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Major
Incident
Plan
- edited version for publishing on internet
(Includes signposting to other planning arrangements)
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IF THIS IS A MAJOR INCIDENT, AND YOU ARE NOT
FAMILIAR
WITH THIS PLAN, DO NOT READ IT NOW – GO STRAIGHT
TO THE ACTION CARDS IN Section 5 or
contained within your Departmental plan
Version
2
Ratified by
Amendments issued
Author
Wye Valley NHS Trust
Accountable Officer
Chief Operating Officer
Responsible Officer
Service Unit Manager Urgent Care & Care Closer to the Home
Date for Review
Intended Audience
Related Documents
September 2013
Wye Valley NHS Trust Staff and specifically those operating
at Strategic and Tactical Levels
This Plan contains the generic detail outlining the Wye Valley
NHS Trust management, coordination, and activation
arrangements which is supported by departmental plans and
risk specific plans.
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CONTENTS PAGE
Section
Page
(full plan)
PART 1
1.1
1.2
1.3
1.4
1.5
1.5.1
1.5.2
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
PART 2
2.1
2.1.1
2.2
2.2.1.
2.2.2
2.2.3
2.2.4
2.2.5
2.2.6
2.2.7
2.2.8
2.2.9
2.2.10
2.3
2.4
2.4.1
2.5
PART 3
3.1
3.2
3.2.1
3.2.2
3.2.3
3.3
3.4
PART 4
4.1
4.2
4.3
Document Management and Version Control
GENERAL INFORMATION
Aim
Objectives
Legal Framework
Defining a Major Incident
Incident levels
NHS Commissioning Board Local Area Team
Herefordshire Clinical Commissioning Group
Herefordshire Council Resilience Team
Risk Profile
Roles and Responsibilities of the Wye Valley Trust NHS Trust
Sharing of Information
Planning Arrangements
Summary of Accommodation used in a Major Incident
Testing of Plan
Emergency Planning Group (EPG)
MANAGEMENT, CONTROL& CO-ORDINATION
National Command and Control Framework
Response guiding principles
Wye Valley Trust Command and Control & incident management process
GOLD
SILVER
BRONZE
Department Plans
Out of Hospital Response
Control of the Hospital Response
Preparation of the Hospital
Departmental Staff
Reporting Areas
Identification of Staff
Ambulance (West Midlands Ambulance Service)
Police (West Mercia Police)
Casualty Bureau
Rail Emergencies
ACTIVATION, INCLUDING ALERT & STAND-BY
General
Notification Channels
Emergency Stand by and Major Incident
Internal Major Incident
CBRN
Notification Procedures for a Major Incident
Notification to Staff
ACTION
Major Incident Stand by
Major Incident Declared
Deceased Persons
6-7
8
8
8
9
11
12
12
13
13
14
15
16
16
17
18
19
20
21
21
23
23
23
23
24
24
24
24
24
25
27
28
28
28
28
29
30
31
32
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4.4
4.5
4.6
4.7
4.8
4.9
4.9.1
4.9.2
4.10
4.11
4.12
4.12.1
4.12.2
4.12.3
4.12.4
4.12.5
4.13
4.13.1
4.13.2
4.13.3
4.13.4
4.14
4.14.1
4.14.2
4.15
4.16
4.17
4.18
4.19
4.20
Hospital Medical Response
a. Reception and Immediate Treatment
b. Definitive Management
Relatives
Casualty Documentation
Casualty Property
Remainder of Hospital
Clinical Support Services
Radiology
Laboratory services
a. Blood and Blood products
b. Diagnostic Services
c. Histopathology Services
Pharmacy
Non Clinical Support Services
a. Portering
b. Supplies
c. Security
d. Catering
e. Linen Services
f. Domestic Services
g. Works
Communications
Existing telephones
Additional extra lines provided by Service providers
Cellular Phones
Radios
Runners
Traffic
Overall responsibility
Approach Routes
Ambulance Circuit
Parking
Enquiries
Enquiries in Person
Enquiries by Telephone
Other Services
a. Chaplains
b. Volunteers
Staff Support services
Administrative Services
a. Loggist
b. Interpreters
Handover
Debrief
Recovery
34
35
36
36
36
36
37
37
38
38
39
39
39
39
39
40
40
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PART 5
A
B
C
D
E
F
G
ANNEXES
CONFIDENTIAL: Action Cards
1. Switchboard Operator
2. Site Manager
3. Duty Manager
4. Nurse Coordinator
5. Nurse in Charge A and E Dept
6. Medical Coordinator
7. Chief Triage Officer
8. Major Incident Manager
9. Chief Operating Officer/Deputy
10. Event/Decision Loggist
11. Minute Takers
12. Communications Manager/Officer
Suggested Template for SITREP
Suggested Agenda for Initial meeting
Drawing – suggested lay out of MCI Room
CONFIDENTIAL: MCI Contacts Directory
Glossary of Abbreviations
Publication and distribution list
Index of Drawings
NHS CB Incident levels
NHS , Control and Co-ordination Arrangements
Wye Valley NHS Trust Command and Control
Incident management process
Activation
Action – Major Incident Standby
Action – Major Incident Declared
Recovery
Major Incident Room/MCI Hub
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46
47
48
50
52
54
56
58
60
61
62
64
66
69
70
72
74
11
17
19
20
27
31
32
41
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Document Management and Version Control
a.
Prepared by
Wye Valley Trust Emergency Planning Officer (EPO) in conjunction with Trust
Emergency Planning Group. It is the responsibility of the EPO to ensure that this plan is
regularly updated, tested and disseminated on behalf on the Trusts Accountable Officer.
b.
Version Control
This document is version 2 of the Wye Valley NHS Trust Major Incident Plan following a
review and rewrite of the previous following substantial change to NHS Emergency
Planning Response and Recovery arrangements.
It replaces all previous versions of the Major Incident Plan. These should be destroyed
securely.
These guidelines are under constant review. Any correspondence requesting changes in
the plan should be addressed to the Trust Service Unit Manager Care Closer to the
Home and Urgent Care, Trust Headquarters, County Hospital, Stonebow Road, Hereford,
HR1 2ER.
c.
Ownership and Authorisation
The plan has been authorised by the Wye Valley NHS Trust Quality and Performance
Board.
To achieve an effective overview and review method the Trust has introduced an
Emergency Planning Group (EPG) which consists of representation from across the Trust
including its facility partners and the West Midlands Ambulance Service. The Group
meets on a regular basis to ensure that emergency planning is a systematic and ongoing
process, preparing the organisational response to major incidents/emergencies (the
terms have the same meaning and are interchangeable in this document and other
similar documents).
In developing the plan the Wye Valley NHS Trust has consulted with a wide range of
partners. This includes staff, its Emergency Planning Group, Herefordshire Clinical
Commissioning Group, NHS England Arden Local Area Team (Emergency Planning
Response and Recovery (EPRR)), Local Resilience Forum Partners, Public Health
England and Herefordshire Council (Director of Public Health).
d.
Publication and Distribution
All members of the Executive Directory and Management Teams will be issued with a
copy of this plan together with key partners, Mercia Healthcare, Sodexo, and Shared
Services Partnerships including HOOPLE (Appendix D). The latest version of this Plan is
held on the Trust Intranet to enable all staff to have access to it, with hard copies in MCI
Room, MCI Coordination Boxes. Additionally, an edited version will be placed on the
Trust’s website.
e.
