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New Zealand Ambulance Major Incident
and Emergency Plan (AMPLANZ)
The Overview
May 2011
Acknowledgements
Ambulance New Zealand would like to acknowledge and warmly thank the following organisations for their
support and contributions towards the completion of AMPLANZ:
Members of Ambulance New Zealand especially St John, Wellington Free Ambulance, LifeFlight and Wairarapa
Ambulance for releasing the members of the AMPLANZ work group:
Peter Cain, Wellington Free Ambulance
Tim Chiswell, St John
Sharon Cretney, Wairarapa DHB
Jeremy Gooders, St John
Alan Goudge, St John
David Greenberg, Lifeflight
Chris Haines, St John
Bruce MacDonald, St John
Andy Parr, Wellington Free Ambulance
Doug Third, St John
Stephen Smith, St John
Ambulance National Clinical Leadership Group
Ambulance NZ Standards and Accreditation Committee
New Zealand Fire Service, Special Operations
Ambulance Victoria, Specialist Emergency Response Department
NZ Ministry of Health, Emergency Management Team
UK Department of Health, Emergency Preparedness Division
Thank you to Shirin Sheida (St John Marketing Services) and Paul O’Connell (St John Learning Media) for the
design of this document.
Thank you also to Catherine Preston, David Wethey, Glenn Cockburn, Matt Ohs, Oz Golan, The Lifeflight Trust
and Hawke’s Bay Today for the use of their photographs in this document
Foreword
New Zealand has for a number of years had a national ambulance major incident and emergency plan
– AMPLANZ. This has ensured that there is a common understanding between ambulance services,
communications centres and our emergency management partners as to how an ambulance will respond in a
time of crisis.
Today however this new plan has had to take into account a number of emerging aspects in the emergency
management environment. These include, for example: a number of high profile and catastrophic events in the
last 5-10 years that has seen a greater focus on emergency management internationally; the redevelopment
of the New Zealand Ambulance Standard (NZ8156) and the increased requirement to align with national
emergency plans across the sector.
There is a continuing requirement on Ambulance Services to develop their own Major Incident and Emergency
Plans based in the detailed operational framework that is AMPLANZ. AMPLANZ now provides clearer guidelines
and tools to assist services at the local, service and national levels. AMPLANZ is noted within NZS8156 and
therefore an Ambulance Service’s Major Incident and Emergency Plan should be audited regularly.
Finally, given the recent emergencies in New Zealand particularly in Canterbury and on the West Coast, it is now
clear that major emergencies do indeed occur in New Zealand. Therefore there is a requirement that AMPLANZ
and the Ambulance Service’s own Major Incident and Emergency Plans continue to be ‘living documents’ that
remain relevant and practical in order to meet the needs of their community and the service.
David Waters
CEO
Ambulance New Zealand
Content
1.0 Introduction
4
4.2 Activation based on National Warnings
12
1.1 What is AMPLANZ?
4
4.3 National Coordination of Ambulance
12
1.2 The Aim of AMPLANZ
4
4.4 Activation based on Regional or Local Warnings
12
1.3 Mandate of AMPLANZ
4
4.5 Response Command Structures, Roles and Responsibilities 12
1.4 Format of AMPLANZ
4
4.5.1 First Ambulance Crew at the Scene
4.5.2 Ambulance Command at the Scene
4.5.3 Ambulance Service Emergency Response
Management Structures
4.5.4 EACC Incident Management Structure
12
12
4.6 Key Facilities for an Ambulance Response
14
2.0 Frameworks and Concepts of Emergency Management 5
2.1 Legislation and National Emergency Management Plans 5
2.2 The 5 ‘Rs’
5
2.3 CIMS (New Zealand Coordinated Incident Management System) 5
2.4 Concept of Ambulance Emergency Management
6
2.4.1 The Responsibilities of Ambulance Services in a Major Incident 6
2.4.2 A structured and consistent approach
6
2.4.3 Whole of Organisation and Sector
7
13
14
4.6.1 Incident Scene Facilities
14
4.6.2 Ambulance Service Emergency Operations Centre (ASEOC) 14
4.7 Communications and Information Management
15
4.8 Ambulance Resources and Equipment
15
4.9 Ambulance Coordination with Health,
Emergency Services and other Agencies 15
16
3.0 Readiness and Reduction 7
3.1 Risk Reduction
7
3.2 Readiness
7
5.0 Recovery 3.2.1 Readiness: Planning
3.2.2 Readiness: exercising
3.2.3 Readiness: training and education
7
8
8
Appendix 1: Glossary of Terms and Abbreviations
17
Appendix 2: References
20
3.3 Review and Audit
8
4.0 Response
8
4.1 Activations, Level of Response, and Notifications
8
4.1.1 Escalation
4.1.2 Types of Incidents
4.1.3 Response Matrix Tool
4.1.4 Risk Assessment and Response
4.1.5 Major Incident Notifications within Ambulance Services and to
partner agencies
9
10
11
11
12
1.0 Introduction
1.1 What is AMPLANZ?
AMPLANZ is a detailed operational framework for
the New Zealand ambulance sector to provide clear
guidance for all Ambulance Services in all parts of the
emergency management cycle. It provides standard
terminology, structures, and roles. It also provides tools
to assist an Ambulance Service in its readiness and
reduction, response and recovery, for example, task
cards, planning templates, debriefing templates etc.
AMPLANZ is mandated to provide:
“….all Ambulance Services with the nationally
standardised framework to command, control and coordinate ambulance resources locally, regionally and
nationally, for the greatest good of the greatest number
of casualties during major incidents”.
1.4 Format of AMPLANZ
The format of AMPLANZ includes two documents. These
are The Overview and The Plan. The Plan is made up of
four parts as noted below.
Specific Ambulance Service Operational and Tactical
Plans must be developed by Ambulance Services based
on this framework.
AMPLANZ cannot be arbitrarily changed. There is a
review process through the Ambulance New Zealand
Standards and Accreditation Committee outlined as part
of AMPLANZ.
In line with health sector and the emergency
management sectors as a whole, there are a large
number of specialist terms and abbreviations. To assist
the reader, there is a glossary in Appendix 1.
1.2 The Aim of AMPLANZ
The aim of AMPLANZ is to:
Ensure the effective and consistent management of
major incidents at local, service and national levels
for the benefit of patients
Minimise the impact of a major incident or multiple
major incidents on normal operations
Adopt and encourage a whole-sector approach to
major incident management
Adopt and encourage a whole-of-organisation
approach within services to major incident
management.
1.3 Mandate of AMPLANZ
AMPLANZ applies to all Ambulance Services in
New Zealand and it is noted in Section 3.2.7 of the
Ambulance Standard (NZS 8156:2008) that an
Ambulance Service “shall be aware of, and where
appropriate, contribute to, regional and/or national large
scale contingency planning and be able to operate in
accordance with such plans including…. AMPLANZ”.
