiving area. Everything that has come into contact with the casualty, e.g. clothing, swabs, dressings, instruments, gloves, overalls, should be collected in plastic bag for subsequent monitoring. Bags should be labelled as radioactive and marked 'Do Not Discard'. Sharps should be put in a similarly labelled sharps box. Fluid used for washing should likewise be retained in suitable containers. Urgent laboratory samples may be sent to the laboratory but the outside of the container should be swabbed to remove any contamination and a specimen label to indicate the need for caution in handling and disposal. Medical physics staff, via support service from Sandwell and West Birmingham NHS Trusts will monitor and advise on the priority of decontamination of casualties who have received their immediate medical treatment or those contaminated persons who are uninjured. 5 HANDLING OF CASUALTIES 5.1 Handling of the casualty will be dictated by the extent of the injury but actually contaminated casualties should not be given either food or drink unless oral medication is urgently required. In this case local facial decontamination should be carried out first. 5.2 Handling Of Seriously Ill Casualties Staff should wear protective clothing such as gloves, caps, overshoes, masks, while handling the casualty or when entering one of the designated areas. However, the need for life saving treatment should always be of paramount importance and if necessary the casualty should be taken immediately to theatre. Major Incident Plan V2.2 October 2017 Page 30 of 114

31 5.2.2 Open wounds will be irrigated with saline and encouraged to bleed (minor) Undress the patient, assuming all clothing is contaminated, placing clothes in a clear polythene bag. Tie up and label the bag with radioactive warning label. Personal belongings should be placed in a small polythene bag, sealed and labelled. Great care must be taken when undressing the casualty not to spread the contamination. It may be necessary to cut clothing off to avoid spreading contamination to face and hair. Any blood samples collected should be labelled with self-adhesive radiation labels. If there none in ED ask the senior radiographer (bleep via switchboard) 5.3 HANDLING OF MINOR CASUALTIES If the patient's condition will allow, await the arrival of medical physics staff from Sandwell and West Birmingham NHS Trusts who will advise on the amount of contamination and its removal Staff should wear protective clothing such as gloves, caps, overshoes and aprons while handling the casualty or when entering the designated area Any treatment that is required to prevent further injuries should be carried out as necessary If there is gross contamination, the patient should undress by him/herself, taking care not to spread the contamination Any obvious area of contamination may be washed using a moist sponge, taking care not to spread the contamination to uncontaminated parts of body. 6 DO NOT GIVE THE CASUALTY A SHOWER UNLESS INSTRUCTED TO DO SO BY THE MEDICAL PHYSICS STAFF AS THIS COULD SPREAD THE CONTAMINATION. 6.1 In extreme cases of considerable whole body contamination, the medical physics staff may recommend the shower in the chemical decontamination shower unit is used. 7 CONTAMINATED STAFF 7.1 All members of staff who have been in contact with a casualty should wait in the receiving area so that they may be monitored by medical physics staff. This will be carried out after the casualty has been assessed. Until such time members of staff should not return to their normal duties and refrain from smoking, eating or drinking. 7.2 Once the members of staff have been monitored and, if necessary, decontaminated, medical physics staff will proceed to monitor any equipment used including the ambulance and decontaminate as appropriate. Major Incident Plan V2.2 October 2017 Page 31 of 114

32 ANNEX 4 PAEDIATRIC MAJOR INCIDENTS 1 Essentially the major incident plan will be invoked as normal. Immediate additional emergency resuscitation equipment can be drawn from Emergency Department, Theatres, ICU, Ward C2 and the Neonatal Unit. Further equipment can be requested from other local hospitals. 2 Paediatric ICU facilities can be arranged via the Regional Capacity Management Team and many Paediatric ICUs send teams to retrieve. When calling-in staff, priority should be given to paediatric doctors and nurses, and then the normal range of staff. 3 Liaise with the paediatric team who will support the management of this group of casualties see action card 49. Major Incident Plan V2.2 October 2017 Page 32 of 114

33 ANNEX 5 ACTION CARDS The action cards relate to key staff and will be issued by members of the coordinating team in silver (tactical) command, which is located in the Capacity Hub Office, behind the main reception desk. Key staff, in the event of a major incident, must make their way to silver (tactical) command to collect their action cards. Action OFFICER Card 1 DUTY DIRECTOR (GOLD COMMANDER) 2 SILVER (TACTICAL) COMMANDER (COO/AEO in hours or nominated Director, OCM OOH) 3 MEDICAL CO-ORDINATING OFFICER 4 NURSE CO-ORDINATING OFFICER 5 SURGICAL & T&O REGISTRARS ON CALL (or junior doctor carrying that responsibility) 6 MEDICAL REGISTRAR ON CALL (or junior doctor carrying that responsibility) 7 INTENSIVE CARE REGISTRAR 8 CONSULTANT OR REG IN CHARGE OF ED LEAD TRIAGE OFFICER 9 DOCTOR/CONSULTANT IN CHARGE OF SHOP FLOOR 10 NURSE MANAGER (ED) 11 NURSE IN CHARGE OF ED 12 RED ZONE RESUS MEDICAL & NURSE TEAM LEADER (ED) 13 RED ZONE ED HDA CUBICLES MEDICAL & NURSE TEAM LEADERS 14 CONTROLLED DRUGS NURSE 15 TRIAGE NURSE RED ZONE WORKING WITH LEAD TRIAGE OFFICER 16 NURSE & MEDICAL TEAM LEADERS YELLOW ZONE 17 NURSE TEAM LEADER GREEN ZONE (ED MAIN WAITING ROOM) 18 NURSE TEAM LEADER BLUE ZONE (CDU) 19 RECOVERY TEAM MANAGER 20 MEDICAL SECRETARIES (EMERGENCY DEPARTMENT) 21 ED RECEPTIONIST TEAM LEADER 22 ED RECEPTIONIST #1 23 ED RECEPTIONIST #2 24 INCIDENT TRACKER 25 SENIOR NURSE OPD 26 PAEDIATRIC TEAM 27 DUTY RADIOGRAPHER 28 IN HOURS : PORTERING MANAGER - OUT OF HOURS : INTERSERVE ZONE MANAGER 29 SECURITY & CAR PARKS MANAGER/DUTY SUPERVISOR 30 PHARMACIST ON CALL OR IN CHARGE, RUSSELLS HALL 31 HOSPITAL STERILE AND DISINFECTION UNIT MANAGER 32 HEALTH RECORDS MANAGER 33 ESTATES OFFICER ON CALL 34 CATERING MANAGER 35 DEPUTY DIRECTOR OF OPERATIONS (INTERSERVE) 36 HAEMATOLOGY TECHNICIAN 37 CONSULTANT HAEMATOLOGIST 38 CAPACITY SITE CO-ORDINATOR 39 CLINICAL SITE CO-ORDINATOR Major Incident Plan V2.2 October 2017 Page 33 of 114

34 40 HEAD OF CUSTOMER RELATIONS OR COMMUNICATIONS MANAGER 41 ON CALL CHAPLAIN 42 TRUST VOLUNTEER TEAM 43 DUTY SOCIAL WORKER 44 HEAD OF PROCUREMENT 45 RUNNERS 46 STAFF BANK CO-ORDINATOR 47 URGENT CARE CENTRE MANAGER/DOCTOR IN CHARGE 48 DECISION LOGGIST 49 GENERAL LOGGIST Major Incident Plan V2.2 October 2017 Page 34 of 114

35 1 Mass Casualties Plans Annexe 6 The objectives of this mass casualty plan are: To establish a shared understanding of mass casualty incidents, mass casualty incident types and their implications across health and social care services To define activation arrangements for mass casualty incidents in the event of a declared major incident To define command, control and co-ordination framework for managing mass casualty incident response To define activities that can be utilised to manage capacity in a mass casualty incident To define essential services to be maintained in the event in order to respond to the health needs of the wider population unaffected by the incident To define triage and treatment arrangements for incident casualties after transport to a health care facility has taken place To define individual organisational roles and responsibilities To define the key risks that may adversely affect the ability to implement mass casualty incident response arrangements To understand the West Midlands Major Incident response plan (IRP) and activation algorithm (Mass casualty plan) This document contains the activation algorithm (page 12 to 13) and the division of casualties (pg 70 71) 1.1 Activation arrangements PHASE ACTION / INDICATOR TIMEFRAME Initial Major Incident / Mass Casualty Incident Declared 0-30 mins Activation Trusts activate Major Incident Plan Mass Casualty arrangements implemented (IRP) if Mass Casualty Plan activated Command, Control, Co-ordination & Security arrangements established. Bronzes set up (including community) Partner Notification including PFI, increasing numbers of security and porters will be required quickly. Share Single Point Of Contact (SPOC) details Join Surge and Escalation Teleconference (Tactical) Activate Business Continuity Plans Activate required supporting plans e.g. Lockdown Implement staffing arrangements to sustain response levels for a number of days Lockdown Policy HAZMAT/CBRN Plan Social Media Policy Response Actions implemented following Joint Surge and Escalation Teleconference (Tactical) for:- - Demand Management, which areas can be cleared? ED, OPD, labs, day case areas. Front load ED with staff. Assess trauma stocks 30 mins 1 hr Major Incident Plan V2.2 October 2017 Page 35 of 114

36 The Consolidation Stand Down & Recovery - Service Prioritisation - Rapid Emergency Discharge, all specialities - Capacity Expansion and staffing for these areas - Triage and Treatment - Supporting Response i.e. security, porters, mortuary status including body bags, HSDU, waste management, laundry, catering for extra staff on site, relatives. Setting battle rhythm for all meetings including teleconferences Join Surge and Escalation Teleconference (Strategic) Community Response, including community bronze to report into silver. Can community support discharges by prioritising only urgent cases, prepare staff that may be required to support Local Authority rest centres Response arrangements are implemented Maintain up to date brief of situation from Ambulance Service Participate in regular Joint Surge and Escalation Teleconferences (Tactical and Strategic level) Continue to implement actions, regularly reviewing to ensure that resources are best utilised for various response components (see overleaf) Joint Surge and Escalation Teleconferences (Tactical and Strategic) are held on regular basis Maintain up to date brief of situation from Ambulance Service Stand down measures implemented on a stepped basis for response components (see overleaf) Reinstate suspended activities Resume normal operating hours Steps are taken to step down Demand Management, Service Prioritisation, Rapid Emergency Discharge and Capacity Expansion measures Resource supplies are replenished Major Incident / Mass Casualty Incident stand down Revert to normal procedures and arrangements 1hrs-up to 5 days 5 days to 10 days Restoration 10 days of Normality Backlog of deferred work has been cleared plus * Whilst the response phase is not considered to start until appropriate preparations have been initiated it is possible that self-presenting casualties may begin arriving within 15 minutes of the incident occurring. 2 Operation Plato Operation Plato is the National response plan to a large-scale incident resulting in a high number of casualties in single/multiple location(s); whether occurring simultaneously, or in close sequential/geographical proximity. This appendix has been developed to meet the Department of Health Requirements under Operation Plato. Locally, Operation Plato can be activated by the Emergency Services in conjunction with NHS England. Actions Upon receipt of the code word Operation Plato, the Trust in summary will: Activate Trust Major Incident Plan(s). Open and staff the Major Incident Room(s). Gold, Silver and Bronze. Inform NHS England that Gold command is operational. Number can be found on the NHS England Incident Response Rota Immediately send a Situation Report using the SBAR format unless NHSE provide an alternative document. Confirm the following: o Levels of activity. Complete the MI Capacity Tracker which can also be forwarded to NHSE and CCG. This is available on the capacity Major Incident Plan V2.2 October 2017 Page 36 of 114

