Preparing for Emergencies- Guidance For Health Boards in Scotland

Section 7 Preparing for Specific Incidents

This section sets out the requirements of Health Boards in relation to preparing for and managing a range of incidents of varying nature and scale.

Communicable diseases

7.1 Travel-related illnesses (e.g. Crimean Congo Viral Haemorrhagic Fever (VHF), Tuberculosis) have recently increased as a result of inward tourism, migration and increased travel abroad by residents of Scotland. These factors, together with an increasing number of large scale public/crowd events, combine to potentially heighten the risk of communicable infectious diseases of varying scale and impact in Scotland.

7.2 The NHS in Scotland routinely deals with illnesses related to infections that develop either in the community or in hospital, some of which may not have been previously recognised in a territorial Health Board area. The virulence of the organism causing infection and the potential impact on the community normally dictates whether it constitutes an outbreak, epidemic or pandemic in public health terms, and this in turn dictates the actions to be taken by Health Boards.

7.3 A number of factors determine the impact of an infectious disease in terms of health, societal and economic costs. These include background levels of immunity (via natural infection or immunisation), infectivity, virulence, whether effective prevention and treatment measures exist, and the availability of appropriate healthcare facilities. These and other factors should be taken into account when planning an appropriate response to the particular condition.

7.4 Most infection is dealt with by primary care, with hospitals dealing with the more severe infections caused by organisms which may be more virulent and less common.

The control of infection

7.5 The Public Health etc. (Scotland) Act 2008^[9] provides the legal basis for notifiable organisms and notifiable diseases, and, in conjunction with a wide range of topic specific guidance documents outlined in Appendix 5, provides the framework for action by Health Boards in relation to public health protection.

7.6 The Act also sets out the notification responsibilities of registered medical practitioners and places a duty on Directors of Diagnostics/Laboratories, where notifiable organisms are identified, to provide written confirmation to the relevant Health Board and Health Protection Scotland (HPS) no later than 10 days after identification, or sooner if the case is considered urgent. In addition, there is a requirement for identification of health risk states (see Glossary). All healthcare professionals should be aware of local 24-hour arrangements for seeking the urgent advice of their Health Board's Consultant in Public Health Medicine if they identify a situation that suggests a health risk state.

7.7 Public Health Departments must be able to identify and respond quickly to new and emerging public health threats, even if the condition is only apparent from symptoms of patients and the precise cause of infection remains unknown. This is particularly relevant in the modern world of global travel and trade.

Responsibilities

7.8 Health Boards are responsible for public health protection, including surveillance, prevention, treatment and control of communicable diseases. They have a shared duty with local authorities and other national agencies (e.g. Care Inspectorate) to ensure adequate standards of infection control are met by all service providers. In line with national guidelines, coordinated Incident Control Plans and Joint Health Protection Plans should be drawn up in collaboration with local authorities and any other public service organisations that may be required to participate in an outbreak response.

7.9 The appropriate response to an outbreak will depend on the particular circumstances. Some outbreaks may not require an Incident Management Team (IMT) to be established, while others may require a locally-based multi-agency IMT. However, in the case of a large scale outbreak or significant public health incident, a coordinated national response will be required, necessitating local and national major incident plans to be activated.

7.10 Some incidents may result in the activation of the local LRP/RRP. In such instances, the LRP/RRP may request the local Health Board to convene and chair a Scientific and Technical Advice Cell (STAC guidance^[10]). If so, the Health Board should retain responsibility for the investigation and management of the public health aspects of the incident in line with The Management of Public Health Incidents Guidance, irrespective of a LRP/RRP-led response.

