New Zealand Ambulance Major Incident and Emergency Plan (AMPLANZ)

Transcription

1 new zealand ambulance major incident and emergency plan (amplanz) New Zealand Ambulance Major Incident and Emergency Plan (AMPLANZ) The Overview May 2011

2 Acknowledgements Ambulance New Zealand would like to acknowledge and warmly thank the following organisations for their support and contributions towards the completion of AMPLANZ: Members of Ambulance New Zealand especially St John, Wellington Free Ambulance, LifeFlight and Wairarapa Ambulance for releasing the members of the AMPLANZ work group: Peter Cain, Wellington Free Ambulance Tim Chiswell, St John Sharon Cretney, Wairarapa DHB Jeremy Gooders, St John Alan Goudge, St John David Greenberg, Lifeflight Chris Haines, St John Bruce MacDonald, St John Andy Parr, Wellington Free Ambulance Doug Third, St John Stephen Smith, St John Ambulance National Clinical Leadership Group Ambulance NZ Standards and Accreditation Committee New Zealand Fire Service, Special Operations Ambulance Victoria, Specialist Emergency Response Department NZ Ministry of Health, Emergency Management Team UK Department of Health, Emergency Preparedness Division Thank you to Shirin Sheida (St John Marketing Services) and Paul O Connell (St John Learning Media) for the design of this document. Thank you also to Catherine Preston, David Wethey, Glenn Cockburn, Matt Ohs, Oz Golan, The Lifeflight Trust and Hawke s Bay Today for the use of their photographs in this document Foreword New Zealand has for a number of years had a national ambulance major incident and emergency plan AMPLANZ. This has ensured that there is a common understanding between ambulance services, communications centres and our emergency management partners as to how an ambulance will respond in a time of crisis. Today however this new plan has had to take into account a number of emerging aspects in the emergency management environment. These include, for example: a number of high profile and catastrophic events in the last 5-10 years that has seen a greater focus on emergency management internationally; the redevelopment of the New Zealand Ambulance Standard (NZ8156) and the increased requirement to align with national emergency plans across the sector. There is a continuing requirement on Ambulance Services to develop their own Major Incident and Emergency Plans based in the detailed operational framework that is AMPLANZ. AMPLANZ now provides clearer guidelines and tools to assist services at the local, service and national levels. AMPLANZ is noted within NZS8156 and therefore an Ambulance Service s Major Incident and Emergency Plan should be audited regularly. Finally, given the recent emergencies in New Zealand particularly in Canterbury and on the West Coast, it is now clear that major emergencies do indeed occur in New Zealand. Therefore there is a requirement that AMPLANZ and the Ambulance Service s own Major Incident and Emergency Plans continue to be living documents that remain relevant and practical in order to meet the needs of their community and the service. David Waters CEO Ambulance New Zealand

3 Content 1.0 Introduction What is AMPLANZ? The Aim of AMPLANZ Mandate of AMPLANZ Format of AMPLANZ Frameworks and Concepts of Emergency Management Legislation and National Emergency Management Plans The 5 Rs CIMS (New Zealand Coordinated Incident Management System) Concept of Ambulance Emergency Management The Responsibilities of Ambulance Services in a Major Incident A structured and consistent approach Whole of Organisation and Sector Readiness and Reduction Risk Reduction Readiness Readiness: Planning Readiness: exercising Readiness: training and education Review and Audit Response Activations, Level of Response, and Notifications Escalation Types of Incidents Response Matrix Tool Risk Assessment and Response Major Incident Notifications within Ambulance Services and to partner agencies Activation based on National Warnings National Coordination of Ambulance Activation based on Regional or Local Warnings Response Command Structures, Roles and Responsibilities First Ambulance Crew at the Scene Ambulance Command at the Scene Ambulance Service Emergency Response Management Structures EACC Incident Management Structure Key Facilities for an Ambulance Response Incident Scene Facilities Ambulance Service Emergency Operations Centre (ASEOC) Communications and Information Management Ambulance Resources and Equipment Ambulance Coordination with Health, Emergency Services and other Agencies Recovery 16 Appendix 1: Glossary of Terms and Abbreviations 17 Appendix 2: References 20

4 1.0 Introduction 1.1 What is AMPLANZ? AMPLANZ is a detailed operational framework for the New Zealand ambulance sector to provide clear guidance for all Ambulance Services in all parts of the emergency management cycle. It provides standard terminology, structures, and roles. It also provides tools to assist an Ambulance Service in its readiness and reduction, response and recovery, for example, task cards, planning templates, debriefing templates etc. Specific Ambulance Service Operational and Tactical Plans must be developed by Ambulance Services based on this framework. AMPLANZ cannot be arbitrarily changed. There is a review process through the Ambulance New Zealand Standards and Accreditation Committee outlined as part of AMPLANZ. In line with health sector and the emergency management sectors as a whole, there are a large number of specialist terms and abbreviations. To assist the reader, there is a glossary in Appendix The Aim of AMPLANZ The aim of AMPLANZ is to: Ensure the effective and consistent management of major incidents at local, service and national levels for the benefit of patients Minimise the impact of a major incident or multiple major incidents on normal operations Adopt and encourage a whole-sector approach to major incident management Adopt and encourage a whole-of-organisation approach within services to major incident management. 1.3 Mandate of AMPLANZ AMPLANZ applies to all Ambulance Services 1 in New Zealand and it is noted in Section of the Ambulance Standard (NZS 8156:2008) that an Ambulance Service shall be aware of, and where appropriate, contribute to, regional and/or national large scale contingency planning and be able to operate in accordance with such plans including. AMPLANZ. Ambulance New Zealand has approved policy to clarify: the mandate of AMPLANZ and to ensure that Ambulance NZ and Ambulance Services understand their roles and responsibilities with regards to the development, maintenance, and operationalisation of AMPLANZ. AMPLANZ is mandated to provide:.all Ambulance Services with the nationally standardised framework to command, control and coordinate ambulance resources locally, regionally and nationally, for the greatest good of the greatest number of casualties during major incidents. 1.4 Format of AMPLANZ The format of AMPLANZ includes two documents. These are The Overview and The Plan. The Plan is made up of four parts as noted below. Part 1 Introduction to AMPLANZ and Emergency Management for the Ambulance Sector AMPLANZ The Overview AMPLANZ The Plan Part 2 Consistent Operations at the Scene Part 3 Ambulance Service Approach Part 4 National Coordination Mechanisms The Overview: This provides a summary for all Ambulance Services and partner agencies of the concepts and approach of the ambulance sector in the management of major incidents. Part 1: Introduction to AMPLANZ and Emergency Management for the Ambulance Sector: This part summarises what AMPLANZ is, the sector, and key ambulance and emergency management concepts. Part 2: Consistent Operations at the Scene: This Part focuses on the activities to be undertaken by responding crews, the duty management and those operational officers directly involved at the scene in coordination with other responding agencies. Part 3: Ambulance Service Approach: This Part focuses on the activities to be undertaken by Ambulance Service Management in all parts of the emergency management cycle. It is designed to guide ambulance managers who are required to support the response at the scene, as well as play a role in preparing for or recovering from a major incident. Part 4: National Coordination Mechanisms: This Part provides a framework for an Ambulance Service to develop its national coordination mechanism to ensure that the ambulance sector is able to respond to a significant regional or national emergency. A CD with AMPLANZ Parts 1-4 and associated appendices is in the back cover of this Overview. 1 An Ambulance Service is defined in NZS8156:2008 Section 1.5 page new zealand ambulance major incident and emergency plan (AMPLANZ)

