Preparing for Emergencies- Guidance For Health Boards in Scotland

Section 8 Care for Vulnerable People Affected by Major Incidents

This section highlights specific populations in the community who may be vulnerable during major incidents and emergency situations and what Health Boards should do with partner agencies to respond to the needs of these populations.

Vulnerable people

8.1 The Civil Contingencies Act 2004 recognises the particular needs of vulnerable people. Emergency response and recovery may require specific consideration of vulnerable people - those who 'are less able to help themselves in an emergency.' This includes people who are:

• under the age of 16;
• of restricted physical ability because of age, disability, illness (including mental illness), pregnancy or other reason; and
• deaf, blind or have visual or hearing impairment.

8.2 Territorial Health Boards must cooperate with other category 1 and 2 responders to:

• plan for and meet the needs of those who may be vulnerable in times of emergency^[27];
• develop arrangements that will assist in reducing the time taken to produce dynamic lists of vulnerable people specific to the location, scale and type of incident;
• build interagency networks;
• agree data sharing protocols and activation triggers/cascade systems; and
• determine/estimate the scale and requirements of vulnerable people in advance of an emergency.

8.3 In order to be prepared to act without delay during a major incident or in an emergency situation, Territorial Health Boards should:

• work with partners on the RRP Care for People Teams^[28] to identify and agree people and/or communities who may be vulnerable during different types of major incidents;
• endeavour to maintain up-to-date information about vulnerable people as well as accessible lists of all residential and day care facilities and health centres in their area on which vulnerable people and their carers depend. It is recommended that these lists are reviewed on a quarterly basis and that this task is overseen by the identified Executive-level Director/Lead for emergency preparedness/resilience;
• identify how, when and what personal data can be shared about people with vulnerabilities with other statutory responder agencies, within the framework of the Data Protection Act 1998^[29] and the Civil Contingencies Act 2004;
• have arrangements for supporting Survivor Reception Centres and Family and Friends Reception Centres, and contingency plans for dealing with an influx of family and friends arriving at hospital facilities following a major/mass casualty incident;
• actively encourage all primary care (GP) contractors to have up-to-date Business Continuity Plans and arrangements for identifying potentially vulnerable patients who depend on the practice. The Health Board's Primary Care Lead should obtain confirmation of the existence of the BC plans and arrangements from General Practice managers; and
• ensure that all services commissioned by the Health Board to support and care for vulnerable people have rigorous, up-to-date Business Continuity Plans, including arrangements for identifying vulnerable people.

8.4 As far as possible within the confines of the organisation's confidentiality policy and in consultation with the Caldicott Guardian, the Health Board should endeavour to develop joint lists with the local authority to enable a quick response in the interests of vulnerable people during emergency situations.

8.5 All lists produced should be marked as 'Protect' under the Government Protective Marking System^[30] and be accessible out-of-hours.

8.6 In preparing their major incident plans, Territorial Health boards:

• must take into account the needs of vulnerable children, vulnerable adults and kinship carers;
• must be able to access language guides, interpreter facilities, or advocate-supporters from particular faith groups to support vulnerable people from minority ethnic communities who are casualties of or caught up in/affected by a major incident; and
• should ensure they can access a pool of staff or accredited volunteers (i.e. people who have been Disclosure Scotland [PVG Scheme] checked and trained by the Health Board or a recognised partner agency) to provide additional support or special assistance to people with disabilities, in support of the emergency services effort.

Children and young people

8.7 Children are more vulnerable in emergency situations than adults for a number of reasons. In younger children size, skeletal maturity and other physiological characteristics make them more susceptible to serious injury than adults. Behavioural and developmental immaturity may impair their ability to recognise or escape from hazardous environments. Children may be less able to describe or assert their needs to others and are particularly vulnerable when separated from parents or carers. Children of all ages are vulnerable to the long term psychological effects of traumatic experience.

8.8 In Scotland, Acute Services for children are organised in a tiered structure with national, regional, district, and local services. Emergency care is therefore provided from units with a spectrum of capabilities^[31]. The larger Children's Hospitals maintain Emergency Departments that are operationally independent from adult services. Adjacent adult Emergency Departments consequently have limited routine practice in the management of seriously ill or injured children.

8.9 This guidance is based on the principle that local District General Hospitals should respond to emergencies involving children. Emergency care, resuscitation, and initiation of intensive care are within the normal range of capabilities for District General Hospitals. The potential need to manage multiple child casualties must be incorporated into major incident plans.