7.11 The Health Board's Director of Public Health should ensure that:

• The Health Board has a range of up-to-date plans (e.g. Business Continuity Plans, Incident Control Plans etc.) and protocols that reflect national guidance and the requirements of the Scottish Government. These should detail measures to:
  • prevent further spread or recurrence of the particular infection or incident;
  • ensure that effective care and treatment is available to all those affected by the outbreak;
  • put in place any necessary control measures including the dissemination of information to the public and appropriate external agencies;
  • document the outbreak including its major epidemiological characteristics and causes; and
  • report on the outbreak.
• The plans are flexible enough to cope with the actual or potential hazards from the simplest outbreak to more complex and widespread problems which cross Health Board boundaries and require multiple agencies to investigate and control them.
• The Public Health Protection Team has adequate and appropriately trained staff and other relevant resources at its disposal to establish an effective IMT when necessary to implement the actions outlined in the relevant guidance documents.
• There are effective arrangements within the Public Health department for:
  • ongoing surveillance, including syndromic surveillance (see Glossary), at local level;
  • receiving reports of relevant information from local health care providers and other local agencies;
  • onward reporting of notifiable disease information or information on health risk states (see Glossary) in to HPS for national surveillance purposes;
  • communicating effectively and timeously with other parts of NHSScotland; and
  • debriefing following an incident and providing a (lessons-learned) report.
• The Public Health Department has the necessary resources (including administrative support) available to simultaneously convene and lead a STAC, if required by the LRP/RRP, and respond to the public health tasks associated with the incident.
• Relevant senior managers within Acute Services and Primary Care are made aware of the Health Board's Public Health duties, the relevant (health protection) policies and plans for their respective service areas and their responsibilities for ensuring their implementation.
• Hospital managers implement the Healthcare Associated Infection Guidance (2012) and use the tools within it to ensure that IMTs are fully aware as to who they should inform and involve in the event of a localised (i.e. single ward) or larger scale outbreak or infection incident; and
• Local plans and protocols are regularly exercised with multi-agency partners where appropriate in order to develop all-important expertise and establish the necessary team working arrangements. Local plans should be revised on a regular basis in light of these revised guidelines.

Communication

7.12 As with all major incidents, internal and external communication is important. The issues to consider are covered in Communications (section 5, E).

Hazardous/chemical, biological, radiological, nuclear materials

7.13 All category 1 designated Health Boards have a duty to provide care for people who may be contaminated with chemical, biological, radiological or nuclear (CBRN) material or hazardous material (Hazmat) and a role in managing the consequences of such incidents. Contamination may result from an accidental release of hazardous material (Hazmat), or from the release of CBRN materials through a deliberate or malicious act. Accidental Hazmat incidents are more likely than those caused by deliberate release, and Health Boards should plan on this basis.

7.14 NHS National Services Scotland (through Health Protection Scotland (HPS)) and the Centre for Radiation, Chemical and Environmental Hazards (CRCE)^[11] also have a role in providing advice and information to health professionals and 'first responder' organisations during such incidents.

7.15 Territorial Health Boards' public health duties require that they respond to the health protection needs of people who are either exposed to, or 'worried' about exposure to Hazmat or CBRN incidents in line with the national Guidance on Management of Public Health Incidents.

7.16 The term CBRN covers a distinct range of hazards:

(i) Chemical: Poisoning or injury caused by chemical substances, including chemical warfare agents, or misuse of legitimate but harmful household or industrial chemicals.

(ii) Biological: Illnesses caused by the deliberate release of dangerous bacteria, viruses, fungi, or toxins (e.g. the plant toxin, ricin).

(iii) Radiological: Illnesses caused by exposure to harmful, radioactive materials, possibly inhaled or ingested from food or drink.

(iv) Nuclear: Where the explosion of a nuclear device causes widespread effects due to blast, heat, and large amounts of harmful radiation.

Chemical incidents

7.17 Chemical incidents, which commonly occur during the manufacture, storage, transport or disposal of chemicals, may result in the direct contamination of people or indirect contamination via air, water, food or property. Health services regularly provide treatment and care for patients following a range of chemical incidents. Information is available from various sources (TOXBASE^[12], SHPIR^[13], CHEMET^[14] and SEISS^[15]) to support planning for chemical incidents.

Biological incidents

7.18 Some biological agents, in very small quantities, can have a substantial impact on the health of a civilian population. Health Boards have established procedures for dealing with outbreaks of infectious disease, which are applicable to biological incidents. The effects of a biological release/incident are likely to be delayed and prolonged as:

• people exposed may not know that they have been affected;
• incubation periods between exposure and the development of symptoms can vary; and
• biological material dispersed may be deposited on clothing, equipment and other surfaces and when these are disturbed secondary dispersal can occur.

