Preparing for Emergencies- Guidance For Health Boards in Scotland

Section 5 Essential Elements of Emergency Planning

This section highlights the essential elements that are required to be in place so that Health Boards are able to respond effectively to major incidents.

Command, control and coordination (C3)

5.1 In general, major incidents are local, time-limited and effectively dealt with either by emergency services or the designated hospital's Emergency Department. However, some will be of a greater magnitude with potential consequences beyond the local Health Board area. These types of incidents will necessitate a higher level of coordination, initially by the LRP or RRP as well as by the Scottish Government Resilience Room (SGoRR).

5.2 In times of pressure and when responding to major incidents, internally or externally, Health Boards need a structure which provides clear leadership, accountable decision-making and arrangements for communicating up-to-date information. C3 is a structured approach to incident management under pressure.

Responsibilities

5.3 Health Boards must have
pre-determined C3 arrangements in place (at Board, hospital/divisional level) to respond effectively and efficiently to a major incident that it can either handle alone or through support provided as part of a wider multi-agency response.

5.4 C3 arrangements should:

• include a suitable functional space for making decisions, collecting and sharing information quickly;
• be able to be activated with the necessary personnel, standard operating procedures and equipment without undue delay;
• have clearly defined roles and (decision-making) responsibilities for Executive-level Directors and other staff delegated to assume control of an internal incident or an external one as part of multiagency strategic command group; and
• have clearly defined processes for maintaining appropriate, contemporaneous records and documenting the incident.

5.5 An adequate pool of staff should be trained as Loggists to support the management of an incident or response. It is essential that incident logs produced reflect best practice standards and that Loggists understand the evidential value and rationale of a robust audit trail.

5.6 All staff identified to assume C3 responsibilities should be given an appropriate level of training in line with the competencies for the various roles they are expected to fulfil.

Communications systems

5.7 Effective and resilient telecommunications systems are essential in enabling C3 groups to communicate with key personnel internally and externally during a major incident. Therefore, Health Boards should ensure that:

• appropriate telecommunications systems (such as Airwave, MTPAS) are available and accessible to the staff who may need them, with accompanying protocols for their use;
• all staff who may be called on to fulfil a C3 function are competent to use the telecommunications systems in emergency situations; and
• communications testing exercises take place regularly.

Mutual aid agreements

5.8 Mutual aid agreements are an important aspect of emergency preparedness. They ensure that an NHS body will have access to appropriate supplementary and/or specialist resources and support from other health organisations in the event of a major incident.

Responsibilities

5.9 The Chief Executive must ensure that his/her organisation has a mutual aid agreement with other Health Boards, category 2 responders and other relevant organisations not covered by the CCA in the RRP area and beyond if necessary. The agreement should clearly outline what aid might be required, what can be offered, who the partners are, and governance arrangements. It should be reviewed and revised at least annually.

5.10 Mutual aid requests for support should be formally triggered by the Chief Executive or named Deputy to maintain normal service provision. This should take place only after the Health Board has invoked its surge capacity plans and the incident C3 Group concludes that the capacity and capability thresholds for operating safely have been reached.

5.11 If the incident is likely to be of a longer duration or deemed to require coordination or mutual aid on a larger scale, the Scottish Government Resilience Room will be activated to fulfil a national, strategic coordination function and to ensure that government assistance is provided if required. (see Role of the Scottish Government, section 6).

5.12 In the event of mutual aid resulting in the clinical care of patients being transferred to another Health Board, there must be a clear agreement on clinical accountability and arrangements for follow-up care to ensure that movement across Health Board boundaries are taken in the best clinical interests of the patient and to ensure close, coordinated clinical supervision.

The major incident plan

5.13 Major incident plans are the culmination of risk assessment (see section 4.7). They reflect that the organisation has an understanding of the challenges that could arise from various types of major incidents or emergencies and is prepared for them. The plan provides the basis for ensuring an effective and efficient response.

5.14 Effective planning requires the Health Board to have an overview of all major incidents that have occurred in its local area, as well as those within other Boards in the RRP area, to assess or monitor their impact and learn from them.