5 2.0 Frameworks and Concepts of Emergency Management 2.1 Legislation and National Emergency Management Plans The ambulance sector in New Zealand, unlike many services internationally, does not have its own legislation that guides and regulates the provision of ambulance services. That said, Ambulance Services are health sector organisations and therefore have responsibilities within, for example, the Health Act 1956 and New Zealand Public Health and Disability Act In the context of emergency management, the ambulance sector must comply with, for example, the Civil Defence Emergency Management Act 2002 and Epidemic Preparedness Act Ambulance services shall be aware of their responsibilities under these legislations as well as other health and workplace legislation. There are two key national plans that relate to emergency management. These are the: National Civil Defence Emergency Management Plan 2006 National Health Emergency Plan 2008 (NHEP). AMPLANZ shall be read in conjunction with these key national plans. Appendix 2 lists the key legislation and plans that guide Ambulance Service emergency planning. 2.2 The 5 Rs Emergency Management in New Zealand is underpinned by the 4 Rs approach to emergency management 2 : Reduction Readiness Response Recovery For the purposes of AMPLANZ, the ambulance sector has identified the importance of building and maintenance of Relationships between Ambulance Service Managers and key personnel in health service providers, traditional emergency services, civil defence and welfare agencies, lifeline organisations and the private sector. 2.3 CIMS (New Zealand Coordinated Incident Management System 3 ) CIMS is New Zealand s approach to incident management. It provides a framework to manage a range of diverse incidents, from routine to major emergencies. The major incident management structures outlined in AMPLANZ are based on CIMS. 2 Taken from the Guide to the National Civil Defence Emergency Management Plan, June 2009, Section 1 Introduction page 2. 3 Taken from the NZ Coordinated Incident Management System (CIMS), Teamwork in Emergency Management 2010 pages The overview MaY

6 2.4 Concept of Ambulance Emergency Management The Responsibilities of Ambulance Services in a Major Incident The role of the ambulance sector in response to a major incident is to deliver and maintain appropriate pre-hospital clinical care. In a mass casualty incident, Ambulance will lead the operational health response to the incident at the scene/s and manage the triage, treatment and transport of patients to appropriate receiving hospitals or health facilities. In all emergencies impacting on the health of the communities, an Ambulance Service will manage and coordinate its response with the DHBs and other emergency services to manage demands on the healthcare system. Below are key responsibilities of Ambulance Services in a major incident, Responsibilities of an Ambulance Service in all major incidents and emergencies: To save life in conjunction with other Emergency Services To notify and liaise with the other Emergency Services To initiate and maintain an Ambulance Service Command and Control structure lead by an Ambulance Service Controller To protect the health, safety and welfare of all ambulance staff generally, and all health workers on the scene of a mass casualty incident To supply sufficient ambulances and staff for the incident To provide a communications system between ambulance and DHBs (including hospitals) To provide Ambulance Liaison Officer/s to the partner agencies as appropriate for the incident To reduce to a minimum, the disruption of the normal work of the Service by implementing Business Continuity Plans, as appropriate, ensuring the restoration of normality at the earliest opportunity. Responsibilities of an Ambulance Service for Mass Casualty Incidents: To provide a structure to support the triage, treatment and transport of casualties from the scene by establishing an Ambulance Control Point, Casualty Clearing Point and Ambulance Loading Point To provide a Senior Ambulance Officer at the scene to act as Ambulance Commander (AC) To be part of the Scene Incident Management Team (IMT) to ensure a coordinated response to the incident To identify, notify and communicate with appropriate receiving hospital(s), health facilities and DHBs of the prevailing situation and the categories and estimated times of arrival of casualties To triage all patients prior to evacuation from the scene To manage all medical resources deployed to the scene for the treatment and care of casualties To determine the priorities for the evacuation of casualties, ensuring even and simultaneous dispatch to the receiving hospital(s) and health facilities To organise transportation for casualties to the receiving hospital(s) and health facilities, and any necessary secondary transfers between hospitals To acquire additional ambulance resources, as necessary, through the use of the Ambulance Service s national coordination mechanisms To forward to the receiving hospital(s) and health facilities, Public Health Units and DHB(s), any information acquired at the scene relating to chemical, biological or radiation (CBR) hazards and possible contamination of casualties or rescuers and advise of the potential for self-presenting patients To assume responsibility for casualty decontamination, in conjunction with the Fire Service To provide the Fire Service with clinical advice and assistance to support on-site decontamination To maintain adequate emergency ambulance cover throughout the Ambulance Service s Operational area for the duration of the major incident To progressively release activated hospital(s) and health facilities and ultimately issue a message indicating completion of casualty evacuation A structured and consistent approach AMPLANZ is aligned with CIMS, important New Zealand emergency management concepts and with key national emergency plans. AMPLANZ also notes that to effectively manage large and complex incidents, the processes and procedures used by ambulance services need to be established and understood within the services and also by partner agencies. Major incidents, such as mass casualty events, are infrequent occurrences and consequently any procedures required to manage such incidents shall follow the same basic processes as for smaller and less complex incidents. Therefore essential processes, such as assigning initial response roles and responsibilities, incident escalation, notifications, situation reports, triage etc are the same no matter what the size or complexity of the incident. 6 new zealand ambulance major incident and emergency plan (AMPLANZ)