7.19 Urgent identification of infecting agents is critical to managing biological incidents. In the event of a biological incident impacting on a large proportion of the population, Health Boards may have to consider invoking a large scale vaccination programme along the lines of the existing Smallpox response plans.

Radiological and nuclear incidents

7.20 Radioactive material is widely used across industry, healthcare and research and may be released at or whilst in transit to or from such sites or accidentally released from a nuclear reactor. Nuclear incidents generally result from accidental leaks at nuclear sites or CBRN/malicious acts with potentially widespread effects from blast, heat and radiation. The response to the effects of an ionising radiation release from a radiological or nuclear incident and the measures required to mitigate them are broadly similar although management of the consequences would differ significantly.

Responsibilities

7.21 As Hazmat/CBRN incidents pose a threat of environmental contamination with public health impacts, Health Boards should undertake scenario-planning with relevant partner agencies to ensure they have the capability to respond to and/or mitigate the effects of any such incident.

7.22 Territorial Health Boards should ensure that:

• a strategic lead is responsible for ensuring that Hazmat/CBRN incident plans are in place and kept up-to-date;
• their major incident plans appropriately reflect contingencies for providing care and treatment for the spectrum of CBRN-related casualties, including the identification and monitoring of anyone, injured or not, contaminated with hazardous material (including ionising radiation);
• plans are proportionate and flexible to cope with hazards ranging from the simplest accidental incident to more complex or widespread incidents that across Health Board boundaries and may require a variety of agencies to investigate and respond to them. They should identify appropriate arrangements for risk assessment, risk management and risk communication;
• appropriate equipment, including Personal Protective Equipment (PPE) and facilities are available to support the plan, including provisions for compliance with Health and Safety;
• there are effective systems to enable primary care services to notify Public Health Departments and vice-versa of specified organisms, specified diseases and health-risk states where there may be significant risk to public health;
• there is access to suitable laboratory testing facilities, including procedures for the collection, transport and processing of samples to assist with identification of the causative agent;
• staff are trained for the roles they are expected to fulfil during a CBRN incident, and they have access to relevant resources, advice and the expertise required to provide care and treatment for casualties, including arrangements for decontamination of patients and distribution and administration of appropriate pharmaceutical supplies;
• local plans are regularly exercised and reviewed with multi-agency partners (see section 5 D); and
• they develop local plans for recovery to enable return to normal as soon as possible.

7.23 Depending on the scale and impact of an incident, Territorial Health Boards should be prepared to:

• convene and chair a STAC, providing advice to the local LRP/RRP on human health, risk management strategies, countermeasures and longer-term health monitoring; and
• advise SAS and other first responders, other public bodies, the public and the media about effects of a Hazmat incident on human health, and of counter-measures to those effects.

7.24 In planning and preparing specifically for radiological and nuclear incidents, Territorial Health Boards should:

• develop specific arrangements for managing the health consequences of environmental contamination from a release of ionising radiation, as well as arrangements for controlling the distribution and administration of stable iodine tablets as appropriate; and notifying and informing Scottish Government HSCD and other Health Boards;
• comply with their obligations under Radiation (Emergency Preparedness and Public Information) Regulations (REPPIR) to work with the operator of a nuclear installation in their area on the development of the Off Site Plan for the nuclear installation, clearly outlining the health service's role and responsibilities, and be capable of responding to an incident, when required;
• consider the Ministry of Defence- Local Authorities and Emergency Services Information (LAESI, Revised 2013)^[16] which outlines action to be taken by a range of organisations in the event of an accident occurring during the transportation of nuclear weapons and special military nuclear material;
• support the local authority in its implementation of pre-negotiated arrangements for Radiation Monitoring Units (RMU)^[17], and be prepared to assess and monitor longer term health effects on contaminated individuals and the public, including facilities for screening a potentially large number of people in the context of assessed risk; and
• have an external communications strategy to provide public advice to limit the impact of a Hazmat/CBRN incident.

Further information on the role of some of the main organisations during a radiological or nuclear incident is outlined in Appendix 5.

