MAJOR INCIDENT RESPONSE PLAN

Transcription

1 MAJOR INCIDENT RESPONSE PLAN Page 1 of 104

2 Contents Paragraph Part 1 Forward from the Chief Executive 3 The plan Page 1 Introduction 4 2 Major Incident definitions 7 3 The role of the Acute hospitals 8 4 Executive responsibilities for development, adoption and review of the plan 8 5 Interface with external parties 9 6 Major Incident evaluation and debrief 12 7 Guidelines for Major Incident exercise 14 8 Hospital Site Plans 15 9 Key Locations and telephone numbers Key Personnel quick reference guide 19 Part 2 Action cards 20 Part 3 Appendices Appendix A A scheme for the support of staff following a Major Incident Guidance for Staff Call-Out Appendix B CBRN Plan 75 Appendix C Appendix D Burns Major Incident Plan 103 Reference Documents 104 Page 2 of 104

3 The PRIMARY Command and Control Centre is situated in Seminar Room 17, Education Centre, Level 1, Queen Elizabeth Hospital Birmingham Should this area become out of action then : The SECONDARY Command and Control Centre will be situated in Trust Headquarters, Mendelsohn Way, Queen Elizabeth Medical Centre. BBW Security will allow access to Trust Headquarters via the side entrance Page 3 of 104

4 FORWARD FROM THE CHIEF EXECUTIVE This Major Incident response plan has been developed for University Hospitals Birmingham NHS Trust (UHB), to meet current legislation and forms part of the Trust Emergency Preparedness Plans. It provides a clear action plan to be undertaken in the event of a Major Incident and should be used with Local Action Cards specific to your areas of work. It is the responsibility of this Trust to ensure that this plan is shared with our staff, tested and updated to reflect the evolving requirements of safety and welfare for our patients, staff and the maintenance of our services. Each and every one of us has the responsibility to familiarise ourselves with the plan and our specific roles during a Major Incident. As an individual working for UHB it is essential that you take time to read this plan, to think about your individual responsibilities during its activation and to share it with others in your area of responsibility. Remember: If you are reading this plan because a Major Incident has been declared, then it is too late. Julie Moore Chief Executive October 2011 Page 4 of 104

5 Part 1 The plan 1. INTRODUCTION THIS PLAN aims to set out the structure and organisation of Queen Elizabeth Hospital Birmingham (QEHB) during the period of a Major Incident. Under the Civil Contingencies Act 2004, University Hospital Birmingham NHS Foundation Trust is classed as a Category 1 Responder. As a Category 1 Responder, the Trust is required to maintain plans which ensure that in the event of an emergency, (MAJOR INCIDENT), it can deliver a co-ordinated and effective response to the Incident. The Plan details the framework for the Trust s response to a MAJOR INCIDENT. The Plan has been written with reference to the NHS Emergency Planning Guidance AIMS OF THE PLAN. To ensure a level of quality response for the needs of the patients, their relatives, the Trusts staff and the media. To ensure effective arrangements for the command, control and co-ordination of services within the Trust. To ensure effective communications between the Trust and the Incident Site. To ensure effective communications between various agencies within the Health Service, other agencies (category 2 responders) and the media. To ensure awareness training of the Plan. To ensure training and education of relevant staff members is maintained in line with national guidance. To ensure that Plans are tested and updated regularly, in line with national guidance. To ensure a response to the needs and welfare of all staff during and after a MAJOR INCIDENT. Page 5 of 104

6 Therefore, ALL staff MUST endeavor to familiarise themselves with the overall plan so that they will have greater understanding of the entire situation. Realistically it is expected that QEHB, as the receiving hospital, could deal with major (immediate / urgent) and minor cases. PLEASE NOTE that it is imperative that each Division/Group/Department organises its own Staff Call-Out procedure (this applies to medical and non-medical Staff) in line with the guidelines in this policy for calling out staff and the action taken by Switchboard. THE CALL OUT PROCEDURE MUST NOT INVOLVE SWITCHBOARD, MUST ALWAYS BE KEPT UP TO DATE AND ALL STAFF WITHIN THE DIVISION / GROUP / DEPARTMENT MUST BE FAMILIAR WITH IT. It is also imperative that all Staff are aware of their arrival/registration point. Key Managers/Heads of Department (HOD) must ensure that all staff called out report to the Human Resource Manager in the Main Library Level 1 (Education Centre QEHB) to be registered before going to their work area. Medical staff will also report to the Library Level 1(QEHB) As well as the Action Cards set out in this Policy, which offer guidelines for all Key Personnel, it is vitally important that Key Managers/HOD ensure their Division/Group/Department has its own up-to-date Local Action Cards which fully detail any action required. Staff must be familiar with their own Local Action Cards ONE COPY OF ALL LOCAL ACTION CARDS AND CALL OUT PROCEDURES MUST BE HELD IN THE HOSPITAL COMMAND AND CONTROL CENTRE (SITUATED IN EDUCATION CENTRE LEVEL 1, SEMINAR ROOM 17 QEHB) Page 6 of 104

