Annex 8.4 Heat Wave Plan Datix Ref: 1923-33785 Shropshire Community Health NHS Trust Annex 8.4 Emergency Response Arrangements HEATWAVE PLAN Version: 3.4 2015 1
Document Management and Version Control Version Date Author Description of Change Number 1.0 June Sherry Woolgrove First issue. 2010 2.0 May 2012 Sherry Woolgrove Update to new DH 2012 Heat wave Plan 3.1 June 2013 Pete Old Update to reflect DH 2013 Heat wave Plan 3.2 June 2014 Pete Old Update to reflect DH 2014 Heat wave Plan 3.3 July 2014 Pete Old Update to reflect organisation changes and remove reference 3.4 November 2015 Pete Old to pre agreed media messages Review against 2015 guidelines and lessons learnt 1. Review This plan will be reviewed annually from the date of publication and following any incidents or exercises in which the plan is used or when there is guidance or legislative changes which affect the plan. 2. Other Plans and Guidance This plan should not be read or used in isolation. Stakeholders should also familiarise themselves with the national Heatwave Plan for England 2014 and associated guidance leaflets; the Trust s Emergency Response Arrangements and directorate business continuity plans or policies relating to heatwave. 3. Plan Validation Appropriate training will be provided and testing and exercising will be carried out in order to test and validate this plan. 2
TABLE OF CONTENTS Page 1. Introduction. 5 2. Aim... 5 3. Objectives... 5 4. Heatwave Preparedness and Alert Levels.. 5 5. Dissemination of Alerts.. 6 6. Plan Activation.. 6 7. Trust Leadership and Management Arrangements 8 8. Command and Control 8 9. Further Information.. 8 APPENDICES 1. Trigger Levels and Key Actions.... 11 2. Heatwave Action Cards.... 12 3
Heatwave Plan 1. Introduction The national Heatwave Plan for England 2013 sets out responsibilities at national, regional and local levels and corresponding actions required to prepare for and deal with a heatwave event. Heat wave conditions are considered a high risk and featured in the Local Resilience Forum Community risk register due to the of the impact of a heat wave on vulnerable people, and infrastructure (transport, power generation and livestock and fire risk). The purpose of this plan is to enhance the Trusts clinical services in response to a heat wave in order to protect staff and patients from harm due to extreme heat. This plan outlines responsibilities at local level and the Trust s Patient Heatwave Policy is an integral part of this plan. 2. Aim The aim of the plan is to define the roles and responsibilities of this NHS organisation prior to and during a heatwave event. 3. Objectives To set out the roles and responsibilities of this NHS organisation in advance of and during a heatwave. Outline command and control arrangements. Reinforce actions required at each Level. Ensure advice and guidance to and by staff are disseminated during a heatwave. 4. Heatwave Preparedness and Alert Levels 4.1 Preparedness This is the normal background alert level in place between the 1 st June and 15 th September. It requires the Trust should ensure that all staff are aware of the health effects of heat and are familiar with the national heatwave plan and the Trust s Patient Heatwave Policy. 4.2 Heat Health Watch Alert Levels There are 4 levels contained in the national Heat Health Watch Alerts which are outlined in Appendix 2. 4
The Met Office in conjunction with the Department of Health operates the Heat Health Watch programme which operates from 1 June to 15 September each year. Up to date information on the current watch level can be found at: http://www.metoffice.gov.uk/weather/uk/heathealth/ Weekly predictions of weather and reaching trigger thresholds are emailed weekly to Resilience managers. 4.3 Threshold Temperatures (Trigger Temperatures) The threshold temperatures for triggering a heat health alert in the West Midlands is 30C (day time temperature) and 15C (night time temperature). 5. Dissemination of Alerts (Level 2,3 and 4) 5.1. Alerts from the Met Office will be received by the following Leads to ensure appropriate action is taken. The Emergency Planning Lead will ensure the appropriate individuals are registered for the service. Director of Nursing and Operations Director of Strategy Human Resources Lead Director of Corporate Affairs Communications and Marketing Lead Emergency Planning Lead Head of Prisons 5.2. Each directorate lead will be responsible for ensuring alerts are cascaded to staff and appropriate actions are undertaken. (See Appendix 3 for Actions). 5.3. A general internal cascade to all staff should be circulated by Communications and Marketing Manager to ensure a general awareness of the alerts and appropriate actions that need to be taken. The trust website will carry relevant information to advise the public and health professionals between June and September. 6. Plan Activation This plan will be activated on receipt of Level 2/3 or 4 alerts. Each Directorate will be responsible for taking appropriate measures or actions in line with the existing national guidance and Operational Arrangements set out in section 7. 5