Responsibilities

5.15 The major incident plan is a key component of preparedness and all category 1 and 2 Health Boards should have one. It should set out how they plan for, respond to and recover from various types of major incidents, and must:

• be fit for purpose and appropriate to the geographical area it covers;
• have appropriate governance arrangements, and set out responsibilities for carrying out the plan;
• be based on the principles of integrated emergency management and associated activities (i.e. assessment, prevention, preparation, response and recovery) and encompass all the phases of major incident;
• be consistent with multi-agency working, especially with partners represented within the same Regional Resilience Partnership (RRP) and link to any multi-agency response that the Health Board has a role in, such as public communications and the Scientific and Technical Advisory Cell^[7] (STAC) (see information on communications at the end of this section);
• reflect the requirements of the Civil Contingencies Act 2004, the 2005 regulations and other relevant guidance documents and have the capability to deal with all the specific incident scenarios and issues identified in this guidance such as CBRN, mass casualties, communicable diseases, burns injuries and meeting the needs of children, young people and vulnerable people;
• identify where and how specialist advice may be obtained or accessed, especially out-of-hours;
• describe local command, control and coordination (C3) arrangements as detailed in section 5.1; identify lead officer posts (at strategic and operational levels) and outline their roles and responsibilities;
• identify mutual aid arrangements with neighbouring Health Boards and other key agencies and how/when they should be triggered;
• identify reporting procedures and links with RRPs, Scottish Government Health and Social Care Directorates (SGHSCD) NHSScotland Resilience as necessary, and how and when they are to be triggered;
• identify the potential source(s) of financial resources that may be needed to respond to various incidents;
• identify resources to be allocated or accessed to deal with various types of incidents in line with defined planning assumptions;
• identify the staff requirements and mobilisation arrangements to respond to various incidents and how the impact on normal services will be addressed; and
• be regularly reviewed (in the light of exercising, training, lessons learned from incident debriefs and policy changes), and endorsed by the Civil Contingencies/Resilience Committee and/or the Health Board.

5.16 Major incident plans should be:

• exercised in full at least every 3 years;
• tested through a table-top exercise every year; and
• communicated/cascaded within the organisation and to partners every 6 months.

Reporting major incidents

5.17 Health Boards should ensure that all relevant staff are aware of the Scottish Government NHSScotland Resilience reporting arrangements using the agreed NHS Situation Report (SitRep) pro-forma. These arrangements must be used when a major incident:

• occurs within a Health Board;
• has been declared by an RRP partner that requires the deployment of healthcare resources; and
• creates significant service pressures for the Health Board and is likely to impact on business as usual.

5.18 The reporting frequency will be agreed by the Health Board representative and SGHSCD depending on the nature of the incident and the assessment of its impact on the Health Board.

Training and exercising plans

5.19 Training and exercising programmes are important in ensuring that incident response plans are up-to-date and will be effective when implemented. They are a means of providing the Health Board with assurance of its capability for various types of major incidents.

Responsibilities

5.20 The Chief Executive must ensure that arrangements and resources, including financial commitments, are in place to enable adequate training, exercising and testing of the Health Board's emergency preparedness. Accordingly, a budget should be allocated to meet the costs of the agreed programmes. Health Board members should be advised at least annually of the Board's state of preparedness.

5.21 As a minimum, Health Boards should have:

• an annual training and exercising plan, the implementation of which is monitored and recorded;
• a process and system for recording and reporting the outcome of exercises and for ensuring that lessons-identified and lessons-learned are incorporated into revisions of the appropriate plans and protocols; and
• training/skills records to help inform capability analysis that are kept up-to-date.

5.22 Disciplines from across the Health Boards services (acute services, public health, primary and community care etc.) as well as contractors and other key LRP/RRP partners where appropriate should be involved in these exercises. It is recommended that scenario-specific exercises are undertaken to test particular aspects of the organisation's capabilities.

5.23 Health Boards should assess their own overall exercise requirement, which for some may be in excess of this minimum.

5.24 Wherever possible, Health Boards should collaborate with each other to organise and participate in joint exercises, involving multiagency partners where practicable. The lessons-identified and lessons-learned from these exercises should be disseminated across the service via appropriate networks as a means of enhancing the overall resilience of NHSScotland.

5.25 Training, testing and exercising should take place in the context of a training needs analysis and a progressive, targeted and graduated training programme that reflects the roles and responsibilities of staff in particular operational settings. Senior managers should ensure that appropriate staff are released to participate in relevant training programmes.

Communication

5.26 Communication with the public is a duty under the CCA and plays a central role in preparing for, responding to, and recovering from emergencies. Effective communication requires Health Boards to think strategically about how they communicate internally, with one another, and how they communicate with patients and with members of the public.

5.27 During an emergency, Health Boards must cooperate with other agencies to develop a communications strategy and issue information that is clear, timely, relevant and accurate. The public expect to be informed quickly and efficiently and, in an incident that has potential health consequences, they will look to the NHS to communicate with them both directly using websites and social media, as well as the mainstream news media.