7 1.2 REQUIREMENTS OF THE CIVIL CONTINGENCIES ACT 2004 Risk Assessment and Emergency Plans. As a Category 1 responder, this Trust must assess the risk of an emergency within, or affecting the geographical area for which they have a responsibility, and prepare plans to mitigate these risks, where possible. Business Continuity The Civil Contingencies Act 2004 places a statutory duty on this Trust to ensure that it can:- Respond to an emergency; Continue to support emergency response partners; Continue to provide critical services to the public, as is reasonably practicable in the event of an emergency. The implementation of Business Continuity Management allows these requirements to be met. This process helps an organisation to continue to deliver its services in the event of a disruption, either internally such as a building flood / fire or externally such as a Major Incident, adverse weather conditions or loss of a service or supplies from an external service provider or contractor. This Trust has a prepared Business Continuity Plan to ensure that the Trust can meet these requirements. Ref UHB Business Continuity plan Warning and Informing The Civil Contingencies Act 2004 requires all Category 1 responders to maintain arrangements to warn the public if an emergency is likely to occur or has occurred, including the provision of information and advice to the public. A formal system for the West Midlands to warn and inform the public is established by the activities of the Local Resilience Forum Communication Group. Co-operation and Sharing Information The Civil Contingencies Act 2004 states there is a legal duty on all Category 1 responders to co-operate in the execution of their emergency planning duties. Within the West Midlands, the principal mechanism for co-operation between the responders is through the county s Local Resilience Forum (LRF) and structured role specific subgroups. Page 7 of 104

8 The Trust recognises that at the local level of it working in collaboration with partner agencies, including the sharing of relevant information, it is important to ensure that any response to a MAJOR INCIDENT is effective and well coordinated. 2. MAJOR INCIDENT DEFINITIONS A MAJOR INCIDENT is defined as an occurrence arising with little or no warning, that presents a serious threat to the health of the community, disruption to the service, or causes (or is likely to cause) such numbers of casualties as to require special arrangements to be made within this Trust. Major incident standby is the term used when there has been a report that a Major Incident has occurred but cannot be confirmed, or where the capabilities/capacities of other hospitals already alerted are filled. The Ambulance service will issue a Major Incident standby message. Major Incident declared is when the call-out procedures are activated. Stand-down is actioned by the Command and Control centre when the pressure on services is reduced after a declared incident or when stand-by is no longer deemed necessary. Major incident exercise is when the Trust initiates an exercise. 3. THE ROLE OF THE ACUTE HOSPITALS University Hospitals Birmingham operates on 2 sites: 3.1 The Queen Elizabeth Hospital Birmingham The Queen Elizabeth Hospital Birmingham is designated as a category 1 responder in the event of a Major Incident The old Queen Elizabeth The old Queen Elizabeth will provide support to the QEHB to enable resources to be used flexibly across both sites in order to respond to the increased activity Paediatric services In the event of UHB being designated as the receiving hospital for a major incident it will provide care to all ages. As UHB has no in-patient Paediatric facility however, Page 8 of 104