7. Trust Leadership and Management Arrangements Alert Level Trust Action Leadership Level 1 Update web site Cascade alert level action cards Agree pre agreed public media messaging Provide specific briefings and training if required Level 2 Ensure level 2 actions have been completed request email response from nursing teams to confirm Consider using business continuity plan i.e. move to Business continuity Standby to monitor impact on services do STEPS assessment. Issue pro-active media messages to public and staff Level 3 Convene a Heat wave Incident Management Team Declare Business Continuity Standby (or declare based on the information). Open the on-site incident coordination room (ICR) Directors to check all services for impact using the Business Impact Assessment Initial Situation Report Appendix 3 of the Corporate Business continuity Plan and send to on-site ICR. Take appropriate actions to protect priority services and clinical/lifesaving care to patients. Level 4 Based on the Business Impact Assessment initial Situation Reports escalate utilise the trusts Emergency response arrangements as necessary. Allocate staff resource to maintain a collated impact assessment and action plan for the trust ans join whatever upward reporting arrangements are required by the NHS E AT. Emergency Accountable Officer Resilience Lead Trust Senior Manager on call (Tactical/Silver) Trust Director on Call (Strategic/Gold) Trust CEO or nominated representative. (Strategic/Gold) 7.1. Situational Reporting ( Sitreps ) There may be a requirement for all NHS Trusts to provide a situational report ( Sitrep ) to the Clinical commissioning Groups or NHS E AT from Level 3 onwards to maintain daily briefing to the Department of Health. 6
7.2 Media and Communications Advice and information will be issued by the Department of Health and the Community Trust will assist this process locally by issuing key messages to staff and service users. The West Mercia Health Cluster Media and Communications Lead or Public Health via the Director of Public Health will ensure national public messaging is disseminated through the media. In the absence of national lines to take local trusts should consider releasing relevant messages to the public to safeguard not only the public but NHS services in particular A&E s. Shropshire Community Trust will adopt national media lines or media messages from the Director of Public Health in the event that the Communications and Marketing Manager is not available. Disseminate health and safety messages to all staff, plus any further advice agreed by the Incident Management Team. 7.3 Stand Down Arrangements Stand-down arrangements will be determined by the Department of Health when health risks due to heatwave conditions have subsided. Please note that following Level 3, until temperatures cool to Level 1 all Level 3 actions are to be maintained. 8. Command and Control The trusts arrangements for command and control of heat wave are set out in Section 7 above and fully in the trust s Corporate Business Continuity Plan 2013 and called the Heat Wave Incident Control Team. 9. Further Information 9.1 Temperatures in the Workplace The Workplace (Health, Safety and Welfare) Regulations 1992 set out requirements for the working environment. Regulation 7 outlines specific requirements for the indoor working environment and states: During working hours, the temperature in all workplaces inside buildings shall be reasonable. Reasonable is defined as: The temperature in workrooms should provide reasonable comfort without the need for special clothing. Where such a temperature is impractical because of hot or cold processes, all reasonable steps should be taken to achieve a temperature which is as close as possible to comfortable. 'Workroom' means a room where people normally work for more than short periods. 7
And: 'An acceptable zone of thermal comfort for most people in the UK lies roughly between 13 C (56 F) and 30 C (86 F), with acceptable temperatures for more strenuous work activities concentrated towards the bottom end of the range, and more sedentary activities towards the higher end.' Where temperatures are uncomfortably high, managers should undertake a risk assessment and where indicated, take measures to ensure a reasonable working temperature is achieved and maintained. The risk assessment can be accessed via the following link: http://www.hse.gov.uk/temperature/thermal/fivesteps.htm Any issues or concerns should be directly referred to the organisations Risk Manager. 9.2 General Advice to Staff General advice on how to keep cool in the working environment should be provided. Acceptable dress codes should also be considered. Some tips include: Advising staff to drink plenty of fluids, cool drinks preferably avoiding coffee and caffeinated drinks. Closing window blinds in direct sunlight. Turning off unnecessary equipment, including lights. Taking breaks in cooler parts of the building if possible. Be aware of staff who may be vulnerable during periods of hot weather. Key messages have been published by Public Health and are helpful to both staff and patients. Stay out of the heat: Keep out of the sun between 11.00am and 3.00pm. If you have to go out in the heat, walk in the shade, apply sunscreen and wear a hat and light scarf. Avoid extreme physical exertion. Wear light, loose-fitting cotton clothes. Cool yourself down: Have plenty of cold drinks, and avoid excess alcohol, caffeine and hot drinks. Eat cold foods, particularly salads and fruit with a high water content. Take a cool shower, bath or body wash. Sprinkle water over the skin or clothing, or keep a damp cloth on the back of your neck. 8