Decontamination

7.25 Decontamination is not an automatic or inevitable response to a Hazmat/CBRN incident. Decisions on decontaminating individuals involved in an incident will depend on the initial assessment of the nature of the emergency by first responders and subsequently by health professionals within the receiving Emergency Department. Health Boards should plan to accommodate a range of scenarios, ranging from those where casualties may be brought in by SAS (usually, although not always, already decontaminated) from the site of a major incident, to contaminated individuals arriving independently by personal transport.

7.26 Arrangements for decontaminating people exposed to hazardous substances should reflect national guidance^[18,19] and Territorial Health Boards should have a plan in place to facilitate the lockdown^[20] of areas in the hospital, or the entire hospital if necessary, to prevent possible cross-contamination.

7.27 In order to comply with the Health and Safety duty to protect staff and members of the public from risk to health, Health Boards must:

• carry out an appropriate risk assessment of decontamination arrangements;
• provide staff with suitable facilities and equipment to carry out their duties (including PPE); and
• adequately train staff to fulfil their duties and use relevant equipment.

The needs of children

7.28 Health Boards should recognise the potential for children to be among those affected in a Hazmat/CBRN and plan accordingly, taking into account their vulnerability and the need to keep families together and children with their carers.

7.29 Consideration should be given to the special requirements of children during decontamination procedures. It will be necessary to reconcile any intention to use a designated general hospital to receive contaminated child casualties with existing protocols for reception of paediatric patients. Where child casualties are received directly at NHS care facilities, the feasibility and impact of 'lockdown' arrangements on children should be considered.

Recovery specific to a Hazmat/CBRN incident

7.30 The type, scale and impact of a Hazmat/CBRN incident will generally dictate the potential length of time and the complexity of the recovery period, and these in turn will influence the level of resources required in response.

7.31 The local authority will normally be the lead agency for recovery. However the scale of the incident will determine the level of involvement of international, national, regional and local organisations. In addition, the cause of the incident may dictate whether the recovery is managed as a devolved or reserved matter.

7.32 The main challenges for Health Boards and partner agencies both during and in the aftermath of a Hazmat/CBRN-related incident are manifold, including those arising from the consequences of people being evacuated from affected neighbourhoods and communities, the need for mutual aid and public communication, and the intense media interest. Although these issues are addressed elsewhere in this guidance, consideration should be given to any specific issues that may arise and actions that need to be taken at various stages during the recovery period.

7.33 Territorial Health Boards should have Recovery Plans^[21] that identify relevant procedures and resources to address the unique and potentially complex issues in the aftermath of a Hazmat/CBRN incident. The plan should ensure that hospital buildings are returned to use following decontamination in line with relevant national guidance^[22].

Management of burn-injured patients

7.34 An incident involving critically injured burn patients can happen in any community or area in Scotland. Such incidents can arise from a major transport accident, an industrial or chemical fire or a terrorist attack.

7.35 In contrast to many other injuries arising from a major incident, what may appear to be a relatively small number of burn-injured patients has the potential to overwhelm the burn care capacity of a Territorial Health Board, region of Scotland, or the collective burns facilities in Scotland. As is the case with healthcare in general, in the event of demand for services exceeding or overwhelming supply, the underlying principle is to achieve best health outcomes for patients based on the ability to achieve health benefits.

Responsibilities

7.36 Territorial Health Boards should plan to manage the care of burn-injured patients in the event of a major incident, ensuring that arrangements:

• identify what might constitute a burn major incident for them;
• identify escalation triggers and responses (see Appendix 7);
• are integrated and consistent with their major incident plan;
• take account of relevant legislation and guidance;
• are consistent with local C3 structure and arrangements; and
• are appropriately and widely supported.

7.37 In planning for the management of burn-injured patients, Health Boards should build on existing day-to-day operational arrangements and liaison between burns services, and integrate these arrangements with the Care of Burns in Scotland (CoBIS)^[23] Managed Clinical Network's operational plan.

7.38 The arrangements to transfer and move patients to a Burns service, or between Burns services, should be clearly set out in the local plan and must include early liaison and coordination with the Scottish Ambulance Service (SAS). In setting out their arrangements, Health Boards should consider allocating patients to appropriate destinations and, wherever possible, plan patient movement to avoid secondary transfers.