9 children will be managed in the following way: Children with minor injuries will be received, treated and discharged from the Trust. Children with major injuries will be received, emergency treatment will be initiated and after stabilization they will be transferred to the Birmingham Children s Hospital or another appropriate facility. 3.2 The Command and Control centre The Command and Control centre will be based in the Education Centre Level 1 seminar room 17 at QEHB. The responsibility of the Command and Control centre team is to: Lead and direct a coordinated approach to the management and deployment of Trust resources during the incident. To maintain an accurate record of actions undertaken during the incident to ensure detailed feedback and debrief. To provide a single focus for operational decisions likely to affect the whole hospital. Ensure clear lines of communication are maintained within and outwith the Trust. To brief call-in list responders and initiate a response by the provision of action cards and departmental plans. 3.3 The role of Divisions To develop an appropriate response on receiving directions from the Command and Control centre To activate call out procedures as per guidelines for calling out staff (appendix A) To develop and maintain a departmental specific plan and action cards for key roles in the event of a Major Incident. To ensure training and awareness of all staff Page 9 of 104

10 4. EXECUTIVE RESPONSIBILITIES FOR DEVELOPMENT, ADOPTION AND REVIEW OF THE PLAN 4.1 Chief Executive It is the Chief Executive s responsibility to ensure that the Trust has a Major Incident plan that complies with national guidance and that the plan is regularly tested and updated as necessary. 4.2 Chief Nurse Ensure the Major Incident procedure is updated and that all services and staff are aware of their responsibility. Arrange exercise of the key elements of the plan within the Trust in line with legislation. Evaluate the hospital s response and ensure modification to the plan as necessary. Ensure that the hospital s response plan is included in the staff induction programme and that staff are aware of their role in the event of there being a Major Incident. Delegate on-going training and awareness. 4.3 Director of Human Resources staff support The Director of Human resources will be responsible for the development and review of plans designed to provide support for staff during the response to the incident and for ensuring arrangements are in place to allow for an appropriate level of de-briefing and on-going support for staff. The Director of Human Resources will assist in the identification of training needs and the coordination and delivery of appropriate training. The Trust will participate with other agencies in the development and delivery of a county wide welfare plan. 4.4 Executive Directors, Directors of Operations Ensure all their staff are aware of their departmental responsibilities. Ensure that action cards are written, maintained and kept up to date for their department. Ensure that call out systems for off duty staff exists. Ensure that the departmental action plan is included in local induction programmes for all staff. Ensure amendments to the plan are notified to the Chief Nurse. Ensure changes to the Trust call in list are notified to the switchboard. Ensure on-going training and awareness. Page 10 of 104

11 5. INTERFACE WITH EXTERNAL PARTIES Dependant on the nature and scale of the Major Incident the Trust will liaise with partner agencies e.g. Police, Ambulance service, Birmingham cluster (formerly the Primary Care Trust) to ensure that it is delivering an effective response which is coordinated with multi-agency partners. The Trust will inform the Strategic Health Authority of the occurrence and nature of any Major Incident. 5.1 The Police In most instances the Police have overall responsibility for coordinating the strategic response to a Major Incident of all the emergency services and other organisations involved. They will coordinate the provision of information to the public and the media and will send a Documentation team to the receiving hospital. The role of the documentation team is to collate demographic information of the arrivals at Emergency department(ed) for the purposes of populating the Casualty Bureau systems of the deceased or injured. The team will consist of a team leader and Police officers trained in the role of hospital documentation. The team leader will, upon arrival, liaise with the Senior Nurse controller in ED. The team will arrive with standard documentation used for casualty collation and will establish an operating centre within the designated hospital documentation room in ED. 5.2 The Public Following a Major incident the Police will establish a casualty enquiry bureau to collate information from the public, mortuaries etc on people who may or may not have been involved in the incident. The information would be passed onto another unit to be checked and processed to determine whether further action is required. Once the bureau has been established the Police will issue a telephone number to the public via the media. In advance of the casualty enquiry bureau being established, enquiries from the public should be referred to the hospital information room until numbers are released by Police authorities. The documentation team will be responsible for forwarding information on all casualties and fatalities at the Trust to the casualty enquiry bureau. However, the Trust is free, as would be under normal circumstances to contact patient Page 11 of 104

