REPORT SUMMARY SHEET. Trust Board 26 th May 2016 Emergency Planning & Business Continuity Annual Report Dr Richard Wright Medical Director

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1 Quality care for you, with you REPORT SUMMARY SHEET Meeting: Date: Title: Lead Director: Corporate Objective: Purpose: Trust Board 26 th May 2016 Emergency Planning & Business Continuity Annual Report Dr Richard Wright Medical Director Providing safe, high quality care For approval Summary of Key Issues for Trust Board High level context: This report summarises the activity of the Southern Trust in relation to Emergency Planning & Business Continuity Key issues/risks for discussion: There is a need to ensure that identified areas of concern are addressed during 2016/17 Summary of SMT challenge/discussion: Need to ensure learning from Hydra exercise is incorporated into Emergency Plan Internal/External engagement: There will be an ongoing need for engagement with both internal and external stakeholders to deliver on the priorities for 2016/17 Human Rights/Equality: Not applicable Updated September 2014

2 TRUST NAME: Southern Health & Social Care Trust Emergency Preparedness & Response Annual Report to Trust Board From: 1/4/15 To: 31/3/16 Report Completed by: Position in Trust: Teresa Cunningham Emergency Planning & Business Continuity Manager 1

3 1. Introduction 1.1 Current Emergency Planning and Business Continuity arrangements Within the SHSCT, the Medical Director has responsibility for Emergency Planning and is responsible for reporting to the Trust s Senior Management Team and Trust Board on emergency planning issues. The Medical Director is supported by a Senior Manager - the Emergency Planning and Business Continuity Manager. Staff from all directorates engage in emergency planning and business continuity management. The Trust has a multi-disciplinary Emergency Planning and Business Continuity Committee comprised of: senior managers, clinicians, Public Health Agency representation, Northern Ireland Fire and Rescue Service, Northern Ireland Ambulance Service, Police Service Northern Ireland and Council representation. It is chaired by the Medical Director or the Emergency Planner and meets on a quarterly basis with the aim of ensuring strategic leadership. The Trust s Emergency Planning Manager also participates in the following regional and local fora: 2 Regional Emergency Planning Forum, frequency quarterly promotion of emergency planning, sharing of good practice, development of policies and guidance. Regional Business Continuity Meetings hosted by DHSSPS Southern Civil Emergency Preparedness Group hosted jointly by Council and PSNI, multi-agency forum (PSNI,NIAS, NIFRS, SHSCT, PHA, Local Councils, MCA, NIHE, Red Cross) meets at least quarterly to raise awareness of individual agency roles in Emergency Planning, development and exercising of multi-agency plans/protocols, share learning, debrief following incidents/exercises. Southern Group Emergency Planning Sub-group, meets usually on a quarterly basis Hosted by Emergency Planning Co-ordinator from the Southern Group of councils - to update on pertinent emergency planning issues, share learning and to progress actions (e.g. exercises). Cross Border Emergency Planning Group recently reconvened with representation from blue light services, councils and Health Agencies from both sides of the border. Meets usually on a quarterly basis and currently aiming to develop protocols for cross border working and facilities and resource mapping. Attendance at other relevant planning groups convened e.g. development of Mass Casualty Guidance (DHSSPS led).

4 There are 3 Emergency Support Centre Teams within the Trust (Armagh & Dungannon, Newry & Mourne and Craigavon & Banbridge) to assist with the response to community incidents, particularly in relation to the establishment of Emergency Support Centres when members of the public are evacuated from their homes. Each team has 8 members and one member from each team is on call every day, 24/7, all year round. 1.2 Short Term Planning Groups Evacuation and Sheltering Guidance In an Evacuation and Sheltering planning group was established to develop evacuation and sheltering guidance. Work on this is ongoing. Transport Protocol for Severe Weather A Small planning group was established to develop a Transport Protocol to outline the arrangements in place for staff to access 4x4 assistance during periods of severe weather, to ensure they get out to their clients in the community and to assist getting staff into the hospitals for work. The protocol is reviewed regularly, usually in response to learning arising from incidents. Special Incidents Plan - CBRN In a small working group was also established to develop a Special Incidents (CBRN) plan. In 2014 the draft plan was reviewed in light of new guidance (Initial Operational Response) on dry decontamination. The draft plan was been issued for consultation to relevant stakeholders. The plan continues to be reviewed and the group last met in October Ebola Planning Group A multi-disciplinary group with representation from NIAS was established to develop an Ebola Plan to deal with any potential presentations at the acute hospitals. The plan continues to be kept under review in light of international and local guidance. Ebola exercises have been carried out on both acute sites and the specified PPE has been purchased. 3