7.39 Given the nature of burn-related injuries and the potential impact this could have on continuing normal business, Health Boards should have business continuity plans that address arrangements for the recovery and restoration of critical services.

Territorial Health Boards with burns services

7.40 Health Boards with burns services should consider what constitutes a burns 'major incident' in the context of available capacity and capability, and this information should be used as the basis for establishing triggers and escalation arrangements.

Territorial Health Boards without burns services

7.41 Patients with burn injuries may be admitted to Emergency Departments anywhere in Scotland. The primary function of Health Boards without burns services should be to assess and stabilise patients, provide treatment and care in an Intensive Treatment Unit where clinically appropriate, and where injuries are severe, or access to specialists requires it, transfer them to a burns unit. Plans should set out arrangements for access to specialist and burns services in Scotland.

Scottish Ambulance Service (SAS)

7.42 The provision of care-at-scene and in-transit to the hospital is the responsibility of SAS. It is not expected that burn specialists would deliver care at the scene of an incident and pre-hospital care of casualties in a burns major incident should be provided according to the agreed pre-hospital arrangements between SAS and Territorial Health Boards.

Care of Burns in Scotland Managed Clinical Network (CoBIS)

7.43 Territorial Health Boards and SAS should:

• take into account CoBIS plans when developing local arrangements, especially where the incident is of such a scale that the numbers of injured patients is likely to be greater than can be managed in Scotland;
• ensure that relevant personnel are aware of the role of CoBIS and raise awareness of this specialist network;
• ensure that all staff are fully informed about planning and preparation for the management of burns-related injuries in the event of a major incident; and
• ensure that C3 and communication arrangements are in place and that any specific burns-related components are incorporated into them.

Mass casualties

7.44 Category 1 and 2 Health Boards will play a significant role in the multi-agency response to mass casualty incidents (MCI). This guidance aims to ensure the NHS actively contributes to multi-agency planning at various levels and that the preparedness of Health Boards (capacity and capability) is assessed in the context of local and national mass casualty planning assumptions^[24].

7.45 Mass casualty plans (MCP) should be integral to a Health Board's major incident plan. Owing to the complexities and challenges involved in preparing for mass casualties, MCPs should be regularly reviewed and exercised in line with guidance on other specific topics outlined elsewhere in this document.

7.46 A mass casualties incident is:

'A disastrous single or simultaneous event(s) or other circumstances where the normal major incident response of several NHS organisations must be augmented by extraordinary measures in order to maintain an effective, suitable and sustainable response.'^[24]

7.47 Such incidents typically result in hundreds of casualties; have the potential to overwhelm health services; disrupt business-as-usual arrangements of some health care facilities/services for several days; and require the activation of mutual aid arrangements. These circumstances will require Health Boards to undertake detailed scenario, capacity and surge/escalation-planning. Further information to assist planning for MCI's is outlined in Appendix 7.

Declaring a mass casualties incident

7.48 A MCI should be declared by the Health Board Chief Executive or named Deputy based on a combination of factors. These include the likely number of casualties, the ability of local health services to cope with demand, and the potential of the incident to overwhelm the combined resources of Health Boards in a local RRP area. The ability of local services to cope with demand may itself be affected if an incident has a direct impact on NHS sites or staff (e.g. through evacuation).

7.49 Any category 1 Health Board may declare a 'mass casualties incident', although in exceptional circumstances
(e.g. a rising tide incident such as pandemic flu), a category 2 Board may make the declaration. However, as a 'blue light'/first responder, the Scottish Ambulance Service (SAS) will usually make the declaration. If the organisation declaring is not the SAS, they should immediately advise Ambulance Control Centre to cascade a 'mass casualties incident' declaration.

7.50 Surge management plans or other arrangements for restricting access to NHS services due to a MCI should only be implemented after a formal declaration of the incident has been recorded and approval has been granted by the Health Board Chief Executive/Executive-level Director or those with delegated authority such as a senior manager or on-call strategic lead.