37 page of the hub and in large printed versions in Silver and Surgical Bronze commands. o What staff, with appropriate skills, are immediately available to support the local response? o What trauma equipment is available for use? o Business continuity issues. Consider decision to instigate a lockdown*. *Lockdown preparations/activities may/may not be required due to proximity to the incident(s) and intelligence available relating to threat. Reporting The Trust will be required to provide a Situation Report every 2 hours up the local NHS command and control structure, unless directed otherwise, providing an overview of activity and any operational issues. Communications It is highly likely that mobile telephones could be disabled in the event of a Plato incident; therefore, a greater reliance will be placed upon landline, video-conferencing and systems for the transmission of information. External Communications including Media Any requests for external information from outside of the NHS, Local Authority or blue light emergency services should be referred to the NHS England Strategic Commander. No information should be released to the media, public or relatives without the express authority of either the NHS England Strategic Commander or the Police through the Strategic Coordinating Group (SCG). 3 Acute Trust Upon receipt of the code word Operation Plato The Trust will conduct the following activities (as a minimum): Activate Trust Major Incident Plans; all teams should have already prepared internal cascade lists which should be tested 6 monthly. Consider WhatsApp or group texting. Do not pull all staff in, this could last for days. Use 1470 if ringing through a Trust phone so the number is not blocked. Open and staff major incident rooms (Gold, Silver and Bronzes). Staff coming in should bring ID passes, enter through North Block. Do not ring switchboard to ask what is happening; do not come in unless called in. Inform NHS England (NHS England Incident Response Rota) that the major incident room is operational, inform CCG who will support the Trust Immediately update EMS. Review staffing arrangements and implement arrangements to ensure optimum staffing of ED, surgical services, critical care, theatres etc. Can staff be re-deployed from Corbett & Guest, OPD, Day case surgery, medical day case, staff in training or the corporate nursing team. Consider if specialist areas need to go to non-framework agencies to open additional beds. Major Incident Plan V2.2 October 2017 Page 37 of 114

38 Review B1 criteria, could this be relaxed to move patients from B2. Can post op X-Rays be delayed to free radiology time for urgent cases. Can specialist teams support emergency cases i.e. ophthalmology, ENT, plastics. Radiology, pharmacy, labs, OPD etc. will prioritise urgent work and cease inpatient none urgent activity Consider: Reminding staff involved to follow the guidelines of the Social Media Policy, any calls from the media should be directed back to switchboard who will consult with the Director on call (Gold) or Communications Team Implement a rapid discharge processes to create capacity; as far as system capacity and available resources of health and social care colleagues will allow. Each team to review who can be discharged quickly to create capacity and who can be stepped down to a lower dependency area Review blood and trauma stocks (receiving Trusts to implement immediate 4 hour resupply via NHS supplies) see section 10.9 of MIP pg. 17 Consider decision to instigate a lockdown* Prepare to receive Police Documentation Teams. See section 14 pg. 21 Consider the use of non-acute NHS facilities, any independent sector capacity to support rapid discharging. What additional capacity can be provided internally (including Corbett and Guest as off-site facilities), how will these areas be staffed? Advise health professionals, other agencies and the public in monitoring long term effects of an incident, consider the need for counseling support for staff involved in a response from an early stage. Provide staff and relatives with the NHS Trauma Leaflet - coping with stress following a major incident Implement mortuary business continuity arrangements, as required Implement triage principles along the principle of hospital treatment for those who will most benefit from it Consider additional drugs or stock that may be required, particularly in theatre. Identify the requirement for voluntary agency and faith sector assistance at Trusts and convey requirements to NHS England via NHS command and control arrangements. Ensure sufficient staff to support relatives in South block restaurant, must be sufficient to prevent the press accessing this area. Coordinator of this area will record names of relatives and those they are searching for. This will assist the Police Coordination Team with patient identification. Any items of clothing or personal effects will require bagging and careful labeling as they may be required for evidence. Ensure sufficient staff to supervise press in room 6 CEC, first floor. Members of the press must not leave room 6 without a member of the Trust to escort (even the toilet where there may be relatives) OOH this is coordinated by the Interserve supervisor Note: *Lockdown may or may not be required due to proximity to the incident/ incidents and intelligence relating to threat. The Department of Health (2007) Mass Casualties Incidents: A Framework for Planning indicates the following illustrative guidance that can be used to calculate the potential numbers of patients in each category in a conventional Major Incident Plan V2.2 October 2017 Page 38 of 114

39 major incident. The column outlining planning assumptions has been added to the table as a guide for the purpose of training. It is vital for NHS Trust plans to consider early in the activation stage of a local/significant emergency (major incident) what the real-time point of criticality is, as internal factors (e.g. theatre closed for maintenance) will have an impact on the numbers of patients in each category a Trust may be able to manage. 3.1 Community Teams Upon receipt of the code word Operation Plato Community Health Services are required to conduct the following activities (as a minimum): Identify non urgent visits, cancel to release staff. Flex services and teams. Set up a community bronze at Brierley Hill Health and Social Care Centre SPA 8am 6pm, OOH service after this. A senior nurse or manager will lead community bronze to liaise with the Trust. Any community staff called into RHH to car share, enter via North block. Community bronze will provide an update of community capacity & update EMS. Provide support for rapid discharge from acute beds, all discharges as a result of the major incident will receive a follow up call. Currently only over 65 s receive a follow up call, these patients are identified on a daily discharge list received daily via an automated . This will be implemented by the Community bronze Local authority may require nurse and medical support in rest centers to assess those displaced from their homes or the site of the incident. These people are likely to arrive with no medication, insulin etc. A request for support will come into Gold or Silver from either Local Authority direct or via the CCG. Any staff deployed must continue to report back to the community bronze commander via the SPA number. 4 UCC and 111 See section 11, page 19. UCC will send all none urgent cases home on receipt of the major incident standby or declared message. The team will receive those patients who have no physical injuries but require psycho-social support as they are too traumatised to send home. Dudley CCG will liaise with the 111 team to prevent none emergency activity from being sent to the Trust. 5 HAZMAT and CBRN The NHS England Emergency Preparedness, Resilience and Response (EPRR) Chemical incidents: Planning for the management of self-presenting patients in healthcare settings documents provides generic guidance on the response expected from NHS Acute Trusts (including Foundation Trusts) and other NHS funded organisations involved in a health response to decontamination of self-presenting persons. It forms part of the NHS Emergency Preparedness Framework 2013 published by the NHS England. Major Incident Plan V2.2 October 2017 Page 39 of 114

40 The document focuses on the following: Planning for the management of self-presenters in a healthcare setting. Initial Operational Response (IOR) Dry decontamination DVD. Preparation for incidents involving hazardous materials: guidance for primary and community care facilities. UK Reserve National Stock for Major Incidents How to access stock in England. Patient Group Directions. Incidents involving hazardous materials and a CBRN event are no different in regards to the symptoms been displayed by the casualty; the only difference between the two is the intent to harm in a CBRN attack. ED will require almost all of its nursing resources to carry out wet decontamination. Silver command must identify appropriate staff as a priority to back fill the gaps to support the rest of ED. 5.1 Front Line Responding Staff Need to be aware that: Patients may arrive with no prior warning. Their symptoms may be non-specific e.g. itching skin, watering eyes, respiratory problems, dizziness or nausea. It may not be obvious that someone has been in contact with a hazardous material. History taking will identify if the patient believes they have been involved in: o An explosion, fire, cloud of smoke or gas, o Being covered in dust, powder or liquid as the result of an accident, o An industrial or agricultural incident; spillage or transport accident or something similar, Staff should: Carry out a dynamic risk assessment; include STEPS 1, 2, 3. How did the casualty arrive at the hospital? Is there a contaminated vehicle on site? Maintain a safe distance away from the casualty(s), Gather intelligence symptoms being displayed, physical effects and appearance of any contaminant Isolate the casualties and the room, Contact the emergency services, Seek advice on any appropriate emergency action that could be delivered to the casualty(s), this could involve initial operational response (IOR), 5.2 Initial Operational Response (IOR) IOR is the First Aid of decontamination and includes non-caustic decontamination (dry decontamination). Staff will identify a safe location for a person contaminated with non-caustic chemicals. The person will be directed to disrobe to underwear only, removed clothing placed into double plastic Clinical Waste bags and secured; then conduct a dry decontamination using an absorptive materials (cloth or paper towels), using a blotting not wiping motion. Hair should be washed, taking care not to allow water run off to travel over the face or body. Once completed, the person should be provided with clothing. Major Incident Plan V2.2 October 2017 Page 40 of 114

41 Wet decontamination is to only occur if there are signs and symptoms of caustic chemical substances. This can involve using water from taps in buckets, showers, hose reels and should be conducted until the substance is completely removed. * Waste water and specialist advice are other factors to be considered. * Existing local procedures for processes including, re-robing, handling of personal items and management of hazardous waste. See HazMat plan which will be on the Emergency Planning page on the hub. Major Incident Plan V2.2 October 2017 Page 41 of 114

42 ACTION CARD NO 1 DUTY DIRECTOR (GOLD COMMANDER) YOUR LOCATION IS: Gold (Strategic) command. CEO s office, 2 nd floor South block. Contact via switchboard 1. Report to the Chief Executive s Office, Second Floor, South Block. 2. Work with the Silver (tactical) command team providing strategic leadership whilst the Major Incident Plan is in operation. 3. Consider setting up a recovery team as soon as practical (see action card 2) to review processes for returning the Trust to normal when the incident has been stood down by Silver (tactical) command. The recovery phase should be planned for by an independent team with a senior Recovery lead that will attend silver meetings to provide updates. Liaise with the silver (tactical) commander who may have already allocated this role. 4. Establish the nature of the incident and visualise the best, worst and most probable outcomes, completing an SBAR assessment (Appendix B) 5. In consultation with Silver Command, establish a battle rhythm to manage the flow of information from Wards and Departments to Silver and Gold Commands, then onwards to external organisations (e.g. CCG, Police, Media, and Local Authority). 6. Manage potential harm to the Trust s reputation. Decide who you need to support you, including a Loggist and a member of the communications team. 7. Ensure from the outset that the green Emergency Decision Log is completed and appoint a Loggist as soon as possible. 8. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 42 of 114

43 ACTION CARD NO 2 SILVER (TACTICAL) COMMANDER (COO/AEO in hours or nominated Director, OCM OOH) YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk. Collect action card and tabard. 2. Lead the Co-ordinating Team. 3. Work with the Medical and Nurse Co-ordinating Officers to manage the Trust s response; this will include: Chairing regular Silver (tactical) meetings for key individuals using the SBAR structure. Recommendations from previous SBARs to be reviewed. Support a plan to empty CDU which will become the blue zone for end of life casualties. Consider closing Corbett and Guest and re-deploying staff, if appropriate. Theatres staff in these areas may have already been re-deployed as part of the Theatre plan Discuss cancellation of Outpatients Clinics, non-urgent admissions, operating lists, as appropriate and arrangements for the return of patients to their homes. Ensure that events are tabulated against time (e.g. use white board or flip charts). Ensure Procurement & HSDU make arrangements to restock essential supplies as necessary. Co-ordinate public relations activity via the Communications Manager Providing regular updates to Gold (strategic) command. Ensure that Switchboard Manager has contacted British Telecom for additional telephone facilities if necessary, to prevent switchboard overload and crash. Confirm lock down with security to ensure main reception is manned and entry is controlled. Consider setting up a Recovery Team as soon as practical to review processes for returning the Trust to normal when the incident has been stood down by Silver (tactical) command. Consider catering arrangements For chemical incidents discuss with switchboard who needs to be called in from the callout list. 4. Deploy all non-medical staff who report for duty, advising them of any specific action. 5. Advise the Trust's Chief Executive and Chairman that a Major Incident has been initiated. 6. Advise Dudley CCG via switchboard or CCG on call ( ) who will escalate as per the West Midlands Major Incident response plan - activation algorithm (see pages 12 & 13). 7. NHS England Incident Response Rota will provide the contact details for the on call Tactical Advisor who will support the Trust (or Trusts) in a Major Incident. Major Incident Plan V2.2 October 2017 Page 43 of 114

44 8. Inform the Regional Capacity Management Team UCIC 07:00 22:00 Tel: RCMT 08:00 17:00 Tel: , OOH Ensure all action cards have been collected and as such all major areas of activity are covered; if not, delegate to senior staff as appropriate. ED have their action cards in the Major Incident resource box and will not come to Silver to collect. 10. Use the green decision log to document all actions and decisions taken - note date and time. This log will be taken over by a loggist once they are on site. Major Incident Plan V2.2 October 2017 Page 44 of 114