1
Ambulance New Zealand has approved policy to clarify:
“…the mandate of AMPLANZ and to ensure that
Ambulance NZ and Ambulance Services understand
their roles and responsibilities with regards to the
development, maintenance, and operationalisation of
AMPLANZ”.
An Ambulance Service is defined in NZS8156:2008 Section 1.5 page 12.
1
4
new zealand ambulance major incident and emergency plan (AMPLANZ)
AMPLANZ – The Overview
AMPLANZ – The Plan
Part 1
Introduction
to AMPLANZ
and Emergency
Management for
the Ambulance
Sector
Part 2
Consistent
Operations
at the
Scene
Part 3
Ambulance
Service
Approach
Part 4
National
Coordination
Mechanisms
The Overview: This provides a summary for all
Ambulance Services and partner agencies of the
concepts and approach of the ambulance sector
in the management of major incidents.
Part 1: Introduction to AMPLANZ and Emergency
Management for the Ambulance Sector: This part
summarises what AMPLANZ is, the sector, and key
ambulance and emergency management concepts.
Part 2: Consistent Operations at the Scene: This Part
focuses on the activities to be undertaken by responding
crews, the duty management and those operational
officers directly involved at the scene in coordination
with other responding agencies.
Part 3: Ambulance Service Approach: This Part focuses
on the activities to be undertaken by Ambulance Service
Management in all parts of the emergency management
cycle. It is designed to guide ambulance managers who
are required to support the response at the scene, as
well as play a role in preparing for or recovering from a
major incident.
Part 4: National Coordination Mechanisms: This Part
provides a framework for an Ambulance Service to
develop its national coordination mechanism to ensure
that the ambulance sector is able to respond to a
significant regional or national emergency.
A CD with AMPLANZ Parts 1-4 and associated
appendices is in the back cover of this Overview.
2.0 Frameworks and Concepts of
Emergency Management
2.1 Legislation and National Emergency
Management Plans
Appendix 2 lists the key legislation and plans that guide
Ambulance Service emergency planning.
2.2 The 5 ‘Rs’
Emergency Management in New Zealand is underpinned
by the 4 ‘Rs’ approach to emergency management2:
The ambulance sector in New Zealand, unlike many
services internationally, does not have its own legislation
that guides and regulates the provision of ambulance
services.
Reduction
That said, Ambulance Services are health sector
organisations and therefore have responsibilities within,
for example, the Health Act 1956 and New Zealand
Public Health and Disability Act 2000.
Recovery
In the context of emergency management, the
ambulance sector must comply with, for example, the
Civil Defence Emergency Management Act 2002 and
Epidemic Preparedness Act 2006.
Ambulance services shall be aware of their
responsibilities under these legislations as well as other
health and workplace legislation.
There are two key national plans that relate to
emergency management. These are the:
National Civil Defence Emergency Management Plan
2006
National Health Emergency Plan 2008 (NHEP).
Readiness
Response
For the purposes of AMPLANZ, the ambulance sector has
identified the importance of building and maintenance
of ‘Relationships’ between Ambulance Service Managers
and key personnel in health service providers, traditional
emergency services, civil defence and welfare agencies,
lifeline organisations and the private sector.
2.3 CIMS (New Zealand Coordinated
Incident Management System3)
CIMS is New Zealand’s approach to incident
management. It provides a framework to manage
a range of diverse incidents, from routine to major
emergencies.
The major incident management structures outlined in
AMPLANZ are based on CIMS.
AMPLANZ shall be read in conjunction with these key
national plans.
Taken from the Guide to the National Civil Defence Emergency Management Plan, June 2009, Section 1 Introduction page 2.
2
Taken from the NZ Coordinated Incident Management System (CIMS), Teamwork in Emergency Management 2010 pages 8–14.
3
The overview MaY 2011
5
2.4 Concept of Ambulance Emergency
Management
2.4.1 The Responsibilities of Ambulance Services in a
Major Incident
The role of the ambulance sector in response to a
major incident is to deliver and maintain appropriate
pre-hospital clinical care. In a mass casualty incident,
Ambulance will lead the operational health response
to the incident at the scene/s and manage the triage,
treatment and transport of patients to appropriate
receiving hospitals or health facilities. In all emergencies
impacting on the health of the communities, an
Ambulance Service will manage and coordinate its
response with the DHBs and other emergency services
to manage demands on the healthcare system.
Below are key responsibilities of Ambulance Services in
a major incident,
Responsibilities of an Ambulance Service in all major
incidents and emergencies:
To save life in conjunction with other Emergency
Services
To notify and liaise with the other Emergency
Services
To initiate and maintain an Ambulance Service
Command and Control structure lead by an
Ambulance Service Controller
To protect the health, safety and welfare of all
ambulance staff generally, and all health workers on
the scene of a mass casualty incident
To supply sufficient ambulances and staff for the
incident
To provide a communications system between
ambulance and DHBs (including hospitals)
To provide Ambulance Liaison Officer/s to the
partner agencies as appropriate for the incident
To reduce to a minimum, the disruption of the normal
work of the Service by implementing Business
Continuity Plans, as appropriate, ensuring the
restoration of normality at the earliest opportunity.
Responsibilities of an Ambulance Service for Mass
Casualty Incidents:
To provide a structure to support the triage,
treatment and transport of casualties from the scene
by establishing an Ambulance Control Point, Casualty
Clearing Point and Ambulance Loading Point
To provide a Senior Ambulance Officer at the scene
to act as Ambulance Commander (AC)
To be part of the Scene Incident Management Team
6
new zealand ambulance major incident and emergency plan (AMPLANZ)
(IMT) to ensure a coordinated response to the incident
To identify, notify and communicate with appropriate
receiving hospital(s), health facilities and DHBs
of the prevailing situation and the categories and
estimated times of arrival of casualties
To triage all patients prior to evacuation from the
scene
To manage all medical resources deployed to the
scene for the treatment and care of casualties
To determine the priorities for the evacuation of
casualties, ensuring even and simultaneous dispatch
to the receiving hospital(s) and health facilities
To organise transportation for casualties to the
receiving hospital(s) and health facilities, and any
necessary secondary transfers between hospitals
To acquire additional ambulance resources, as
necessary, through the use of the Ambulance
Service’s national coordination mechanisms
To forward to the receiving hospital(s) and health
facilities, Public Health Units and DHB(s), any
information acquired at the scene relating to
chemical, biological or radiation (CBR) hazards and
possible contamination of casualties or rescuers and
advise of the potential for self-presenting patients
To assume responsibility for casualty
decontamination, in conjunction with the Fire Service
To provide the Fire Service with clinical advice and
assistance to support on-site decontamination
To maintain adequate emergency ambulance cover
throughout the Ambulance Service’s Operational
area for the duration of the major incident
To progressively release activated hospital(s) and
health facilities and ultimately issue a message
indicating completion of casualty evacuation.