5 2. Notification of Incidents to Trust Table 1 Incidents notified to Trust: Date Incident Level of Response Activated/Outcome 18/7/15 ESC Security Alert Lurgan PSNI advised the on-call Manager of a security alert in Victoria Street, Lurgan and that a rest centre had been established at Waves Leisure Centre but no families had turned up. ESC Manager received a further telephone Call from Armagh, Banbridge & Craigavon Council at approximately 3pm to advise a Slovakian family of 5 had turned up at the Leisure Centre. ESC Manager arrived at Waves Leisure Centre at approximately 3.20pm spoke to family members. The services of an interpreter were offered, but one member of the family was able to communicate in English. The family were happy to stay with extended family 29/12/15 6/1/16 Potential flooding Emergency Planning & Business Continuity Manager participated in regional multi-agency teleconferences instigated through CCGNI protocols to deal with the threat of flooding. 31/12/15 ESC Standby due to flooding risk ESC Managers alerted to the potential need for ESCs as a result of flooding across the southern area but none were required. 13/3/16 ESC Emergency Planning and Business Continuity Manager received a call from PSNI indicating an emergency rest centre was being established in Armagh as a result of a security alert. The EP&BC Manager contacted the on-call manager for the Armagh & Dungannon area who made her way to the rest centre. Six evacuees turned up at the rest centre,. At 3.15pm 5 evacuees chose to leave the Rest Centre and go to St Patricks Cathedral. At 4.45pm the Recreation Centre manager arrived with an update from the PSNI that the security alert had ended and that the area was being reopened. 4

6 Lessons Learned ESC Activations The PSNI have not always notified Trust when an ESC is to be set up. This issue continues to be raised and reinforced with PSNI, through Southern Emergency Preparedness Group meetings and by the SHSCT Emergency Planner with PSNI Emergency Planner. Flooding November 2015 Identified the need to establish data sharing agreements between PSNI and other agencies to facilitate prompt sharing of information on vulnerable clients during an emergency situation. It also identified the need to establish mechanisms within the Trust to quickly gather information on vulnerable clients from information systems. 3. Incidents responded to by the SouthernTrust 3.1 Severe Weather Flooding December 2015 in Northern Ireland was the wettest December since To add to the impacts of the heavy rainfall, there were warnings that sea levels and accompanying strong winds could impact on coastal areas and compromise overhead power lines. In line with Civil Contingencies Group Northern Ireland (CCGNI) protocols, there was multi-agency escalation and conference calls were instigated following weather warnings from the Met Office regarding the risks posed. This activity commenced formally early on 29 th December and continued until 6 th January; the Trust s Emergency Planning and Business Continuity Manager participated in the conference calls for the southern area and a number of the western area s conference calls. The EP&BC Manager provided regular updates to Directors on areas affected by flooding and liaised with Trust transport to ensure community staff could get out to vulnerable clients when it was safe to do so. Business continuity plans for community services were implemented in flooded areas and the Coastguard provided assistance to get medications out to clients in flooded areas. A multi-agency debrief was carried out and learning arising from the Trust s response included: Pump required for Portadown Health Centre (flooded basement carpark) or arrangements implemented to be able to hire/borrow one at short notice. Risk assessment for staff delivering community services to be carried out during periods of severe weather. Arrangements to be put in place to allow GP OOHs to be able to write and scripts to pharmacies in extreme circumstances only. The Trust needs to be aware of the limitations of 4x4 s in flooding situations. Contingency arrangements for Emergency Planner to be put in place. Update contact details for emergencies (check Resilience Direct). Log in details for Resilience Direct to be provided to staff if they seek access. 5