7 2.4.3 Whole of Organisation and Sector AMPLANZ is designed to ensure that all parts of the ambulance sector and the individual services are involved in the response, recovery and development of readiness of the sector. This will then contribute to the resilience of the health sector. Within an Ambulance Service there are roles and responsibilities of first-responding crews, for ambulance service management and also for key support staff in non-operational or core support positions. Across the sector, clear guidance is given to further integrate the individual service s response and planning at the tactical and operational levels and also nationally in the coordination of all services with national agencies, such as MoH. 3.0 Readiness and Reduction 3.1 Risk Reduction AMPLANZ does not cover all aspects of risk management and therefore risk reduction in individual Ambulance Services of the sector. The incidents covered by the AMPLANZ are normally considered as having risk of: low likelihood of occurrence and high impact on normal business. The focus here is on the requirement to ensure that normal services can be maintained and Ambulance Services are able to respond safely and appropriately to known hazards in the community. Specifically, the focus is on business continuity, tactical plans and their prioritisation, and coordination of plans with health sector partners and other emergency service partners. Finally, there is a clear emphasis on the need for ongoing education and training within the services and across the sector. 3.2 Readiness Readiness: Planning The majority of operational and tactical response planning is undertaken by individual Ambulance Services with the EACC, their local emergency management agencies and neighbouring Ambulance Services. The planning shall focus on: Business Continuity Planning within individual Ambulance Services, including the EACC Specific Ambulance Tactical Plans to respond to known and priority risks in the community. These are to be coordinated with the traditional emergency services, including health, private sector agencies and Civil Defence and Emergency Management Agencies Ambulance Service Major Incident and Emergency Plans Inter-Ambulance Service cooperation to ensure a whole of sector approach is developed to specific known hazards, which will require cross border responses The development of national coordination mechanisms by each Ambulance Service to ensure that an Ambulance Service is able to call upon or provide support to or from other Ambulance Services Health Emergency Planning with the focus on the integration of the operational planning of both Ambulance Services and DHB service providers Alignment of the Ambulance Service plans with national plans such as the National Transport Plan and the National Mass Casualty Plan. The overview MaY

8 Plans shall be appropriately tested in exercises involving Ambulance Services, DHBs, other emergency service partners and national agencies, such as MoH. The ambulance sector contribution to national health emergency planning can be undertaken in a number of ways. These include: Meeting the obligations set out in legislation (e.g. CDEM Act) for Ambulance Services, DHB, MoH or other national agency. Individual Ambulance Services may be tasked and funded to coordinate the emergency planning and capability development of the ambulance sector. For example, (chemical, biological and radiological) CBR capability development Cooperation between services for specific known preplanned events or known threat (e.g. International Sports Events, VIP tours / meetings etc) Using an Ambulance Service s national coordination mechanism in planning for exercises, pre-planned events or known threats, where it is felt necessary that national coordination will be required. Individual Ambulance Services contributing to specific issues relating to emergency response planning. For example, revision of the New Zealand Influenza Pandemic Action Plan. The choice as to which approach is used will depend on the planning issue, priority for individual services, capability in the sector and the resources available to assist the sector Readiness: exercising A complete Ambulance Service Response, including the set up and activation of an Ambulance Service Emergency Operations Centre (ASEOC) and activation of the Ambulance Service s national coordination mechanism, shall be exercised in at least one major CDEM (Tier ) exercise as well as at least one major emergency services or health exercise each year. Communication and activations systems shall be tested as appropriate for all exercises where there is a likelihood of a significant ambulance and health response. All exercises shall be evaluated and results reported internally within the Ambulance Service. Lessons will be identified and shared. Processes will be developed to incorporate changes into the appropriate level of planning within the sector. This shall include the annual AMPLANZ review by Ambulance New Zealand Readiness: training and education To enable a complete Ambulance Service emergency response, all potential responders shall be trained appropriately to be able to undertake their roles. Training needs analysis is required to further enhance the appropriateness of emergency management training and education within Ambulance Services. Training and education in emergency management for Ambulance Services shall align appropriately with competency frameworks and guidelines of other emergency service partners, as well as with Civil Defence and Emergency Management Agencies. 3.3 Review and Audit The Ambulance Service major incident and emergency plans, and the related operational procedures to ensure the notification, activation and management of a full and coordinated ambulance service response, shall be audited and reviewed as part of the Ambulance Service s quality management systems. AMPLANZ will be reviewed annually to take into account local and internationally significant development and lessons identified or learnt. There will be a formal review of AMPLANZ no later than every three years. The Ambulance New Zealand Standards and Accreditation Committee has national responsibility for the review of AMPLANZ on behalf of Ambulance New Zealand trustees. 4.0 Response 4.1 Activations, Level of Response 5, and Notifications This section is outlines the Ambulance activation mechanisms and levels of response required for an incident in the community that may require escalation to national level. The aim is to ensure that every major incident is managed appropriately as early as possible in the response. This will improve patient outcomes and ensure that the responding ambulance officers are supported quickly and effectively. The classification of the type of incident is essential to ensure that appropriate activations and notifications occur. Once an incident has been classified, it triggers certain actions which must be taken by the affected Ambulance Service and the EACC. This will enable quick decisionmaking to determine the level of coordination required. The major variables that govern the type of response from an Ambulance Service include: Time to respond to the incident (travel, triage, treat and transport) The complexity of the incident The number of patients. 4 Ministry of Civil Defence Emergency Management (MCDEM) Tier 3 exercises test territorial local authority (TLA) and CDEM group (CDEMG) operations. MCDEM Tier 4 exercises test National Crisis Management Centre (NCMC), CDEMG and TLA operations. Both of these will require a service and national response from Ambulance. 5 This section draws on Ambulance Victoria (AV) Emergency Response Plan AV s generous support is acknowledged. 8 new zealand ambulance major incident and emergency plan (AMPLANZ)