2.4.2 A structured and consistent approach
AMPLANZ is aligned with CIMS, important New Zealand
emergency management concepts and with key national
emergency plans.
AMPLANZ also notes that to effectively manage large
and complex incidents, the processes and procedures
used by ambulance services need to be established
and understood within the services and also by partner
agencies.
Major incidents, such as mass casualty events, are
infrequent occurrences and consequently any procedures
required to manage such incidents shall follow the same
basic processes as for smaller and less complex incidents.
Therefore essential processes, such as assigning initial
response roles and responsibilities, incident escalation,
notifications, situation reports, triage etc are the same no
matter what the size or complexity of the incident.
2.4.3 Whole of Organisation and Sector
AMPLANZ is designed to ensure that all parts of the
ambulance sector and the individual services are
involved in the response, recovery and development of
readiness of the sector. This will then contribute to the
resilience of the health sector.
Within an Ambulance Service there are roles and
responsibilities of first-responding crews, for ambulance
service management and also for key support staff in
non-operational or core support positions.
Across the sector, clear guidance is given to further
integrate the individual service’s response and planning
at the tactical and operational levels and also nationally
in the coordination of all services with national agencies,
such as MoH.
3.0 Readiness and Reduction
3.1 Risk Reduction
AMPLANZ does not cover all aspects of risk management
and therefore risk reduction in individual Ambulance
Services of the sector. The incidents covered by the
AMPLANZ are normally considered as having risk of:
low likelihood of occurrence and
high impact on normal business.
The focus here is on the requirement to ensure that
‘normal’ services can be maintained and Ambulance
Services are able to respond safely and appropriately
to known hazards in the community. Specifically, the
focus is on business continuity, tactical plans and their
prioritisation, and coordination of plans with health
sector partners and other emergency service partners.
Finally, there is a clear emphasis on the need for ongoing
education and training within the services and across
the sector.
3.2 Readiness
3.2.1 Readiness: Planning
The majority of operational and tactical response
planning is undertaken by individual Ambulance Services
with the EACC, their local emergency management
agencies and neighbouring Ambulance Services. The
planning shall focus on:
Business Continuity Planning within individual
Ambulance Services, including the EACC
Specific Ambulance Tactical Plans to respond to
known and priority risks in the community. These
are to be coordinated with the traditional emergency
services, including health, private sector agencies
and Civil Defence and Emergency Management
Agencies
Ambulance Service Major Incident and Emergency
Plans
Inter-Ambulance Service cooperation to ensure a
whole of sector approach is developed to specific
known hazards, which will require cross border
responses
The development of national coordination
mechanisms by each Ambulance Service to ensure
that an Ambulance Service is able to call upon or
provide support to or from other Ambulance Services
Health Emergency Planning with the focus on the
integration of the operational planning of both
Ambulance Services and DHB service providers
Alignment of the Ambulance Service plans with
national plans such as the National Transport Plan
and the National Mass Casualty Plan.
The overview MaY 2011
7
Plans shall be appropriately tested in exercises involving
Ambulance Services, DHBs, other emergency service
partners and national agencies, such as MoH.
Training needs analysis is required to further enhance
the appropriateness of emergency management training
and education within Ambulance Services.
The ambulance sector contribution to national health
emergency planning can be undertaken in a number of
ways. These include:
Training and education in emergency management
for Ambulance Services shall align appropriately with
competency frameworks and guidelines of other
emergency service partners, as well as with Civil Defence
and Emergency Management Agencies.
Meeting the obligations set out in legislation (e.g.
CDEM Act) for Ambulance Services, DHB, MoH or other
national agency. Individual Ambulance Services may
be tasked and funded to coordinate the emergency
planning and capability development of the ambulance
sector. For example, (chemical, biological and
radiological) CBR capability development
Cooperation between services for specific known preplanned events or known threat (e.g. International
Sports Events, VIP tours / meetings etc)
Using an Ambulance Service’s national coordination
mechanism in planning for exercises, pre-planned
events or known threats, where it is felt necessary
that national coordination will be required.
Individual Ambulance Services contributing to
specific issues relating to emergency response
planning. For example, revision of the New Zealand
Influenza Pandemic Action Plan.
The choice as to which approach is used will depend
on the planning issue, priority for individual services,
capability in the sector and the resources available to
assist the sector.
3.2.2 Readiness: exercising
A complete Ambulance Service Response, including
the set up and activation of an Ambulance Service
Emergency Operations Centre (ASEOC) and activation
of the Ambulance Service’s national coordination
mechanism, shall be exercised in at least one major
CDEM (Tier 3-44) exercise as well as at least one major
emergency services or health exercise each year.
Communication and activations systems shall be tested
as appropriate for all exercises where there is a likelihood
of a significant ambulance and health response.
All exercises shall be evaluated and results reported
internally within the Ambulance Service. Lessons will
be identified and shared. Processes will be developed
to incorporate changes into the appropriate level of
planning within the sector. This shall include the annual
AMPLANZ review by Ambulance New Zealand.
3.2.3 Readiness: training and education
To enable a complete Ambulance Service emergency
response, all potential responders shall be trained
appropriately to be able to undertake their roles.
3.3 Review and Audit
The Ambulance Service major incident and emergency
plans, and the related operational procedures to ensure
the notification, activation and management of a full
and coordinated ambulance service response, shall be
audited and reviewed as part of the Ambulance Service’s
quality management systems.
AMPLANZ will be reviewed annually to take into account
local and internationally significant development and
lessons identified or learnt. There will be a formal
review of AMPLANZ no later than every three years. The
Ambulance New Zealand Standards and Accreditation
Committee has national responsibility for the review of
AMPLANZ on behalf of Ambulance New Zealand trustees.
4.0 Response
4.1 Activations, Level of Response5, and
Notifications
This section is outlines the Ambulance activation
mechanisms and levels of response required for an
incident in the community that may require escalation to
national level.
The aim is to ensure that every major incident is
managed appropriately as early as possible in the
response. This will improve patient outcomes and ensure
that the responding ambulance officers are supported
quickly and effectively.
The classification of the type of incident is essential to
ensure that appropriate activations and notifications occur.
Once an incident has been classified, it triggers certain
actions which must be taken by the affected Ambulance
Service and the EACC. This will enable quick decisionmaking to determine the level of coordination required.
The major variables that govern the type of response
from an Ambulance Service include:
Time to respond to the incident (travel, triage, treat
and transport)
The complexity of the incident
The number of patients.
Ministry of Civil Defence Emergency Management (MCDEM) Tier 3 exercises test territorial local authority (TLA) and CDEM group (CDEMG)
operations. MCDEM Tier 4 exercises test National Crisis Management Centre (NCMC), CDEMG and TLA operations. Both of these will require a
service and national response from Ambulance.
4
This section draws on Ambulance Victoria (AV) Emergency Response Plan 2009. AV’s generous support is acknowledged.