12 relatives if they feel it is appropriate. Relatives arriving at the hospital for information will be accompanied by volunteers to the relative reception area situated in the Level 1 Therapies Services, South Suite Treatment The Media The Trust communications manager will continually brief the Chief Executive to enable effective communication with the public and the press. The Trust communications manager will liaise with the Police and other partner agencies in handling press activity for the Major Incident to ensure that briefings released to the media are consistent. Reference should be made to Local Resilience Forum (LRF) communications plan where an incident involves a multi agency response. NOTE: The Trust s communications manager must only brief the media on the Trust s response to an incident and not on the incident(s) itself. 5.4 The role of the Ambulance service The role of the Ambulance service is to: Alert the most appropriate receiving hospitals, based on local circumstances at the time. Dispatch an Ambulance Liaison Officer to each receiving hospital to supervise ambulance activity and liaison at the receiving hospital and provide mobile radio communication links between the hospital and the Ambulance service Ensure the Ambulance Incident officer will work closely with the Medical Incident Officer at the site of the emergency The Ambulance Liaison Officer will be based in the Emergency department and West Midlands Ambulance service will provide a Silver Commander to the hospital Command and Control room. 5.5 The role of the Birmingham Cluster (formerly the Primary care Trust) The role of the Cluster is to: Coordinate the local NHS response to an incident Mobilise primary and community care resources in support of the ambulance service Page 12 of 104

13 Provide support to acute and non acute hospital Trust s in their response to an incident 5.6 The role of Birmingham City Council Emergency planning division The role of the Birmingham City Council is to: Coordinate the City response to an emergency In the event of a mass fatality situation consult with the Police and appropriate Coroner to select the most suitable pre designated emergency mortuary option Arrange for rest centres/survivors reception centres/emergency accommodation to be provided or those who have been evacuated during an emergency Facilitate the provision of City council and other resources to assist the emergency services Co-ordinate the recovery from the emergency together with other agencies 6. MAJOR INCIDENT EVALUATION AND DEBRIEF 6.1 Evaluation Following any Major Incident practice or incident the relevant Executive Director will be responsible for ensuring the evaluation and debrief of the effectiveness of the Trust response takes place. In order to assist this process, every division and department must: Evaluate the effectiveness of their call out procedures. Ensure mechanisms are in place to evaluate the level of response Record any problems related to poor communication or unavailability of resources Record variations to normal service delivery The Command and Control centre will ensure monitoring arrangements are in place to record all information received by the centre and all actions that generate from within the Command and Control centre. Page 13 of 104

14 6.2 Debrief A formal Trust wide debrief will be completed within 6 weeks of the incident and may involve external agencies. Individual departmental debriefs will be completed at a time deemed appropriate by the departmental lead clinician. The Trust will participate in an inter-agency debrief as initiated by the regional City Emergency planning officers. 6.3 Review of the Major Incident plan It is the responsibility of the Chief Nurse in conjunction with the Major Incident planning team to review the plan as required by legislation. This review will take into consideration any action arising from the evaluation of any incident or exercise, changes within the Trust, and of any new guidelines that may have been issued. Account will also be taken of any changes to Major Incident plans of partner organisations. 6.4 Training and awareness The Trust will provide mandatory training for all Trust staff in Major Incident awareness. The level of training will depend on the level of responsibility of staff. Staff who undertake key roles in the event of a Major Incident will be given role specific training. 7. GUIDELINES FOR MAJOR INCIDENT EXERCISE In the event of a major incident ambulance control will notify Queen Elizabeth Hospital Birmingham Switchboard using the following code words:- Page 14 of 104

15 7.1. If the Hospital is to be alerted only of a possible Major Incident (yet to be confirmed), or where the capabilities / capacities of other hospitals already alerted are filled then the message passed will be:- "MAJOR INCIDENT - STANDBY" If, having initiated "STANDBY", it is found not to be required Ambulance Control will pass on the following message to Switchboard:- "MAJOR INCIDENT - CANCELLED" The Hospital Switchboard will then immediately notify those individuals originally informed of the Standby If the Hospital is required to initiate the Major Incident Plan then the message passed will be:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN" The Hospital should be informed whether it is a RECEIVING or SUPPORTING Hospital When the site of the incident is cleared and all casualties have been moved Ambulance Control will pass on the following message to Switchboard:- MAJOR INCIDENT STAND DOWN The hospital switchboard will then immediately notify the Command and Control Centre manager, who will then decide the point at which to call the Hospital Stand Down, i.e. when Hospital activity has fallen to near normal levels MAJOR INCIDENT EXERCISE This is when the Trust initiates an exercise of one or more of its components. All test messages will be prefixed with EXERCISE, EXERCISE, EXERCISE. Page 15 of 104

