1. Hull and East Yorkshire Hospitals NHS Trust Membership Event: 7 October 2014 Emergency Preparedness: How would HEY respond to a major incident?

2. What is a major incident? For the NHS a major incident is defined as: “Any occurrence that presents serious threat to the health of the community, disruption to the service or causes (or is likely to cause) such numbers or types of casualties to require special arrangements to be implemented by hospitals, ambulance trusts or primary care organisations” NHS Commissioning Board Command and Control Framework For the NHS during significant incidents and emergencies (January 2013)

3. What are our responsibilities? To plan for, and respond to a wide range of incidents and emergencies that could affect health or patient care To plan for, and respond to a wide range of incidents and emergencies that could affect health or patient care To ensure highest level of service is maintained, regardless of what might happen (Civil Contingencies Act (2004)) To ensure highest level of service is maintained, regardless of what might happen (Civil Contingencies Act (2004)) To have trained, competent staff and facilities available 24/7 to effectively manage a major incident or business continuity incident (Health and Social Care Act 2012) To have trained, competent staff and facilities available 24/7 to effectively manage a major incident or business continuity incident (Health and Social Care Act 2012) To ensure the needs of those using services continue to be met To ensure the needs of those using services continue to be met (CQC Essential Standards) (CQC Essential Standards)

4. How prepared are we? The Trust’s emergency preparedness, resilience and response (EPRR) plans provide a structured framework for staff The Trust’s emergency preparedness, resilience and response (EPRR) plans provide a structured framework for staff The Trust’s Emergency Preparedness intranet site, contains EPRR plans and is accessible to staff The Trust’s Emergency Preparedness intranet site, contains EPRR plans and is accessible to staff The Trust’s Resilience Committee is responsible for reviewing, testing, validating and updating plans The Trust’s Resilience Committee is responsible for reviewing, testing, validating and updating plans The Trust’s EPRR plans ensure the organisation maintains essential services, delivers optimum care, minimises disruption and brings about a speedy return to normal levels of functioning in the event of a major incident or business disruption The Trust’s EPRR plans ensure the organisation maintains essential services, delivers optimum care, minimises disruption and brings about a speedy return to normal levels of functioning in the event of a major incident or business disruption

6. Emergency Preparedness and Response (EPRR) Plans EMERGENCY PREPAREDNESS, RESILIENCE & RESPONSE Major Incidents Acute Major Incidents HEY as Supporting Responder Medical Emergency Response Incident Team HEY as Lead Responder Generic Major Trauma Mass Casualties Chemical, Biological, Radiation & Nuclear Incidents Threat to Public Health Pandemic Outbreak of Infection Business Continuity Seasonal Variation Winter Heat Wave Bank and Public Holidays Public Infrastructure Disruption Fuel Supply Disruption Terrorism PREVENT Others Internal Disruption Loss of facilities or evacuation Fire CBRN or oth er incident Interruption to critical functions Planned Equipment loss or failure Public utilities interruption Communications loss or disruption Failure of systemLoss of data Industrial Action Failure of Service Provider PFI partners Other supplier or contractor Maintaining Services Standard Operating Procedures Significant Incident Planning On-Call

7. What about training? Briefing all new staff during induction Briefing all new staff during induction eLearning eLearning Face to face training Face to face training Table top exercises Table top exercises Live major incident exercises Live major incident exercises Medical Emergency Response Incident Team (MERIT) Medical Emergency Response Incident Team (MERIT) Decontamination Decontamination Radiation monitoring Radiation monitoring

9. What if a major incident happens? Incident which can not be managed within normal resources Incident which can not be managed within normal resources Emergency Department (receiving / supporting hospital) formally notified by Yorkshire Ambulance Service Emergency Department (receiving / supporting hospital) formally notified by Yorkshire Ambulance Service Assessment by doctor in charge of ED Assessment by doctor in charge of ED “Major Incident Declared Activate Plan” or “Stand By” “Major Incident Declared Activate Plan” or “Stand By” ED may be asked to send Medical Emergency Response Incident Team (MERIT) to incident ED may be asked to send Medical Emergency Response Incident Team (MERIT) to incident Hospital switchboard operators initiate cascade call out of staff with specific responsibilities and skills using bleeps / group call systems Hospital switchboard operators initiate cascade call out of staff with specific responsibilities and skills using bleeps / group call systems

10. Command and Control – once the Major Incident Plan has been declared Bronze (Operational) Command will lead operational responses in each clinical area Bronze (Operational) Command will lead operational responses in each clinical area Silver (Tactical) Command, also known as the Hospital Control Team, will lead and co-ordinate the Trust’s operational response Silver (Tactical) Command, also known as the Hospital Control Team, will lead and co-ordinate the Trust’s operational response Gold (Strategic) Command will have Executive control of the organisation, command resources, manage external communications and plan recovery Gold (Strategic) Command will have Executive control of the organisation, command resources, manage external communications and plan recovery

11. What happens during a major incident? Determined by scale of incident Determined by scale of incident Individual and departmental Action Cards allocated – main tasks and sequence followed Individual and departmental Action Cards allocated – main tasks and sequence followed Possibly contain impact of incident within ED Possibly contain impact of incident within ED Possibly create additional capacity on wards, operating theatres and critical care facilities Possibly create additional capacity on wards, operating theatres and critical care facilities Possibly suspend planned operating sessions, OPD clinics, planned admissions, transfer or discharge existing patients – medically assessed Possibly suspend planned operating sessions, OPD clinics, planned admissions, transfer or discharge existing patients – medically assessed Hospital Lockdown to control site entry / exit Hospital Lockdown to control site entry / exit

12. Are any specific areas created during a major incident ? Incident Command and Information Centre Incident Command and Information Centre Staff Holding Area Staff Holding Area Patient Transport and Discharge Area Patient Transport and Discharge Area Relatives Centre Relatives Centre Media / Press Centre Media / Press Centre

13. How do the Hospital Control Team know what is happening during the incident? The Hospital Information Team update the Hospital Control Team every 30 minutes The Hospital Information Team update the Hospital Control Team every 30 minutes Hospital Information Team confirm: Hospital Information Team confirm: - Adult / Paediatric bed availability - Adult / Paediatric bed availability - Critical Care facilities available - Critical Care facilities available - Operating Theatre availability - Operating Theatre availability - Discharge status - Discharge status - Major Incident patient status - Major Incident patient status The Hospital Control Team provide Gold Command with regular information updates The Hospital Control Team provide Gold Command with regular information updates

14. What happens after “Stand Down” of the major incident? Immediate Trust debriefing – what went well, lessons learned and opportunity to thank staff Immediate Trust debriefing – what went well, lessons learned and opportunity to thank staff Formal Trust debriefing (within 1 week) – all staff directly and indirectly involved Formal Trust debriefing (within 1 week) – all staff directly and indirectly involved Formal Inter- Agency Debriefing (YAS, Police, etc) Formal Inter- Agency Debriefing (YAS, Police, etc) Final Major Incident report to Trust Board and Trust Development Authority (within 2 weeks) Final Major Incident report to Trust Board and Trust Development Authority (within 2 weeks) Review and amend Trust Major Incident Plan Review and amend Trust Major Incident Plan Ongoing staff awareness through Major Incident training and exercises Ongoing staff awareness through Major Incident training and exercises

15. Thank you. Any Questions?