5
8
new zealand ambulance major incident and emergency plan (AMPLANZ)
There are four levels of response:
Normal operations
Level 1: medium impact on normal operations
Level 2: high impact on normal operations
Level 3: severe impact on normal operations.
To allow the identification of correct response levels, two
tools have been developed:
An Escalation Flow Chart that notes the actions of all
ambulance parties in the initial escalation
A Response Matrix to be used by the EACC.
4.1.1 Escalation
The Escalation Flow Chart – Figure 1 – provides an
overview of the actions by the EACC and the Ambulance
Duty Operational Manager6 in the initial stages of a
major incident. This outlines when to use the Response
Matrix and the initial assessment, as well as clearly
defining the actions to be undertaken by the EACC and
Duty Operational Manager based on the level of incident.
Figure 1: Escalation Flow Chart
EACC receive
“111” call, Inter CAD or direct (e.g.
airport alert, ambulance approaching
an incident) notification
Issue identified by
the calltaker and/or Dispatcher
as possibly outside of Normal
Operations
Escalate to the Comms Centre
Team Manager
Dispatch immediate
appropriate
resources
Use Response
Matrix
Normal
Operations
What Level?
If Level 1, 2, or 3
Then EACC to:
1. Page “Possible Major
Incident” Level 1
2. Inform Duty
Operational Manager
Duty Operational
Manager to undertake
initial and ongoing
assessment
Level 1
Manage Locally by
Duty Operational
Manager
Ambulance Manager
Responded as
Commander
Ensure Public
Information Manager in
place
Inform/Update Ambulance
Service Duty Executive
Inform Health Partners
(EACC page)
Level 2
Escalate to Sevice Duty
Executive
Level 3
Escalate to Sevice Duty
Executive
Ambulance Manager
responded as Commander
Ambulance Service Duty
Executive to Manage
Other Ambulance Services
informed / on standby
National
Coordination Mechanisms
Informed /on standby
Brief Ambulance
Management
Inform/Brief Health
Partners (EACC page/
teleconference)
Ensure Public Information
Manager in place
Ambulance Manager
responded as Commander
Ambulance Service Duty
Executive to Manage
Other Services
on standby /activated
National
Coordination Mechanisms
on standby /activated
Brief Ambulance
Management
Inform/Brief Health
Partners (EACC page/
teleconference)
Ensure Public Information
Manager in place
Continual
reassessment based
on situation reports
from the scene
Duty Operational Manager is a generic position title that covers a number of positions used across the sector such as Operations Team Manager,
Duty Operations Manager, and Duty District Manager etc.
6
The overview MaY 2011
9
4.1.2 Types of Incidents
A major incident or emergency for ambulance is defined as:
Any occurrence that presents serious threat to the health of the community, disruption to the service or
causes (or is likely to cause) such numbers or types of casualties as to require special arrangements to be
implemented by appropriate responding agencies including:
Ambulance Services
District Health Boards (including, for example, hospitals, primary care, and public health)
The Ministry of Health.
AMPLANZ has adopted a set of descriptors for types of incidents applicable to all hazards. These incident descriptors
relate to the ability to access patients, involvement of a lead agency or a comprehensive CIMS structure and the
complexity of the response and its impact on normal services.
Time to respond, triage, treat and transport is another factor that will impact on patient care and normal service
delivery. Therefore this will need to be taken into account in the decision-making process.
Figure 2: Types of Incidents
Type of Incident
Description
Complex
Incident that is not routine or it is an infrequently used procedure (e.g. CBR, Airport
emergency, major Civil Defence Emergency Management (CDEM) event (e.g. tsunami))
Controlled
Incident that has a lead agency (e.g. Police, Fire, Health, CDEM etc) or comprehensive CIMS
structure in place or a large number of personnel are deployed
Restricted
Where access to patients is difficult owing to hazardous, environmental or security factors
Open
Where there are no issues regarding the access to or egress from patients
Simple
Incident where normal or routine Ambulance procedures apply
10
new zealand ambulance major incident and emergency plan (AMPLANZ)
4.1.3 Response Matrix Tool
The initial assessment of an incident is the responsibility of the EACC Team Manager using the response matrix below
in Figure 3.
Figure 3: Response Matrix
>21
Level 2
Level 2
Level 2
Level 3
Level 3
11–20
Level 2
Level 2
Level 2
Level 3
Level 3
6–10
Level 1
Level 1
Level 2
Level 2
Level 2
3–5
Normal
Operations
Level 1
Level 1
Level 2
Level 2
0–2
Normal
Operations
Normal
Operations
Level 1
Level 1
Level 2
Numbers of
Patients
Type of
Incident
Simple/
Open
Simple/
Restricted
Simple/
Restricted/
Controlled
Time
<1hr
1–2hr
2–4hr
Complex/
Controlled
4–8hr
>8hr
How to use the Response Matrix
1. Estimate the total likely ‘Time’ or duration of the incident for ambulance (travel, triage, treatment and transport)
and plot on the Response Matrix
2. Determine the ‘Type of Incident’ from Figure 2 and plot it on the Response Matrix
3. Determine the ‘Severity of the Incident’ by comparing the time estimate to the Type of Incident, and select the
greater (i.e. further to the right of the matrix)
4. Determine the likely number of patients and plot against the Severity of the Incident on the Response Matrix
5. An Initial ‘Possible Major Incident’ notification will be sent (Level 1) to inform those who will be directly impacted by
this incident
6. The Duty Operational Manager will be informed and will respond accordingly.
4.1.4 Risk Assessment and Response
Once an incident has been classified using the Response Matrix Tool and determined to be outside of normal
business, a local Level 1 ‘Possible Major Incident’ notification will be sent by the EACC and the Ambulance Service
Duty Operational Manager will be informed.
Ambulance Service Duty Operational Manager will then be required to confirm that a major incident has occurred
and will declare a major incident for ambulance at the appropriate level. This will be done using information from
the incident scene, the EACC, partner agencies and other reliable sources. Tools have been provided to Operational
Managers to assist with decision-making.
The overview MaY 2011
11
4.1.5 Major Incident Notifications within Ambulance
Services and to partner agencies
Partner agencies will be informed of Major Incidents by
Ambulance:
Liaise and coordinate with key National Emergency
Management Agencies (MoH and MCDEM for
example) and on behalf of the responding Ambulance
Service/s in the response and recovery phases of the
emergency
Local DHBs will be informed via a paging / text
notifications system as part of the activation of the
ambulance response for all Level 1, 2, or 3 incidents
Provide a sustainable support structure, with trained
personnel and appropriate infrastructure, to be able
to operate 24/7 if required.
The MoH Regional Emergency Management Advisors
will be informed for Level 2 and 3 incidents
Notification and activation procedures for an Ambulance
Service’s national coordination mechanism will need to
be developed and communicated across the sector and
to key partners.