16 Parking on the Queen Elizabeth Hospitals site When visiting our hospitals we recommend the following Car Parks as the most convenient: For the new Queen Elizabeth Hospital Birmingham use Car Park A (sat nav postcode B15 2WB) For the old Queen Elizabeth Hospital use Car Park D (sat nav postcode B15 2TH) For the Emergency Department (A&E) or CDU use Car Park D (sat nav postcode B15 2TH) Key Entrance Entrance and info desk Disabled Entrance Disabled Parking Parking Bus Stop Centro / WM Walk Route Disabled drop-off / Taxi drop-off / nonemergency transport Shuttle bus Metchley Lane Harborne Park Rd Queen Elizabeth Hospitals Busy Bees Nursery 64, /a/b 647 Harborne /a/b Harborne Lane Staff Car Park F Selly Oak Mindelsohn Way Clinical Decision Unit (CDU) entrance Shuttle Staff Car Park B1 Ambulances & Buses only 448/a/b 647 Mindelsohn Way Vincent Drive Access for residents only /a/b CDU Birmingham Women s Hospital A&E The Barberry (BSMHFT) Metchley Park Road A&E entrance and drop-off (15 mins waiting only) Queen Elizabeth Hospital Birmingham 64, /a/b Main Entrance Patient / Visitor/ Outpatients (non - A&E, CDU) Shuttle Shuttle 647 Aston Webb Boulevard THQ New QEHB Parking Car Park A Visitor and Patient (non - A&E & CDU) Post Graduate Centre The Oleaster (BSMHFT) Old QE Parking Car Park D Visitor / Patient / A&E / CDU Shuttle Cancer Centre Shuttle Hospital Way Mindelsohn Way Mindelsohn Crescent Shuttle B15 2WB New Fosse Way Nuffield House Mindelsohn Way Old Queen Elizabeth Hospital Staff Car Park E 64, 76 84, 98 64, 76, 84 98, /a/b Medical School Vincent Drive closed to vehicles 64, 76 84, 98 98, /a/b New Fosse Way Aston Webb Boulevard Centre Club (one way only) Shuttle Shuttle 98, /a/b Bristol Road A38 Vincent Drive University Station Car Parking Charges 0 1hr hrs hrs hrs hrs hrs hrs 6.40 Over 8hrs Weekly Pass The service runs from 07:00-19:00 Monday-Friday (excluding Bank Holidays). Parking on the Selly Oak Hospital site When visting Outpatients Departments at Selly Oak Hospital choose the parking area closest to the location of your appointment. This is identified on your appointment letter. 61, 62, 63, 64 61, 62, 63, Oak Tree lane Oak Tree lane Harborne Lane Sainsbury s 11 61, 62, 63, 64 H.A.R.C Centre Raddlebarn Road Bristol Road A38 Birmingham Selly Oak Hospital Raddlebarn Road Raddlebarn Road B29 6JD Selly Oak Fenced off area Correct at 27 July 2012

17 9. Key locations and telephone numbers KEY LOCATIONS AND TELEPHONE NUMBERS Internal HOSPITAL CONTROL CENTRE Seminar room 17 Level 1 Education centre QEHB DDI Phone for receiving external calls only Fax Breakout room 1 Seminar room 16 Level 1 Education centre QEHB Breakout room 2 Seminar room 18 Level 1 Education centre QEHB TRIAGE POINT MAJOR INJURIES AREA (immediate & urgent cases) MINOR INJURIES Ambulance Entrance Emergency Department Main Emergency Department AREA BODY HOLDING AREA Quiet room (rear of resus) Emergency Department MAIN ADMISSIONS AREA DISCHARGE AREA Those patients in A&E at the time of the emergency and other hospital inpatients RELATIVES AREA Page 17 of 104 Runners Resuscitation area See and treat area Ward 410 QEHB Ward West 4 old QE Therapy services south suite Level 1 QEHB

18 INFORMATION CENTRE PRESS AREA POLICE AREA (DOCUMENTATION TEAM) STAFF REPORTING AREA QEHB RCDM CONTACT OFFICER Sister s office, Emergency Department Old QEH Post graduate centre Emergency Department Seminar Room Main library Level1 Education centre QEHB Education Reception RCDM TEMPORARY MORTUARY MEDICAL STAFF REPORTING AREA Furniture and Equipment store Level -1 Main library Level 1 Education centre QEHB BBW SECURITY BBW HELPDESK + CAR PARKING Page 18 of 104