7 3.2 Smoke Incident at CAH On Friday 26 February 2016 at approximately 14.30, members of the public in Craigavon Area Hospital reported smelling smoke to nursing staff. The nursing staff quickly informed switchboard staff who contacted the Trust s Fire Officer. The Fire Officer began investigating the source of the smoke. Coincidentally, contractors were burning felled trees on the hospital grounds and initial thoughts were this might have been the source of the smell. Inspections of the basement, hospital roof and plant room revealed no fire. Smoke had however escaped internally up the fourth floor of the hospital through the lift shaft, and also into the neo-natal unit. At the smoke alarms went off and switchboard staff bleeped the Duty Engineer with a fire Alarm Activated in basement message. At this point in time, the lifts stopped working. On instruction from the Bed Manager, switchboard staff began contacting the wards asking staff to be on standby for evacuation. The Duty Engineer along with the Fire Officer continued their inspections to try and locate the source of the smoke. NIFRS took control of the incident when they arrived at NIFRS asked for mechanical ventilation systems to be activated to extract the smoke from the basement and babies in NICU were put into incubators as a precaution. A hot debrief on the incident was carried out on 29 February 2016 and a full multi-agency debrief was carried out on 15 March 2016 to cover this incident and two others which had occurred in the hospital. A composite report to cover the 3 incidents has been drafted with an associated action plan. 3.3 Gas Incident CAH On Wednesday 9th March an existing Firmus gas supply pipe was struck by a mechanical digger carrying out excavations to land beside the GP Out of Hours car park. The strike to the gas pipe caused a drop in gas pressure in the pipe network which automatically triggered an integrated alarm system alerting the NIFRS to the incident. The Contractor contacted Firmus directly to notify the incident and a Firmus response team arrived on site an hour after the service break was notified. The contractor also immediately contacted Trust operations personnel who identified the gas line isolation valve to isolate this section of pipe. NIFRS arrived on site approximately 30 minutes after the incident occurred and established an exclusion zone. Firmus gas engineers repaired the damaged gas pipe section and reset the gas meters. The building contractor remained on site until the affected gas boilers had been purged to restore the heating service. 6

8 3.4 Fire Incident x 2 CAH There were two fires on the roof of the laundry in CAH in March The first incident occurred on 10 March, whilst contractors were carrying out hot works on the roof. The fire caused a build-up of smoke in the main laundry room. Upon confirmation of the fire, a member of staff broke the nearest manual call point to activate the fire alarm. Staff in the immediate vicinity of the fire evacuated. Soon after, a full evacuation of the laundry building was executed. The fire was confined to the area of origin by the use of water extinguishers used by members of Estates Services who were present in the Laundry building at the time of the incident. Estates staff liaised with NIFRS to identify the exact location of the fire and to confirm that occupants had evacuated. The second incident occurred on 15 March when again an unintentional lit fire caused a build-up of smoke within the main laundry room. As before, a member of staff broke the nearest available manual call point to activate the fire alarm and staff were evacuated from the immediate area once the fire was confirmed, followed by a full evacuation of the laundry building. Estates staff contained the fire to the area of origin with the use of fire extinguishers. Estates staff liaised with NIFRS when they arrived to identify the exact location of the fire incident and to confirm that occupants had evacuated. Due to the confirmed fire incident occurring on the roof as a result of contractors, NIFRS did recommend that hot works on felting of roof cease and that maintenance of removal of lint deposits be carried out on vented areas prior to works commencing. 3.6 EVENTS Famine Commemoration A famine commemoration event took place in Newry in September 2015; this is the first time the event was held in Northern Ireland and was attended by Ministers from both sides of the border. The event passed without incident. 7