7.51 A decision to declare a MCI will primarily be influenced by casualty numbers and the potential impact and pressures on clinical services. However, other considerations may influence a MCI declaration including:

• media interest - may be intense and reactive; and
• Government interest - a situation-reporting cycle will be influenced or decided by central government information requirements.

Responsibilities

7.52 Health Boards must have a MCP, which has been developed in conjunction with key stakeholders and relevant RRP partners to:

• minimise/mitigate the impact of a MCI on its normal pattern of service provision;
• identify and prepare an adequate level of resources on a stepped basis to respond effectively to a MCI;
• outline the arrangements required to support the organisation during a MCI where there is a potential for the incident to overwhelm the (lead responding) Health Board or other Boards/organisations in the local area. This may involve support for the incident response and for business continuity for defined periods; and
• prioritise and coordinate resources to ensure optimal healthcare for all during a MCI.

7.53 To ensure that there is an effective response to a MCI, Health Boards should have in place:

• accelerated discharge and surge management plans;
• plans to rapidly escalate community services to avoid admissions into acute settings; business continuity management plans for critical functions/services. Some challenges that are relevant to a MCI are: managing capacity across different services/departments and over a long period of time. Demand for services may peak in one part of the hospital (the Emergency Department) after several hours, but there may be increased demand on other areas such as operating theatres and radiology/imaging, for a much longer period afterwards. There may be a need to expand the capacity of certain types of specialities for particular types of incidents e.g. multiple burns. In these circumstances senior clinicians may need to take a decision to temporarily re-align treatment protocols to re‑prioritise patient care;
• policies and practiced plans for the lockdown of buildings and sites^[25];
• mutual aid arrangements;
• training and exercising programmes so that capacities can be increased, e.g. through dual-skilling that is consistent with professional codes of practice and competences; and more generally, that all relevant clinical and management staff and partner agencies have a common understanding of their role and responsibilities during an MCI; and
• C3 arrangements which can be activated timeously when a mass casualties incident has been declared.

7.54 MCI plans should reflect how the Health Board, either individually or in collaboration with other Health Boards/organisations in the RPP area, will respond to different types of events/scenarios (e.g. sudden impact or rising tide incidents) that may result in mass casualties.

Activation

7.55 Receiving hospitals notified of a MCI, or declaring one themselves, should inform the Health Board Chief Executive/named Deputy/on-call senior manager. Depending on the nature of the incident, SAS may also advise 'lockdown' (see Glossary) and Health Boards should ensure that this happens in accordance with national lockdown guidance. Health Boards should therefore ensure that arrangements are in place to cascade that message to all relevant services and staff.

Roles of key agencies and groups

7.56 The roles and responsibilities of Health Boards and other key agencies during a MCI are outlined in Appendix 7.

Pre-hospital medical support

7.57 Some MCIs will result in large numbers of casualties. In these incidents the demand on healthcare services will be extreme and will have an immediate impact on the pre-hospital phase of the response, especially where pre-hospital medical support may be required at or close to an incident site for longer than is usual in major incidents.

7.58 The scope of incidents that would warrant a pre-hospital medical support response is difficult to define specifically. It would include any multiple casualty incidents where paramedics at the scene of an incident identify a potential benefit, following assessment and triage, of having specialist or advanced clinical care and decision-making and critical interventions for adults and children at the scene. Scenario planning and exercising will greatly assist in identifying where risks require specific planning.

7.59 Category 1 Health Boards should produce a joint plan, procedures and ethical guidelines to address these scenarios in a local RRP area, taking into account ambulance service joint agency response arrangements for the most extreme circumstances, and agree the Health Board response with other local agencies. Health Boards should allow for medical staffing at casualty clearing stations and casualty collection points to be sustained for longer periods if the incident is on-going and/or circumstances make casualty movement dangerous. The SAS should describe available specialist resources.

7.60 Category 1 and 2 Health Boards in a RRP area should work together to agree a model for immediate medical care at the scene and the provision of Site Medical Teams or their equivalents. This is to ensure support for SAS at the scene to triage, treat and provide appropriate specialist interventions.

7.61 All category 1 Health Boards should ensure they have access to pre-hospital medical emergency care services, such as Site Medical Teams and that these services are ready to be sent to the scene of any incident at the request of either the Ambulance or the Medical Commanders.