9 There are four levels of response: Normal operations Level 1: medium impact on normal operations Level 2: high impact on normal operations Level 3: severe impact on normal operations. To allow the identification of correct response levels, two tools have been developed: An Escalation Flow Chart that notes the actions of all ambulance parties in the initial escalation A Response Matrix to be used by the EACC Escalation The Escalation Flow Chart Figure 1 provides an overview of the actions by the EACC and the Ambulance Duty Operational Manager 6 in the initial stages of a major incident. This outlines when to use the Response Matrix and the initial assessment, as well as clearly defining the actions to be undertaken by the EACC and Duty Operational Manager based on the level of incident. Figure 1: Escalation Flow Chart EACC receive 111 call, Inter CAD or direct (e.g. airport alert, ambulance approaching an incident) notification Issue identified by the calltaker and/or Dispatcher as possibly outside of Normal Operations Escalate to the Comms Centre Team Manager Use Response Matrix Dispatch immediate appropriate resources Normal Operations What Level? If Level 1, 2, or 3 Then EACC to: 1. Page Possible Major Incident Level 1 2. Inform Duty Operational Manager Duty Operational Manager to undertake initial and ongoing assessment Level 1 Manage Locally by Duty Operational Manager Level 2 Escalate to Sevice Duty Executive Level 3 Escalate to Sevice Duty Executive Continual reassessment based on situation reports from the scene Ambulance Manager Responded as Commander Ensure Public Information Manager in place Inform/Update Ambulance Service Duty Executive Inform Health Partners (EACC page) Ambulance Manager responded as Commander Ambulance Service Duty Executive to Manage Other Ambulance Services informed / on standby National Coordination Mechanisms Informed /on standby Brief Ambulance Management Inform/Brief Health Partners (EACC page/ teleconference) Ensure Public Information Manager in place Ambulance Manager responded as Commander Ambulance Service Duty Executive to Manage Other Services on standby /activated National Coordination Mechanisms on standby /activated Brief Ambulance Management Inform/Brief Health Partners (EACC page/ teleconference) Ensure Public Information Manager in place 6 Duty Operational Manager is a generic position title that covers a number of positions used across the sector such as Operations Team Manager, Duty Operations Manager, and Duty District Manager etc. The overview MaY

10 4.1.2 Types of Incidents A major incident or emergency for ambulance 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 as to require special arrangements to be implemented by appropriate responding agencies including: Ambulance Services District Health Boards (including, for example, hospitals, primary care, and public health) The Ministry of Health. AMPLANZ has adopted a set of descriptors for types of incidents applicable to all hazards. These incident descriptors relate to the ability to access patients, involvement of a lead agency or a comprehensive CIMS structure and the complexity of the response and its impact on normal services. Time to respond, triage, treat and transport is another factor that will impact on patient care and normal service delivery. Therefore this will need to be taken into account in the decision-making process. Figure 2: Types of Incidents Type of Incident Complex Description Incident that is not routine or it is an infrequently used procedure (e.g. CBR, Airport emergency, major Civil Defence Emergency Management (CDEM) event (e.g. tsunami)) Controlled Incident that has a lead agency (e.g. Police, Fire, Health, CDEM etc) or comprehensive CIMS structure in place or a large number of personnel are deployed Restricted Where access to patients is difficult owing to hazardous, environmental or security factors Open Where there are no issues regarding the access to or egress from patients Simple Incident where normal or routine Ambulance procedures apply 10 new zealand ambulance major incident and emergency plan (AMPLANZ)

11 4.1.3 Response Matrix Tool The initial assessment of an incident is the responsibility of the EACC Team Manager using the response matrix below in Figure 3. Figure 3: Response Matrix >21 Level 2 Level 2 Level 2 Level 3 Level Level 2 Level 2 Level 2 Level 3 Level Level 1 Level 1 Level 2 Level 2 Level Normal Operations Level 1 Level 1 Level 2 Level Normal Operations Normal Operations Level 1 Level 1 Level 2 Numbers of Patients Type of Incident Simple/ Open Simple/ Restricted Simple/ Restricted/ Controlled Complex/ Controlled Time <1hr 1 2hr 2 4hr 4 8hr >8hr How to use the Response Matrix 1. Estimate the total likely Time or duration of the incident for ambulance (travel, triage, treatment and transport) and plot on the Response Matrix 2. Determine the Type of Incident from Figure 2 and plot it on the Response Matrix 3. Determine the Severity of the Incident by comparing the time estimate to the Type of Incident, and select the greater (i.e. further to the right of the matrix) 4. Determine the likely number of patients and plot against the Severity of the Incident on the Response Matrix 5. An Initial Possible Major Incident notification will be sent (Level 1) to inform those who will be directly impacted by this incident 6. The Duty Operational Manager will be informed and will respond accordingly Risk Assessment and Response Once an incident has been classified using the Response Matrix Tool and determined to be outside of normal business, a local Level 1 Possible Major Incident notification will be sent by the EACC and the Ambulance Service Duty Operational Manager will be informed. Ambulance Service Duty Operational Manager will then be required to confirm that a major incident has occurred and will declare a major incident for ambulance at the appropriate level. This will be done using information from the incident scene, the EACC, partner agencies and other reliable sources. Tools have been provided to Operational Managers to assist with decision-making. The overview MaY