19 10. Key personnel quick reference guide KEY PERSONNEL QUICK REFERENCE The following list defines the roles to be undertaken by personnel in the event of a Major Incident:- 1. MEDICAL CONTROLLER Medical Director of UHB Trust, or nominated deputy 2. NURSING CONTROLLER Chief Nurse or Deputy Initially Site Senior Nurse/site on-call sister until relieved by above 3. CONTROL CENTRE MANAGER Overall responsibility for the management of the incident within the Trust Exec on call Initially site manager until relieved by above. 4. TRIAGE OFFICER Duty Emergency Department SpR Until relieved by 2 nd available ED Consultant 5. EMERGENCY DEPARTMENT - CLINICAL CONTROLLER 6. CRITICAL CARE UNIT CLINICAL CONTROLLER 7. THEATRES CLINICAL CONTROLLER Duty Emergency Department SpR Until relieved by Duty ED Consultant ITU registrar Until relieved by Duty ITU Consultant 1 st on call Anaesthetist Until relieved by Duty Anaesthetic Consultant Duty Trauma Consultant 8. TRAUMA WARDS CLINICAL CONTROLLER 9. CLINICAL STAFF Duty Medical Consultant CONTROLLER 10 STAFF VOLUNTEER Human resource manager RECEPTION MANAGER 11 CAPACITY LEAD MANAGER ADN or Available site manager. 12 EMERGENCY DEPARTMENT On call manager SUPPORT 13 BBW SECURITY (119) Ensure doors are deactivated and signage erected 14 BBW HELPDESK (777) Ensure Consort On Call Manager has been contacted 15 CONSORT ON CALL MANAGER Ensures, BBW, Q-Park and Kcom ( if applicable) are continuously updated Page 19 of 104

20 PART II ACTION CARDS THE SPECIFIC ACTION CARDS and notes that follow act as guide to key personnel in the organisation of the hospital during the emergency ONLY key personnel responsible for organisation of key tasks or whose role will change dramatically are included in the document. One Copy of the Action Cards forming part of this policy will also be held separately in the Command and Control Centre in the Education Centre, Level 1, Seminar Room 17 QEHB. A second set of action cards are held in the SECONDARY Command and Control Centre, Trust Headquarters. Key personnel must have their own, and their Division/Group/Department Action Cards available and copies of all local Actions Cards will be kept in the Hospital Control Centre. All key personnel must collect their card from the Control Centre and sign for it as soon as possible after "Call Out". This will enable the Control Centre Manager to monitor staff in position. All key personnel and Heads of Department must ensure that all their staff are issued with local Action Cards immediately. It is also the responsibility of key personnel and/or Heads of Department that staff under their control are fully aware of their responsibilities set out on the Local Action Cards. Page 20 of 104

21 SWITCHBOARD OPERATORS Major Incident calls should come from Ambulance control; however they may sometimes be made from the Emergency Department. On receipt of a call that states: MAJOR INCIDENT STANDBY OR MAJOR INCIDENT DECLARED ACTIVATE PLAN Switchboard operator will take details of the incident using the MAJOR INCIDENT METHANE PROFORMA M identity of caller ( WMAS or ED or other) confirm major incident standby or declared or internal response plan E exact location of the incident T type of incident (e.g. rail crash) H Ask if any particular hazards present at the scene (e.g. Fire/chemical/explosion) A assessment of the situation from the caller any further information relevant to the Trust N number and type of casualties / injuries ask for estimated number of casualties involved. E emergency / internal services present on scene or required to the scene. if internal response plan, then ask if emergency services have been contacted.- if not ask caller what is required and then make 999 call on behalf of the trust. A copy of this report (blank proformas kept in switchboard) must be taken to hospital control room after call-out procedure completed. Page 21 of 104