9 4. Emergency Preparedness Training Individual Specialised Training 4.1 HOSPITAL MAJOR INCIDENT MEDICAL MANAGEMENT (HMIMM) AND SUPPORT (HMIMMS) HMIMMS courses are run by the NI Ambulance Service to give hospital staff the knowledge to plan and train for major incidents. The HMIMMS 2 day course comprises of lectures, workshops and table top exercises. Candidates who attend the course are required to sit an exam. In nine members of staff attended a HMIMMS course. November 2015 February 2016 Patricia Loughran, Patient Flow Manager Jayne Culberth Band 6 CAH ED Mary Burke, Head of Service, ED Zara Spratt Band 5 DHH ED Breige McCullough Clinical Sister, CAH ED Shannon Brush Band 5 CAH ED Lisa Small Band 6 DHH ED Vincent Burke, Estates Services Catriona Kavanagh, Bed Manager Nominations continue to be sought for future courses. 4.2 Multi-Agency Gold Incident Command Course The Trust s Medical Director attended a Multi-Agency Gold Incident Command Course between 29/2/16 and 3/3/16 at the Police Service NI Simulated Learning Suite in Steeple Barracks, Antrim. The course was delivered by the College of Policing with input from the Ministry of Defence. Representatives from the following agencies also attended:. Department of Justice Northern Ireland Ambulance Service Maritime and Coastguard Agency Police Service of Northern Ireland Local Government Northern Ireland Fire and Rescue Service The course provided excellent training from an experienced team in a safe environment. The Medical Director gained a valuable insight into the resources available to the region in the event of a major emergency and had the opportunity to 'test drive' the system in a controlled manner. 8

10 4.3 Initial Operational Response A staff training DVD on the new arrangements for dry decontamination, Initial Operational Response (IOR) was made available to both Emergency Departments (EDs) and was uploaded to the Trust s e-learning platform. The short film clearly demonstrates how casualties or self-presenters contaminated with non- caustic chemical agents should be decontaminated. ED staff who would be involved in this process, (nursing, medical, security and receptionists) have watched the DVD as part of their training for the implementation of the new process on 1/9/15. IOR TRAINING - % STAFF WHO HAVE WATCHED IOR TRAINING DVD Date Total Number of Staff Staff who have watched DVD % of staff who have watched DVD 16/5/ DECONTAMINATION TENTS Following delivery of the new decontamination tents to the 2 acute hospitals in March 2015, two staff from estates attended the Cupola Tent training sessions. This training was rolled out to relevant estates and portering/security staff on 22/5/15 in CAH and on 27/5/16 in DHH. NIAS attended the session in CAH and NIFRS attended the session in DHH and demonstrated how to put on and take off Powered Respirator Protection suits (PRPS) which are used for decontamination. 4.5 EMERGENCY DEPARTMENT STAFF TRAINING Three members of staff attended the Powered Respirator Protective Suits (PRPS) Train the Trainer training in October 2015 and are currently drawing up a programme to roll this out to the relevant staff in the Emergency Departments of both acute hospitals. 4.6 EMERGENCY SUPPORT CENTRES The Trust s Emergency Planning Co-ordinator continues to meet individually with all new ESC Managers to talk through roles and responsibilities. New team members are also inducted by their team colleagues and are invited to attend multi-agency awareness sessions facilitated by members of the Southern Civil Emergency Preparedness Group (SCEPG). Awareness sessions were carried out in October 2015 in Craigavon and in January in Newcastle. 9