12 4.1.5 Major Incident Notifications within Ambulance Services and to partner agencies Partner agencies will be informed of Major Incidents by Ambulance: Local DHBs will be informed via a paging / text notifications system as part of the activation of the ambulance response for all Level 1, 2, or 3 incidents The MoH Regional Emergency Management Advisors will be informed for Level 2 and 3 incidents The MoH will be informed via 0800 GET MOH of Level 3 incidents The local Civil Defence and Emergency Management Group (CDEMG) will be informed for Level 3 incidents Police and Fire services are informed routinely via Inter-CAD communications within the Communication Centres. There are EACC and Ambulance Service Procedures in place to hold an initial briefing teleconference with partner agencies and neighbouring Ambulance Services, based on the scale of the incident. This will be facilitated by the EACC and managed by the Ambulance Commander, Ambulance Service Controller or their delegate. Following the initial briefing, further teleconference briefings may be required or communication between the Ambulance Services and DHBs will continue via other channels depending on the incident requirements. 4.2 Activation based on National Warnings 7 MoH and MCDEM will send out National Warning notifications to all emergency management stakeholders in the health sector and the wider CDEM sector. Ambulance Sector Single Point of Contact (SPOC) for MoH and MCDEM notifications is the EACC. The EACC is responsible for cascading these to the ambulance sector. Note: If there is an ambulance major incident response required, this will be activated and escalated using the process noted in Section 3.1 and usually before MoH or MCDEM alerts have been received. 4.3 National Coordination of Ambulance Each Ambulance Service shall develop and maintain its own national coordination mechanism. This is broadly defined as a mechanism that, with supporting procedures, is able to: Receive requests from the responding Service or part Service that has been overwhelmed Coordinate the provision of requested ambulance resources from other Ambulance Services or nationally Liaise and coordinate with key National Emergency Management Agencies (MoH and MCDEM for example) and on behalf of the responding Ambulance Service/s in the response and recovery phases of the emergency Provide a sustainable support structure, with trained personnel and appropriate infrastructure, to be able to operate 24/7 if required. Notification and activation procedures for an Ambulance Service s national coordination mechanism will need to be developed and communicated across the sector and to key partners. 4.4 Activation based on Regional or Local Warnings There are also Regional Health, Regional CDEM Group or Local Authority notifications. The mechanisms used at these levels currently vary across New Zealand. The EACC will cascade these notifications appropriately to the local or regional Ambulance Service. Local or regional Ambulance Service Management may also receive notification directly and will ensure that the EACC is informed. 4.5 Response Command Structures, Roles and Responsibilities This section summarises the key parts of the management structure, and their roles and responsibilities, as used by Ambulance Services in a major incident First Ambulance Crew at the Scene The actions of the first attending ambulance crew at the scene of a Major Incident are crucial to establishing an effective response. The primary role of the first crew can be summarised as being to assess and inform. The scene is assessed and reported to the EACC in a standard (METHANE 8 report) format. Accurate, high quality information must be given as quickly as possible to enable adequate resources to be sent to the scene Ambulance Command at the Scene The overall aim of ambulance management at the incident scene is to provide the operational and tactical leadership. This will include the set up of appropriate command and communications structures, safety of all health responders and the appropriate triage, treatment and transport of patients from the scene to the appropriate healthcare facilities. This will require coordination and communications with receiving health facilities, DHBs and emergency service partners. 7 The Guide to the National CDEM Plan 2006, Section 19 and The National Health Emergency Plan 2008, page See Appendix 1 for the definition of METHANE. 12 new zealand ambulance major incident and emergency plan (AMPLANZ)

13 The scale and complexity of the command structure is dependent of the incident. For example: A Level 1 incident of short duration and low patient numbers may be managed by an Ambulance Operations Manager (AOM) undertaking the CIMS functions A long duration controlled and / or complex incidents (Level 2 or 3), or simple / restricted incidents equivalent to Level 1 or 2 (short duration but with large numbers of casualties) will require the Ambulance Commander or Ambulance Operations Manager to decide how the Ambulance and CIMS roles will be implemented and the staffing required. The key roles in an Ambulance Command structure are: Ambulance Commander (AC): The officer responsible for scene management for complex and prolonged incidents. The AC will be part of the Incident Management Team when an IMT has been established for controlled or complex incidents (Level 2 or 3 Incidents). This is an incident management role and therefore shall not have clinical management responsibilities. Ambulance Operations Manager (AOM): The officer delegated with the responsibility to manage operational activities of the incident at the point of patient contact, and the site role most commonly established for open simple, restricted or minor controlled incidents (Level 0, 1 or 2 incidents). This is an incident management role and therefore shall not have clinical management responsibilities. Ambulance Triage Officer/s: Responsible for the triage of all patients in an incident or sector. In command of all Triage Areas and is responsible to the AOM or Sector Officer. Ambulance Treatment Officer/s: Responsible for coordinating patient treatment, liaising closely with the Transport Officer and the Triage Officer. Delegates tasks to all medical and other personnel at the Casualty Clearing Point. Reports to the AOM / Sector Officer. Ambulance Transport Officer: The officer responsible for all transport, loading and parking management in consultation with the AOM. Responsibilities include: ensuring that suitable access and egress is available into the ambulance loading point at or near the CCP, for the efficient use of vehicles, allocating vehicles for transport while taking into account patient priority, establishing an appropriate ambulance parking area. Reports to the AOM / Sector Officer. There are other roles such as: Ambulance Sector Officer/s Ambulance Safety Officer Ambulance Administration Officer Ambulance Communications Officer on-site Ambulance Logistics Officer Aviation Co-ordinator Ambulance Planning and Intelligence Officer. These will be deployed depending on the duration, scale and complexity of the incident. It may be necessary to combine roles depending on the availability of personnel. Medical, Nursing and allied health professionals may also be deployed or volunteer and will be under the command of the Ambulance Commander. See AMPLANZ Part 2: Consistent Operations at the Scene for more details Ambulance Service Emergency Response Management Structures In a similar way, for simple, open or restricted Level 1 incidents of short duration and relatively small patient numbers, an Ambulance Service may be able to provide strategic direction, support and coordination to the Ambulance Commander or Operations Manager through normal business arrangements and structures. For complex, long duration incidents (Level 2 3), an Ambulance Service Controller (ASC) shall be appointed to lead the overall Ambulance Service response. All key CIMS roles or functions will need to be undertaken but it is recognised that an Ambulance Service may not be able to fill all roles with individual managers. CIMS roles may have to be shared. How this issue is managed within the Ambulance Service is the responsibility of the ASC. A key role/s will be the Liaison Officer roles to partner agencies. These may include: Ambulance Liaison to ED Ambulance Liaison to a Hospital EOC or DHB EOC Ambulance Liaison to Emergency Services EOC, including Police, Fire or CDEM Ambulance Liaison to the NHCC or NCMC. The type, duration and scale of incident will dictate where Ambulance Liaison Officers should be placed. When local ambulance resources have been overwhelmed, it may be necessary to request support from neighbouring Ambulance Services or nationally to ensure the appropriate roles are undertaken effectively for the duration of an incident. This will be done by the Ambulance Service s national coordination mechanism. The Ambulance Service Emergency Response Management roles are noted in detail AMPLANZ Part 3: Ambulance Service Approach. The overview MaY