Audience
This plan is aimed at Wye Valley NHS Trust staff with a role to play in a major incident,
and professional partners.
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f.
Review
As a minimum requirement, this plan will be reviewed annually from the date of
publication and following any exercises in which the plan is used, or where legislative or
organisational changes occur. Amendments will be issued to the plan periodically and
the person incorporating the amendment should sign the amendment record.
g.
Responsibilities of Plan Holders
Plan holders are required to:
familiarise themselves with the contents of this Plan;
promptly send details of any amendments to this plan to the EPO;
receive and promptly insert any amendments issued by the EPO into the plan;
and
record this action on the Amendment Record on page 7.
h.
Other Plans and Guidance
This plan should not be read in isolation, as there is a significant number of health and
multi-agency plans that have been prepared nationally, regionally and locally to
complement the response to a major incident.
A list of relevant plans is contained in section 1.8 post; however, this list is not
exhaustive.
i.
Testing and Exercises
Appropriate training will be carried out to reinforce the plan in a timely manner and testing
and exercising will be carried out in order to test and validate this plan. NHS
recommendation is that Trust carry out live exercise every three years, table top annually
and communication test every 6 months. Internal training is delivered at a number of
levels and based on the National Standards for Civil Contingencies.
j.
Version
1.00
2.00
Amendment Record
Issued
November
2011
Change
Re-issued after review of previous plan,
exercise and consultation
November
2012
Reviewed – awaiting developments of new
EPRR arrangements
Re-issued after lessons learnt from Emergo
Exercise, implementation of National EPRR
arrangements April 2013 and introduction of
employing EPO in house replacing previous
SLA with Herefordshire Council
Insert
By
John Sharman/Paul
Dubberley
Paul Dubberley
Mel Bolton/Paul
Dubberley
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PART 1
GENERAL INFORMATION
1. General Information
1.1
Aim
The aim of this plan is to set out how Wye Valley NHS Trust (WVT) will manage its
response to a major incident, setting out the framework to which WVT departmental plans
link.
Whilst this plan essentially considers the County Hospital as the site which is central to
the WVT response the principles and plan can be applied to other Trust buildings should
they become the focus of a major incident.
Community Hospitals in particular play an important role in the support of incidents such
as mass casualty when the County Hospital would look to accelerate existing patients
through the system to enhance existing bed space and additionally redeploy staff to
assist in the response effort.
1.2
Objectives
The objectives of this plan are to:
Set out WVT’s role and responsibilities under the Civil Contingencies Act 2004
(CCA 2004), Health and Social Care Act 2013 and supporting guidance and
legislation.
Define what a major incident is and outline the types of emergency that Wye
Valley NHS Trust would be expected to respond to;
In the event of a significant incident or emergency the Trust may be required to
share their resources as directed by NHS England and specifically it’s Arden
Local Area Team (LAT) (Arden comprises of Herefordshire, Worcestershire and
Warwickshire)
Outline the command, control and co-ordination arrangements within the Trust
and its links to those maintained by Arden LAT and those maintained and
implemented at the multi-agency level by West Mercia Local Resilience Forum
(WMLRF) (Forum is aligned to West Mercia Police geographic area i.e.
Herefordshire, Worcestershire, Shropshire and Telford and Wrekin).
Detail Wye Valley NHS Trust’s roles and responsibilities during a major incident
and establish a framework within which these can be fulfilled;
Provide assurance that Wye Valley NHS Trust meets criteria of NHS Core
Standards for EPRR (NHS Commissioning Board Command and Control
Framework) during significant incidents and emergencies
Identify the arrangements for communicating information to staff, patients and
stakeholders both prior to, during and after a major incident; and
Set out the process for recovery from a major incident.
1.3
Legal Framework
The framework is centred on two central planks the Civil Contingencies Act 2004 and the
Health and Social Care Act 2012.
The CCA 2004 establishes a statutory framework of roles and responsibilities for local
responders. The CCA 2004 is supported by Regulations (The CCA 2004 Contingency
Planning Regulations) and statutory guidance (Emergency Preparedness).
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It provides the national framework and approach that is utilised by responding
organisations across the United Kingdom as it prepares for, responds to and recoveries
from emergencies addressing the six principles of Integrated Emergency Management
(Anticipation, Assessment, Prevention, Preparation, Response and Recovery)
The Wye Valley NHS Trust is a Category 1 Responder as defined by the Act, and
therefore has a legal duty to perform an important part of not only managing incidents
that occur within the Trust but also to provide a role in the national the emergency
response.
It is therefore required to:
Assess the risk of emergencies occurring and use this to inform contingency
planning;
Put in place emergency plans;
Put in place business contingency arrangements;
Put in place arrangements to make information available to the public about civil
protection matters and maintain arrangements to warn, inform and advise the
public in the event of an emergency;
Share information with other local responders to enhance co-ordination; and
Co-operate with other local responders to enhance co-ordination and efficiency.
April 2013 saw the enactment of the Health and Social Care Act and the establishment of
national EPRR Command and Control Framework.
The inclusion of, or availability of the Trust Company Secretary maybe crucial to the
Trust Control and Coordination teams at both GOLD and SILVER levels since expert
knowledge maybe required taking into account factors which may be considered such as
the Freedom of Information Act 2000, and the Data Protection Act 1998.
1.4
Defining a Major Incident
The CCA 2004 defines an emergency as:
“An event or a situation which threatens serious damage to human
welfare in a place in the UK, the environment of a place in the UK,
or war or terrorism which threatens serious damage to the security
of the UK”.
The definition is concerned with consequences rather than the cause or source. For the
purposes of this definition, an event or situation threatens damage to human welfare only
if it involves causes or may cause:
Loss of life;
Human illness or injury;
Homelessness;
Damage to property;
Disruption of a supply of money, food, water, energy or fuel;
Disruption of a system of communication;
Disruption of facilities for transport; or
Disruption of services relating to health.
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For the NHS, major incident is the term in general use. However, the term ‘emergency’
may be used instead of incident. Within WVT the term Major Civil Incident (MCI) is
commonly used and the terms MCI, Major Incident and Emergency are interchangeable
within the context of this document.
For the NHS, a major incident is defined by the Department of Health as:
“Any occurrence that presents serious threat to the health of the
community, disruption to the service or causes (or is likely to
cause) such numbers or types of casualties as to require special
arrangements to be implemented by hospitals, ambulance trusts
or primary care
organisations”.
st
On the 1 April 2013 NHS Commissioning Board (NHS England) became responsible for
ensuring and implementing the NHS Emergency Planning Response Recovery (EPRR)
effort and will direct and lead the NHS response as necessary.
NHS England and locally through its Arden LAT is responsible for leading the
mobilisation of the NHS in the event of an emergency or incident and for ensuring it has
the capability for NHS control, communication and co-ordination and leadership of all
providers of NHS funded care.
This plan links to the NHS national Incident Plan maintained by Arden LAT. During an
incident the LAT will operate from an Incident Coordination Centre with its primary
location at Wildwood (Worcester) or Parkside (Coventry) depending on the location of the
incident and the responding staff.