The MoH will be informed via 0800 GET MOH of
Level 3 incidents
The local Civil Defence and Emergency Management
Group (CDEMG) will be informed for Level 3 incidents
Police and Fire services are informed routinely via
Inter-CAD communications within the Communication
Centres.
There are EACC and Ambulance Service Procedures in
place to hold an initial briefing teleconference with partner
agencies and neighbouring Ambulance Services, based
on the scale of the incident. This will be facilitated by
the EACC and managed by the Ambulance Commander,
Ambulance Service Controller or their delegate. Following
the initial briefing, further teleconference briefings may
be required or communication between the Ambulance
Services and DHBs will continue via other channels
depending on the incident requirements.
4.2 Activation based on National
Warnings7
MoH and MCDEM will send out National Warning
notifications to all emergency management stakeholders
in the health sector and the wider CDEM sector.
Ambulance Sector Single Point of Contact (SPOC) for
MoH and MCDEM notifications is the EACC. The EACC is
responsible for cascading these to the ambulance sector.
Note: If there is an ambulance major incident response
required, this will be activated and escalated using the
process noted in Section 3.1 and usually before MoH or
MCDEM alerts have been received.
4.3 National Coordination of Ambulance
Each Ambulance Service shall develop and maintain
its own ‘national coordination mechanism’. This is
broadly defined as a mechanism that, with supporting
procedures, is able to:
Receive requests from the responding Service or part
Service that has been overwhelmed
Coordinate the provision of requested ambulance
resources from other Ambulance Services or nationally
4.4 Activation based on Regional or
Local Warnings
There are also Regional Health, Regional CDEM Group
or Local Authority notifications. The mechanisms used at
these levels currently vary across New Zealand. The EACC
will cascade these notifications appropriately to the local or
regional Ambulance Service. Local or regional Ambulance
Service Management may also receive notification directly
and will ensure that the EACC is informed.
4.5 Response Command Structures,
Roles and Responsibilities
This section summarises the key parts of the management
structure, and their roles and responsibilities, as used by
Ambulance Services in a major incident.
4.5.1 First Ambulance Crew at the Scene
The actions of the first attending ambulance crew at the
scene of a Major Incident are crucial to establishing an
effective response. The primary role of the first crew
can be summarised as being to ‘assess’ and ‘inform’.
The scene is assessed and reported to the EACC in a
standard (METHANE8 report) format.
Accurate, high quality information must be given as
quickly as possible to enable adequate resources to be
sent to the scene.
4.5.2 Ambulance Command at the Scene
The overall aim of ambulance management at the
incident scene is to provide the operational and tactical
leadership. This will include the set up of appropriate
command and communications structures, safety
of all health responders and the appropriate triage,
treatment and transport of patients from the scene to
the appropriate healthcare facilities. This will require
coordination and communications with receiving health
facilities, DHBs and emergency service partners.
The Guide to the National CDEM Plan 2006, Section 19 and The National Health Emergency Plan 2008, page 16.
7
See Appendix 1 for the definition of METHANE.
8
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new zealand ambulance major incident and emergency plan (AMPLANZ)
The scale and complexity of the command structure is
dependent of the incident. For example:
A Level 1 incident of short duration and low patient
numbers may be managed by an Ambulance
Operations Manager (AOM) undertaking the CIMS
functions
A long duration controlled and / or complex incidents
(Level 2 or 3), or simple / restricted incidents
equivalent to Level 1 or 2 (short duration but
with large numbers of casualties) will require the
Ambulance Commander or Ambulance Operations
Manager to decide how the Ambulance and CIMS
roles will be implemented and the staffing required.
The key roles in an Ambulance Command structure are:
Ambulance Commander (AC): The officer responsible
for scene management for complex and prolonged
incidents. The AC will be part of the Incident
Management Team when an IMT has been established
for controlled or complex incidents (Level 2 or 3
Incidents). This is an incident management role
and therefore shall not have clinical management
responsibilities.
Ambulance Operations Manager (AOM): The officer
delegated with the responsibility to manage operational
activities of the incident at the point of patient contact,
and the site role most commonly established for open
simple, restricted or minor controlled incidents (Level
0, 1 or 2 incidents). This is an incident management
role and therefore shall not have clinical management
responsibilities.
Ambulance Triage Officer/s: Responsible for the triage
of all patients in an incident or sector. In command of
all Triage Areas and is responsible to the AOM or Sector
Officer.
Ambulance Communications Officer – on-site
Ambulance Logistics Officer
Aviation Co-ordinator
Ambulance Planning and Intelligence Officer.
These will be deployed depending on the duration, scale
and complexity of the incident. It may be necessary to
combine roles depending on the availability of personnel.
Medical, Nursing and allied health professionals may
also be deployed or volunteer and will be under the
command of the Ambulance Commander.
See AMPLANZ Part 2: Consistent Operations at the
Scene – for more details.
4.5.3 Ambulance Service Emergency Response
Management Structures
In a similar way, for simple, open or restricted Level 1
incidents of short duration and relatively small patient
numbers, an Ambulance Service may be able to
provide strategic direction, support and coordination
to the Ambulance Commander or Operations Manager
through normal business arrangements and structures.
For complex, long duration incidents (Level 2–3), an
Ambulance Service Controller (ASC) shall be appointed
to lead the overall Ambulance Service response.
All key CIMS roles or functions will need to be
undertaken but it is recognised that an Ambulance
Service may not be able to fill all roles with individual
managers. CIMS roles may have to be shared. How this
issue is managed within the Ambulance Service is the
responsibility of the ASC.
A key role/s will be the Liaison Officer roles to partner
agencies. These may include:
Ambulance Treatment Officer/s: Responsible for
coordinating patient treatment, liaising closely with
the Transport Officer and the Triage Officer. Delegates
tasks to all medical and other personnel at the Casualty
Clearing Point. Reports to the AOM / Sector Officer.
Ambulance Liaison to ED
Ambulance Transport Officer: The officer responsible
for all transport, loading and parking management in
consultation with the AOM. Responsibilities include:
ensuring that suitable access and egress is available
into the ambulance loading point at or near the CCP,
for the efficient use of vehicles, allocating vehicles for
transport while taking into account patient priority,
establishing an appropriate ambulance parking area.
Reports to the AOM / Sector Officer.
Ambulance Liaison to the NHCC or NCMC.
There are other roles such as:
Ambulance Sector Officer/s
Ambulance Safety Officer
Ambulance Liaison to a Hospital EOC or DHB EOC
Ambulance Liaison to Emergency Services EOC,
including Police, Fire or CDEM
The type, duration and scale of incident will dictate
where Ambulance Liaison Officers should be placed.
When local ambulance resources have been
overwhelmed, it may be necessary to request support
from neighbouring Ambulance Services or nationally to
ensure the appropriate roles are undertaken effectively
for the duration of an incident. This will be done by the
Ambulance Service’s national coordination mechanism.