14 4.5.4 EACC Incident Management Structure The EACC may activate its national incident management team in support of the local communication centre depending on the communications demands of the incident and normal service delivery. Level 1 2 incidents may be managed by the Team Manager with support from the Communications Centre Manager and EACC Duty Executive as required. For more complex, long duration incidents, a formal incident management structure will be required with incident management responsibilities with an EACC Emergency Response Manager. This is noted in detail in AMPLANZ Part 3: Ambulance Service Approach. 4.6 Key Facilities for an Ambulance Response CIMS requires consistent facilities at the incident at the scene. Ambulance also requires specialist facilities. There are also specialist facilities for the Ambulance Service Emergency Response Management and EACC Incident Scene Facilities Below is a summary of the facilities that may be required at an incident. For full descriptions see AMPLANZ Part 2: Incident Control Point (ICP) Ambulance Command Point Sectors Assembly Area/s Staging Area/s Ambulance Parking Area/s Safe Forward Point/s (SFP) Landing Zone/s (LZ) or Helipad/s (HP) Forward Triage Casualty Clearing Point/s (CCP) including a Triage Area/s and Treatment Area/s Ambulance Loading Point/s (ALP) Ambulance Service Emergency Operations Centre (ASEOC) An ASEOC is a facility that aims to: Coordinate the ambulance response to a major incident with the Scene Commander(s) and the EACC Plan for future resource requirements of a major incident Manage the impact of the incident/s on normal service delivery Ensure that all ambulance management and key stakeholders are informed of the current incident situation, plans and resource requirements. For smaller incidents, an ASEOC may be virtual with minimum staffing and physical set up, or be able to operate from the EACC MCI Room or from a partner agency EOC. However, an ASEOC will physically be required for complex or long duration incidents (Level 2 3) where there is a significant Ambulance response. The Ambulance Service shall have a space appropriately set up or able to be set up as an ASEOC within 30 minutes of a major incident Level 2 or 3 being declared. The ASEOC setup specification shall enable it to operate securely and independently for the duration of the emergency. 14 new zealand ambulance major incident and emergency plan (AMPLANZ)

15 Where a non-dedicated space is identified for use as the ASEOC, management protocols shall be in place to give priority to use of this space as an ASEOC for the duration of the emergency response and recovery phases. The EACC is required to maintain an MCI Room in each Communications Centre to enable the communications management of a complex major incident to be separated from normal service delivery when appropriate. The EACC MCI Rooms will require similar specifications as the ASEOC. 4.7 Communications and Information Management The most significant factor that will contribute to successful command and control of an incident is effectiveness of the communications systems, protocols and tools. These include: On-scene communications within the Ambulance Service and within the Incident Management Team Communications between the responding crews, the Ambulance Commander and the EACC The detail and timeliness of information given to the Incident Controller, to the EACC and to health partners The tools available to the Ambulance Commander, EACC and Ambulance Service Controller to manage the information, including Sitreps, action planning and Emergency Management Information Services (EMIS). A number of protocols, tools and information management systems have been developed as part of this plan. See AMPLANZ Parts 2 and Ambulance Resources and Equipment An Ambulance Service shall ensure that key managers are aware of and trained in the use of specialist resources that may be used in their operational area during a major incident. These may include: Ambulance major incident cache of medical materials and equipment Ambulance Specialists Operations Teams and their capability (SERT, Rescue, USAR and CBR etc) DHB medical materials etc that may be accessible to a pre-hospital response Specialist materials, equipment, services and personnel from a partner emergency service or support agency that may be required by a prehospital response. For example, USAR equipment, CDEM logistics, Red Cross volunteers. All Ambulance Services are required to maintain major incident equipment and materials, with efficient means of deployment, to ensure a major incident in their service area can be appropriately resourced. These materials and equipment will be nationally consistent kits or caches to ensure interoperability between Ambulance Services. Ambulance officers shall be regularly trained in the deployment and use of these materials and equipment. These major incident caches or kits may also be used in major public events to improve familiarity with the materials and equipment. The EACC Computer Aided Dispatch (CAD) system will maintain current information on the majority of ambulance resources available for deployment. The status of ambulance resources shall be in a form that is immediately accessible to the NHCC. For example, this may be via the health EMIS (WebEOC, E.SPONDER or similar). This will include the location and detail of major incident caches in urban centres and rural station kits in strategic rural stations. The Air Ambulance Services, particularly fixed wing, not normally deployed by the EACC, shall ensure that their status is able to be tracked by the EACC and therefore in a major incident may be able to be coordinated by the EACC as part of a major incident response. The ambulance or event services, including NZ Defence Force (NZDF) or NZ Red Cross, not normally deployed by the EACC, will maintain their resource status, capacity and capability in a form that is immediately accessible to the EACC and NHCC. For example, this may be via the health EMIS (WebEOC, E.SPONDER or similar). The national coordination of all land-based, rotor and fixed wing assets in a major incident will be outlined in the MoH National Transport Plan. 4.9 Ambulance Coordination with Health, Emergency Services and other Agencies In a complex mass casualty incident or major emergency, it is unlikely that any one agency will have the required resources to meet the needs of a response. The CIMS approach provides for coordination across all responding agencies. The Ambulance Service will ensure that there are timely, accurate and ongoing briefings of health partners. Section also notes the need for ongoing development and planning by all health and emergency management agencies. The coordination of patient transport, according to priority, to the most appropriate health facility is recognised as critical. Ambulance Services are responsible for ensuring that all staff who may fulfil the key roles at the scene or in the ASEOC shall be fully aware of and trained in: Capacity and capability of the local and regional receiving health facilities The overview MaY