The NHS is accustomed to normal fluctuations in daily demand for services and at times
this may lead to facilities being fully stretched. Such fluctuations are managed without
activation of special measures by means of established management procedures and
escalation policies.
The Trust has recently introduced an Addendum to this plan which considers those risks
and threats that would normally fall short of declaring a major incident and has reviewed
its surge planning arrangements There may be other occasions when an incident
(internal or external) occurs on a scale that affects our ability to respond within normal
resources. If this happens, it may be appropriate to call the Co-ordinating Team together
to decide whether the incident requires a special response that may include activating the
Major Incident Plan either in full or in part. An Executive Director will make the decision
to initiate the call in these circumstances.
What is a major incident to the NHS may not be a major incident for other responding
agencies. The WVT can therefore declare a major incident when its own facilities and/or
resources or those of partner organisations are overwhelmed.
A major incident may arise in a variety of ways and the WVT response will be dependent
on, and appropriate to, a number of situations including:
Big Bang
Examples
A serious transport accident, explosion, or series of smaller
incidents.
Rising Tide
A
developing
infections
disease
epidemic
or
a
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capacity/staffing crisis.
Cloud on the Horizon
A serious threat such as a major chemical or nuclear
release developing elsewhere and needing preparatory
action.
Headline News
Public or media alarm about a personal threat.
Internal Incidents
Fire, breakdown of utilities, major equipment failure,
hospital acquired infections, violent crime.
Deliberate Release
Chemical, biological or nuclear materials.
Mass Casualties
Casualty numbers that are beyond the capacity created by
the local implementation of major incident plans – or other
major disruptive challenges to the delivery of health care,
regardless of their cause.
Pre-planned
Events
1.5
Major events that require planning such as sports fixtures,
mass gathering of people, demonstrations etc.
Incident levels
1
2
3
4
1.5.1
Major
NHS CB Incident levels
A health related incident that can be responded to and managed by local
health provider organisations that requires co-ordination by the local CCG
A health related incident that requires the response of a number of health
provider organisations across an NHS CB Local Area Team area (Arden)
boundary and will require an Arden Team to coordinate the NHS local support
A health related, that requires the response of a number of health provider
organisations and across a region requiring regional coordination to meet the
demands of the incident
A health related incident that requires NHSCB National co-ordination to
support the NHS and NHS CB response
NHS Commissioning Board Arden Local Area Team (LAT)
In the event of a significant health related emergency/incident Arden will direct and
control the local NHS response.
Details of the arrangements are contained within its Major Incident Plan. Its Incident
Management Team (IMT) may be located at its Incident Coordination Centres at
Wildwood (Worcester) or Parkside (Coventry) depending on the location of the incident
and the responding staff.
“The strategic aim of all NHS West Midlands staff and organisations operating within this
structure with respect to a major incidents and disruptive challenges is to :
Save Lives, minimise Ill health and to mitigate the adverse impacts of major incidents that
cause (or have the potential to cause) significant disruption to the health of the population
and/or normal NHS business.
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The above aim will be achieved implementation of the following prime strategic
objectives:
• Provide strong leadership and organisational co-ordination with clear lines of
communication during preparedness; response; and recovery phases
• Coordinate provision of swift and effective health care to those affected escalating as
necessary in light of subsidiarity and mutual aid needs
• Maintain critical business functions and core service delivery through dynamic business
continuity management
• Restore NHS services to „normality‟ as soon as possible
• Contribute appropriately to the overall multi-agency effort
• Work with partners to mitigate disruption to society
• Provide appropriate system challenge to NHS organisations, partners and other
organisations involved in the response. For example: during the 2009 pandemic repeated
assurances processes were undertaken relating to immunisation plans and antiviral
collection points
(Reproduced from Arden Incident Plan – Version 3 10th March 2013)
1.5.2
Herefordshire Clinical Commissioning Group (HCCG)
HCCG based at Brockington, 35 Haford Road, Hereford HR1 1SH as a Category two
responder under the CCA has a number of duties including the requirement to
support Arden LAT should any emergency require wider NHS resources to be
moblised effectively mobilizing and coordinating all applicable providers that
support primary care services
maintain service delivery across their local health economy to prevent business
as usual pressures and minor incidents within individual providers from becoming
significant or major incidents. This includes the management of commissioned
providers to effectively coordinate increases in activity across their health
economy which may include support with surge in emergency pressures
Site Team has access to Rota for the duty commissioner who is available 24/7.
1.6
Herefordshire Council Resilience Team
The Herefordshire Council Resilience Team undertakes the co-ordination of multiagency Silver arrangements (physical meeting or by teleconference), and the activation
of the 4 x 4 volunteer drivers. The Resilience Team can be contacted as follows:
Left intentionally blank
1.7
Risk Profile
The potential hazards that may affect the communities that form the West Mercia Local
Resilience Forum (LRF) geographic area, which includes Herefordshire, have been
identified, assessed and then ranked according to severity of potential impact and the
likelihood of occurrence, and can be found on the LRF’s Risk Register at:
http://www.westmerciaprepared.org/index.php?riskcat=-1
The Risk Register takes into account national and regional hazard assessments mirroring
the National Capabilities programme. The generic risks categories are Transport
Accidents, Industrial Technical Failure, Structural Failure, Severe Weather, Industrial
Accidents and Pollution, Public Protest, and Animal Health as well as Human Health for
which the NHS generally assumes the role of Lead Responder.
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Arden LAT is in the process of developing a Local Health Reduction Partnership (LHRP)
risk register which will specifically examine health risk and inform NHS planning
arrangements at the local level..
The Wye Valley NHS Trust is represented on the West Mercia Local Resilience Forum
(WMLRF) Risk Assessment Sub-Group and at Herefordshire Multi-Agency Tactical Silver
Group.
Changes to risks and threats are reported to the Trust Risk Manager and captured in the
EPG risk register with escalation to the organisational or departmental registers as
appropriate. This forms the risk platform to which plans are formulated and exercised.
1.8
Role of WV NHS Trust
The generic building blocks to understand roles and responsibilities and statutory
responsibilities are contained within in the Civil Contingencies Act, and accompanying
Regulations and non statutory Guidance, NHS Emergency Planning Guidance 2005 and
LRF Good Practice Guide Joint Emergency Response Arrangements which outlines the
key roles and responsibilities placed on the WVT both during the response to, and the
recovery from, a major incident. Contextualized but not inclusive the key roles applicable
to the NHS are:
Saving and protecting life - provide a 24 hour emergency management and
clinical response;
Relieving suffering - provide appropriate clinical settings for the treatment of
people with minor injuries and conditions which might include reception centers,
minor injury units,
Walk in centers, community hospitals and general practice;
Containing the emergency – limiting the escalation or spread;
Providing the public with warning;
Protecting the health and safety of personnel;
Maintaining normal services at an appropriate level;
Facilitating investigations and enquiries (e.g. by preserving the scene and
effective records management);
Facilitating the physical, social, economic and psychological recovery of the
community; and
Evaluating the response and recovery effort and identifying lessons to be learnt.
Link to the primary care, community and mental health response;
Liaise with local authorities;
Maintain liaison with and co-ordinate the response with the Strategic Health
Authority through the West Midlands Emergency Response Management
Arrangements for the NHS West Midlands (ERMA).
1.9
Sharing Information
The key principles are defined within the HM Government Data Protection and Sharing –
Guidance for Emergency Planners and Responders Non-statutory guidance and are
summarised below;
• Data protection legislation does not prohibit the collection and sharing of personal data
– it provides a framework where personal data can be used with confidence that
individuals’ privacy rights are respected.
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• Emergency responders’ starting point should be to consider the risks and the potential
harm that may arise if they do not share information.
• Emergency responders should balance the potential damage to the individual (and
where appropriate the public interest of keeping the information confidential) against the
public interest in sharing the information.
• In emergencies, the public interest consideration will generally be more significant than
during day-to-day business.
• Always check whether the objective can still be achieved by passing less personal data.
•
Category 1 and 2 responders should be robust in asserting their power to share
personal data lawfully in emergency planning, response and recovery situations.
• The consent of the data subject is not always a necessary pre-condition to lawful data
sharing.
• You should seek advice where you are in doubt – though prepare on the basis that you
will need to make a decision without formal advice during an emergency.
A copy of the West Mercia LRF memorandum of understanding is held on intranet
emergency planning page.
1.10
Planning Arrangements
A myriad of plans and arrangements are maintained at national, regional, LRF, category
1 responders, category 2 responders as well by site specific operators. Importantly Trust
plans must be line with published guidance, threat specific plans and the plans of other
responding partners.
In addition to this Plan, the Wye Valley NHS Trust maintains a number of other specific
functional emergency plans.
These plans cover a range of activities, which may be needed to support the overall
response structure. In addition to electronic copies maintained on the Wye Valley NHS
Trust intranet, are hard copies contained within the MCI Control Room (term MCI (Major
Civil Incident) is commonly used within Trust but has been replaced by has been
replaced by term Incident Coordination Centre(ICC)) and, if the incident determines, its
secondary control room.
Plans are maintained by departments which link to this plan but other specific plans
include:
Wye Valley NHS Trust Addendum to Major Incident Plan – this plan considers
risks that maybe managed without activating Major Incident arrangements
including risks presented by severe weather, staff absence (industrial dispute),
the working environment, buildings and equipment, fuel shortages, surges in
activity, IT and communications and supply chain failure
Wye Valley NHS Trust Business Continuity Plan and associated service area
plans including recovery
Wye Valley NHS Trust County Hospital Lock Down plan
Wye Valley NHS Trust Major Outbreak Plan
Wye Valley NHS Trust Influenza Flu Plan
Wye Valley NHS Trust Health Economy, Ambulance and Social Services
Capacity Escalation Plan
Wye Valley NHS Trust CBRN Plan (Chemical, Biological, Radiological & Nuclear)
Wye Valley NHS Trust maintains an active link to other responding agencies including,
NHS England Arden, Herefordshire Clinical Commissioning Group (CCG), Public Health
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England (PHE), the Local Health Resilience Partnership (LHRP), the Local Resilience
Forum (LRF) and Herefordshire Council.
Relevant Plans include;
NHS Commissioning Board Arden, Herefordshire and Worcestershire Area Team
th
Incident Response Plan (Version 3 – 10 March 2013)
Herefordshire LRF Multi-Agency Silver Group Guide
Public Health England (PHE) Joint Outbreak Control Plan
Herefordshire Council Excess Deaths Plan
Herefordshire Council Rest Centre Plan
West Mercia LRF Mass Fatalities Plan
West Mercia LRF Generic Evacuation Framework
West Mercia LRF Humanitarian Assistance Centers Plan
West Mercia LRF Fuel Contingency Plan
West Mercia LRF Communications Plan
West Mercia LRF Resilient Telecommunications Plan
West Mercia LRF Joint Emergency Response Arrangement
West Midlands Region Scientific Technical Advice Cell (STAC) arrangements
West Midlands Region Reception for Military Patients (RAMP). Plan
West Midlands Health Region – arrangements for dealing with the public health
impacts of radiation incidents;
West Midlands Ambulance Service (WMAS) – Major Incident Plan
Copies of Plans are contained on Trust Intranet
(Emergency Planning page)
1.11
Summary of Accommodation used in a Major Incident
LOCATION
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All other wards and departments will be used as normal unless the scale of the
emergency requires a review of use. The Co-ordinating Team will make this decision if
this becomes necessary.
1.12
Testing of Plan
It is the responsibility of all departments and ward managers to ensure their staffs have
read the Major Incident Response Plan and understand their role in the Hospital and their
departmental response. Testing of staff contact details must be conducted every six
months, coordinated by the departmental/ward sister. The Emergency Planning Officer
will assist with this if needed.
1.13
Emergency Planning Group (EPG)
The EPG provide the focus and internal consultation to achieving the Trusts annual work
programme including training and exercises. The work programme is processed in the
form of matrix framework centred on the NHS Core Standards for EPRR effective March
2013 and previously used Cabinet Office Expectations and Indicators of Good Practise
Framework which continues to be recognised as indicator expected to be met by all
Responders.
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PART 2
MANAGEMENT, CONTROL AND CO-ORDINATION
COBR
SAGE
Lead Government
Department
Department of Health
NHS England
PHE National Office
Regioal Government
Departments
West Mercia
Strategic
Coordinating Group
NHS England Regional Office
PHE regional
PHE Centres
NHS England LAT
Arden & Shropshire and Staffordshire
(act as Health GOLD at SCG)
Herefordshire
CCG
Herefordshire
County Silver
(act as initial local Health
SILVER)
Wye Valley NHS Trust
All Cat. 1 & 2 responders
have right to attend (cat 1
are expected to attend)
CCG will coordinate local
Herefordshire County
initial health response at
Silver level
(Glossary of terms is included in appendix I)
2.1
Command, Control and Coordination
The above drawing replicates the local control and coordination arrangements aligned to
national arrangements that maybe implemented to respond and recovery to a major
incident (emergency). Category 1 and 2 responders are legally obliged to share
information and cooperate with each other as part of that response. The Trust is a
category 1 responder along with emergency service organisations and local authorities.
.
Gold – Strategic decision makers at the local level. They establish the framework within
which operational and tactical managers work. Multi-Agency cooperation and
coordination at this level is delivered through the Strategic Coordinating Group (SCG)
and normally Arden LAT will attend on behalf of the NHS.
Silver – tactical level of management determining priorities in allocating resources’ and
planning and coordinating tasks. Normally chaired by West Mercia Police and would
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meet at Hereford Police Divisional Headquarters in bath Street, Hereford.
Bronze – reflects the normal day-to-day arrangements for responding to smaller scale
incidents. It is the management of the ‘hands on work’.
2.1.1
The generic GOLD, SILVER and BRONZE command framework is supported by the use of eight
guiding principles
anticipation – ongoing risk identification and analysis is essential to the anticipation and
management of the direct, indirect and interdependent consequences of emergencies;
preparedness – all organisations and individuals that might have a role to play in emergency
response and recovery should be properly prepared and be clear about their roles and
responsibilities;
subsidiarity – decisions should be taken at the lowest appropriate level, with co-ordination at
the highest necessary level; local agencies are the building blocks of the response to and
recovery from an emergency of any scale;
direction – clarity of purpose comes from a strategic aim and supporting objectives that are
agreed, understood and sustained by all involved. This will enable the prioritisation and focus
of the response and recovery effort;
information – information is critical to emergency response and recovery and the collation,
assessment, verification and dissemination of information must be underpinned by
appropriate information management systems. These systems need to support single and
multi-agency decision making and the external provision of information that will allow
members of the public to make informed decisions to ensure their safety;
integration – effective co-ordination should be exercised between and within organisations
and levels (i.e. local, regional and national) in order to produce a coherent, integrated effort;
co-operation – flexibility and effectiveness depends on positive engagement and information
sharing between all agencies and at all levels; and
continuity – emergency response and recovery should be grounded in the existing functions
of organisations and familiar ways of working, albeit on a larger scale, to a faster tempo and
in more testing circumstances.
http://www.cabinetoffice.gov.uk/content/emergency-response-principles-effective-responseand-recovery
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2.2 Wye Valley NHS Trust Command & Control
The below diagram demonstrates the generic start towards establishing Wye Valley NHS Trusts
Command and Control arrangements and the concept of operations that exist.
Information/Intelligence and Communication are the life blood to the response effort - the
thinking towards recovery is intrinsically linked to the response.
Escalate to
NHS England
Arden LAT/
Trust GOLD
Herefordshire
CCG
SILVER Coordination (CO) Team
CO Triage
(A and E Consultant)
Warn and Inform
(Comms)
Intelligence
CO Medical
(Obstetrician/
Gynaecologist)
CO Nursing
(Head of Nursing)
Lock Down
Estates
Major Incident Manager
(service Unit Manager –
Urgent Care)
Logistics
Integrated Family Health Services
Care Closer to Home and Urgent Care
Integrated Family Health Services
Service Unit Director & Service Unit
Manager
Service Unit Director & Service Unit
Manager
Service Unit Director & Service Unit
Manager
Recovery
Accident and Emergency
SPA and Patient Flow
Midwifery
Maternity, Gynaecology and
Neonatal
Childrens and Family Services
Medical Nursing
Surgical
Neighbourhood Teams
Cancer Services
Therapies
Outpatient and Audiology
Services##Pharmacy and Medicine
Management
Diagnostic and Scientific Services
Countywide Specialist Teams
Dental
Learning Disabilities Day Services
Patient Access Centre and Business
Mortuary
Emergency Planning
Individual action cards aligned to those who have roles responsibility to the initial response are
maintained in the Annex to this plan. Each Department maintains individual Action Cards specific
to their role in a major incident including Community hospitals which have a key support role in
patient management and their movement.
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Incident management process
Anticipation,
Assessment,
Prevention
Preparation
CONSIDER
Resource
Information
(Capacity and
Capability)
PLAN
Set Objective(s)
and prioritise
(Consider generic
plans and build
Response and
Recovery plan)
Control
OUTCOMES
Review and evaluate !!!!
Incident
Information
(Sitrep)
Communicate
Hazards and
Safety
Information
Important to the process is the concept of considering
What? So what? and What now?
Adopt a risk based decision making process
Adapted from model used by Fire Service
2.2.1 GOLD – on being informed of an incident it is suggested the initial conference will include
all Service Unit Directors, Communications Manager/Officer, and Loggist/Minute Additionally, it
may be necessary to obtain legal advice and therefore presence Company Secretary may be
needed.
Its role is to review and instigate policy, resources and strategy and develop a strategic plan in
line with NHS England Arden Local Area Team who has overall responsibility for the NHS
response.
Suggested actions for development include;











Compile/Review Sitrep
Agree activation
Agree/review objectives set
Liaise with Herefordshire CCG and or Arden LAT and agree NHS actions and
arrangements
Authorise Call in internal support or and request external NHS support
Ensure Organisational Log is maintained
Review briefing arrangements
Develop/review Strategic Plan (includes thinking towards tactics and operational delivery)
Risk – lead assessment and cataloguing process
Task and log
Decide Battle Rhythm (linked to Arden, SCG, Herefordshire Silver)
Its responsibilities include;
To provide leadership for the Trust in dealing with the local implications of a flu pandemic.
To ensure effective and on-going communication both internally and externally.
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To establish a rota of senior staff in the organization to ensure commitment to Trust,
County and NHS England response is achieved.
To report to the Trust Quality and Performance Board.
To decide decisions on re-deployment of Trust staff deployment including restricting or
withdrawing the usual standard of services.
To maintain essential services wherever possible.
To work collaboratively with Health providers and other organizations.
To encourage cohesiveness, resilience and self-help, maintaining trust across
organisations and with the public.
To ensure full normal services are resumed as soon as possible.
To ensure that an audit trail is kept to record key decisions and the reasons for these.
Ensure debrief occurs when normality is achieved.
A suggested agenda for the initial meeting is contained at Appendix Section 5 of this plan.
2.2.2












SILVER - GOLD will activate/agree SILVER arrangements which are will be drawn from;
Major Incident Manager (Service Unit Manager care Closer to the Home and Urgent
Care) ;
Coordinator Nurse (Head of Nursing or deputy);
Coordinator Medical ;
Coordinator Triage (A and E Consultant);
Consultant Microbiologist;
Service Unit manager Women and families;
Service Unit Manager Planned(Elective) care;
Estates - Sodexo and Mercia.
Shared Services including HOOPLE,
Human resources
IT
Occupational Health
Quality Safety and Patient Experience
Company Secretary
Loggist
If any of the above is absent, a suitable alternative must be appointed.
2.2.3
BRONZE – as the response escalates it may become necessary to create dedicated
roles to tasks commonly referred to as BRONZE commanders whose role is to manage and
report developments to the task allocated.. It is the norm in response phase to implement
functions below which underpin most responses, The listed tasks are by no means conclusive
and it maybe that the tasks do not need to be undertaken by person dedicated to do so and can
be achieved by person who normally be called to do so as part of their ‘day job’.
Intelligence - provision of accurate and timely situation reports (Sitreps) is crucial to the decision
making process.
Communications- both internal and external messages are key.
Agreed, timely, and accurate information is imperative to mitigate the effects of an
emergency situation.
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Internal
Regular updates will be necessary and will be as far as possible delivered as part of normal
business i.e. daily bed management meetings, staff meetings/briefings,SMS text messages and
or by e-mail.. Heads of Department will be responsible for developing a system to ensure that
staff not on duty or working from home is given updates either through telephone (land line or
mobile) or internet contact.
External
Media will be a major consideration and the Chief Operating Officer and their Trust
Communications Team. When appropriate, WVT will collaborate with both County Responders
and NHS Responders to deliver a joined up and consistent approach. The West Mercia LRF
maintains a Communications Plan a copy of which is held on Trust Intranet Emergency Planning
page.
The overarching consideration is to identify and target audience for published communications
and what particular sections of the public need to know.
This includes:
• survivors – those in the immediate vicinity and directly affected, possibly as wounded
casualties;
• those who might be affected by the emergency – those nearby who may need to take action
to avoid further harm;
• local people – those in the area who may be disrupted by the consequences of the emergency
and clean-up process;
• friends and relatives – those who are not directly affected but know or are related to those who
might be;
• the general public – those who are not affected but are concerned or alarmed about the wider
implications or simply interested; and
• the media.
The Chief Operating Officer will authorise appropriate messages prepared by the Trust
Communications Manager/Officer to the media and when requested act as spokesperson or
alternatively, nominate suitably trained deputy. The Communications Team will continue to
operate from their office in Trust Headquarters throughout duration of incident.
Left intentionally blank
The importance of joint media strategy particularly during the ‘golden hour’
and being proactive are recognised principles for dealing with the media
during a crisis.
A Media Room will be set up in the Diabetes Centre. The establishment of the briefing centre will
be an important consideration which will need careful planning and control. It will be the
responsibility of Communications Manager/Officer to implement supported by staff and resources
from other areas of the hospital.
Visits by VIPs - The Chief Operating Officer, in conjunction with the Medical Co-ordinator, will
decide at which stage VIP visitors can be accepted. The MCI Manager, the Medical Co-ordinator,
and the Security Officer appointed specifically for this task, will co-ordinate such visits
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Logistics – capacity and capability of staff, buildings and equipment are what the response is
based upon. Non availability of staff and as equipment and medical supplies become scarce are
important factors for the decision makers to understand and plan around.
MCI Room – the Trust maintains the coordination room which will be chiefly used for the
implementing Hospital response towards capacity and capability to receive patient
A drawing of the set up within the MCI room is attached at appendix D.
In the event of a continued escalation the MCI Control Room will continue to control and
coordinate patient reception and movement but the need will arise to set up an additional
coordination capacity including control room(s) and meeting rooms within the Trust Headquarters
to coordinate liaison with other agencies, and link support facilities including that of the hospital
estate, security and media handing etc.
Set up and coordination of the additional room will be the responsibility of the Nurse in Charge of
the A & E Dept.
2.2.4
Departmental Plans
Heads of Departments maintain department plans and confidential staff profiles to support
the overarching Trust response.
Departmental Plans must be reviewed and updated every 12 months.
2.2.5
Out of Hospital Response
The out of hospital medical response will be provided by the West Midlands Ambulance
Service Medical Incident Manager (MIC) and Medical Emergency Response Incident
Team (MERIT). (Copy of WMAS Incident Plan is held on Trust intranet).
2.2.6
Control of the Hospital Response
The Co-ordinating Team (SILVER) will control the Major Civil Incident Procedure and will
be based in the MCI Room within the A&E Department. The overarching aim linked to the
team will be to plan towards, and implement the hospitals capacity and capability to deal
with the consequences attached to an emergency situation and in doing so effectively
communicate its planned response.
Medical Co-ordinator
Chief Triage Officer
Nurse Co-ordinator
MCI Manager
Clinical Site Team
2.2.7
Left intentionally blank
Preparation of the Hospital
The amount of preparation that is possible depends on the warning given. The priority is
for preparation for reception of casualties. This involves preparation of clinical areas as
directed by the Nurse Coordinator, assisted by Clinical Site Team who will continue to
coordinate Trust capacity and managed by the individual department senior staff.
Supporting these efforts and subsequent preparation of non-clinical areas and
requirements are the responsibility of the MCI Manager in conjunction with Sodexo and
Atkins.
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2.2.8
Departmental Staff
The Nurse Bank will be established out of hours to call in nursing staff as necessary.
Other departments are responsible for keeping an up to date call-in list and for having a
departmental plan for staff call-in. Staff with local numbers should be called initially. Calls
should not be made via switchboard.
The senior staff member on duty/call in each department is responsible for nominating
someone to call in additional staff once the Major Civil Incident Plan has been activated.
2.2.9
Reporting Areas
Staff and volunteers not tasked individually in the plan should be directed to the Staff
Reception Area in Spires Reception where a record will be kept of available staff and
volunteers and non-specific tasks will be allocated.
2. 2.10 Identification of Staff
It is essential that all staff wear identification badges. Temporary name badges will be
issued by staff in the Staff Reception Area or the Voluntary Services Co-ordinator to staff
or volunteers respectively who are allocated a specific task.
Nobody will be allowed into clinical areas unless they have an
identification badge.
2.3
West Midlands Ambulance Service (WMAS)
WMAS act as a gateway from the Incident to all other NHS resources and coordinates
the NHS/medical resources involved at an incident site, including Voluntary Aid Society
assets.
They are responsible for the safe decontamination of casualties and their onward
treatment until arrival at appropriate destination and recording and collation of casualty
information and the appropriate destination to which they have been sent ensuring
effective communication with the Trust and to partners who are receiving patients.
2.4
West Mercia Police (WMP)
The Police are able to marshal large numbers of resources, e.g. Police Support Units to
provide containment, information gathering and a public order capability, as well as
specialist resources such as firearms and investigation. Also available are Commanders
for Civil Contingencies and critical incident events, Family Liaison Officers(FLO), Senior
Investigating Officers(SIO), Counter Terrorist Specialists and a variety of CBRN
specialists.
Left intentionally blank
2.4.1
Casualty Bureau
Although the Casualty Bureau has a wider remit than just being part of the Police
investigation, it does form an integral part of that investigation.
Left intentionally blank
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2.5
Rail Emergencies
Train Operating Companies have teams of specially selected volunteers who have been
trained and equipped to respond to the needs of those affected in the hours and days
immediately following a rail emergency. These are referred to as Rail Incident Care
Teams.
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Part 3
ACTIVATION
Transport
Accidents,
CBRNe Incident
Notification
(Chemical, Biological,
Radiological, Nuclear or
explosion)
Mass casualties
Sudden
Impact
999 call(s)
Internal Incident -
Fire
Self
presenters
Other calls
Liaise with
Ambulance to
verify
Series of small
incidents,
Infectious disease
outbreak
including Flu
Pandemic
Industrial Action
Severe Weather
Rising Tide
Surveillance and
management of patient flow
including potential
pressure points monitored
as part of core Trust
business
Major Incident/
Emergency
declared by other
Agency including
Arden LAT,
Public Health,
Police, Fire, Local
Authority etc.
Ambulance
Switchboard
Accident and
Emergency
First Sitrep
METHANE
M – Major Incident
E – Exact location
T - Type of location
H
– Hazards
A
– Access
N
– Number of
E
casualties
– Emergency
Services
Level 2
Site Manager/Duty Manager
Level 3
Duty Manager/Site Manager
Level 4
Major Incident Manager/
Duty Executive Officer
3.1
Addendum to this
plan gives
guidance as to
appropriate C, C &
C arrangements
for lower level
incidents
Consider
escalation by
declaring
Standby Major
Incident /Major
Incident
General
The above drawing demonstrates the lines of communication that exist in response to a
sudden impact and rising tide incident.
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It is essential that, where possible, that notification channels to the Hospital are clear, and
not susceptible to hoaxes. It is also essential that notification to staff is unambiguous.
Equally it is important that the Hospital is prepared to meet the consequences attached to
an emergency situation whether initiated from an internal or external incident and
therefore an early decision to call a major incident allows the development of a
proportionate and flexible response.
Left intentionally blank
3.2
Notification Channels
3.2.1
Emergency Standby and Major Incident
The usual channel of notification to the Hospital in the event of a Major Incident is
through Ambulance Control (normally Hereford & Worcester or Welsh Ambulance
Services). The procedures will be implemented from within the hospital if it becomes
apparent to Level II Clinical Site Manager (CSM) that a Major Incident has occurred.
If notification comes from another source the situation should be discussed with the
respective Ambulance Control before the MCI Plan is implemented.
3.2.2
Internal Major Incident
The CSM will contact the Head of Nursing (in hours) or Level 3 Manager (out of hours)
and the Director on-call, and provide a briefing on the incident.
Once all parties have agreed the plan is to be activated, the Level 3 Manager or Head of
Nursing will call switchboard and provide notification and place the hospital on standby or
declared status.
3.2.3
CBRN Emergency
Notification of an emergency requiring decontamination procedure will usually be via
Ambulance Control. However, single or multiple contaminated casualties may arrive
unannounced in the Accident & Emergency Department (A&E) and the Chemical
Decontamination Plan would be activated. Even a single case needing decontamination
requires a special response from A&E.
The Nurse in Charge or Department lead who consider that a special emergency
situation is developing should discuss the matter with the duty Executive Director and
consider appropriate escalation response, The response will be proportionate and
necessary to the possible consequences and risk that prevails. For example, one of two
self-presenters maybe contained and decontaminated without putting the hospital into
major incident mode and implementing the management procedures contained within the
Major Incident Addendum Plan and supporting CBRN and Lockdown Plans. However,
larger numbers of patients being received or areas of hospital becoming contaminated
will give rise to major incident being declared.
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3.3
NOTIFICATION PROCEDURES FOR A MAJOR INCIDENT
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Part 4
ACTION
4.1
Standby
Major Incident
Declared
Escalate to
Herefordshire
CCG /
NHS England
Arden LAT
Trust GOLD
Senior manager/Director on call
Level 4
SILVER Coordination (CO) Team
CO Triage
(A and E Consultant)
CO Nursing
(Head of Nursing)
CO Medical
(Obstetrician/
Gynaecologist)
Escalate to
Herefordshire
CCG
Major Incident Manager
(Service Unit Manager –
Urgent Care)
Duty Manager
Comms
(Warn and Inform)
Clinic Site Manager
Major Incident Stand
by
Cascade on call by relief
telephonist
Level 3
Nurse in
Charge A & E
Nurse
Coordinator
(Head of Nursing
HON)
Medical Coordinator
(Consultant
Obstetrician/
Gynaecologist)
Switchboard
Service
Delivery
Managers
Senior Duty
Porter
Consultants
Anaesthetics,
Orthopaedics,
Surgery
Medicines
Age Care
Paediatrics
Radiology
Biomedical
Scientist
Haematology
The above drawing replicates the standing operating procedure that exists within the
hospital during normal activity. Out of hours the Clinical Site Manager who acts as the
Single Point of Access, acts as sleeping Silver and in the event of an internal escalation
towards or declaration of an Internal Major Incident occurring the Switchboard acts as the
conduit to cascade the information to on call staff and level III (Silver), level IV(GOLD)
Coordinating Teams and Chief Operating Officer.
Initial Actions
Duty and or Major Incident and Site Managers supply the initial lead and preparation as
Trust makes ready for MCI Incident. Other staff should ensure that the area under their
control is ready to manage a large number of casualties in the event of the incident being
upgraded to “declared”.
Biomedical
Scientist
Clinical
Chemistry
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MAJOR INCIDENT “DECLARED”
In the event of escalation the suggested start point for Trust control and coordination
when a major incident is declared. Responsibility for declaring a major incident normally
falls to the Trust duty executive (GOLD)
Left intentionally blank
Major Incident declared - the hospital sets itself as a receiving hospital to manage the
in-hospital response, to collate data concerning casualties, to provide optimum care and
assistance to victims and to provide information to the police documentation team as
appropriate.
Priority will be given to the admission and treatment of cases from the Major Incident and
other patients of equal or greater clinical need.
Clears lines of communication between units are vital to ensure an efficient
and coherent response and recovery are achieved.
The following will be Key Administrative Areas
Name
Location
Extension No(s.
Left intentionally blank
4.3
Deceased Persons
Deceased patients will not normally be removed from the scene of the incident and will
be the responsibility of the Coroner. Patients who die on route to or after they have
arrived at the hospital will also be the responsibility of the Coroner.
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Key considerations for the hospital is to respect the integrity of the bereaved and that
attached to the DVI process at the same time ensuring that persons are processed in an
expeditious manner to prevent bed blockage.
4.4
Hospital Medical Response
The medical response can be broadly divided into 2 phases
a.
b.
Reception and Immediate Treatment
Definitive Management
Left intentionally blank
4.20
Recovery
The recovery phase is consonant to the response to any major incident and both Control
Teams are responsible for ensuring that the Trust returns to normal in a planned way.
The Recovery Team membership will be dependent on the impact and consequences to
the trust but would normally be chaired by a Service Unit Manager (Silver) reporting to
the Chief Operating Officer (GOLD) and will be supported by a operational team.
The handover from response team to the recovery is part of a formal process and as a
start point the following are considered key objectives
Managing the return to normal service delivery;
Priority of elective services including the impact on targets;
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Communication with patients affected by the incident including the rebooking of
cancelled appointments;
Staffing levels in the immediate future;
Identifying patients who require further surgical intervention;
Number of beds occupied by major incident casualties including critical care beds
and other specialist beds;
Support of staff welfare including appropriate counseling;
Restocking of supplies and equipment; and
Auditing and reporting of the incident
The Trust maintains both Corporate and Clinical Business Continuity Management
Plans which collate and escalates risks and threats where necessary.
The below diagram is adapted from HM Government: Preparing for Emergencies
November 2008, a copy of which can be found on the Trust Intranet emergency
planning page, and whilst the document seeks to provide guidance and good
practice to community events, the principles can be applied to any recovery effort.
Humanitarian
Assistance
Economic
Infrastructure
Physical impacts (including patients and employees health and finical needs)
Psychological impacts
Deaths
Trust displacement
Economic and business recovery
Reputational damage – widespread concerns
Salvage and Insurance
Legal
Disruption to Trust life (services and business)
Disruption to buildings utilities and essential services, catering, portering,
transport, etc.)
Security of buildings
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Environmental Pollution and decontamination
Waste
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Part 5
ANNEX
A
CONFIDENTAL: Action Cards
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Switchboard Operator
Site Manager
Duty Manager
Nurse Coordinator
Nurse in Charge A and E Dept
Medical Coordinator
Chief Triage Officer
Major Civil Incident Manager
Chief Operating Officer
Event/Decision Loggist
Minute Takers
Communications Manager/Officer
B
Suggested Template for SITREP
C
Suggested Agenda for Initial Meeting
D
Drawing of MCI Control Room
E
CONFIDENTAL: Contacts Directory for MCI Room only
F
Glossary of Abbreviations
G
Publication and distribution list
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5. A.1 Switchboard Operator
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5.A.2
Clinical Site Manager
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5.A.3
Duty Manager
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5.A.4
Nurse Co-ordinator
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5.A.5
Nurse in Charge A&E Department
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5. A.6 - Medical Co-ordinator
(On-call Obstetrician/Gynaecologist)
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5. A.7
Chief Triage Officer
(A&E Consultant on call)
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5.A.8
Major Civil Incident Manager
(Service Unit Manager Urgent Care/Care closer to the home)
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5. A.9 Chief Operating Officer
(Accountable Officer)
Role – to establish and manage policy and strategy for the overall response
framework
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5. A.10 Trust Event/Decision Loggist
(Generic role)
Role: To capture in chronological order events and reports. To capture fully all of
the decisions and rationale for the incident commander and agree them with him or
her as a factual account of what has happened. To be located with the Incident
Control Room or with Commander at all times outside of the room. Actions and
Responsibilities
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5. A.11 Minute Takers
(Generic role)
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5.A. 12 Communication Manager/Officer
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4B Suggested Template for SITREP
Sitrep No.
Date and Time
Overview of event
Information, intelligence and data
Organisational Log
Chronology of events
County Hospital
Community
Beds
Threats and Risk
Staff
Logistics –
equipment and
supplies
Other issues
Projected
positions
Other issues
Involvement of NHS LAT/ Herefordshire CCG
Implications for strategic management of the NHS
Community
Services
Other
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Involvement of other responding agencies
Media and Communications
Media coverage
Media tone / Current themes /Issues
Key Lines to take / Public messages
Warning and Informing / Public Advice
Future Threats and Forward Look
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5C Draft Agenda for Initial Meeting
Venue: Date: Time:
Attendee’s
1. Information, intelligence and data received/available to date
- Discussion of initial Sitrep
- Information from partner structures and organisations
2. Creating a Sitrep/Common Recognised Information Picture
- Internal dissemination
- DH notification
- External LRF/County dissemination
2. Consideration of the Health Sector Strategic Aim and Prime Objectives
3. Appropriate level of response – to escalate/de-escalate
4. Structure and staff required to manage the response effectively and call out of
staff
5. Establish battle rhythm in line with requests from other Commanders
6. Risk assessment and horizon scanning – expectations and forecasts
- 24 hours ahead
- 36 hours ahead
- 48 hours ahead
7. Impact on patients, staff, services, and resources – business continuity
8. Response tactics in progress, planned, and/or outstanding from SILVER Coordination Team
- Levels of cooperative working
- Information sharing requirements
- Development of a Battle Rhythm
9. Warning, informing and/or providing instructions
- Key messages for staff
- Key messages for health organisations
- Key message for the public
- Development and dissemination of Frequently Asked Questions (FAQs)
10. DECISION MAKING
DECISION No 1
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(Decisions to do or not to be included)
REASON
DECISION No 2
REASON
DECISION No 3
REASON
DECISION No 4
REASON
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POLICY
Identification/Review of Strategic Aim
Identification of policy decisions made as a result of this meeting
12.
ACTIONS
The identification of actions that support the previously identified policy decisions
13.
TIME, DATE AND PLACE OF NEXT MEETING
Incident Manager ___________________________
Signed _____________________________________
Date ___/___/___ Time: ___:___hrs
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5 D Drawing of MCI Room(MCI Hub)
The coordination of a major incident will require the setting up of a dedicated control
room or rooms and that will be dependent on the characteristics of the emergency.
The start point will be to use the MCI room sited at rear of A and E principally TO
coordinate patient flow. Briefings and meetings will not normally be conducted in the
hub if necessary will be supported by utilising other areas of hospital to conduct
briefings, holding meetings and for coordinators to establish areas from which they
and their supporting teams operate from
However, and dependent on consequences such as security issues or disruption
caused by heavy snow falls or freezing temperatures the Major Incident Manager
will set up an alternative Control Rooms thus ensuring Hub continues to continue its
central function for patient flow.
Contact details and telephone numbers will be allocated during initial set up
and cascaded but the below drawing is a suggested start point for the
response to mass casualty incident .
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Major Incident Contacts Directory
Name
Location
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Extension/Speed Dial
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5 F Glossary of Abbreviations
Lexicon used in resilience planning can be found in Emergency Response and Recovery
Annex C but below table aligns those used within this plan.
https://www.gov.uk/government/publications/emergency-responder-interoperability-lexicon
Abbreviation
Primary
Working definition
or acronym
Term
Clinical
CCG
Commissioning
Group
Chemical,
Biological
Radiological,
Nuclear and
Explosives
Cabinet Office
Briefing Room
CBRNE
A term used to describe Chemical, Biological Radiological,
Nuclear and Explosives with deliberate criminal, malicious
or murderous intent.
COBR
UK Government’s dedicated crisis management facilities, which are
activated in the event of an emergency requiring support and coordination at the national strategic level
Common
recognised
Information
Picture
Department of
Health
Director
of
Public Health
Emergency
/Major
Incident
/MCI Incident
Emergency
Planning
Officer
Emergency
Planning
Response &
Recovery
Family Liaison
Officer
Incident
Commander
or
Major
Incident
Manager
Incident
Coordination
Centre
Local
Area
Team
CRIP
A single authoritative strategic overview of an emergency,
developed according to a standard template. Within COBR
the CRIP is typically collated and maintained by the Central
Situation Cell and circulated where relevant to responders.
DH
DPH
Events or situations that requires a response a response
from the emergency services or other responders and
which require special deployment by one or more
responder.
EPO
EPRR
FLO
IC or MIM
Police Officer designated to facilitate an investigation into
people believed to be missing and to assist identification.
The nominated officer with overall responsibility for tactics
and resource management at the tactical level.
ICC
LAT will management and coordinate NHS response from
ICC
LAT
NHS England is supported Local Area Teams who in event
of significant emergency would control and coordinate all
NHS assets.
Herefordshire forms part of Arden local team which also
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Lead
Government
Department
Local Health
Resilience
Partnership
Local
Resilience
Forum
LGD
Public Health
England
Strategic
Coordination
Group
PHE
Wye
Valley
NHS Trust
WVT
covers Worcestershire and Warwickshire
Department of the Government or devolved administration
responsible for overall management of response to an
emergency or disaster.
LHRP
LRF
SCG
Process for bringing together multi-Agency responders
within a police force area for the purpose of fulfilling their
duties under the Civil Contingences Act. Herefordshire
forms part of the West Mercia LRF (WMLRF)..
Multi-agency body for coordinating the joint response to an
emergency at the local strategic level. WMLRF normally
stage SCG meetings at its Strategic Coordinating Centre
(SCC situated at West Mercia Police Headquarters, Hindlip,
Nr Worcester).
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5G DISTRIBUTION
The following table shows the distribution arrangements for the WVNHST MIP and
its appendices:
Organisation
Distribution/Contact details
INTERNAL
Trust MCI Control Room
WVT
Sodexo
Mercia
Hard
Copy
4
Electronic
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
All staff can access the plan via the Intranet Emergency Planning page
External (Health)
Herefordshire
Council
Herefordshire
Clinical
Commissioning
Group
NHS England
Arden Local
Area Team
Public Health
England
Director of Public Health
Town Hall
St Owen Street
HEREFORD
HR1 2PJ


Head
of
Emergency
Planning,
Response & Resilience
Wildwood, Wildwood Drive, Worcester
WR5 2LG
Area Team
Elgar House,
Green Street,
Kidderminster
DY10 1JL
West Midlands
Ambulance Service
NHS Trust
EXTERNAL (via Local Resilience Forum Network)
West Mercia Local
Police Station,
Resilience Forum
Worcester Road,
Ledbury
HR8 1JG
www.westmerciaprepared.org
PUBLISHED
An edited version of this plan can be accessed from the Internet
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