22 For STANDBY The following will be informed: Medical Director Duty Emergency Department Consultant Duty Anaesthetic Consultant QEHB Critical Care unit Duty Medical Consultant Site managers QEHB Senior Manager on call Haematology Technician Switchboard Manager Duty Surgical Consultant (Vascular) & General Surgery Duty Trauma Consultant Lead/on call Radiologist QEHB Emergency Department alert phone ext On call manager / DIV C Support manager For ACTIVATE PLAN Switchboard Staff: Will be informed that a Major Incident has been declared and that they should activate their plan giving brief details of the type of incident. Switchboard should inform all staff of the Incident via Mass Bleep giving very brief details, (eg plane crash, chemical spillage, etc) and location, stating: MAJOR INCIDENT DECLARED details location ACTIVATE PLAN Inform Switchboard manager who will activate call-out of other Switchboard staff. Contact staff according to Operator Priority List. Inform or Fax Control room with response from call out. Once the Command and Control room confirms that the Casualty Bureau has been set up by the Police, Switchboard will be issued with the number to give out to all incoming enquiries. Page 22 of 104

23 OPERATOR ONE LIST In support of the Mass Bleep, Switchboard will contact staff according to the priority list as follows. All listed should implement their own internal call-out plans. A list should be maintained for reference of any staff that are not contactable. Area Contact 1 Emergency Department (staff base) 2 Emergency Department Consultant on call 3 On-Call Manager (Division C support manager in hours) 4 Chief Nurse 5 Medical Director 6 Chief Executive 7 2 nd on call manager 8 Management Executive on call 9 Medical Consultant on call QEHB 10 BBW Helpdesk 11 Trauma Consultant on call 12 Anaesthetics Consultant on call ( Critical care) 13 Anaesthetics Consultant on call (Theatres) 14 Burns and Plastics Consultant on call 15 Surgical Consultant on call - Vascular 16 Surgical Consultant (Liver Consultant on call if not available) 17 On call Chaplain 18 Trust Head of Communications 19 Trust Estates & Contracts On Call 20 Facilities Manager on call 21 Medical Records Manager 22 On call Haematologist 23 On Call Radiographer 24 Duty Consultant Radiologist Page 23 of 104

24 OPERATOR TWO LIST In support of the Mass Bleep, Switchboard will contact staff according to the priority list as follows:- A list should be maintained for reference of any staff who are not contactable.. 1 Director of Human Resources. 2 Loggist (see Loggist Rota) 3 Consultant Maxillofacial Surgeon on call. 4 Biochemistry on call 5 Neurosurgical Consultant on call 6 Pharmacist on call 7 Cardiothoracic Consultant on call 8 Anaesthetics Consultant on call (Neuro Critical Care) 9 Cardiology Consultant on call 10 Neurology Consultant on call 11 Renal Medical Consultant on call 12 RCDM Duty Officer 13 Physiotherapist on call 14 Oncology Consultant on call 15 Medical Illustration 16 Social work manager Page 24 of 104

25 CHIEF EXECUTIVE The Chief Executive will be primarily responsible for managing external affairs during the incident including:- 1. Liaise with other Local Provider Chief Executives. 2. Attend ERMA 2 Control Room if requested/on-call 3. Liaise with communications officers to oversee any Press releases on behalf of the Trust. 4. Be prepared to give Press briefings as required. 5. Strategically oversee the control room(s) and advise with regard to UHB service provision 6. Inform Chairman of UHB Trust Page 25 of 104

26 CONTROL CENTRE MANAGER Tabard from Command and Control Centre Control Centre Manager The first available On-Call Manager will assume the role of Control Centre Manager and proceed as the controller undertaking the listed duties unless/until relieved by a Senior Manager / Executive on-call. The Control Centre manager will be responsible for the overall management and control of the incident within the Trust. The Control Centre Manager will liaise with the Medical and Nursing Controller throughout the Incident On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN. 1. Initiate Major Incident Call-Out procedure. Including Chief Operating Officer or Deputy Chief Operating Officer and Directors of Operations 2. Proceed to Hospital Control Centre (QEHB), refer to Action Card and don Tabard. Take out command and control centre managers box from major incident cupboard. 3. Ensure that the Emergency Incident log book 101 is used and that all decisions, actions and messages are being logged. Until Loggist is present, commence Log book 101, documenting time, reason and person who has opened the Command and Control centre. 4. Liaise with Medical and Nursing Controller and ascertain nature of incident 5. Designate manager to undertake Emergency Department support 6. Designate Manager to undertake duties of Press Officer and Information Officer until relieved by appropriate personnel 7. Discuss with Loggist how key decisions will be maintained and recorded 8. Send available Manager to Main Library Level 1 (staff reporting) to act as Liaison with Control Room until HR and ADN in place. Page 26 of 104

