National incident response levels: guidance for health boards

2. Incident Types And Classifications

2.1 Types of Incidents

For Health Board purposes there are three main types of incidents:

a. Business Continuity Incident

b. Critical Incident

c. Major Incident These are defined as:

(a) Business Continuity Incident (BCI) – an event or occurrence that reduces or might reduce, a Health Board’s normal service delivery to below acceptable levels and would require special arrangements (such as temporary re-deployment of local / regional resources and mutual support) to be put in place until services can return to an acceptable level. There may also be impacts from wider issues such as supply chain disruption or provider failure.

(b) Critical Incident (CI) – any localised incident where the level of disruption results in a Health Board losing its ability to deliver critical services, or, where patients and staff may be at risk of harm. It could also be linked to the environment potentially being unsafe and requiring special measures and support from other agencies to restore normal operating functions.

A CI is principally an internal escalation response to increased system pressures/disruption to operations delivered by the Health Board. Unlike a major incident, a CI does not have any actions prescribed by either legislation or national guidance that must be taken as a result.

(c) Major Incident (MI) – is defined in the Joint Emergency Services Interoperability Principles (JESIP) as:

“An event or situation with a range of serious consequences that require special arrangements to be implemented by one or more emergency responder.”

For Health Boards in Scotland this will cover any occurrence^[1] that presents serious threat to the health of the community, or is otherwise likely to cause, such numbers or types of casualties as to require special arrangements to be implemented.

This may involve a single health board, although it is more likely to require a multi-agency response, which may be in the form of mutual aid or multi- agency support to a lead responder organisation, for example a local authority or Police Scotland.

The severity of the consequences associated with a MI are likely to constrain or complicate the ability of responders to resource and manage the incident, although a MI is unlikely to affect all Health Boards or other responders equally.

2.2 Classification of Types of Major Incidents

The following list provides commonly used classifications for types of Major Incidents (MI). This list is not exhaustive and other classifications may be used as appropriate to describe the nature of the incident. In some situations, these classifications can also apply to BCI and CI.

• Rapid onset/Big Bang – develops quickly, and usually with immediate effects, thereby limiting the time available to consider response options (in contrast to rising tide) e.g. a serious transport accident, explosion, or series of smaller incidents in the same geographical Health Board area.
• Cloud on the horizon – a serious threat such that develops relatively quickly over a short period of time - e.g. a significant chemical or nuclear release developing elsewhere and needing preparatory action.
• Rising tide – develops slowly over a period of time with increasing impact – e.g. developing infectious disease epidemic.
• Chemical, biological, radiological, nuclear and explosives (CBRNe) – CBRNe terrorism is the actual or threatened dispersal of CBRNe materials (one or several, or in combination with explosives), with deliberate criminal, malicious or murderous intent.
• Hazardous Materials (HAZMAT) Commonly used in relation to procedures, equipment and incidents involving hazardous materials. HAZMAT incidents are not treated as terrorist incidents yet can require a similar NHS response.
• Control of Substances Hazardous to Health Regulations (COSHH) – requires adequate control exposure to materials in the workplace that cause ill health.
• Cyber security – a breach of a systems security policy to disrupt its integrity or availability or the unauthorised access or attempted access to a system. (Consider impact on service delivery, timescale to recovery, etc.)
• Major Incident with Mass Casualties (MIMC) – an incident (or series of incidents) causing casualties on a scale that is beyond the normal resources of the emergency and healthcare services’ ability to manage.

2.3 Other Key Factors and Indicators which may impact/improve the incident response.

In addition to performance and delivery focussed data and intelligence, it is important that other key factors, indicators, and potential incidents are fully considered when assessing the national position of NHS Scotland. This includes (but is not limited to):

• Upcoming known events
• System pressures & capacity
• Consideration of National-level Risks, as contained in National Security Risk Assessment (NSRA) and Scottish Risk Assessment (SRA)
• Horizon scanning (risks and threats)
• Impact from non-health incidents/ response posture
• International incidents/alerts