45 ACTION CARD NO 3 MEDICAL CO-ORDINATING OFFICER (see point 4, callout list page 99) YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk and co-ordinate internal arrangements with the Silver (tactical) commander and Nurse Co-ordinating Officer. 2. Notify Ambulance Control on when the Hospital Control Centre (silver command) is established and communicate with the incident site. In consultation with ambulance control, assess the Hospital's ability to accept further casualties. 3. Inform Emergency Department and Registrars in Medicine (medical bronze - ext or 3139), Orthopaedics and Surgery (in surgical bronze ext. 4269) of: (a) Number and category of casualties expected (b) Rate of evacuation of casualties from site of incident. (c) Type of injuries expected which will influence the teams called in to support e.g. ophthalmic & maxilla facial. 4. Assume overall responsibility for the management of beds across the Trust through the registrars in Surgery, Medicine and Orthopaedics. 5. For CBRN incidents, discuss with Silver (tactical) commander and Nurse Coordinating officer if the full callout list is required. Nurse Coordinating officer will speak to switchboard. Check List (a) All other hospitals and personnel notified (b) Medical and nursing teams called and the reason for calling (c) Bed state at Hospital established (d) Communications satisfactory (e) Possible duration of incident clearance known as soon as possible, to warn back-up services if required (f) If any special services are required these will be arranged by Ambulance Control. (g) Ensure Police Information Room (Medical Secretaries office in the Emergency Department) is aware of casualty receiving arrangements and of any changes (h) ED may require speciality support (i.e. ENT if on site, max fax, surgery, T&O, Paeds) and will request this via Silver. Patients that have been triaged and assessed by the ED Consultant as stable will be moved direct to the area they are referred to. A brief handover will be given verbally as Soarian will not be active to make referrals. WHEN THE MAJOR INCIDENT IS AT AN END THE AMBULANCE CONTROL WILL INFORM THE HOSPITAL BY THE USE OF THE FOLLOWING TERMS: 'MAJOR INCIDENT CASUALTIES CLEARED' 'MAJOR INCIDENT CANCELLED' Major Incident Plan V2.2 October 2017 Page 45 of 114

46 6. The Medical Co-ordinating Officer will, in conjunction with other members of the Co-ordinating Team and ED Consultant, decide how and when to react to the message received from the Ambulance Service. It may be several hours after WMAS have reported major incident cancelled before the Trust can stand down. 7. For CBRN incidents, see additional policy for actions required. 8. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 46 of 114

47 ACTION CARD NO 4 NURSE CO-ORDINATING OFFICER (see point 5, callout list page 99) YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk and co-ordinate internal arrangements with the Silver (tactical) commander and Medical Co-ordinating Officer. 2. Ensure that the Wards, ICU and Theatres are notified. 3. Patients identified for transfer to home or community beds from Russells Hall Hospital should be sent to the discharge lounge or if patient is a discharge consider liaising with DSU, GI unit and MDCU, to assess if they can wait for ambulance transfer in these areas. 4. Identify who should oversee them and co-ordinate transfer. 5. Direct a Senior Nurse to CDU which is the blue zone for end of life casualties. 6. Decide if nursing and therapies staff in residences should supplement pool of staff. If so send runner(s) to each residence at Russells Hall. 7. Identify some-one to alert residents and request that they report to the Lecture Theatre, 1st floor South Block to await instruction. 8. Direct a senior nurse to the Lecture Theatre, 1st floor South Block to coordinate the deployment of additional staff including those called in from the residences. 9. Delegate staff to work with members of the Chaplaincy looking after the relatives in the Common Room/Dining area in South block. 10. Liaise with the Silver (tactical) commander on the need for voluntary helpers and deploy as necessary. 11. Liaise with staff bank in hours (ext. 2209) over the availability of additional nursing staff to support inpatient areas to back fill any permanent staff deployed to support the Major Incident. 12. For CBRN incidents, inform switchboard who needs to be called in from the callout list following discussion with Silver (tactical) commander and Medical Coordinating officer. 13. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 47 of 114

48 ACTION CARD NO 5 SURGICAL & T&O REGISTRARS ON CALL (Or junior doctor carrying that responsibility) YOUR LOCATION IS: Surgical Bronze Command, First Floor Clinical Offices 1st Floor, West Wing Ext The receiving ward for surgical, T&O and Gynaecology emergencies will be B5 (West Wing). Other wards will be used to decant existing patients from B3 (vascular), Critical Care (ICU, Surgical and Medical HDU) as clinically appropriate. 2. Each registrar will go to Surgical Bronze Command (West Wing) and agree responsibilities. Alert all junior staff but remember that this incident could last for days and cover must not be depleted. 3. In immediate liaison with the Surgical Bed Manager (Bleep 8931) and T&O Bed Manager (Bleep 8700) establish bed availability in Surgery & T&O. 4. This information will be passed by the bed managers to the Co-Ordinating team in Silver (tactical) command. (ext or 1359) 5. Take responsibility for decanting patients out of B5 (West Wing) and B2 (East wing) by either discharge or transfer to other Surgical or T&O wards. 6. If possible, do not accept any further domiciliary admissions, refer them to other 'supporting' hospitals until the incident is over and bed availability allows it. Ensure the on-call doctors are also aware of this instruction. ED Non Major Incident patients that arrive and cannot be sent to g.p. or home will be moved to EAU. Patients identified by the ED Triage Consultant as requiring Surgery or T&O must be pulled from EAU as a matter of urgency. EAU will not be a holding area for these patients. 7. Handover to On-Call Consultant on arrival, who will take over the responsibility of this action card and contact the Medical Co-ordinating Officer for direction who is based in Silver (tactical) command. Unless otherwise advised by the Medical Coordinating Officer, remain on B5 (if not in Theatre) to re-assess patients' condition. 8. On arrival, the next Surgical Consultant will go to ED to liaise with the Shop Floor Medical Lead in ED and Anaesthetist based in ED to prioritise those patients requiring surgery. 9. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 48 of 114

49 ACTION CARD NO 6 MEDICAL REGISTRAR ON CALL (Or junior doctor carrying that responsibility) YOUR LOCATION IS: Medical Bronze Command, desk by doctor s office/bedded area in EAU Ground floor, West Wing Ext 3136 or The receiving area for medical emergencies will be EAU. Medical wards will be used to decant existing patients from EAU if they cannot be discharged. 2. Liaise with the surgical and T&O Registrars in Surgical Bronze (ext. 4269) to agree responsibilities. 3. Alert all junior medical staff available but remember that this incident could last for days and cover must not be depleted. 4. In the absence of the MHDU Consultant, take responsibility for decanting patients out of MHDU (West Wing) by either discharge or transfer. 5. In normal working hours, the parent teams will assess patients on medical wards and assess those that can be discharged. Out of hours, the medical Registrar will assess those patients identified by ward nurses as suitable candidates for an early discharge. 6. If possible, do not accept any further domiciliary admissions, refer them to other 'supporting' hospitals until the incident is over and bed availability allows it. ED Non Major Incident patients that arrive and cannot be sent to G.P. or home will be moved to EAU. Patients identified by the ED Triage Consultant as requiring medicine must be pulled from EAU as a matter of urgency. These patients must be triaged by a doctor on arrival and assessed for EAU, AEC or home. 7. Handover to On Call Consultant on arrival, who will take over the responsibility of this action card, and contact the Medical Co-ordinating Officer for direction who is based in Silver (tactical) command (ext or 1359). 8. Make contact with the Medical Co-ordinating Officer to advise on the status of medical beds following patients reviewed for discharge. 9. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 49 of 114

50 ACTION CARD NO 7 INTENSIVE CARE REGISTRAR YOUR LOCATION IS: Surgical Bronze Command, First Floor Clinical Offices 1st Floor, West Wing Ext 4269 Note: Admissions to Critical Care will follow the usual criteria of need for specialist level 2 or 3 care. Ward patients not requiring this increased level of care will not be admitted into a High Dependency or Critical Care facility. Preparations should be made to transfer current patients who do not require level 2 or 3 care from these areas. The receiving ward for patients not requiring level 2 or 3 care will be B5. Other wards will be used to decant existing patients from B3 (vascular) & Surgical HDU as clinically appropriate. The Critical Care Co-ordinator will take overall charge of ALL Critical Care facilities i.e. SHDU and MHDU. 1. Contact Consultant On-Call for ICU and inform them about the activation of the Major Incident Plan. This consultant will assume the role of Critical Care Co- Ordinator on arrival. 2. Contact the Consultant Anaesthetist On-Call who will assume the role of Anaesthetic Co-ordinator on arrival. 3. Contact Resident Theatre On-Call Anaesthetist and Resident Obstetric On-Call Anaesthetist and inform them of the activation of the Major Incident Plan. One of these anaesthetists will be required to take on the role of Anaesthetic Co-ordinator prior to the arrival of the Consultant Anaesthetist On-Call. However, if both anaesthetists are fully occupied, the ICU Registrar may also have to temporarily cover this role. 4. Assume the role of Critical Care Co-ordinator (Action Card in the Major Incident Box in the large Consultants office in the Anaesthetic Department) until the Consultant On-Call for ICU arrives. 5. Contact Nurse in Charge (NIC) of Critical Care and inform them about the activation of the Major Incident Plan. The NIC will assume the role of Nurse Coordinator and will implement their own Action Plan (in the Major Incident Box in Store Room [with Paediatric Airway Trolley]). The Matron or Deputy will assume the role of Nurse Co-ordinator on arrival. 6. Liaise with the Resident Anaesthetists above and assess current situation as far as current involvement in ongoing emergency work is concerned. Roles may have to be swapped according to skill mix and at least one Anaesthetist may be needed immediately in ED to attend to severely injured casualties or liaise with the Surgical Consultant to prioritise the order of those patients requiring surgery. 7. Hand over to Consultant On-Call for ICU as soon as they arrive on site. They will assume the role of Critical Care Co-ordinator and manage/delegate as necessary and liaise with the Anaesthetic Co-ordinator on a regular basis to ensure a joint approach between Critical Care and Anaesthetics. 8. Review In-Patients on Critical Care, including MHDU, with the NIC regarding their suitability to be transferred to a normal ward. Major Incident Plan V2.2 October 2017 Page 50 of 114

51 9. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 51 of 114

52 ACTION CARD NO 8 ED CONSULTANT OR REGISTRAR DOCTOR IN CHARGE (DIC) - Lead Triage Officer YOUR LOCATION IS: ED Resus entrance Ext 2309 BACKGOUND INFORMATION Triage officer will be an ED consultant or most senior doctor on duty. Triage sieve model will be used. You will be provided with a team a senior ED nurse/s and ED receptionist/runner/s. You will complete the triage. Nursing staff will not complete any triage their role is to support your role and ensure smooth flow & tracking of patients into appropriate areas of department/hospital. All Major incident patients whatever category will pass through this single point of access. Any none major incident patients arriving that are not able to be sent to GP or home will be reviewed and sent to EAU with an exit plan for either medics to take over or surgery/t&o. (No formal triage or intervention will be completed for this group) Runners to be utilised to escort to EAU, this may need to be a trained nurse. Patients requiring surgical or T&O intervention will be sent from EAU who will liaise with SAU. If you have delay in triage your senior nurse will escalate this for additional staffing to your team. Patients will have paper notes with specific Major incident number your triage nurse will ensure appropriate notes and arm band is allocated and tracking commenced before directing them to appropriate ED areas. 1. Proceed to ED Ambulance entrance 2. Introduce yourself to triage nurse Wear your tabard at all times 3. Remain in area until relieved or stood down 4. Your role is to provide dynamic triage using Triage sieve model. 5. Highlight any delays/concerns to triage nurse who will resolve or escalate. 6. Report to Silver Command if the department is unsafe due to volume or dependency. The Silver Commander will liaise with WMAS. 7. When stood down complete hot debrief with your medical team and partake in wider staff hot debriefings. 8. When stood down - Secure all documentation that you have made (additional to patient s notes) then hand to Nurse Manager. Major Incident Plan V2.2 October 2017 Page 52 of 114