The Ambulance Service Emergency Response
Management roles are noted in detail AMPLANZ Part 3:
Ambulance Service Approach.
Ambulance Administration Officer
The overview MaY 2011
13
4.5.4 EACC Incident Management Structure
Safe Forward Point/s (SFP)
The EACC may activate its national incident management
team in support of the local communication centre
depending on the communications demands of the
incident and normal service delivery. Level 1–2 incidents
may be managed by the Team Manager with support
from the Communications Centre Manager and EACC
Duty Executive as required.
Landing Zone/s (LZ) or Helipad/s (HP)
For more complex, long duration incidents, a formal
incident management structure will be required with
incident management responsibilities with an EACC
Emergency Response Manager.
This is noted in detail in AMPLANZ Part 3: Ambulance
Service Approach.
4.6 Key Facilities for an Ambulance
Response
CIMS requires consistent facilities at the incident at
the scene. Ambulance also requires specialist facilities.
There are also specialist facilities for the Ambulance
Service Emergency Response Management and EACC.
4.6.1 Incident Scene Facilities
Below is a summary of the facilities that may be required
at an incident. For full descriptions see AMPLANZ Part 2:
Incident Control Point (ICP)
Ambulance Command Point
Sectors
Assembly Area/s
Staging Area/s
Ambulance Parking Area/s
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new zealand ambulance major incident and emergency plan (AMPLANZ)
Forward Triage
Casualty Clearing Point/s (CCP) including a Triage
Area/s and Treatment Area/s
Ambulance Loading Point/s (ALP).
4.6.2 Ambulance Service Emergency Operations
Centre (ASEOC)
An ASEOC is a facility that aims to:
Coordinate the ambulance response to a major
incident with the Scene Commander(s) and the EACC
Plan for future resource requirements of a major
incident
Manage the impact of the incident/s on normal
service delivery
Ensure that all ambulance management and key
stakeholders are informed of the current incident
situation, plans and resource requirements.
For smaller incidents, an ASEOC may be ‘virtual’ with
minimum staffing and physical set up, or be able to
operate from the EACC MCI Room or from a partner
agency EOC. However, an ASEOC will physically be
required for complex or long duration incidents (Level
2–3) where there is a significant Ambulance response.
The Ambulance Service shall have a space appropriately
set up or able to be set up as an ASEOC within 30 minutes
of a major incident Level 2 or 3 being declared. The ASEOC
setup specification shall enable it to operate securely and
independently for the duration of the emergency.
Where a non-dedicated space is identified for use as the
ASEOC, management protocols shall be in place to give
priority to use of this space as an ASEOC for the duration
of the emergency response and recovery phases.
The EACC is required to maintain an ‘MCI Room’ in each
Communications Centre to enable the communications
management of a complex major incident to be
separated from normal service delivery when
appropriate. The EACC MCI Rooms will require similar
specifications as the ASEOC.
4.7 Communications and Information
Management
The most significant factor that will contribute to
successful command and control of an incident is
effectiveness of the communications systems, protocols
and tools. These include:
On-scene communications within the Ambulance
Service and within the Incident Management Team
Communications between the responding crews, the
Ambulance Commander and the EACC
The detail and timeliness of information given to the
Incident Controller, to the EACC and to health partners
The tools available to the Ambulance Commander,
EACC and Ambulance Service Controller to manage
the information, including Sitreps, action planning and
Emergency Management Information Services (EMIS).
A number of protocols, tools and information
management systems have been developed as part of
this plan. See AMPLANZ Parts 2 and 3.
4.8 Ambulance Resources and
Equipment
An Ambulance Service shall ensure that key managers
are aware of and trained in the use of specialist
resources that may be used in their operational area
during a major incident. These may include:
and equipment will be nationally consistent kits or
caches to ensure interoperability between Ambulance
Services. Ambulance officers shall be regularly trained
in the deployment and use of these materials and
equipment. These major incident caches or kits may also
be used in major public events to improve familiarity with
the materials and equipment.
The EACC Computer Aided Dispatch (CAD) system
will maintain current information on the majority of
ambulance resources available for deployment. The
status of ambulance resources shall be in a form that is
immediately accessible to the NHCC. For example, this
may be via the health EMIS (WebEOC, E.SPONDER or
similar). This will include the location and detail of major
incident caches in urban centres and rural station kits in
strategic rural stations.
The Air Ambulance Services, particularly fixed wing, not
normally deployed by the EACC, shall ensure that their
status is able to be tracked by the EACC and therefore
in a major incident may be able to be coordinated by the
EACC as part of a major incident response.
The ambulance or event services, including NZ Defence
Force (NZDF) or NZ Red Cross, not normally deployed by
the EACC, will maintain their resource status, capacity
and capability in a form that is immediately accessible
to the EACC and NHCC. For example, this may be via the
health EMIS (WebEOC, E.SPONDER or similar).
The national coordination of all land-based, rotor and
fixed wing assets in a major incident will be outlined in
the MoH National Transport Plan.
4.9 Ambulance Coordination with
Health, Emergency Services and other
Agencies
In a complex mass casualty incident or major
emergency, it is unlikely that any one agency will have
the required resources to meet the needs of a response.
The CIMS approach provides for coordination across all
responding agencies.
Ambulance major incident cache of medical
materials and equipment
The Ambulance Service will ensure that there are timely,
accurate and ongoing briefings of health partners.
Ambulance Specialists Operations Teams and their
capability (SERT, Rescue, USAR and CBR etc)
Section 3.2.1 also notes the need for ongoing
development and planning by all health and emergency
management agencies.
DHB medical materials etc that may be accessible to
a pre-hospital response
Specialist materials, equipment, services and
personnel from a partner emergency service or
support agency that may be required by a prehospital response. For example, USAR equipment,
CDEM logistics, Red Cross volunteers.
All Ambulance Services are required to maintain major
incident equipment and materials, with efficient means
of deployment, to ensure a major incident in their service
area can be appropriately resourced. These materials
The coordination of patient transport, according
to priority, to the most appropriate health facility
is recognised as critical. Ambulance Services are
responsible for ensuring that all staff who may fulfil
the key roles at the scene or in the ASEOC shall be fully
aware of and trained in:
Capacity and capability of the local and regional
receiving health facilities
The overview MaY 2011
15
Capacity and capability of the Ambulance Services
locally, including air ambulance (rotary and fixed wing)
Emergency plans of the local DHBs as they impact on
ambulance
The communication channels with receiving health
facilities or DHBs to coordinate patient transport
The communication channels with Regional Health
Coordination structures
The role, capacity and capability of the emergency
services, NGOs, such as Salvation Army and NZ Red
Cross, private sector organisations and Civil Defence
Emergency Management Organisations
The communication channels with non-health
organisations to be able to access appropriate
resources (e.g. CDEM Groups).