Keep your environment cool: Keeping your living space cool is especially important for infants, the elderly or those with chronic health conditions or who can t look after themselves. Place a thermometer in your main living room and bedroom to keep a check on the temperature. Keep windows that are exposed to the sun closed during the day, and open windows at night when the temperature has dropped. Close curtains that receive morning or afternoon sun. However, care should be taken with metal blinds and dark curtains, as these can absorb heat consider replacing or putting reflective material in-between them and the window space. Turn off non-essential lights and electrical equipment they generate heat. Keep indoor plants and bowls of water in the house as evaporation helps cool the air. If possible, move into a cooler room, especially for sleeping. Electric fans may provide some relief, if temperatures are below 35 C. 9.3 Publications A number of documents have been published in support of the National Heatwave Plan: Heatwave: Looking after yourself and others during hot weather Heatwave: Supporting Vulnerable People before and during a heatwave Advice for Health and Social Care Professionals Heatwave: Supporting Vulnerable People before and during a heatwave Advice for Care Home Managers http://www.nhs.uk/livewell/summerhealth/documents/heatwave-plan-looking-afteryourself-and-others.pdf http://www.nhs.uk/livewell/summerhealth/documents/heatwave-plan-supportingvulnerable-people-advice-health-social-care-professionals.pdf http://www.nhs.uk/livewell/summerhealth/documents/heatwave-supporting-vulnerablepeople-advice-care-home-staff.pdf 9
Annex 8.4 Heat Wave Plan Datix Ref: 1923-33785 National Trigger Levels and Key Actions Appendix 1 10
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Appendix 2 TRUST HEAT WAVE LEVEL 1 ACTIONS Level 1 Summer Preparedness - All Directorates Actions System is in place to identify individuals who are at risk from extreme heat Staff are aware of the plan and their responsibilities during a heatwave. This include: Identifying any changes to individual care plans for at risk clients that might be necessary in the event of a Heatwave. Identify vulnerability to heat in patient record/care plan. Consider including initiating daily visits by formal or informal carers to check people living on their own. Operational Responsibility Service Delivery Leads Service Delivery Leads Raising awareness of the dangers of heat and how to protect yourself. Working with at risk families and informal carers to put simple protective measures in place. Ensure voluntary/partner agencies are aware of the Plan and any actions required. Ensure all staff are aware of the Patient Heatwave Policy. Identify cool rooms (<26 c ) and number of air conditioning units/fans to be leased/bought Install thermometers in rooms where individuals spend substantial time Ward / Service Managers with assistance from estates. Ward / Service Managers with assistance from estates 12
TRUST HEATWAVE LEVEL 2 ACTIONS NHS Community Services Actions Actions Identify/review patients and service users considered at risk/vulnerable to heat. Arrangements should be made, where appropriate, for a daily visit/phone call by informal or formal carer (family, neighbour, friend, voluntary and community sector workers) during heatwave period. Remind Staff to include vulnerability to heat risk assessment in patient record/care plan. Repeat messages on risk and protective measures to Staff and public (See Trust web site). Review resilience of estates and equipment (IT/Medical Equipment) Assurance to be provided to the Emergency Planning Lead. Ensure that staffing levels will be sufficient to cover the anticipated heatwave period. Consideration should be made to have additional staff on a voluntary rotating standby should a Level 3 alert be implemented after hours. Review Business Continuity Plans. Operational Responsibility Community Health Care Staff Service Leads Media Communications Lead Facilities and IT Leads Executive Directors Service Leads Service Leads
