Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Teams - October 2011

DEFINITIONS

Hazards and Exposures

12. The broad categories of agents which endanger health (hazards) and how we come into contact with them (exposures) are presented below with examples:

Hazards

• Biological - infectious agents, mould, pollen, biological warfare agents;
• Chemical- natural or man-made (industrial, domestic, chemical warfare agents);
• Radiation - ionising (e.g. nuclear) and non-ionising (e.g. UV) emissions from natural sources e.g. radon or man-made e.g. deliberate release; and
• Physical - natural particulates and man-made pollution, volcanoes, forest fire combustion products, hydrocarbons, extreme weather events floods.

Exposures and pathways

• Person to person (respiratory, skin to skin, sexual, faeco-oral or via devices);
• Food;
• Water;
• Air;
• Animal (including vectors); and
• Environmental

Incidents

13. For simplicity throughout this framework the terms incident and Incident Management Team (IMT) are used as generic terms to cover both incidents and outbreaks. However, there is an important distinction between outbreaks where there is already evidence of impact on human health and incidents where an environmental or other hazard has been identified but the aim is to assess the hazard and risk and prevent impact on health.

14. A public health incident may arise in the following situations:

• a single case of a serious illness with major public health implications (e.g. botulism, viral haemorrhagic fever, vCJD, XDR-TB) where action is necessary to investigate and prevent ongoing exposure to the hazardous agent;
• two or more linked cases of unexplained illness that could indicate the possibility that they may both be caused by the same known or unknown agent or exposure i.e. an outbreak;
• higher than expected number of apparently unlinked cases or geographic clustering of a serious pathogen
• a high likelihood of a population being exposed to a hazard (e.g. a chemical or infectious agent) at levels sufficient to cause illness, even though no cases have yet occurred (e.g. contamination of the drinking water supply).

15. The Public Health (Scotland) Act 2008 provides a legal definition of a public health incident that can be summarised as follows:

• if a person has an infectious disease or there are reasonable grounds to suspect that a person has such a disease; or
• a person has been exposed to an organism that causes an infectious disease or there are reasonable grounds to suspect that a person has been exposed; or
• a person is contaminated or there are reasonable grounds to suspect that a person is contaminated; or
• a person has been exposed to a contaminant or there are reasonable grounds to suspect that a person has been exposed; or
• any premises or any thing in or on premises is infected, infested or contaminated, or there are reasonable grounds to suspect it; AND
• there are reasonable grounds to suspect that the circumstance is likely to give rise to a significant risk to public health.

16. An Incident Management Team (IMT) is a multi-disciplinary, multi-agency group with responsibility for investigating and managing the incident.

Emergencies and Major Incidents

17. The Civil Contingencies Act 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.

18. A major incident is a widely accepted term used to describe any emergency that requires the implementation of special arrangements by one or more of the emergency services, the NHS or the Local Authority. Major incidents are events that may severely disrupt health and social care and other functions (power, water etc) and may exceed even collective capability within the NHS or Local Authority. The response to these events will be co-ordinated through the SCGs, Scottish and UK arrangements as described in Preparing Scotland.