5.28 Liaising with the media during an emergency is a resource-intensive operation. It requires those involved to have the necessary skills and training to cope with a surge of repeated requests for information, especially in the early stages of a major incident. Effective handling of the media will affect how the emergency and the response to it are reported and that, in turn, can enhance the effectiveness of that response, both immediately and in the longer term.

Responsibilities

5.29 Health Boards should appoint a Lead Communications Officer who should participate in the multi-agency strategic communications group formed to deal with the incident.

The following guidance is presented under the various IEM activities.

(1) Preparation

5.30 Health Boards must have a communication plan (see Appendix 4), which is developed in conjunction with the RRP and integral to its major incident plan. They should ensure that managers responsible for emergency response are familiar with media needs, methods and time schedules, and should prepare and train them and other appropriate staff for media liaison duties.

5.31 The communications plan should:

• outline the roles and responsibilities of the organisation and staff (particularly in the communications department) at various levels, the resources to be made available to them and the use of websites and social media;
• indicate the procedures to be followed by the on-call Communications Officer in the event of a media enquiry or a statement by a member of the public on social media alerting the Health Board to a possible incident;
• indicate how and when NHS 24 emergency helplines and its social media outlets will be used to keep the public informed;
• indicate actions to be taken at various phases during and after an emergency has occurred; and
• be exercised, and the communications arrangements should be tested in as practical a way as possible. All training and exercising should take account of lessons identified from previous emergencies and exercises.

5.32 The communication plan as a whole and the specific arrangements for communicating with the public and staff should be assessed against Equalities and Human Rights Act duties.

5.33 Use of social media has the ability to reach a vast and varied audience in a very short period of time, respond to requests for information, answer queries or counter rumours and inaccurate information. Using social media in a coordinated way with multi-agency partners can have a positive effect on public perception and reassurance.

5.34 Health Boards should:

• have suitably equipped space for use as a Media Centre in the event of an emergency;
• have their own website and identified staff with access to update the website 24 hours a day. Consideration should be given to:
• communications departments having the ability to make their websites a low graphic text-only version in the event of an emergency; and
• having a mobile-friendly version of the website so that potentially large numbers of people can visit the site using mobile devices;
• have in place social media platforms, such as Facebook and Twitter; and
• ensure that communications team staff have 24-hour access to the social media outlets and be trained in how to use them to disseminate 'real time' information to the public.

(2) Response

5.35 In relation to the response phase, the communications plan should clearly set out:

• the procedure to be followed in the event of a major incident being caused, or suspected to be caused by an act of terrorism, the potential consequences of security being imposed on casualties and the hospitals treating them. It is important that, as far as possible, a communications procedure/protocol is agreed with multi-agency partners in advance. This will help ensure that essential healthcare personnel are not prohibited from entering hospital grounds or reporting for duty; media briefings on site that are coordinated by the police are cleared by the Health Board's senior Communications Officer; and that a clear and timely message is communicated to staff who normally work at the hospitals;
• the procedures and standards to be followed at first and subsequent media briefings; and
• the point at which assistance will be required from communications staff from other Health Boards in the event of a major incident/emergency and liaise with the Scottish Government Communications Directorate (SGCD).

5.36 Patient confidentiality and staff's right to privacy must be maintained during an emergency situation. No information about particular patients being treated should be released without first checking with the police and the consultant responsible for their care. Interviews or photographs must not be permitted without the consent of the patient concerned.

Internal communications

5.37 Internal communications are also important during a major incident. Any major incident will have an impact on the local community in which staff live and they will have an obvious need to be informed. While staff will get updates from the external communications channels outlined above it is good practice to disseminate regular updates, including key messages and reassurance, to staff through agreed internal communications channels in line with internal communications protocols.

VIPs

5.38 VIPs or other dignitaries will often visit the site of a major incident and hospitals involved in the response to it; they may also be admitted to NHS facilities as patients. The SGCD in consultation with other press offices as appropriate will be responsible for providing advice on media coverage on such occasions. Health Boards should have a VIP protocol for such occasions that has been agreed with the police.

(3) Recovery

5.39 It is likely that a major incident could run on for some weeks or months. While local authorities lead during the recovery phase, it may be necessary for health information to be provided by Health Boards in an ongoing, consistent manner during this period as part of a process of public reassurance. This may have resource implications for the organisation. NHS 24
may have a key role in assisting the Health Board on such occasions by acting as a point of contact for disseminating information or providing helpline support.

5.40 All Health Boards should, as part of their communications plans, outline how they will accommodate this situation and collaborate with NHS 24 to develop outline protocols and agreements for responding quickly on such occasions.