TRUST HEAT WAVE LEVEL 2 ACTIONS Community Hospitals, Prison Healthcare, Care and Residential Settings Actions Identify patients and service users considered at risk (those with chronic/severe illness, on multiple medication, or bed bound, (see Advice to Health and Social Care Professionals publication for full list) 12 who may be prioritised for time in cool room. Those who are bed bound action should be undertaken to ensure appropriate hydration is readily available. Operational Responsibility Ward / Service Managers Remind Staff to include vulnerability to heat risk assessment in patient record/care plan. Install thermometers where vulnerable individuals spend substantial time. Service Leads Ward Managers Identify naturally cooler rooms for patients to be moved into if necessary. Ward / Service Managers and Estates and Facilities Assess requirements for air conditioning units for cool rooms and ensure supplier delivery arrangements are in place. Estates and Facilities Ward / Service Managers Ensure that cool rooms are ready and consistently at 26 C or below. Estates and Facilities Obtain supplies of ice and cool water. Ward / Service Managers/Catering/Facilities 1 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/201035/9543-tso-2901033-heatwave_-_supporting_vulnerable_people_hscp_accessible.pdf 2 http://www.ageuk.org.uk/health-wellbeing/keeping-your-body-healthy/staying-cool-in-a-heatwave/the-sun-and-skin-health/
TRUST HEATWAVE LEVEL 3 ACTIONS Community Nursing Staff Actions Operational Responsibility Continue to distribute advice to service users 3 Community Health Care Staff Commence daily visits/phone calls for identified high risk individuals, especially individuals living on their own who have no regular daily contact. Community Health Care Staff Remind Staff to include vulnerability to heat risk assessment in patient record/care plan. Service Leads Advise social care or informal carers to contact the GP if there are concerns about an individuals health Community Health Care Staff Ensure staff and informal carers are aware to seek early medical help if individual becomes unwell. Review Staffing Levels against potential surge in demand. Directorate Leads Review Business Continuity Plans. Directorate Leads Convene a Heat wave Incident Management Team. Director Lead for Emergency Planning 3 http://www.nhs.uk/livewell/summerhealth/pages/heatwave.aspx
Ensure Trust is represented at any Health Economy Silver, if convened. Emergency Planning Officer/Lead Consider placing Trust on major incident standby or if situation warrants to declare a major incident.
HEAT WAVE LEVEL 3 ACTIONS Community Hospitals, Prison Services, Care and Residential Settings, Clinics Actions Implement Patient Heatwave Policy and utilise Patient Master Care Plan document. Implement appropriate protective factors, including regular supplies and assistance with cold drinks. Ensure staff are advised to seek early medical help if individual starts to become unwell. Ensure cool rooms are consistently below 26 c. Check indoor temperatures are monitored and recorded during the hottest part of the day in all areas with patients. Outpatient Clinics: temperatures should also be monitored and action taken if temperatures are a significant risk to patient safety. Identify patients for prioritisation in cool rooms. Reduce internal temperatures by turning off unnecessary light and electrical equipment. Consider moving visiting hours to cooler parts of the day. Consider cross ventilation at night to assist in cooling the building. Ensure that discharge planning take into account the temperature of accommodation and level of daily care needed during heatwave event. Planning should reflect local and individual circumstances to ensure people at risk are not discharged into unsafe environments. Operational Responsibility Ward Managers, Leads and Staff Ward / Service Managers, Ward Staff Ward / Service Managers/Matrons Ward / Service Managers, Ward Staff Ward Managers/Estates and Facilities Clinic staff Ward / Service Managers/Matrons Ward / Service Managers/Ward Staff Ward Managers/Matrons Estates and Facilities Ward Managers/Social Care staff
HEATWAVE LEVEL 4 ACTIONS ALL DIRECTORATES Actions Continue with level three responsibilities. At this level illness and death may occur among the fit and healthy and not just in at risk groups. Consider activation of Business Continuity Arrangements. If not declared declaration of major incident may be recommended to ensure full cooperation of all responding agencies and other NHS organisations. Operational Responsibility All Leads All Leads Business Continuity Lead Chief Executive or nominated Deputy It is likely the civil resilience management structures will be implemented such Silver (TCG 4 ) and Gold (SCG 5 ) 4 Shropshire Multi-agency Silver if formally sitting called a Tactical Coordinating Group (TCG) 5 West Mercia Police footprint Multi-agency Strategic Command Group or Strategic Coordination Group (SCG)
Out of Hours Alert Level Notification Cascade Actions (Level 3 Alert Receipt Out of Hours Only) Actions Emergency Planning Lead or Director on Call will have the capability to receive notification remotely (email or sms messaging) Cascade to appropriate staff immediately in order to begin implementation of actions required via SMS Responder OOHs). Assess the requirement for additional staff. Arrange meeting of Heat wave Incident Control Team in the A.M. to ensure actions are undertaken swiftly and recommend implementation of Emergency Response Arrangements if required. Responsibilities Emergency Planning Lead to contact both Director on Call and Senior Manager on Call Director on Call Senior Manager on Call With assistance from Emergency Planning Lead Director on Call Senior Manager on Call Chief Executive