8.10 The needs of children in specific emergency situations are also reflected in other sections of this guidance.

Responsibilities

8.11 Territorial Health Boards should have:

• arrangements to alert local child health services as soon as the possibility of child casualties is recognised. Although the initial response to a major incident will be by the local service, early contact should be made with national or regional services able to provide assistance, or who may need to receive patients for ongoing specialist care;
• arrangements to provide a paediatric intensive care mobile team to support care at the local hospital and transport services to transfer intensive care patients;
• plans to accommodate the possibility that intensive care may be needed for longer periods than normal, and to take responsibility for the transfer of some patients where there is an urgent need for multiple patients to be transferred to a specialist centre;
• arrangements in place to provide children with intensive care at their local hospital before transfer to a Paediatric Intensive Care Unit in Edinburgh or Glasgow. The transfer of paediatric intensive care patients should be undertaken by a specialist paediatric intensive care retrieval team;
• arrangements to support effective collaboration between community or rural general hospitals and supporting paediatric inpatient units; and
• clear protocols, agreed with the Scottish Ambulance Service, to indicate when children would be diverted to adult Emergency Departments and how this would be coordinated, in the event that a mass casualty incident occurred in a Health Board area that has separate Emergency Departments for adult and paediatric patients.

8.12 Territorial Health Boards providing a pre-hospital response should:

• consider their requirements, in terms of equipment and training, to be able to deal with any incident where there are child casualties. This may be a particular challenge for services that do not routinely care for paediatric patients; and
• provide the staff deployed to a major incident or emergency with the appropriate specialist training, equipment, and preparation so that they are able to function effectively and safely.

Children's rights and child protection

8.13 The Health Board's major incident plan and emergency planning arrangements should reflect the specific requirements to maintain both generic children's rights, such as the need to keep children with their parents, and child protection standards.

8.14 In a situation where parents are separated from children, systems must be in place to communicate timeously with parents regarding the location and condition of their child. Consideration should be given to how vulnerable or looked after children can be identified quickly during incidents and their location and condition must be communicated to the responsible local authority as soon as possible.

8.15 In the event of volunteers or staff being recruited by the Health Board to provide support in potential emergency situations, PVG checks must be undertaken as part of the screening process.

8.16 Health Boards should consider what arrangements may be required to provide appropriate follow-up and support for children and families involved in major incidents. Consideration should be given to inclusion of a 'Children's Services Coordinator' for any major incident whose responsibility would be to track the destination and outcome of children involved and coordinate ongoing support for their families. This person might be a paediatrician or senior children's nurse.

Psychosocial care and mental health

8.17 Most people are resilient when faced with adversity. In general, people who are involved in disasters recover over time with the support of their families, friends and colleagues, but some experience extensive and sustained effects on their health, relationships and welfare. The nature of resilience is such that everyone affected can benefit from social support and this principle is the core component of all humanitarian aid, social welfare and healthcare responses to disasters.

8.18 Only certain components of the wide range of responses required by people affected by major incidents and disasters fall within the prime responsibilities of the NHS. Therefore, providing comprehensive responses requires the key agencies in each area of work or professional discipline to plan together. They also need to agree which agency should take the lead on specific issues and to review the adequacy of joint plans on a regular basis.

8.19 Health Boards, particularly category 1 and 2 responders, should consider the recommendations in the Care for People Affected by Emergencies Guidance^[32] (2009) and the Supplementary Guidance^[33] (2013), and any relevant local arrangements.

Responsibilities

8.20 Territorial Health Boards should have an up-to-date plan outlining what resources the organisation will contribute at particular (short, medium and longer term) stages in the recovery phase of a major incident and the process by which they will be delivered.

The plans:

• should identify mental health staff with particular skills and the key healthcare services that will form the Board's response and provide advice to the RRP Care for People Group;
• should highlight the role for primary care in supporting/following up survivors at various stages in the aftermath of a major incident;
• must identify the occupational health/psychosocial support to be made available to NHS staff delivering services as part of the organisation's duty of care;
• should outline arrangements for data collection (including evaluation of outcomes) and audit in relation to NHS service provision in such circumstances, to contribute to a multi-agency lessons-learned exercise at the appropriate time;
• must comply with its duties under Equalities and Human Rights legislation;
• must be consistent with actions to be taken in response to mass casualties and mass fatalities; and
• should identify flexible arrangements for Child and Adolescent Mental Health Services to be up-scaled at short notice to address the psychological needs of children and young people who experience trauma following a major incident.

8.21 In line with best practice evidence on psychosocial care in the aftermath of major incidents, Territorial Health Boards should promote a stepped-care model of support and intervention, based on the principles of Psychological First Aid (see Appendix 9).

8.22 Territorial Health Boards must be represented on the local multi-agency Care for People Team by an appropriately experienced and/or senior member of staff with delegated authority and responsibility for:

• making decisions about the organisation's contribution to the interagency (Care for People) plan;
• disseminating information within the organisation and promoting an awareness of NHS provision amongst partner agencies;
• securing the engagement of the relevant healthcare services from the local area or further afield through mutual aid or service level agreement;
• ensuring that the relevant operational staff are trained in line with identified (professional) competences; and
• ensuring that appropriate staff participate in exercises to test the local Care for People Plan.

8.23 In collaboration with the local Care for People Team, Territorial Health Boards should:

• develop methods to enable people, or groups of people, who might be at additional risk following an emergency to be identified quickly by drawing on understanding of, and information about, such people held by partner agencies; promote and/or advise partner agencies on how to access Psychological First Aid training.

8.24 The Health Board's Resilience Committee should receive regular updates on the local interagency Care for People plan and address the potential implications, such as resource requirements, for the organisation.