Each Ambulance Service is responsible for ensuring
that their ASEOC has access to appropriate operational
‘points of contact’ for the local and regional health
services and non health agencies.
Each Ambulance Service shall put in place a Liaison
Manager who will have the responsibility for maintaining
the relationship with coordination mechanisms within
partner agencies during a response. This will include:
sharing information, requesting resources if required and
inputting into a multi-agency action plan.
At a national level, the Ambulance Service’s national
coordination mechanism shall specify how liaison with
key national agencies and groups will occur. These
agencies include but are not limited to:
National Health Coordination Centre (MoH)
National Crisis Management Centre (MCDEM)
National Welfare Coordination Group
National Fire Service Headquarters
National Police Headquarters.
It will be necessary to prioritise the placement
ambulance liaison at the national level according to the
incident’s complexity, duration and impact on ambulance
operations, health services and the wider community.
The NHCC will be given priority.
5.0 Recovery
The process of recovery for an Ambulance Service
is defined as the re-establishment of normal service
delivery after a major incident. This process should
start as soon as possible in the response phase and
be aligned with Ambulance Service business continuity
plans. Ambulance Services will be required to contribute
to the overall recovery of the health services and
community. It may also be the case that, dependent
on the incident, there may be a new ‘normality’ for the
community. Ambulance Services may have to realign
themselves appropriately as part of the recovery process.
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new zealand ambulance major incident and emergency plan (AMPLANZ)
It is envisaged that even in a moderately sized major
incident there will be an effect on staff, supplies, equipment,
finance and vehicles. Areas requiring consideration for
recovery will include, but should not be limited to:
Staff welfare/debriefs
Rosters
Leave
Operational review and learning
Consumables (medical/fuel)
Equipment
Vehicles (servicing repairs etc)
Finance and cost recovery.
Recovery roles have been built into the role descriptions
for response managers at the service level as well as key
non-operational staff.
For complex incidents that have impacted significantly
on the ongoing functioning of the Ambulance Service, a
Recovery Manager may be required to concentrate on
the rebuilding or modification of the service.
The Ambulance Commander and Ambulance Service
Controller are required to undertake a number of actions
as part of the recovery process. These are:
Hot Debrief with responding crews and appropriate
EACC staff held as soon as possible
Complete an Ambulance Commander’s After Action
Report within one month of the incident
Hold an Ambulance Service formal debrief for a
significant incident within two months
Complete an Ambulance Service Major Incident
Report for significant events within six months
Attend and share experience / learning in an
Interagency Debrief and reporting process when and
if required.
At the national level, ambulance recovery coordination
following a complex and nationally significant emergency
shall be based on the requirements of the local
Ambulance Services and / or the needs of the health
sector locally and nationally. Therefore an Ambulance
Service shall consider recovery functions as part of its
national coordination mechanism.
An Ambulance Service’s national coordination
mechanism shall have debriefing and reporting
processes in place to capture lessons identified and for
action planning and service improvement.
All logs and notes made during an incident at the scene,
Ambulance Service and national levels will need to be
correlated and stored in case of possible inquiries into
an incident management.
Appendix 1
Glossary of Terms and Abbreviations
AA
Assembly Area
AAP
Agency Action Plan
AC
Ambulance Commander
AIO
Ambulance Incident Officer (now called Ambulance Operations Manager or AOM)
ALP
Ambulance Loading Point
ALS
Advanced Life Support
AMPLANZ
New Zealand Ambulance Major Incident and Emergency Plan
AOM
Ambulance Operations Manager
AOS
Armed Offenders Squad (Police)
AS/NZS
Australian Standards / New Zealand Standards
ASC
Ambulance Service Controller
ASEOC
Ambulance Service Emergency Operations Centres
BCP
Business Continuity Plan
BLS
Basic Life Support
CAD
Computer Aided Dispatch (system)
CBR
Chemical Biological Radiological
CCP
Casualty Clearing Point
CDEM
Civil Defence Emergency Management
CDEMG
Civil Defence Emergency Management Group (Regional Council)
CEO
Chief Executive Officer
CIMS
New Zealand Coordinated Incident Management System
CIMS 2
CIMS introductory training
CIMS 4
2-3 day training for Emergency Management personnel at the Scene
Clan Lab
Short for ‘clandestine lab’: generally used in any location / facility involving the production of
illicit compounds.
Cordon
Physical demarcation of the border between zones. e.g.
Inner cordon separates hot and warm zones
Outer cordon separates cold zone for the public areas or traffic exclusion zone (that may still
be patrolled by security or police)
DES
The Cabinet Committee for Domestic and External Security Coordination. The committee is
chaired by the Prime Minister and includes those ministers responsible for departments that
may play essential roles in emergency situations.
DHB
District Health Board
DHBNZ
District Health Board New Zealand
The overview MaY 2011
17
Glossary of Terms and Abbreviations continued...
Duty Executive
Senior Ambulance Manager with strategic management of an Ambulance service. May also be
known as Regional Operational Executive, Ambulance Operational Executive.
Duty Manager
Ambulance Officer responsible for the operational management and running of an Ambulance
Service for a shift. May also be known as District Duty Manager, Duty Operations Manager.
E.Sponder
Emergency Management Information System used by MCDEM (see below)
EACC
Emergency Ambulance Communications Centre (St John Communications Ltd and Central
Emergency Communications Ltd)
Emergency
Defined in Section 4 of the CDEM Act 2002
EMIS
Emergency Management Information System. A system to assist with the recording, flow and
timely transfer of information between Emergency Management agencies during an emergency.
EOC
Emergency Operations Centre
Executive
Management Team
The wider management team (including Human Resources, training, finance and
administration, other business arms) of an Ambulance Service headed by a CEO or General
Manager. Will provide strategic guidance and oversight to the management of an incident.
HazMat
Hazardous Material/s
HEP
Health Emergency Plan (of a DHB or health service)
Hot zone
The immediate area surrounding the site of a hazardous materials incident and where the
hazard level is high. The boundary of this zone should be clearly marked with ‘hot zone’ tape
to indicate the high risk to responders and the need for specific protective clothing. Hot zone
marking should extend far enough to prevent adverse effects from the release of the hazardous
material to any persons outside the hot zone. A hot zone will be defined by Fire or Police.
HP
Heli Pad
HR
Human Resources
ICP
Incident Control Point
ICT or IT
Information Communication Technology
ILS
Intermediate Life Support
LZ
Landing Zone
Major Incident
For the ambulance sector this is defined as:
Any occurrence that presents serious threat to the health of the community, disruption to
the service or causes (or is likely to cause) such numbers or types of casualties as to require
special arrangements to be implemented by appropriate responding agencies including:
Ambulance Services
District Health Boards (including, for example, hospitals, primary care, and public health)
The Ministry of Health.