53 ACTION CARD NO 9 DOCTOR IN CHARGE OF EMERGENCY DEPARTMENT - SHOP FLOOR MEDICAL LEAD DURING INCIDENT YOUR LOCATION IS: ED Main department Ext 2309 u will be an ED consultant or Middle grade/spr delegated this role by the Doctor in charge of shift at time of incident until relieved by more senior ED doctor 1. Immediately liaise with nurse in charge (NIC) of ED to assess current capacity and resources available. 2. Commence your own log. 3. Put on your tabard 4. Allocate doctors to areas within department delegate team leader roles for: a) Red /priority 1 areas: Resus & HDA (2 team leaders) b) Yellow/priority 2 area New Patients & minor s area (1 team leader) c) Liaise with NIC of ED work closely with NIC to formulate plan and ensure regular scheduled reviews/updates planned. d) Review response from medical call out list inform Silver Command if you need additional medical staffing. e) Liaise with all Medical Team Leaders- ensure they are performing effectively and have necessary resources available instruct each Team Leader to liaise directly with you. f) Allocate additional medical staff to each priority area to be deployed by the areas medical team leaders. g) Ensure consultant grade General surgeon have arrived in ED. Within MI Plan this is specified to ensure appropriate theatre triage is provided. If not available escalate to silver command. When arrive ensure they liaise with you to formulate effective theatre triage h) Ensure Consultant grade Anaesthetist has arrived in ED. If not available escalate to silver command. Within MI plan this is specified to assist in the appropriate theatre/itu triage and co-ordinate appropriate anaesthetic staffing to manage complicated airways, manage ventilated patients in CT/imaging and onwards to theatre/itu. i) When staffing allows allocate medical staffing to manage P3 steam (Waiting in ED Main waiting room/ed paediatric area) j) If the volume of P3 s is overwhelming this area but the number of P1 s and P2 s is currently low assess if some P3 s can be pulled into yellow (minors) to be treated and discharged. k) If pulling P3 s into minors is not an option discuss with the Silver Command team if OPD can pull a cohort of patients i.e. those requiring plastering before discharge. If this is agreed liaise with the Green Team Leader in the main waiting room who will liaise with the Senior OPD nurse. Major Incident Plan V2.2 October 2017 Page 53 of 114

54 5 Once WMAS have given Stand down the department may remain very busy, liaise with Silver Command re: when stand down can be given by the Trust. Retain all major incident documentation following stand down and hand over to the ED nurse manager Major Incident Plan V2.2 October 2017 Page 54 of 114

55 ACTION CARD NO 10 NURSE MANAGER EMERGENCY DEPARTMENT YOUR LOCATION IS: Emergency Department 1. Make early contact with ED nurse in charge (NIC) of ED, identify yourself as ED Nurse Manager. 2. Ensure a clear channel of communication with the ED NIC is instigated. 3. Avoid liaising directly with Team leaders, unless requested to by the NIC of ED. It is essential all communication is consistently passed through the NIC of ED. Additional communication channels will only confuse issues. 4. AT ALL TIMES WEAR YOU RE IDENTIFICATION BADGE, YOUR JOB TITLE BADGE AND DESIGNATED TABARD. 5. Base yourself between ED and EAU within Bronze Control. 6. Your main role is to: Facilitate the smooth running of the ED. Assist the ED NIC in accessing recourses. Assist the ED NIC in complex problem solving issues. Act as a conduit for communication between bronze and silver commands. Optimize the patient care for all patients within the area Manage the general welfare of all staff working within the ED environment. Facilitate debrief for all staff following stand down of incident 7. Retain all documentation following the incident for the Emergency Planning & Capacity manager who will collate all MI paperwork. 8. Keep a log of all actions and decisions taken note date and time as it is unlikely there will be a loggist available for you. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 55 of 114

56 ACTION CARD NO 11 NURSE IN CHARGE (NIC) OF THE EMERGENCY DEPARTMENT YOUR LOCATION IS: Emergency Department Message major incident declared initiate plan will be received via ambulance controldocument details given using METHANE report ensure initiate trust plan by calling 2222 and informing switch board major incident declared initiate plan. 1. Liaise with Doctor in charge of ED to assess current capacity and resources available. 2. Obtain nurse in-charge resource box from Major incident store room. 3. Communicate as soon as possible with Clinical Site Co-ordinator (CSC) who will initiate Silver command. 4. Brief all ED staff utilise discretion 5. Advise senior receptionist and Doctor in charge to follow their action card. 6. Allocate ED nursing staff to key roles - give action cards (in your resource box) clear instructions to communicate directly with you - stipulate how often you wish briefing. 7. Additional staff should be allocated to support team leaders ensure you use the MI allocation sheet. 8. Expedite all exit plans to free space in ED. 9. Delegate nurse in traditional pre incident triage role to make Main waiting room announcement to leave and seek GP review to escalate numbers and details of any patients not able to leave to NIC to be included in capacity and resources plans - following this then re-deploy this nurse to appropriate role) 10. Assess resources needed, organise and document when requested (form on resources clip board). Utilise Silver Command and ED Nurse Manager. 11. Liaise regularly with ED Incident Tracker, CSC, and Team Leaders to assess capacity, bottlenecks, problems and resources needed. 12. Maintain an up to date rolling capacity form to enable instant and accurate information to be disseminated to Silver Command. 13. Retain all ED major incident documentation following stand down and hand over to ED Nurse Manager. AT ALL TIMES WEAR YOUR IDENTIFICATION BADGE, JOB TITLE BADGE AND DESIGNATED NURSE IN CHARGE TABARD. DO NOT LEAVE THE EMERGENCY DEPARTMANT UNTIL RELIEVED OR STOOD DOWN Major Incident Plan V2.2 October 2017 Page 56 of 114

57 ACTION CARD NO 12 RED ZONE RESUS MEDICAL & NURSE TEAM LEADERS YOUR LOCATION IS: ED Resuscitation Room Background The red area RESUS -P1 life threatening injuries. If no P1 life threatening injuries are to be managed at Russell Hall this area will manage any P2 serious but not life threatening category patients RHH will have up to 10 patients of this category in the first hour. A senior doctor and ED nurse will act as a team to manage this area. 1. Precede to Red Zone Resuscitation area 2. Wear your tabard at all times 3. REMAIN NONE CLINICAL hands off to provide effective leadership 4. Develop effective Red Zone Resus team working. 5. Assess capacity/resources-escalate needs/problems to NIC 6. Expedite all exit plans to available cubicles to receive MI casualties 7. Patients will arrive in your area with pre-numbered documentation and ID bracelets. The documents in the patient folder must remain with the patient at all times. (Patient is not to be registered on computer) 8. Allocate staff to a cubicle to formulate a team. Only communicated as ready to receive when team and equipment prepared. 9. Ensure triage white board by ambulance doors is kept up to date with availability to ensure triage can allocate space efficiently 10. Maintain tracking register. 11. Liaise with Incident Tracker to ensure early identification of patients requiring theatre this will be communicated with Surgical Consultant acting as Surgical Triage. 12. Liaise with Incident Tracker to ensure early identification of patients requiring CT will collate information for ED DIC/Anaesthetic Co-ordinator. 13. Liaise with Incident Tracker need to admit. 14. Ensure you develop a robust and efficient system to ensure patient through put within this critical area is optimal. 15. Ensure clear line of communication with nurse in charge of ED and ED Patient Tracker. 16. Secure all documentation (additional to patient notes e.g. patient register) and hand this over to nurse in charge of ED once stood down. Major Incident Plan V2.2 October 2017 Page 57 of 114

58 ACTION CARD NO 13 RED ZONE ED HIGH DEPENDENCY CUBICLES MEDICAL & NURSE TEAM LEADERS YOUR LOCATION IS: ED High Dependency Cubicles HDA 1 to 8 Background The red area High Dependency will manage P1 life threatening injuries. If no P1 life threatening injuries are to be managed at Russell Hall this area will manage any P2 serious but not life threatening category patients RHH will have up to 10 patients of this category in the first hour. A senior doctor and ED nurse will act as a team to manage this area. 1. Proceed to Red Zone High dependency cubicles numbers 1 to 8 (AED ) 2. Wear your tabards at all times 3. REMAIN NONE CLINICAL hands off to provide effective leadership 4. Develop effective Red Zone team working. 5. Assess capacity/resources - escalate needs/problems to Nurse in charge 6. Expedite all exit plans to free cubicles to receive MI casualties 7. Convert all cubicles to manage P1 severity patients delegate staff to obtain equipment 8. Patients will arrive in your area with pre-numbered documentation and ID bracelets. The documents in the patient folder must remain with the patient at all times. (Patient is not to be registered on computer) 9. Allocate staff to a cubicle to formulate a team. Only communicated as ready to receive when team and equipment prepared. 10. Ensure triage white board by ambulance doors is kept up to date with availability to ensure triage can allocate space efficiently. 11. Maintain tracking register. 12. Liaise with Incident Tracker to ensure early identification of patients requiring theatre this will be communicated with Surgical Consultant acting as Surgical Triage. 13. Liaise with Incident tracker to ensure early identification of patients requiring CT will collate information for ED DIC/anaesthetic co-ordinator. 14. Liaise with Incident tracker need to admit. 15. Ensure you develop a robust and efficient system to ensure patient through put within this critical area is optimal. 16. Ensure clear line of communication with nurse in charge of ED and ED Patient tracker. 17. Secure all documentation (additional to patient notes e.g. patient register) and hand this over to nurse in charge of ED once stood down. Major Incident Plan V2.2 October 2017 Page 58 of 114

59 ACTION CARD NO 14 CONTROLLED DRUGS NURSE YOUR LOCATION IS: Emergency Department Clean Utility 1. Set up your post in the clean utility room (Room AED 027, adjacent to the main staff base). 2. Transfer all controlled drugs with the controlled drug book from the ED paediatric area to the clean utility room. Do not remove controlled drug book and drugs from the Resuscitation room. (The Red Area Resuscitation room staff will access their own controlled drugs for the duration of the incident to prevent delay and relieve congestion in the clean utility) 3. You will take responsibility for the entire stock of controlled drugs, CD keys and the CD books within the clean utility until relieved or stood down. 4. All controlled drugs will be issued against your signature. 5. All requests must be in writing on a Major Incident numbered treatment sheet and must be signed by the doctor prior to issue. The normal preparation and check procedure will apply. 6. A floating nurse may check out controlled drug with you on behalf of the nurse responsible for the individual patient, this is permissible as long as they are a trained nurse. They will countersign the checked column in the controlled drugs book, this nurse will then transport the drug with the controlled drugs book for the drug to be once again checked and given by either the doctor or nurse responsible for the patients care. The controlled drugs book will be completed by the administrator of the drug. A runner will then return the completed controlled drugs register immediately to the drugs nurse NO DELAY MUST OCCUR IN RETURNING THIS REGISTER. Whilst the register is out of the clean utility the drugs nurse will access drugs from one of the two remaining controlled drugs registers following the same procedure, therefore no delay in accessing controlled drugs will occur. 8. The Nurse or Doctor administering the drug is responsible for the final checking process before administration of the drug. 9. Complete requisition book to order additional controlled drugs as you assess the need. Send a runner to the Resuscitation room to liaise with Red Team Leader Resuscitation room to determine stock levels of Controlled drugs in the resuscitation room and order controlled drugs for their stock if required. 10. Liaise with the Nurse in charge of ED if you experience delays or any problems Major Incident Plan V2.2 October 2017 Page 59 of 114

60 ACTION CARD NO 15 TRIAGE NURSE RED ZONE YOUR LOCATION IS: ED Ambulance Bay BACKGOUND INFORMATION The Triage Officer will be an ED Consultant or most senior doctor on duty. Nursing staff will not complete any triage. The Triage Nurse role is to support the Triage Officer s role and ensure smooth flow & tracking of patients into appropriate areas of department/hospital. Triage sieve model will be used. Additional support from an ED receptionist & runners will be provided. All Major incident patients whatever category will pass through this single point of access. Any none major incident patients arriving not able to be sent to GP/home will pass though this point of access to be redirected into EAU. One point of access to hospital. Patients will have paper notes with specific Major incident number you will ensure appropriate notes and arm band is allocated and tracking commenced before directing them to appropriate ED areas. 1. Collect triage documentation from ED major incident room in designated and marked box. Take this to triage area by the ED ambulance doors 2. Wear your designated Triage Nurse tabard. 3. Issue each patient with a pre-prepared notes pack apply pre-prepared ID bracelet. The patients identity will from this point be the given Major Incident number on both pack and ID bracelet. 4. Ensure Triage Officer completes brief triage documentation - completed on front of ED paper notes. Clearly document Priority category 5. Complete triage tracking sheet ensure each patient is added to this. 6. Utilise white board adjacent to ambulance doors to assess capacity ensure this is kept up to date by runners/tracker escalate to ED NIC any problems DO NOT LEAVE THE AREA YOURSELF TO CHECK FOR SPACE. RED CATEGORY P1 ED resus or high Dependency YELLOW CATEGORY P2 ED new patients/minors GREEN CATEGORY P3 ED Main Waiting room To be escorted by runner via internal corridors past ED x-ray then pharmacy. BLUE CATEGORY P4 CDU WHITE CATEGORY P5 Direct to Mortuary ensure patient is certified deceased. Documentation completed on patients notes. ID and notification death slip Major Incident Plan V2.2 October 2017 Page 60 of 114

61 completed. Then liaise with mortuary to accept (ensure added to tracking sheet) 7. None major incident Patients that cannot be sent home or to g.p. will be directed to present via ED ambulance triage. (1) NO formal triage to be completed but the Triage Officer will assess to confirm that the patient cannot be sent home. (2) The Triage Officer will send the patient to EAU with instructions for assessment by EAU or Surgery (T&O) If the patient is to go to the surgical team they will go to EAU initially who will liaise with surgery (Or T&O) for immediate transfer (3) Ensure these patients are tracked complete their details on tracking board make sure it is clear that they are not a major incident patient. (4) DO NOT GIVE MI NUMBER/NOTE PACK. 8. Escalate any delays in triage/flow to NIC of ED. 9. Secure all documentation and hand this over to nurse in charge of ED once stood down. Major Incident Plan V2.2 October 2017 Page 61 of 114

62 ACTION CARD NO 16 MEDICAL & NURSE TEAM LEADERS - YELLOW ZONE YOUR LOCATION IS: ED New Patients / minors - Yellow Zone Background Yellow area New patients/minors area of ED for P2 serious but none life threatening injuries. If no P1 life threatening injuries are to be managed in RHH Resus and high dependency will accommodate P2 patients in preference to new patients/minors RHH will have up to 10 patients of this category in the first hour. A senior doctor and ED nurse will act as a team to manage this area 1. Proceed to Yellow Zone new patients/minors 2. Wear your tabards at all times 3. REMAIN NONE CLINICAL hands off to provide effective leadership 4. Develop effective Yellow team working 5. Assess capacity/resources - escalate needs/problems to NIC 6. Expedite all exit plans to free cubicles to receive MI casualties 7. Convert all cubicles to manage P2 severity patients delegate staff to obtain equipment 8. If the number of patients allocated to this area are low, the Shop floor Consultant may allocate some P3 s from the Green zone for treatment and discharge 9. Patients will arrive in your area with pre-numbered documentation and ID bracelets. The documents in the patient folder must remain with the patient at all times. (Patient is not to be registered on computer) 10. Allocate staff to a cubicle to formulate a team. Only communicated as ready to receive when team and equipment prepared. 11. Ensure triage white board by ambulance doors is kept up to date with availability to ensure triage can allocate space efficiently 12. Maintain tracking register. 13. Liaise with Incident Tracker to ensure early identification of patients requiring theatre this will be communicated with Surgical Consultant acting as Surgical Triage. 14. Liaise with Incident Tracker to ensure early identification of patients requiring CT will collate information for ED DIC/Anaesthetic Co-ordinator. 15. Liaise with Incident Tracker need to admit. 16. Ensure you develop a robust and efficient system to ensure patient through put within this critical area is optimal. 17. Ensure clear line of communication with NIC of ED and ED Patient Tracker. 18. Secure all documentation (additional to patient notes e.g. patient register) and hand this over to nurse in charge of ED once stood down. Major Incident Plan V2.2 October 2017 Page 62 of 114

63 ACTION CARD NO. 17 NURSE TEAM LEADER GREEN ZONE YOUR LOCATION IS: ED waiting room/paediatric area Green Zone Background P3 walking wounded will access the department via ED ambulance doors and undergo triage by senior ED doctor. Will then be directed to green area ED MWR by walking them through ED X-ray onto the main hospital corridor and left to the back entrance to the ED waiting room. RHH is scheduled to be able to accommodate up to 70 patients of this category A senior ED nurse will be the team leader with clinical decision makers sent to attend when available. 1. Proceed to Green Zone Paediatric area/ed main waiting room 2. Wear your tabard at all times 3. REMAIN NONE CLINICAL hands off to provide effective leadership. 4. Assess capacity/resources - escalate needs/problems to NIC. E.g. cancellation of clinic. 5. Convert all cubicles to manage P3 severity patients send a request to Silver (tactical) command via the NIC if additional equipment or runners are required. 6. Patients will arrive in your area with pre-numbered documentation and ID bracelets. The documents in the patient folder must remain with the patient at all times. (Patient is not to be registered on computer) 7. Consider prioritising patients/secondary triage. 8. Maintain tracking register. 9. Liaise with NIC/DIC for clinical decision makers to attend. 10. Liaise with NIC ED to send patients for diagnostics may need to delay to prioritise resources. 11. Liaise with Incident Tracker to ensure early identification of patients requiring theatre this will be communicated with Surgical Consultant acting as Surgical Triage 12. Liaise with Incident Tracker need to refer to speciality/admit. 13. Liaise with NIC if patient deteriorates or requires any involved interventions to escalate level of dependency and move to the yellow/red area. 14. Keep NIC of ED informed of patient numbers and flow. Escalate delays or capacity issues, the Shop floor Consultant may pull P3 patients through to the yellow zone if that area has reduced activity. The Shop floor Consultant and Silver Command Team may open OPD capacity to overflow some P3 patients to. This will be communicated by the ED NIC and any patient moves will be coordinated with the Senior OPD nurse. Patients must be tracked to OPD with their MI paperwork. 15. Ensure clear line of communication with NIC of ED and ED Incident tracker. 16. Secure all documentation (additional to patient notes e.g. patient register and hand this over to NIC of ED once stood down. Major Incident Plan V2.2 October 2017 Page 63 of 114

64 ACTION CARD NO 18 NURSE TEAM LEADER BLUE ZONE YOUR LOCATION IS: Clinical Decisions Unit (CDU ext 1798) 1) Proceed to Blue Zone Clinical Decisions Unit (CDU) ( AED 038-AED 043) 6 cubicles. AT ALL TIMES WEAR YOUR IDENTIFICATION BADGE, YOUR JOB TITLE BADGE AND DESIGNATED TABARD. (Your job title in this instance is Blue Zone NURSE TEAM LEADER). 2) Blue Triage category- Expectant -patients will be sent to your area. These patients will be assessed as mortally wounded and admitted to your zone for End of life care. 3) You may not be an ED nurse; however you will liaise with and report directly to the Nurse in charge of ED. 4) Additional nursing staff and voluntary helpers will be sent to your section. Delegate these staff as required. All current CDU patients will require discharge or relocation before casualties arrive. 5) Liaise with Incident Tracker and senior ED doctor to access space within CDU (first patient triaged may be blue category patient). 6) Patients will arrive in your area with major incident documentation. This documentation must remain with the patient at all times or under your supervision if more appropriate. 7) Maintain an up to date and accurate register of all patients managed within the area. A pre- prepared register is kept in the major incident resource box stored in the major incident room (will be accessed by the nurse in charge of the ED at the onset of the incident).delegate this role as soon as possible. 8) Attempt to find identification for the patient. Liaise with police identification team based in ED medical secretary s office ext. 2211(adjacent to the resuscitation room). ED receptionists will be available within this team to assist 9) All deceased patients will require formal certification. 10) Liaise with chaplaincy and PALS team to support relatives. 11) All deceased patient will be placed into a body bag with all property (Labelled). Consult police regarding washing and undressing any bodies as this may have forensic implications. 12) The NIC of ED will be available to assist in handling delays. Report any difficulties to the NIC of ED. 13) Avoid leaving your zone if possible. 14) Secure all documentation (additional to patient notes e.g. patient register) and hand this over to nurse in charge of ED once stood down. 15) Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 64 of 114

65 ACTION CARD NO: 19 RECOVERY TEAM MANAGER YOUR LOCATION IS: An office in the social services office by main reception Ext. to be confirmed on the day The Gold (strategic) or Silver (tactical) commander will identify a Recovery team to plan the return to normal working. This team will consider planned activity in the days to come. 1. This team will not be based in the capacity hub and will not be involved in the capacity management. 2. The Recovery team will be led by a senior manager from the Trust who is able coordinate teleconferences, liaise with local authorities, community nurse managers, CCG s, Care Home Select, Discharge facilitators and the capacity team to expedite discharges to bring the Trust to a position where normality will resume following the incident. 3. The Recovery team leader will report into silver (tactical) command meetings to understand the Trust position in order to communicate with colleagues in the teleconference meetings (Appendix K) 4. A declared state or the impact of the incident could last for days. The Recovery team will look at planning for the next 2 7 days. This will require senior decision makers to input elective activity, staffing and additional contingency areas. This will also be discussed at silver (tactical meetings) 5. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 65 of 114

66 ACTION CARD NO 20 MEDICAL SECRETARIES YOUR LOCATION IS: Emergency Department 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. 2. Work with Nurse Manager, Emergency Department in liaison with Silver command. 3. Liaise with Interserve FM Health Medical Records Manager in maintenance of master index. 4. Work with Triage Medical and Nursing Officers with documentation of patients arriving in the Red Zone (ED ambulance bay) 5. Set up and work Fax machine as appropriate, assisting Police, Ambulance or other services with despatching information. 6. If this room is required as Silver Command, identify a room that the Police Documentation Team can use. 7. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 66 of 114

67 ACTION CARD NO 21 ED RECEPTIONIST TEAM LEADER YOUR LOCATION IS: ED department You will be the most senior ED receptionist on duty. You will remain in this role until relieved by the ED reception manager. 1. Brief your staff. 2. Allocate administration staff to individual roles (listed below) according to the number of staff available at the time and provide each staff member with aide memoir for their role. 3. Remain in the Emergency Department at all times to act as a point of contact for administration / nursing / medical staff. Administration Team Roles Receptionist #1 - Reception Area - Emergency Department Receptionist #2 - Triage Area - Emergency Department Receptionist #3 - Emergency Department Patient Liaison Assistant - Nurse Desk - Emergency Department Major Incident Plan V2.2 October 2017 Page 67 of 114

68 ACTION CARD NO 22 ED RECEPTIONIST #1 YOUR LOCATION IS: ED department Each area will have a nurse allocated as team leader. They will be identified by a tabard. Please liaise with / take instruction from these nurses. 1. Obtain telephone call-out list from Major Incident folder which is kept in the reception area. Initiate call out list. 2. Preparation: If clinic is running, re-arrange appointments for any clinic patients who have been asked to leave the department. Update any paperwork, discharges etc. of patients who were in the department before the Major Incident was announced. Clear the reception area of any outstanding information or documentation regarding patients who are no longer in the department. Obtain telephone number for Police Information Line to give to relatives if necessary and ascertain that the relatives area has been established and familiarise yourself with directions to give to relatives if necessary. 3. Remain in the Emergency Department reception area to act as a point of contact for nursing / medical / other admin staff. 4. P3 green category walking wounded patients will be directed to wait to be seen in the main ED waiting room act as point of contact and escalate any concerns to Green Team Leader. 5. Answer any telephone calls and deal with accordingly. Redirect ALL patient enquiries relating to the major incident to the Information Line. Major Incident Plan V2.2 October 2017 Page 68 of 114

69 ACTION CARD NO 23 ED RECEPTIONIST #2 YOUR LOCATION IS: ED department Each area will have a nurse allocated as team leader. They will be identified by a tabard. Please liaise with / take instruction from these nurses. 1) Preparation: a) Clear desk of any outstanding information or documentation regarding patients no longer in the department. b) Obtain relevant telephone numbers for Police Information Line to give to relatives if call does come through to department. c) Answer any telephone calls and deal with accordingly. Redirect ALL patient enquiries to the Information Line. d) Obtain nurse call out list from Nurse in charge call in designated number of nursing staff complete call out documentation (explanations clear on actual call out documentation) e) Provide feedback to Nurse in charge (NIC) re: nurse call out 2) To assist the NIC and work as a runner if necessary to relay messages, secure resources, make necessary telephone calls. 3) Perform administration duties regarding patient paperwork, e.g. preparing admission paperwork / photocopying as necessary. 4) Keep up to date the stock of stationery to be used by medical and nursing staff in the department. 5) Remain stationed at the nurse base as much as possible in order to be a point of contact for nursing / medical staff. Major Incident Plan V2.2 October 2017 Page 69 of 114

70 ACTION CARD NO 24 ED INCIDENT TRACKER YOUR LOCATION IS: ED department Background Your role during a major incident is pivotal to the smooth running of the ED flow. The role will be very similar to your normal duties with the following additions. 1) Liaise with all team leaders to formulate an up to date list of patients who require: (a) Theatre (b) Critical care (c) CT scan (d) X-ray (e) Admission (f) Referral to speciality. (g) Requiring secondary transfer out of trust 2) Keep Nurse in charge (NIC) and Doctor in charge (DIC) updated re: this live list. 3) Advise each Team Leader of information that you require and organise how frequent this needs to be updated you will need to physically meet with each team leader avoid using phone. 4) Take direction from NIC/DIC for liaising with Theatre/Critical Care. 5) Liaise with each Team Leader to ensure all P1 patients have clear plans of care within1hr 6) Liaise with each Team Leader to ensure all P2 patients have clear plan of care within 2hrs 7) Liaise with Green Team Leader to ensure all P3 patients have clear plan of care within 3hrs. 8) Inform NIC of any delays in care/bottle necks or problems identified. Major Incident Plan V2.2 October 2017 Page 70 of 114

71 ACTION CARD NO 25 SENIOR NURSE OPD YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect Action Card. 2. The Silver Command team will provide a plan for OPD, in hours this will involve continuing, scaling down or cancelling OPD activity. 3. The senior OPD nurse will be required to give an update on planned activity for that day in order for the Silver Command Team to assess the impact of cancelling clinics compared to releasing nursing and medical staff to support the incident. 4. The Outpatients department is no longer the receiving area for P3 patients as per the previous MI plan. However, the OPD team have an internal plan to open the OPD OOH to provide an overflow area if the ED Shop floor Consultant and Silver Command Team require it. 5. In working hours the Outpatients department will be considered (in collaboration with the OPD Senior nurse) for P3 overflow or use for patients requiring Impact team assessment before admission or discharge. The Impact team, with the Therapy Managers coordination, will support the movement of Impact patients from EAU to provide additional medical capacity. 6. The OPD senior nurse will review available staff; can any staff be re-deployed as runners or to assist the Green Team Leader with P3 patients in the ED waiting room? 7. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 71 of 114

72 ACTION CARD NO 26 Paediatric team (Consultant & nurse in charge of C2/Matron) YOUR LOCATION IS: PAU Ext The receiving ward for paediatric emergencies will be C2 (East Wing). The Paediatric Registrar and nurse in charge/matron will assess all patients already on C2 and Paediatric Assessment Unit (PAU) to assess who can safely be discharged or sent on home leave if more capacity is required. 2. Discuss with surgical bronze on ext if there are any theatre cases that may require cancellation. 3. The Paediatric Registrar will go to Surgical Bronze Command in First Floor Clinical Offices (West Wing), agree responsibilities and feedback the plan to the paediatric team. 4. Alert all paediatric medical and nursing staff if the Major Incident involves children but remember that this incident could last for days and cover must not be depleted in the next 48hrs. 5. The nurse in charge (NIC) or Matron will liaise with the Surgical Bronze command on extension 4269 with capacity updates. 6. If possible, do not accept any further domiciliary admissions, refer them to other 'supporting' hospitals until the incident is over and bed availability allows it. Ensure the on-call doctors are also aware of this instruction. None Major Incident patients arriving in ED that cannot be sent home or to the G.P. may need to be accepted direct onto the ward. 7. Handover to On-Call Consultant on arrival, who will take over the responsibility of this action card. 8. The paediatric team will liaise with ED re: any paediatric casualties or children requiring a place of safety if the adult they are with are injured and unable to take responsibility for the child. 9. Consider as a team the referrals in ED from the incident, could PAU or Children s Outpatients be used once ED have triaged and completed the emergency treatment required. 10. Are other contingency areas required? what additional paediatric staff would be required to open these areas if they are needed? 11. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 72 of 114

73 ACTION CARD NO 27 DUTY RADIOGRAPHER YOUR LOCATION IS: Main X-Ray Department 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. (If not possible contact by telephone Telephone No or 1359) 2. Contact the Superintendent Radiographer and the Senior Radiographer on Call informing them of the emergency in order that they might call in additional staff for the main Department and the Emergency Department Satellite Unit if appropriate. 3. Proceed to the X-ray Department to prepare equipment in readiness for any incoming casualties. 4. Ensure that the X-ray Department is cleared of all patients who do not require immediate treatment and that patients are informed that a new appointment will be forwarded to them. Ensure that any patients brought to X-ray by ambulance are not left stranded or that appropriate care is given to them. 5. Establish if additional lead aprons are required by the Emergency Department and ensure that these are taken to the Department. 6. Contact medical physics at Sandwell and West Birmingham NHS Trusts for advice in the event of radiation contamination patients presenting in the Emergency Department. 7. The external telephone line to the Department normally used for making appointments should be used where possible in order to relieve pressure on the Hospital's switchboard. 8. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 73 of 114

74 ACTION CARD NO 28 IN HOURS: PORTERING MANAGER OUT OF HOURS: INTERSERVE ZONE MANAGER YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect Action Card. 2. Re-allocate porters' short-range radios, as directed by the Silver (tactical) commander ensuring staff designated by the Control Team are shown how to use the short range radios. 3. Liaise with the Nurse Manager, Emergency Department as extra porters may be needed to move patients to wards prior to influx of Major Incident casualties. 4. Call in additional staff and deploy according to need. 5. Portering staff will undertake a range of duties including working with the security staff to restrict access to the Hospital. 6. Ensure all lifts are available for passenger use. 7. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 74 of 114

75 ACTION CARD NO 29 SECURITY & CAR PARKS MANAGER/DUTY SUPERVISOR YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect Action Card. 2. The Security Staff will in accordance with instructions from the Silver (tactical) command team and in liaison with the Police, undertake a range of duties, including restriction of access to the Hospital. 3. Call in additional staff and deploy according to need. 4. Allow access to the site for staff involved in the Major Incident Procedure. 5. Station an officer on the first floor of South Block to control press and relatives. If out of hours there will be reduced security staff on site. Porters or Interserve zone managers will be required to escort relatives to the cafeteria on the 1 st floor and the press to room 6 in the CEC, 1 st floor. Both groups will require staff to supervise and to prevent the press leaving room 6 without an escort. Press must not be given access to the relative s area. 6. All entrances to be locked down as per the Lockdown Policy. 7. In the event of a chemical, biological or radiation incident lock the entrances to the hospital in the following priority order: Outer door from the service corridor to the medical gases ramp. Exit from ED to the main hospital via UCC corridor Main Entrance Women and Children s/renal Entrance this will be manned for controlled entry into the hospital. Rear Entrance by Switchboard South Block Entrance FM Access Points D Block Emergency Department Entrance In addition, ensure all ground floor fire doors in East and West Wings are secured. 8. In the event of a chemical, biological or radiation incident secure, via deployment of security staff, the maternity entrance in East wing will be the only entrance allowing staff to enter. 9. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 75 of 114

76 ACTION CARD NO 30 PHARMACIST ON CALL OR IN CHARGE, RUSSELLS HALL YOUR LOCATION IS: Pharmacy contact via pager 1. On-call pharmacist arranges for the second on call pharmacist and at least one other pharmacist to attend. Where possible, this will be a senior pharmacist involved in operational/clinical services. In all instances the Head of Pharmacy Services or Deputy needs to be informed as soon as possible. 2. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. 3. While there, collect copy of this Action Card to signal that a pharmacist is on site. 4. Take personal initiatives to react to the situation that has developed. 5. Ensure availability of sufficient IV fluids and controlled drugs. 6. Contact B5 (West Wing) and Discharge Lounge to determine if any TTOs required. 7. If further supplies are required, contact the on-call pharmacists at neighbouring Trusts or pharmaceutical wholesalers, as appropriate. Telephone numbers are in the pharmacist's on-call folder. 8. Contact the Help Desk (ext. 1234) to arrange for a porter to be allocated to Pharmacy to deliver medicines. 9. Obtain the Pharmacy Major Incident Plan folder from the Pharmacy Clerical office and follow departmental procedures, i.e. (CPS-13) Pharmacy Out of Hours Response to a Major Incident and business continuity plans within the folder. 10. Call in additional staff (e.g. Technicians and Pharmacy Assistants) if required. The external telephone line to the Department should be used where possible in order to relieve pressure on the Hospital's switchboard. 11. Ensure proper records of medication dispensing and supply issues are kept. 12. Speak to ED Green team leader in the main waiting room. Once patients are ready to decant to the OPD, additional drugs will be required to be stored securely in locked cupboard in room adjacent to Triage base keys to be given to triage nurse. Fridge drugs will be accessed directly from ED clean utility. 13. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 76 of 114

77 ACTION CARD NO 31 HOSPITAL STERILE AND DISINFECTION UNIT MANAGER YOUR LOCATION IS: HSDU 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect Action card. 2. Check pre-sterile stocks and be sure that Department is ready to supply any immediate requirements. 3. Prepare machines, i.e. warm up autoclaves and run routine tests in case required. 4. Call in additional members of staff as required. 5. Visit the Emergency Department and contact the Nurse Manager to receive indication of the immediate needs for stock within the Department. 6. Notify Sister in Charge of Operating Theatres (bleep 7224) and Intensive Therapy Unit (ext. 2070) of your arrival at the Hospital and ask for details of equipment required. 7. Ensure there is adequate technical support to maintain the efficient running of the autoclaves and other sterilising equipment. 8. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 77 of 114

78 ACTION CARD NO 32 HEALTH RECORDS MANAGER YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Be responsible for calling in additional clerical staff to assist in documenting patients and brought in dead and covering the reception area. 3. Check that the clerical procedures for documenting incoming patients are being operated satisfactorily. Also ensure that the appropriate follow-up action is undertaken in documenting patients more fully and obtaining case notes where possible of patients who have been admitted to Hospital on previous occasions. 4. Ensure that during the daytime appointments in Outpatients and follow-up appointments in the Emergency Department are cancelled and arrangements made to provide patients with new appointments. 5. Provide additional clerical staff to cover the Reception Desks in Main Reception, discharge lounge, OPD and ED Reception. 6. Cover the ED resus entrance to ensure that Major Incident Procedure patients entering here are sufficiently documented, including numbering of brought in dead documentation. 7. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 78 of 114

79 ACTION CARD NO 33 ESTATES OFFICER ON CALL YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Call in additional maintenance staff as necessary. 3. Ensure adequate supplies of heat, light and power. 4. Ensure technical support is given to the Sterile Services Unit for their autoclaves and other sterilising equipment. 5. For contamination incidents, discuss the need for to turn off ventilation in designated areas if there is a risk of pulling the contaminant into the hospital. Make arrangements for the safe disposal of contaminated water after the incident is concluded. 6. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 79 of 114

80 ACTION CARD NO 34 CATERING MANAGER YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Make arrangements for the provision of refreshments for relatives who will be accommodated in the Common Room/Dining Area, 1st Floor, South Block. 3. Make arrangements for the provision of refreshments for members of the press who will be accommodated in the room 6 in the CEC, first floor, South Block. 4. Make arrangements for the provision of refreshments for staff and volunteers. 5. Ensure appropriate food is available for patients attending the Emergency Department and/or who have been admitted and for patients being moved into extra contingency areas that would usually be closed at the time of the incident. 6. Call in additional catering staff, as required. 7. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 80 of 114

81 ACTION CARD NO 35 DEPUTY DIRECTOR OF OPERATIONS (INTERSERVE) YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Ensure that the main reception, OPD reception and Discharge lounge are aware that there is a Major Incident in progress and agree appropriate arrangements. Out-of-hours, designate a member of staff to oversee these functions. 3. Ensure that refreshments are sent to the agreed location for the care of relatives. 4. Make arrangements with the catering staff to make beverages for relatives when they arrive. 5. Receive relatives, making a note of the name of the patient involved. 6. Control the movement of relatives around the Hospital, escorting them to the wards, departments or toilets as necessary. A nurse will be delegated to assist. 7. Assist the Catering Manager to call in additional staff to provide food and beverages for all involved. 8. Assist generally, acting as co-ordinator of the Services 'across-the-board' as appropriate and responding to directions from the Hospital Control Centre. 9. Assist in the deployment of the Trust Volunteer Team located in the Reception Area, First Floor, South Block. 10. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 81 of 114

82 ACTION CARD NO 36 HAEMATOLOGY TECHNICIAN YOUR LOCATION IS: Haematology contact via switchboard 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Contact laboratory personnel using the cascade system in the department. 3. Inform NHSBT in Birmingham of the Major Incident and order extra components as detailed in your departmental procedure. 4. Prepare the laboratory area for increased workload. 5. Assign pathology runners and ED based laboratory personnel. 6. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 82 of 114

83 ACTION CARD NO 37 CONSULTANT HAEMATOLOGIST YOUR LOCATION IS: Haematology contact via switchboard 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Attend the Blood bank and prioritise incoming component requests. 3. Attend and liaise with treatment areas as necessary. 4. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 83 of 114

84 ACTION CARD NO 38 CAPACITY SITE CO-ORDINATOR (Bleep 6000) YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or 1359 In Hours: Undertake usual role 1. Out of Hours (OOH): 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Don tabard - SILVER COMMANDER until the role is taken over by the on call Manager or Director. 3. Switch on the Major incident radio set up in the Silver (tactical) command (Appendix E) 4. Complete an SBAR assessment (Appendix B) to assess immediate actions required. 5. Start Log Book in the Major incident folder (major incident cupboard in Silver command) 6. Set up Silver (tactical) command instructions are in the major incident cupboard. 7. Hand out appropriate Action Cards to arriving staff and note time, name and Action Card in Log, until relieved by Senior Manager (Duty Manager or Duty Director). 8. Surgical bed manager (Bleep 8931) and T & O bed manager (Bleep 8700) will be informed of the incident via the baton bleeps. Ask the Bed Managers to collate information on bed capacity for Surgery and T&O. 9. Ensure Critical Care and Medical HDU are reviewing their capacity and dependency of patients to identify ones that can be transferred to a ward to create additional capacity. 10. Ensure that appropriate medical staff are deployed to wards to facilitate patient discharge or transfer to create additional beds. 11. Handover to On-Call Manager / Director on arrival using SBAR format and handover tabard. 12. All decisions made by the Silver (tactical) commander must go in the green log book. Once the role of Silver is taken over the Capacity CSC will continue to log decisions made and actions taken. 13. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 84 of 114

85 ACTION CARD NO 39 CLINICAL SITE CO-ORDINATOR (Bleep 6026) YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or 1359 In Hours: Undertake usual role Out of Hours (OOH) : 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Report to the Nurse Co-ordinator in ED to ascertain current situation (METHANE) and REPORT BACK TO Silver (tactical) commander. 3. Assist with ensuring ED department is adequately staffed. Staffing will be the responsibility of the Nurse Coordinator once on site. 4. Open Discharge Lounge, if there are patients for discharge and ensure it is staffed. 5. Get regular, up to date bed status and report back to 6000 Bleep holder. Follow Battle Rhythm for reporting, once set by the Silver Commander. 6. All tasks going onto Nerve centre that are not urgent will be delayed for more urgent reviews required for moving or discharging patients (i.e. TTO s) 7. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 85 of 114

86 ACTION CARD NO 40 HEAD OF CUSTOMER RELATIONS OR COMMUNICATIONS MANAGER YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or 1359 The Head of Customer Relations or the Communications Manager will: 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Call in other members of the communication team as required. 3. Establish a Press Room in Room 6, 1st Floor CEC, South Block in case this is required. 4. Instigate Hub emergency page to keep staff informed and produce flyers for briefings. 5. Check names, publication/broadcaster and identification of media and control movements of members of media as far as possible (Security will assist) arranging interviews/photo calls, as appropriate. 6. Prevent members of the media from making direct and unwelcome contact with casualties or their relatives. (Security will assist) 7. Liaise with the Dudley CCG and NHS England Communications Teams and advise them of Major Incident Situation giving regular updates. 8. Receive and manage all press enquiries liaising with Police and Ambulance Control and Operations Director on release of information to media 9. Liaise with Director of Operations for medicine and integrated care on public relations matters relating to patients transferring to community beds or being discharged. 10. Ensure use of media for regular situation reports to the public, provide updates on the Trust website as appropriate. 11. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. NB: In the event the major incident is a chemical or biological incident members of the medial will not be allowed on the site. If required, a media facility will be established in the office area adjacent to the restaurant at Corbett Hospital during open hours. Major Incident Plan V2.2 October 2017 Page 86 of 114

87 ACTION CARD NO 41 ON CALL CHAPLAIN YOUR LOCATION IS: South block Starbucks cafe The Chaplain On Call will: 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Call in other Chaplaincy Team members using the cascade system in the department. 3. Inform the Crisis Support Team Co-ordinator to mobilize Crisis Support Team members to support and comfort distressed relatives and patients. 4. Co-ordinate the Chaplaincy Team and Crisis Support Team within the Hospital. 5. Assist in the support of distressed relatives and staff. 6. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 87 of 114

88 ACTION CARD NO 42 TRUST VOLUNTEER TEAM YOUR LOCATION IS: First Floor Reception Area, South Block 1. Sign in on reception by main entrance; you must bring your ID badge with you. 2. There will be no volunteers accepted who are not already approved volunteers for the Trust. 3. If you are not required your details will be recorded and you will be sent home to be called at a later date or time if required. 4. If you are asked to stay, the Volunteer Coordinator or Volunteer mentor will allocate you a task or ask you to go to the volunteer collection point, 1 st Floor Reception Area, South Block for a briefing. 5. Team members will assist with specific duties as allocated by the Volunteer Co-ordinator, mentor or the Interserve Duty Manager. 6. All volunteers will be offered the opportunity to take part in a debrief in the days following the incident. Counselling may be required via the Health & Wellbeing team. 7. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 88 of 114

89 ACTION CARD NO 43 DUTY SOCIAL WORKER YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or 1359 The Duty Social Worker will: 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Assist in facilitating the rapid discharge of patients to create capacity for casualties. 3. Call in other members of the Social Work Team as required. 4. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 89 of 114

90 ACTION CARD NO 44 HEAD OF PROCUREMENT YOUR LOCATION IS: Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Make Procurement staff aware of the situation so that they can prepare to meet any immediate requirements for products and services. 3. Visit the Emergency Department and contact the Nurse Manager to receive an indication of the immediate needs for products and services. 4. Contact the Sister in Charge, Duty Manager / Senior Practitioner of Operating Theatres and Intensive Therapy Unit to determine the products and services they require. 5. Ensure that there is sufficient staff available to place urgent orders and distribute products to the appropriate areas. 6. Keep a log of all actions and decisions taken - note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 90 of 114

91 ACTION CARD NO 45 RUNNERS YOUR LOCATION IS: Allocated Ward / Department 1. You have been designated as a runner to assist the free flow of information between your ward / department and Silver (tactical) command located in the Capacity Hub. 2. Take a written note of information you have been asked by your line manager to pass to the Control Centre (such as available beds, staffing and other resource issues). 3. Take a written note from silver command back to your ward / department with an update. 4. Where requested by your line manager communicate information to and from specified wards or departments. 5. Any paper communication to be handed back to Silver (tactical) command once the incident has been stood down. Major Incident Plan V2.2 October 2017 Page 91 of 114

92 ACTION CARD NO 46 STAFF BANK CO-ORDINATOR YOUR LOCATION IS: In hours bank office OOH Silver (tactical) command in the capacity hub behind main reception Ext 3163 or Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Make contact with Operations Director and Duty Matron to ascertain additional nursing staff required and where/who they are to report to. 3. Out of hours, work from silver (tactical) command from the discharge coordinator desk. 4. Check on ERostering Trust validation of requirements to identify surplus staffing numbers within all clinical areas. 5. Ask all Bank Staff already working that are due to finish shifts to stay. 6. Make contact with all relevant banded Bank Staff registered with Staff Bank via text / phone. 7. Where additional nursing staff are still required all contact details of Bank Staff will be available in hard copies in a file called Staff Bank Contact Numbers in the Staff Bank Office (or electronically via the Health roster) 8. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 92 of 114

93 ACTION CARD NO 47 URGENT CARE CENTRE MANAGER/DOCTOR IN CHARGE YOUR LOCATION IS: Urgent Care Centre Ext or UCC are on the callout list for a major incident, once a call has been received for standby or declared the doctor or manager in charge will coordinate emptying of UCC for all patients that are not requiring urgent attention. All other patients will be asked to visit their own G.P. or return when the incident is over. Information will be available via local media. 2. The role of Urgent care centre during a major incident will be to stream patients involved in the incident that can be managed outside the emergency department. These patients will have only minor physical injuries but are traumatised and cannot be sent home without psycho-social support. 3. Patients involved in the incident will attend the UCC with the major incident paperwork assigned to them at triage. 4. Psychological support will be provided in the department with referral for after care via the patient s own G.P. if required. 5. Advice leaflets will be available to give to patients when they leave UCC Advice for Persons Affected by a Major Incident 5. The hospital chaplain may be asked to attend UCC, via Silver Command on ext. 3163, 1359 or Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 93 of 114

94 ACTION CARD NO 48 DECISION LOGGIST YOUR LOCATION IS: Gold command X 1, Silver (tactical) command X 1, Surgical & Medical bronze X 1 each Ext 3163 or 1359 The Decision Loggists will:- 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Record in written form all information / decisions made by the Silver (tactical) commander in the green log book. 3. Always use black biro to record information in the log book (to assist photocopying), ensuring that notes are clear, intelligible and accurate. 4. Ensure each page is annotated with required details (name, date, time). 5. Never tear leaves out of the log book, use tippex or scribble out words. Any mistakes should be struck through once and initialled. 6. Record entries sequentially, beginning each entry on a new line, but ensuring there are no gaps between entries. If there are any gaps they should be ruled through with black biro. 7. Always use long hand and never use shorthand, symbols or abbreviations (unless defined in the log). 8. Give a clear and succinct handover to the relief person. 9. Ensure that a record is kept of all decisions reached with a note of the rationale and ask the Incident Commander to initial each record as correct. 10. Record handover or stand down and sign the log book. 11. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 94 of 114

95 ACTION CARD NO 49 GENERAL LOGGIST YOUR LOCATION IS: Gold X 1, Silver (tactical) command X 1 Ext 3163 or 1359 The general loggists will:- 1. Proceed to Silver (tactical) command in the Capacity Hub office, behind the main reception desk at Russells Hall Hospital for briefing. Collect action card. 2. Using a printed general log booklet, the general loggist will document information coming into Silver (tactical) command to provide collateral information around decisions made in the decision log. 3. Always use black biro to record information in the log book (to assist photocopying), ensuring that notes are clear, intelligible and accurate. 4. Ensure each page is annotated with required details (name, date, time). 5. Never tear leaves out of the log book, use tippex or scribble out words. Any mistakes should be struck through once and initialled. 6. Record entries sequentially, beginning each entry on a new line, but ensuring there are no gaps between entries. If there are any gaps they should be ruled through with black biro. 7. Always use long hand and never use shorthand, symbols or abbreviations (unless defined in the log). 8. Give a clear and succinct handover to the relief person. 9. Ensure that a record is kept of all decisions reached with a note of the rationale and ask the Incident Commander to initial each record as correct. 10. Record handover or stand down and sign the log book. 11. Keep a log of all actions and decisions taken note date and time. All logs to be handed in to Silver (tactical) command following stand down. Major Incident Plan V2.2 October 2017 Page 95 of 114

96 Appendix A Incident Log Form (WMAS Methane Report) METHANE FROM SCENE Time: Callers name Location address Documented by: Name Designation Contact number M Major incident declared: E Exact location: T Type of incident: H Hazards present or suspected: A Access routes that are safe to use: N Number, type, severity of casualties: E Emergency services present and required: If there is any doubt about the authenticity of the call, the alert must be verified by calling a recognised number for the alerting body. Notes/Further updates NOTE: This form will be kept for official debrief hand into Silver command following stand down of incident Major Incident Plan V2.2 October 2017 Page 96 of 114