11 4.7 EBOLA Training An Ebola training DVD was developed by the Infection Prevention and Control team (IPCT) which is available on the Trust s intranet for refresher training for those staff who have previously attended face to face training with IPCT. 5. Exercises 5.1 Southern Regional College Desktop Exercise The Southern Civil Emergency Preparedness Group (SCEPG) facilitates an annual desktop exercise for students from the Southern Regional College studying the Extended Level 3 Diploma in Uniformed Public Services. Emergency Planning scenarios are presented to the students and they are asked to think about the problems/ issues which would arise and how they think the emergency services would respond. Members of the SCEPG guide them through potential solutions. As well as providing an excellent practical learning opportunity for the students, it provides a further opportunity for multi-agency engagement to learn about the roles and responsibilities of the various agencies in an emergency situation. Such an exercise was carried out on 14 March Medical Records Desktop Exercise A desktop exercise was facilitated by the Emergency Planning and Business Continuity Manager for Emergency Department Administrative Staff on 3 November The objectives of the exercise were to: examine roles and responsibilities of Medical Records staff during a Mass Casualty Incident examine co-ordination issues examine inter-department/team dependencies discuss activation and communication issues test business continuity plans identify training needs A short debrief was carried out after the exercise and an action plan was drawn up to identify learning and recommendations arising. 5.3 Local Ebola Exercises Two Emergency Department Ebola exercises were carried out this year: 3 rd June Ebola walk through in ED DHH 9 th July Ebola walk through in ED CAH 10

12 6. Controls Assurance Standards The Trust s Controls Assurance Score this year was substantive (84). There are a number of areas of concern for the Trust, and a range of prioritised actions for 2016/17 are detailed below to address these concerns: Controls Assurance Criteria Compliance Action for Appropriate levels of resources allocated in response to risk assessments, the vulnerabilities of the organisation, its civil contingencies responsibilities and its agreed work programme All of the organisation s staff are aware of the role of the organisation in an emergency and of the existence and outline of the generic plan and any relevant specific plan There is a programme of training included in the emergency preparedness or corporate plans. This is reviewed annually. Clear processes for communicating the need for evacuating HSC premises exist, should that become necessary for both patients and staff. Key information exists on who is to be evacuated, when and why, how the evacuation is to be carried out and where patients will be evacuated to The organisation has hospital lockdown plans in place Partial Partial Partial Partial Partial SMT have approved additional support to the Emergency Planning Manager to enable greater engagement and training with operational staff The additional resource being provided will allow the Emergency Planner to work with Directorates/services to ensure staff are aware of the role of the service during an emergency situation and what is expected of them in terms of roles and responsibilities. A training needs analysis will be undertaken to ensure the relevant training is identified and delivered Draft Evacuation and Sheltering Plans exist; these require completion and implementation during 2016/17 Full lockdown plans are currently being developed 11

13 7. Business Continuity Management progress In the Emergency Planner compiled an inventory of division and service Business Continuity plans in place. The inventory details the date the plan was developed, date of last review and date last tested. Updates on the plans are included in the Medical Directors Report which is presented to the Trust s Senior Management Team, Governance Committee and Trust Board. This gives key stakeholders an opportunity to review the status of plans and reassure themselves that there are adequate arrangements in place to restore the Trust s key services to an agreed level within an agreed timeframe after a disruption to ensure continued achievement of its key objectives during a disruption. 8. Emergency Preparedness & Response Audit There were no audits carried out in the past year other than self-assessment for Controls Assurance Standards. 9. Areas of future risk in relation to emergency preparedness & response within the trust. 9.1 CONTROLS ASSURANCE STANDARDS Following completion of Controls Assurance Standards, an action plan has developed to identify the actions necessary to improve compliance for This action plan will be monitored in to ensure actions are implemented. 9.2 EXERCISE DEBRIEFS The Trust has a number of action plans arising out of exercises and incidents that have occurred. In the forthcoming year we need to better monitor these action plans to ensure that all actions identified have been progressed to ensure better preparedness to deal with incidents in the future. 9.3 DECONTAMINATION ACTION PLAN The Trust has a live decontamination action plan which is regularly reviewed and updated in line with the introduction of new guidance (e.g. Initial Operational Response). The action plan is monitored to ensure completion of actions listed. In the coming year, we need to ensure that all actions are completed. 12

14 10. Action plan for the next 12 months to manage identified risks and areas of concern raised during responses to actual incidents. Funding for additional resources for Emergency Planning and Business Continuity has been agreed to progress actions identified in the Controls Assurance Action Plan and the various debrief reports. 13