7.62 Health Boards must have in place clear and effective governance arrangements to support clinicians and paramedics involved in delivering a pre-hospital care response.

Emergency treatment centres/access points

7.63 Territorial Health Boards should ensure that primary care services are engaged in the MCI planning process so they can assist in setting up and staffing Emergency Treatment Centres (ETC) or appropriate facilities for the treatment and management of Priority 3 patients to protect acute hospitals from being overwhelmed. These ETCs can be located both at and remote from healthcare establishments. They should be designed to take some of the pressure off hospital Emergency Departments to allow them to focus on high priority patients.

Scottish National Blood Transfusion Service (SNBTS)

7.64 Territorial Health Boards should ensure that SNBTS and National Procurement is actively engaged in developing the local MCP and contingency planning arrangements for blood supplies and consumable products during a MCI.

Communications

7.65 Health Boards that experience a MCI should be involved in all aspects of public communications, including:

• liaison with multi-agency partners within the multi-agency Public Communications Group, ensuring adherence with the agreed communications strategy;
• coordination of communications across NHS organisations and with partner agencies to ensure consistency of message;
• ensuring the right health messages are communicated to NHS staff and the public in a timely manner;
• working with partner agencies to ensure effective media management; and
• through the appropriate channels, providing regular information to Scottish Government Communications, NHSScotland Resilience and SGoRR.
• Action logging system

7.66 Health Boards must have an effective recording system in place that can formulate an action log of events from a MCI.

Mass fatalities

7.67 Health Boards have an important role to play in working with other agencies through the Regional Resilience Partnership (RRP) to plan for an effective response when a major incident results in mass fatalities.

7.68 The term mass fatalities is used to mean:

• deaths in large numbers that can or cannot be managed under the normal procedures of one or more agencies, or
• deaths where the number or fragmentation of bodies, taken together with the circumstances of the incident, require special arrangements for statutory investigation, or where the condition of bodies makes victim identification difficult, or
• deaths requiring the implementation of National Emergency Mortuary Arrangements (NEMA).

7.69 Preparing Scotland Guidance^[26] distinguishes two types of mass fatalities emergencies:

• intensive emergencies which are localised and usually require further statutory investigation; and
• extensive emergencies, which are not localised and where the general circumstances of the deaths are often already known, such as natural disaster or disease, e.g. pandemic flu.

7.70 The duties of Territorial Health Boards in such circumstances are outlined in the Public Health etc. (Scotland) Act 2008 (Part 6). These duties should be considered along with the specific issues (e.g. Equalities and Human Rights, integrated emergency management, business continuity and communication) covered in other parts of this guidance, when preparing an NHS response to events involving mass fatalities.

Responsibilities

7.71 By definition, mass fatality situations are likely to require the reprioritisation of some health services and temporary changes to normal working practices of others. In these circumstances it will be important for Health Boards to communicate any service changes to the public and to engage with patient groups to explain the reasons for any suspension of normal procedures.

7.72 Territorial Health Boards should:

• have a clear understanding of who the stakeholders are in planning for such emergency situations and engage with them either directly or via the RRP;
• be aware of the role and requirements of the Crown Office in relation to mass fatality situations;
• have a clear understanding of their statutory duties in mass fatality emergencies and have in place business continuity management arrangements to address potential disruptions to the main services that will be impacted on. Key stakeholders should be informed of these arrangements.
• collaborate with local authorities to plan for the provision of an adequate level of mortuary facilities;
• assess and plan for the impact of the increased mortality on body-storage capacity. Such planning should address the possibility that Health Board staff may be required to be deployed within NEMA, away from NHS facilities;
• identify the death certification process and the role to be played by primary care so as to avoid delays which would result in difficulties for other responders;
• ensure the provision of appropriate (role-based) training for the relevant staff, particularly mortuary staff, in conjunction with other key agencies;
• exercise plans using reasonable worst case scenarios and ensure that the relevant staff participate; and
• maintain up-to-date Pandemic Flu plans in the light of lessons learned from exercises and ensure that their Mass Casualties and Mass Fatalities plans are consistent with each other.