97 Appendix B Meeting No: Date: Time: SBAR - MEETING AND REVIEW This SBAR is to be used to provide a structured plan when dealing with a Business Continuity problem or Major Incident meetings. It will be used at agreed intervals until the Incident is resolved but MUST not replace the LOG. Current situation or issues since the last meeting Situation Background Has there been any improvement/deterioration in the situation since the last update? What recommendations are outstanding since the last meeting. Assessment Is this situation still Business Continuity? Do we need to set up Gold command; is the On Call Director aware? Do we need other help? Who else needs to know? Recommendation What actions are required and who will do them, what time are they expected to feed back to Silver command? 1/ Major Incident Plan V2.2 October 2017 Page 97 of 114

98 Time of the next review Major Incident Plan V2.2 October 2017 Page 98 of 114

99 Appendix C Silver command - Incident meetings SBAR 1 CSC to complete SBAR 1 to consider the Situation, Background & Assessment of the initial incident. Escalate to - OCM & OCD who will give recommendations Set up Silver Command - COO or deputy COO in hours - Or OCM OOH with CSC support. Other key members of silver may be needed i.e. senior IT, estates, security etc. Is Gold command required? - Discuss with OCD. OCD to consider communication with CCG & RCMT Silver command Team - SBAR 2 Meet and do second SBAR at the time agreed. What has been done already and what is now recommended? - Agree time for SBAR 3 if needed. Regular Updates - Who else needs to be informed? WMAS, Comms, matrons, lead nurses. This will depend on the problem. End of Incident - SBAR debrief - DATIX - Copy documents for major incident cupboard (BCP drawer) and send original to COO Major Incident Plan V2.2 October 2017 Page 99 of 114

100 Appendix D General log booklet, this must only be used by general loggist. The decision loggist must use the green Major Incident log book. Incident Log-Book (not to be used by the DECISION LOGGIST during a MAJOR incident, must use GREEN BOOK instead) Major Incident Plan V2.2 October 2017 Page 100 of 114

101 Appendix E Major Incident radio Major Incident Plan V2.2 October 2017 Page 101 of 114

102 Written instructions for using this equipment are with the radio in Silver command. Major Incident Plan V2.2 October 2017 Page 102 of 114

103 Appendix F Bronze command - Incident meetings Major Incident Standby message received Bronze commander to report to silver command for an update Using an SBAR form at this point, both the silver and bronze commander will document the Situation and background, Assess what impact this will have on the Trust and make initial recommendations. Copy form for bronze commander to take. ALSO START LOG Set up Bronze control by ITU Set up surgical bronze control in first floor clinical offices, put up the posters directing people to bronze. (call out list, phone line etc.) Using the information at the Silver meeting bronze and team will follow up recommendations Send runners to get bed states, theatres info etc. Silver command Team - SBAR 2 Meet and do second SBAR at the time agreed. What has been done already and what is now recommended? - Agree time for SBAR 3 if needed. Regular Updates End of Incident - SBAR debrief in silver, is one also needed for Bronze? - If a Datix is done write the number on Log book - Copy all documents used during the incident for emergency planning officer and send originals to COO Major Incident Plan V2.2 October 2017 Page 103 of 114

104 Appendix G Date: Time: MAJOR INCIDENT SBAR INCIDENT DEBRIEF This SBAR is to be used to provide a structured plan when dealing with a Business Continuity problem. It will be used at agreed intervals until the Incident is resolved but MUST not replace the LOG. Situation What was the initial Business Continuity issue? What other problems occurred related to this incident i.e. loss of power resulting in loss of IT. Background Who set up silver command, who formed the core team, who else was informed? How long did the incident last Assessment Recommendations (Lessons learned) and Recovery phase. CSC and silver commander What went well, what could have improved, what created problems, was the BCP used, was the information provided in the folder useful, was there any information needed but not available? All staff involved in this incident should be invited to the debrief once the incident has concluded. Those involved can give recommendations or comments about what could change if this issue happens again or what created problems for them. Send original Log and SBAR to EP & Cap manager, put copies in the Log folder in the Business Continuity drawer. emergency.planning@dgh.nhs.uk to inform Emergency planning officer that there has been an incident. Major Incident Plan V2.2 October 2017 Page 104 of 114

105 Appendix H SWITCHBOARD CALL OUT PROCEDURE - First call out list (These would all be called for Major Incident Standby and Major Incident Declared) If the Major Incident location is the Merry Hill Centre the call from Switchboard must state Major Incident Merry Hill. Job Title Name Contact number Time contacted 1 Send a message to on site baton bleeps (includes trauma team) CSC CSC T&O bed manager How long will it take to get here? Surgical bed manager ED nurse in charge ED & ICU matrons Med Reg Weekend 2 nd Med Reg Surgical Reg Obs & gynae Reg Paeds Reg ITU Reg T&O SHO Haematology Biochemistry Radiographer Head of nursing med Head of nursing sur Theatre sister & duty manager Surgical SHO Resus officer Resus officer Surgical capacity manager Medical capacity manager & N/A all on site Major Incident Plan V2.2 October 2017 Page 105 of 114

106 2 Job Title Name Contact number Time contacted Switchboard manager or deputy Names with switchboard Switch have this How long will it take to get here? a 6b 7 ED Consultant INFORM BOTH Medical coordinating officer START AT THE FIRST NAME, ONCE SOME-ONE CAN COME IN, MOVE TO THE NEXT ROLE Nurse coordinating officer START AT THE FIRST NAME, ONCE SOME-ONE CAN COME IN MOVE TO THE NEXT ROLE Chief Operating Officer (COO) or Director of Operations for medicine or surgery. START AT THE FIRST NAME, ONCE SOME-ONE CAN COME IN MOVE TO THE NEXT ROLE Director on call (out of hours or if noone from 5a can be contacted in hrs) Manager on call - out of hours. 1/ Major Incident lead 2/ On call rota for Consultant for the day 1/ 2/ 3/ 4/ 1/ 2/ 3/ 4/ 1/ COO 2/ Director of Ops medicine 3/ Director of Ops Surg/Womens & Children During office hours Monday to Friday On call rota On call rota Switch have this On call rota Trust mobile or ext 1019 Trust mobile or ext 5444 Trust mobile or ext 2207 On call rota list On call rota WE ONLY NEED ONE PERSON. WE ONLY NEED ONE PERSON. ONLY IN OFFICE HOURS, WE ONLY NEED ONE PERSON. 1/ 2/ 8 9 Emergency Planner Via switchboard work mobile or home number T&O Registrar See rota Via on call rota (not baton bleep) ED emergency planning leads Ring 1 who will ring the other Out patients manager or deputy Via switchboard Bleep 7648 Home via switch Major Incident Plan V2.2 October 2017 Page 106 of 114

107 Job Title Name Contact number Time contacted Theatres senior nurses Ring 1 who will ring the others Urgent Care Centre Interserve security officer Zone manager - Interserve Communications manager Only inform 1 person On call Consultants Page pharmacist on call or ring dept in hours HSDU manager Head of facilities management (Trust) Names with switchboard Names with switchboard Names with switchboard Names with switchboard Name with switchboard Via switchboard bleep in hours Ext 2215 Direct to security office Via radio via switch (switch have home numbers if OOH) Via switch Pager via switch or ext 2448 Numbers with switch if OOH Ext 1000 Or estates manager on call OOH via helpdesk Chaplain If available, no rota Via switch We only need 1 person How long will it take to get here? If a Major Incident is DECLARED, the first and second call list staff will be informed. SECOND CALL LIST 22. Catering Manager 23. Duty Social Worker 24. Linen Services & transport Manager (in hours) 25. Domestic Service Manager 26. Senior Post Mortem Room Technician 27. Head of Outpatients and Health Records Manager 28. Volunteer Co-ordinator 29. Infection control 30. Therapies manager 31 Trust Procurement manager Major Incident Plan V2.2 October 2017 Page 107 of 114

108 Appendix I IMPORTANT NOTICE ROAD ACCESS MERRY HILL CENTRE In the event that the Major Incident Plan is initiated and the location of the incident is the Merry Hill Centre, the call from Switchboard will state MAJOR INCIDENT MERRY HILL. All staff called into Russells Hall Hospital who are travelling from the south, southwest and east of the Borough (Lye, Pedmore, Stourbridge, Norton, Halesowen, Cradley, Quarry Bank etc.) are advised to avoid: - A4036 Thorns Road/Pedmore Road - A4100 Mill Street/Mt Pleasant - A461 High Street/Dudley Road Staff should travel south to the Stourbridge Ring Road and drive down the A491 past the old Corbett and Wordsley Hospitals then turn right at Kingswinford Cross down the A4101 High Street through Pensnett and into Russells Hall Hospital. Please take note of this advice as the Police may decide to close the main carriageways around the Merry Hill Centre and will not be able to assist hospital staff in bypassing any road closures. HOSPITAL ACCESS IN THE EVENT OF A CHEMICAL, BIOLOGICAL OR RADIATION INCIDENT In the event that a chemical, biological or radiation incident is called - the main entrance points to the hospital will be secured by security. Staff must access the hospital via the maternity entrance in East wing or North block staff entrance. The previous MIP policy (2014) brought staff in via South block which is close to the area that patients will be decontaminated. Major Incident Plan V2.2 October 2017 Page 108 of 114

109 Appendix J HOSPITAL CO-ORDINATING TEAM The three co-ordinating Officers are: The Medical Co-ordinating Officer Deputy 1 Deputy 2 Deputy 3 - The Nursing Co-ordinating Officer Deputy 1 Deputy 2 Deputy 3 - The Operations Director Deputy 1 Deputy 2 OCD These will be supported by: Interserve manager Deputy 1 - Deputy 2 - Switchboard and the Emergency Planning & Capacity manager will update this document when there are any changes to the senior staff carrying out these roles. The document will be forwarded to those staff carrying out these roles. Major Incident Plan V2.2 October 2017 Page 109 of 114

110 Appendix K Teleconference Teleconference Guidance During an incident there may be requirements for teleconference calls; this document is designed to assist in managing the teleconference. Time: The teleconference will be held at Attendees: The following people should be present: Chair (Director or senior manager) Other attendees will depend on the time of day and type of incident External attendees to consider inviting:- Dudley CCG, RCMT, WMAS, LA (Dudley, Sandwell, Wolverhampton, South Staffs) Teleconference Joining Instructions: Teleconferences are hosted via Chairperson code followed by # Participants code followed by # If the Chair person needs to confer without the participants press * 5 to mute/ to rejoin the conference - Press *5 again If there are any difficulties with the conference - Press * 0 for the conference assistant who will help. Agenda: 1. Current Trust position:- capacity position Incident update Impact of incident Support required 2. Specific issues 3. Agree required actions 4. A.O.B. 5. Date and time of further Teleconference Calls Major Incident Plan V2.2 October 2017 Page 110 of 114

111 Teleconference Template Date : Time: Present: Current Capacity Position Trust Escalation Surgery Level Escalation Level Maternity Escalation Level Paediatrics Escalation Level Predicted Ambulances: Actual Ambulances Avg. Turnaround Time Predicted Attendances Actual Attendances Predicated Admissions Actual Admissions: medical Surg/T&O total ED Waiting to be seen Volume of patients Referrals/Speciality Majors Minors Paeds Resus CDU longest wait EAU Spaces Definite discharge Main Beds Potential discharge Patients expected Flexi AEC Number to admit - Major Incident Plan V2.2 October 2017 Page 111 of 114

112 Bed status Medicine Beds now/ *Level Definite discharges Potential discharges Lists to come in Surgery T & O Paeds *Maternity & Neonates Breaches & Reasons Local Trust Escalation Levels Walsall Wolverhampton Sandwell Other agencies Community Beds WMAS urgent and none emergency patient transport Local Authority Urgent Care Centre Major Incident Plan V2.2 October 2017 Page 112 of 114

113 2 Specific Issues Staffing: 3 Agreed actions Person responsible Action agreed Status 4 A.O.B. 5 Time of next call Major Incident Plan V2.2 October 2017 Page 113 of 114

114 Appendix L Site map Major Incident patient triage - Resus entrance Main entrance Maternity entrance. Major Incident Plan V2.2 October 2017 Page 114 of 114