MCDEM
Ministry of Civil Defence Emergency Management
METHANE
A METHANE report is the internationally recognised tool for incident management and is
utilised in this plan. It covers the following:
Major Incident Status
Exact location of incident
Type of incident
Hazards identified
Access to the scene
Number of casualties
Emergency services available and Extra resources required
MoH
Ministry of Health
NCMC
National Crisis Management Centre (run by MCDEM)
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new zealand ambulance major incident and emergency plan (AMPLANZ)
Glossary of Terms and Abbreviations continued...
NHCC
National Health Coordination Centre (run by MoH)
NGO
Non Government Organisation
NZFS
NZ Fire Service
ODESC
Committee of Officials for Domestic and External Security Coordination. A committee of
government chief executives charged with providing strategic policy advice to ministers.
It provides support to DES and oversees emergency readiness, intelligence and security,
terrorism and maritime security. Activation of ODESC is at ministerial request; for example,
where a growing risk of a particular threat has been identified.
OIC
Officer in Charge (Fire)
OPF
Operational Policy Framework. One of a group of documents collectively known as the ‘Policy
Component of the District Health Board Planning Package’ that sets out the operational level
accountabilities for DHBs for each fiscal year. The OPF is executed through Crown funding
agreements between the Minister of Health and each DHB. The OPF covers emergency
obligations based on the four ‘Rs’.
PIM
Public Information Management
Recovery
The coordinated efforts and processes used to bring about the immediate, medium-term and
long-term holistic regeneration of an organisation and community following an emergency.
Readiness
The process of developing operational systems and capabilities before an emergency occurs.
Reduction
The process of identifying and analysing long-term risks to human life and property from
natural or non-natural hazards; taking steps to eliminate these risks, if practicable and, if not,
reducing the magnitude of the impact and likelihood of them occurring.
Response
The actions taken immediately before, during or directly after an incident or emergency to
save lives and property, and to help communities recover.
SAR
Search And Rescue
Sector
For complex and large scale incidents it may be required to divide a scene into sectors.
Sectors may be defined by the Incident Controller for overall use or by individual agency
commanders for their agency’s needs.
SERT
Special Emergency Response Teams
SFP
Safe Forward Point
Sitrep/s
Situation Report/s
STG
(Police) Special Tactics Group
TBC
To Be Confirmed
TLA
Territorial Local Authority
UHF
Ultra High Frequency (radios)
USAR
Urban Search And Rescue
VHF
Very High Frequency (radios)
VIP
Very Important Person/s
Warm zone
Zone surrounding the hot zone. An area that presents minimal hazard to personnel. The zone
where decontamination takes place. Will be defined by Fire.
WebEOC
Emergency Management Information System used by the Health Sector (under review).
WFA
Wellington Free Ambulance
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19
Appendix 2
References
Legislation
Primary acts and associated regulations outlining legislative
responsibilities for health sector organisations and therefore
Ambulance Services are the:
Civil Defence Emergency Management Act 2002
Epidemic Preparedness Act 2006
Health Act 1956
National Civil Defence Emergency Management Plan Order
2005
New Zealand Public Health and Disability Act 2000.
Other important acts and regulations covering emergency
management include, but are not restricted to, the:
Emergency Medical Services: The Forgotten First Responder—A
Report on the Critical Gaps in Organization and Deficits in
Resources for America’s Medical First Responders. New York,
NY: Center for Catastrophe Preparedness and Response,
New York University. Mar 2005 http://www.nyu.edu/ccpr/
NYUEMSreport.pdf
Focus on Recovery: A Holistic Framework for Recovery in
New Zealand
Information for the CDEM Sector [IS5/05] Feb 2005
KAMEDO Report 90: Terrorist Attacks in Madrid, Spain, 2004.
Roger Bolling; Ylva Ehrlin; Rebecca Forsberg; Anders Rüter;
Vivian Soest;Tore Vikström;
Civil Defence Emergency Management Regulations 2003
Per Örtenwall; Helge Brändström (ed)
Fire Service Act 1955 (section 330)
Forest and Rural Fires Act 1977
Pre-hospital and Disaster Medicine http://pdm.medicine.wisc.
edu Vol.22, No. 1
Health and Disability Commissioner (Code of Health and
Disability Services Consumers’ Rights) Regulations 1996
London Assembly: Report of the 7 July Committee June 2006.
(London Bombings)
Health and Safety in Employment Act 1992
National Health Emergency Plan, NZ MoH, Dec 2008
Health (Infectious and Notifiable Diseases) Regulations
1966
New Zealand Influenza Pandemic Plan: A framework for action.
April 2010.
Health Information Privacy Code 1994
NSW Heathplan May 2008
Human Rights Regulations 1993
NZFS Incident Management – Command and Control Technical
Manual Nov 2007
Injury Prevention, Rehabilitation and Compensation
(Ancillary Services) Regulations 2002
Local Government Act 2002
Health Practitioners Competence Assurance Act 2003
(WHO) International Health Regulations 2005.
Other References
Ambulance Victoria Emergency Response Plan 2009
Ambulance NSW State Major Incident / Disaster Plan Feb 2006
Ambulances to Nowhere: America’s Critical Shortfall in:
Medical Preparedness for Catastrophic Terrorism. Joseph A.
Barbera, MD, Anthony G. Macintyre, MD, Craig A. DeAtley, PA-C
October 2001. http://www.gwu.edu/~icdrm/publications/
Ambulances_to_Nowhere.pdf
Australian Triage Cards: Toward A National Agreement. Norton
and Field 2009
British Columbia Ambulance Service – Mass Casualty Incident
Emergency Management Plan Jul 2008
Civil Defence Emergency Management Competency Framework
Technical Standard for the CDEM Sector [TS 02/09] June 2009
Comparative Analysis of Multiple Casualty Incident Triage
Algorithms: Garner, Lee, Harrison, Schultz. Annals of
Emergency Medicine Nov 2001.
Coordinated Incident Management System (CIMS)1998 (Blue
Book)
Emergency Medical Services: At the Crossroads 2007. Chapter.
6
http://books.nap.edu/openbook.php?record_
id=11629&page=175
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new zealand ambulance major incident and emergency plan (AMPLANZ)
NZS8156:2009 Ambulance Service Sector Standard
NZS 31000:2009 Risk Management – Principles and guidelines
Report On Tilt Train Derailment At Rosedale (Berajondo). Dept.
of Emergency Services, Queensland Government, Jan 2005
State Major Incident and Disaster Plan (Queensland) July 2004
The Guide to the National Civil Defence Emergency
Management Plan 2006
The New Zealand Ambulance Service Strategy: The first line of
mobile emergency intervention in the continuum of health care
http://www.naso.govt.nz/wp-content/uploads/2009/10/finalambulance-strategy.pdf
Tier 1 Emergency Departments Service Specification DHBNZ /
MoH Dec 2002
Triage: a position statement. T Hodgetts. May 2001 for the
European Union Core Group of Disaster Medicine
Notes:
Notes:
Notes: