Emergency Incident Planning in the NHS Sam Moffitt Emergency Planning Manager KCH

Agenda INTRODUCTION LEGISLATION & DUTIES TYPES OF INCIDENT Aims & Objectives LEGISLATION & DUTIES TYPES OF INCIDENT ANATOMY OF AN INCIDENT FOLLOW ON ACTIVITIES POST INCIDENT ACTIVITIES

Aims & Objectives Aim:- To provide a brief overview of Emergency Preparedness Resilience & Response (EPRR) within the NHS Objectives:- By raising awareness of what is occurring in the background to ensure successful incident response outcomes and how an incident is managed

LEGISLATION & DUTIES Civil Contingencies Act 2004 Contingencies Planning Regulations 2005 NHS Act 2006 Sect 252A Emergency Planning Statutory Guidance Emergency Response and Recovery Non-statutory Guidance Health and Social Care Act 2012 NHS Emergency Planning Resilience & Response (EPRR) Framework 2013 Amended 2015

Categories of Responders Category 1 (primary responders) Category 1 responders for health are:- Department of Health (DH) on behalf of Secretary of State for Health (SofS) NHS England Acute service providers Ambulance service providers Public Health England (PHE) Local authorities (Inc. Directors of Public Health (DsPH)) or Category 2 responders (supporting agencies) Category 2 responders for health are:- CCGs

Categories of Responders Uncategorised Responders:- Primary care, including out of hours providers, community providers, mental health service providers, specialist providers, NHS Property Services and other NHS organisations (for example NHS Blood &Transplant, NHS Supply Chain and NHS 111) are not listed in the CCA 2004. However, DH and NHS England guidance expects them to plan for and respond to emergencies and incidents in a manner which is relevant, necessary and proportionate to the scale and services provided.

Category 1 Responders’ Duties assess the risk of emergencies occurring and use this to inform contingency planning put in place emergency plans put in place business continuity management 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 cooperate with other local responders to enhance co-ordination and efficiency

EPRR planning structure for the NHS in England

Integrated Emergency Management (IEM) IEM Manage the Consequences not the Incident! Consequences Are:- Damage to People Casualties Damage to Property Lack of Access Damage to Process Service Continuity (BCPs)

Types of Incident Business Continuity Incident Critical Incident A business continuity incident is an event or occurrence that disrupts, or might disrupt, an organisation’s normal service delivery, below acceptable predefined levels . Critical Incident A critical incident is any localised incident where the level of disruption results in the organisation temporarily or permanently losing its ability to deliver critical services, patients may have been harmed or the environment is not safe requiring special measures and support from other agencies, to restore normal operating functions. Major Incident A major incident is any occurrence that presents serious threat to the health of the community or causes such numbers or types of casualties, as to require special arrangements to be implemented.

Anatomy of an Incident Becoming Aware Of An Undesired Event:- Calls to 999 Ambulance Teams Attend the Scene Ambulance Control Creates Response Strategy Notifies Hospitals Declare Major Incident Treat Casualties Restore Normality Stand down Activities Debrief

Becoming Aware Of An Undesired Event Wednesday 22nd March 14:40

Becoming Aware Of An Undesired Event Wednesday 22nd March 14:40 Vehicle collides at speed with pedestrians Vehicle crashed into railings outside Parliament Assailant exits car armed with 2 knives Enters Palace of Westminster grounds Fatally stabs unarmed police officer Shot by armed police Lasted 82 seconds

First 999 Call made to LAS at 14:40 In the next 10 – 15 mins 50+ 999 calls received to various RTCs along the length of Westminster Bridge. LAS Declared MI At 14:51

The Cost 23 Patients conveyed to Hospitals 3 deceased at scene

KCH Response

KCH Response Plus 43 Business As Usual Patients Through The Emergency Department

Types of Casualty Theatre 18:07 ICU Triage 16:15 CT 16:34 36 male P1 Hit by car.   Unable to move lower limbs. Back pain ?#pelvis. Open leg fractures Spinal precautions / analgesia CT head-pelvis C7 # T5/6 # dislocation Bilateral tib/fib # (Open on L) Loss of lower limb power Theatre 18:07 ICU

Patient Pathway A & E Triage Theatre Ward Discharge Majors; Minors; Resus CT - MRI - X-rays – etc. Theatre Intensive Care High Dependency Ward Discharge

Advantages of Major Incident Declarations It focuses the minds of staff generally Additional Resources become available Comms Team are involved Warning & Informing Security become involved (Lockdown) Dignity for Friends and Relatives Press Intrusions

Follow on Activities Police Evidence Gathering Police Casualty Bureaux Dealing with Friends & Relatives Dealing with Embassies Counselling of:- Patients Friends & Relatives Staff (Direct and Indirect)

Post Incident Hot Debriefing Cold Debriefing Lessons Learnt Review of Plans Training of New Processes

Conclusion Thank you for your time Any Questions? Sam Moffitt Emergency & Business Continuity Planning Manager Kings College Hospital sam.moffitt@nhs.net