16 Capacity and capability of the Ambulance Services locally, including air ambulance (rotary and fixed wing) Emergency plans of the local DHBs as they impact on ambulance The communication channels with receiving health facilities or DHBs to coordinate patient transport The communication channels with Regional Health Coordination structures The role, capacity and capability of the emergency services, NGOs, such as Salvation Army and NZ Red Cross, private sector organisations and Civil Defence Emergency Management Organisations The communication channels with non-health organisations to be able to access appropriate resources (e.g. CDEM Groups). Each Ambulance Service is responsible for ensuring that their ASEOC has access to appropriate operational points of contact for the local and regional health services and non health agencies. Each Ambulance Service shall put in place a Liaison Manager who will have the responsibility for maintaining the relationship with coordination mechanisms within partner agencies during a response. This will include: sharing information, requesting resources if required and inputting into a multi-agency action plan. At a national level, the Ambulance Service s national coordination mechanism shall specify how liaison with key national agencies and groups will occur. These agencies include but are not limited to: National Health Coordination Centre (MoH) National Crisis Management Centre (MCDEM) National Welfare Coordination Group National Fire Service Headquarters National Police Headquarters. It will be necessary to prioritise the placement ambulance liaison at the national level according to the incident s complexity, duration and impact on ambulance operations, health services and the wider community. The NHCC will be given priority. 5.0 Recovery The process of recovery for an Ambulance Service is defined as the re-establishment of normal service delivery after a major incident. This process should start as soon as possible in the response phase and be aligned with Ambulance Service business continuity plans. Ambulance Services will be required to contribute to the overall recovery of the health services and community. It may also be the case that, dependent on the incident, there may be a new normality for the community. Ambulance Services may have to realign themselves appropriately as part of the recovery process. It is envisaged that even in a moderately sized major incident there will be an effect on staff, supplies, equipment, finance and vehicles. Areas requiring consideration for recovery will include, but should not be limited to: Staff welfare/debriefs Rosters Leave Operational review and learning Consumables (medical/fuel) Equipment Vehicles (servicing repairs etc) Finance and cost recovery. Recovery roles have been built into the role descriptions for response managers at the service level as well as key non-operational staff. For complex incidents that have impacted significantly on the ongoing functioning of the Ambulance Service, a Recovery Manager may be required to concentrate on the rebuilding or modification of the service. The Ambulance Commander and Ambulance Service Controller are required to undertake a number of actions as part of the recovery process. These are: Hot Debrief with responding crews and appropriate EACC staff held as soon as possible Complete an Ambulance Commander s After Action Report within one month of the incident Hold an Ambulance Service formal debrief for a significant incident within two months Complete an Ambulance Service Major Incident Report for significant events within six months Attend and share experience / learning in an Interagency Debrief and reporting process when and if required. At the national level, ambulance recovery coordination following a complex and nationally significant emergency shall be based on the requirements of the local Ambulance Services and / or the needs of the health sector locally and nationally. Therefore an Ambulance Service shall consider recovery functions as part of its national coordination mechanism. An Ambulance Service s national coordination mechanism shall have debriefing and reporting processes in place to capture lessons identified and for action planning and service improvement. All logs and notes made during an incident at the scene, Ambulance Service and national levels will need to be correlated and stored in case of possible inquiries into an incident management. 16 new zealand ambulance major incident and emergency plan (AMPLANZ)

17 Appendix 1 Glossary of Terms and Abbreviations AA AAP AC AIO ALP ALS AMPLANZ AOM AOS AS/NZS ASC ASEOC BCP BLS CAD CBR CCP CDEM CDEMG CEO CIMS CIMS 2 CIMS 4 Clan Lab Cordon DES DHB DHBNZ Assembly Area Agency Action Plan Ambulance Commander Ambulance Incident Officer (now called Ambulance Operations Manager or AOM) Ambulance Loading Point Advanced Life Support New Zealand Ambulance Major Incident and Emergency Plan Ambulance Operations Manager Armed Offenders Squad (Police) Australian Standards / New Zealand Standards Ambulance Service Controller Ambulance Service Emergency Operations Centres Business Continuity Plan Basic Life Support Computer Aided Dispatch (system) Chemical Biological Radiological Casualty Clearing Point Civil Defence Emergency Management Civil Defence Emergency Management Group (Regional Council) Chief Executive Officer New Zealand Coordinated Incident Management System CIMS introductory training 2-3 day training for Emergency Management personnel at the Scene Short for clandestine lab : generally used in any location / facility involving the production of illicit compounds. Physical demarcation of the border between zones. e.g. Inner cordon separates hot and warm zones Outer cordon separates cold zone for the public areas or traffic exclusion zone (that may still be patrolled by security or police) The Cabinet Committee for Domestic and External Security Coordination. The committee is chaired by the Prime Minister and includes those ministers responsible for departments that may play essential roles in emergency situations. District Health Board District Health Board New Zealand The overview MaY

18 Glossary of Terms and Abbreviations continued... Duty Executive Duty Manager E.Sponder Senior Ambulance Manager with strategic management of an Ambulance service. May also be known as Regional Operational Executive, Ambulance Operational Executive. Ambulance Officer responsible for the operational management and running of an Ambulance Service for a shift. May also be known as District Duty Manager, Duty Operations Manager. Emergency Management Information System used by MCDEM (see below) EACC Emergency Ambulance Communications Centre (St John Communications Ltd and Central Emergency Communications Ltd) Emergency Defined in Section 4 of the CDEM Act 2002 EMIS EOC Executive Management Team HazMat HEP Hot zone HP HR ICP ICT or IT ILS LZ Major Incident Emergency Management Information System. A system to assist with the recording, flow and timely transfer of information between Emergency Management agencies during an emergency. Emergency Operations Centre The wider management team (including Human Resources, training, finance and administration, other business arms) of an Ambulance Service headed by a CEO or General Manager. Will provide strategic guidance and oversight to the management of an incident. Hazardous Material/s Health Emergency Plan (of a DHB or health service) The immediate area surrounding the site of a hazardous materials incident and where the hazard level is high. The boundary of this zone should be clearly marked with hot zone tape to indicate the high risk to responders and the need for specific protective clothing. Hot zone marking should extend far enough to prevent adverse effects from the release of the hazardous material to any persons outside the hot zone. A hot zone will be defined by Fire or Police. Heli Pad Human Resources Incident Control Point Information Communication Technology Intermediate Life Support Landing Zone For the ambulance sector this is defined as: MCDEM METHANE MoH NCMC 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 as to require special arrangements to be implemented by appropriate responding agencies including: Ambulance Services District Health Boards (including, for example, hospitals, primary care, and public health) The Ministry of Health. Ministry of Civil Defence Emergency Management A METHANE report is the internationally recognised tool for incident management and is utilised in this plan. It covers the following: Major Incident Status Exact location of incident Type of incident Hazards identified Access to the scene Number of casualties Emergency services available and Extra resources required Ministry of Health National Crisis Management Centre (run by MCDEM) 18 new zealand ambulance major incident and emergency plan (AMPLANZ)

19 Glossary of Terms and Abbreviations continued... NHCC NGO NZFS ODESC OIC OPF PIM Recovery Readiness Reduction Response SAR Sector SERT SFP Sitrep/s STG TBC TLA UHF USAR VHF VIP Warm zone WebEOC WFA National Health Coordination Centre (run by MoH) Non Government Organisation NZ Fire Service Committee of Officials for Domestic and External Security Coordination. A committee of government chief executives charged with providing strategic policy advice to ministers. It provides support to DES and oversees emergency readiness, intelligence and security, terrorism and maritime security. Activation of ODESC is at ministerial request; for example, where a growing risk of a particular threat has been identified. Officer in Charge (Fire) Operational Policy Framework. One of a group of documents collectively known as the Policy Component of the District Health Board Planning Package that sets out the operational level accountabilities for DHBs for each fiscal year. The OPF is executed through Crown funding agreements between the Minister of Health and each DHB. The OPF covers emergency obligations based on the four Rs. Public Information Management The coordinated efforts and processes used to bring about the immediate, medium-term and long-term holistic regeneration of an organisation and community following an emergency. The process of developing operational systems and capabilities before an emergency occurs. The process of identifying and analysing long-term risks to human life and property from natural or non-natural hazards; taking steps to eliminate these risks, if practicable and, if not, reducing the magnitude of the impact and likelihood of them occurring. The actions taken immediately before, during or directly after an incident or emergency to save lives and property, and to help communities recover. Search And Rescue For complex and large scale incidents it may be required to divide a scene into sectors. Sectors may be defined by the Incident Controller for overall use or by individual agency commanders for their agency s needs. Special Emergency Response Teams Safe Forward Point Situation Report/s (Police) Special Tactics Group To Be Confirmed Territorial Local Authority Ultra High Frequency (radios) Urban Search And Rescue Very High Frequency (radios) Very Important Person/s Zone surrounding the hot zone. An area that presents minimal hazard to personnel. The zone where decontamination takes place. Will be defined by Fire. Emergency Management Information System used by the Health Sector (under review). Wellington Free Ambulance The overview MaY

20 Appendix 2 References Legislation Primary acts and associated regulations outlining legislative responsibilities for health sector organisations and therefore Ambulance Services are the: Civil Defence Emergency Management Act 2002 Epidemic Preparedness Act 2006 Health Act 1956 National Civil Defence Emergency Management Plan Order 2005 New Zealand Public Health and Disability Act Other important acts and regulations covering emergency management include, but are not restricted to, the: Civil Defence Emergency Management Regulations 2003 Fire Service Act 1955 (section 330) Forest and Rural Fires Act 1977 Health and Disability Commissioner (Code of Health and Disability Services Consumers Rights) Regulations 1996 Health and Safety in Employment Act 1992 Health (Infectious and Notifiable Diseases) Regulations 1966 Health Information Privacy Code 1994 Human Rights Regulations 1993 Injury Prevention, Rehabilitation and Compensation (Ancillary Services) Regulations 2002 Local Government Act 2002 Health Practitioners Competence Assurance Act 2003 (WHO) International Health Regulations Other References Ambulance Victoria Emergency Response Plan 2009 Ambulance NSW State Major Incident / Disaster Plan Feb 2006 Ambulances to Nowhere: America s Critical Shortfall in: Medical Preparedness for Catastrophic Terrorism. Joseph A. Barbera, MD, Anthony G. Macintyre, MD, Craig A. DeAtley, PA-C October Ambulances_to_Nowhere.pdf Australian Triage Cards: Toward A National Agreement. Norton and Field 2009 British Columbia Ambulance Service Mass Casualty Incident Emergency Management Plan Jul 2008 Civil Defence Emergency Management Competency Framework Technical Standard for the CDEM Sector [TS 02/09] June 2009 Comparative Analysis of Multiple Casualty Incident Triage Algorithms: Garner, Lee, Harrison, Schultz. Annals of Emergency Medicine Nov Coordinated Incident Management System (CIMS)1998 (Blue Book) Emergency Medical Services: At the Crossroads Chapter. 6 id=11629&page=175 Emergency Medical Services: The Forgotten First Responder A Report on the Critical Gaps in Organization and Deficits in Resources for America s Medical First Responders. New York, NY: Center for Catastrophe Preparedness and Response, New York University. Mar NYUEMSreport.pdf Focus on Recovery: A Holistic Framework for Recovery in New Zealand Information for the CDEM Sector [IS5/05] Feb 2005 KAMEDO Report 90: Terrorist Attacks in Madrid, Spain, Roger Bolling; Ylva Ehrlin; Rebecca Forsberg; Anders Rüter; Vivian Soest;Tore Vikström; Per Örtenwall; Helge Brändström (ed) Pre-hospital and Disaster Medicine edu Vol.22, No. 1 London Assembly: Report of the 7 July Committee June (London Bombings) National Health Emergency Plan, NZ MoH, Dec 2008 New Zealand Influenza Pandemic Plan: A framework for action. April NSW Heathplan May 2008 NZFS Incident Management Command and Control Technical Manual Nov 2007 NZS8156:2009 Ambulance Service Sector Standard NZS 31000:2009 Risk Management Principles and guidelines Report On Tilt Train Derailment At Rosedale (Berajondo). Dept. of Emergency Services, Queensland Government, Jan 2005 State Major Incident and Disaster Plan (Queensland) July 2004 The Guide to the National Civil Defence Emergency Management Plan 2006 The New Zealand Ambulance Service Strategy: The first line of mobile emergency intervention in the continuum of health care Tier 1 Emergency Departments Service Specification DHBNZ / MoH Dec 2002 Triage: a position statement. T Hodgetts. May 2001 for the European Union Core Group of Disaster Medicine 20 new zealand ambulance major incident and emergency plan (AMPLANZ)

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