27 9. Ensure Action Cards available together with record sheet of staff roles. Check that all Action Cards are taken by appropriate personnel 10. Ensure that Division / Department Call-Out procedures have been implemented if required. 11. Liaise with RCDM of Major Incident via the RCDM Duty officer 12. Coordinate the set up of the temporary mortuary in furniture and equipment store, level Ensure all priority areas are made ready to receive patients. 14. Ensure staff are allocated to the Information Room where Staff will receive calls from the general public and press initially until press room established. Ensure staff are allocated to the Press Area until relieved by the Communications team. 15. Liaise with Police, Ambulance and Fire Services as necessary 16. Liaise with Capacity Lead Manager, who will be working from the breakout room near to the control centre. 17. Liaise with Information Room Officer and Press Officer 18. Liaise with Medical and Nursing Controllers to manage bed state effectively 19. Where this is an external incident, receive Stand Down from West Midlands Ambulance Service and make executive decision, in collaboration with Medical and Nursing Controllers, to stand down the Trust. Emergency Response and Management Arrangements (ERMA) Activation Procedure To contact the ERMA Level 2 Commanders (PCT and Acute Chief Executives on call) for the West Midlands Conurbation please telephone First Response on First Response will then contact the appropriate on-call person. This telephone number is a 24/7 priority line. Page 27 of 104

28 NURSING CONTROLLER Tabard in Command and Control Centre Nursing Controller This role will be undertaken by the Site Manager for the Hospital (24/7 Team or Hospital at Night) until relieved by the Chief Nurse / Deputy Chief Nurse. In the absence of both the Chief Nurse and the deputy Chief Nurse this role will be undertaken by an Associate Director of Nursing. The Nursing Controller will be based in the Hospital Control Centre and will be responsible to the Control Centre manager who has overall responsibility for managing the incident. On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". 1. Proceed to Hospital Control Centre and set up room from Major Incident Cupboard. (See guidance notes in major incident cupboard) Start a log book of all actions and times. If available, task untrained member of staff to assist you in initial set-up. 2. Liaise with Medical Controller and ascertain the nature of the incident. Proforma will be sent from switchboard with initial METHANE message. 3. Call all Senior Nurses available and instruct them to inform all ward and Nursing departmental areas to be ready to activate their plan. Advise staff to await instruction from control centre before activating call out staff procedure (guidance at appendix A). Only ED will activate their call out at this stage. Advise ward staff to remain on duty until senior nurse for their area decides otherwise. Please bear early consideration to other key areas that may need staff to be called in. e.g. Critical care, Theatres, Burns. 4. Implement Nursing Directorate staff call out procedure as decided from within the Control centre. 5. Assess present bed state, liaise with Medical Controller and continue to monitor throughout the incident. Notify Admission Areas. 6. Give instruction to begin transfer / discharge of current patients from Ward Give instruction to begin transfer/discharge of current patients from Therapies Services Level 1 South Suite Treatment 7 to accommodate the relatives area. Page 28 of 104

29 8. Liaise with Key Admission Areas (below) regarding patient flow and staffing. Emergency Department and Minors area (see & treat) WARD 410 Critical Care Unit Theatres Ward West 4 old QE Therapies Services Level 1 Ambulatory Care level 0 9. Delegate Trained Staff from Staff Reporting, Main Library, Education Centre Level 1, to areas being prepared for patients. Consider staffing Education Centre Level 1 early until controlled by The H.R Dept. Assign ADN to this area. 10. Liaise with Human Resource Manager with regard to deployment of Nursing Staff under the supervision of the assigned ADN. 11. Liaise with Medical Consultants and Senior Nurses to manage bed state 12. Liaise with Nursing, Management and Clinical Controllers to agree the point at which stand down is called. Page 29 of 104

30 MEDICAL CONTROLLER Tabard in Command and Control Centre Medical Controller This role will be undertaken by the Medical Director of the Trust or a nominated Deputy The Medical Controller will be based in the Hospital Command and Control Centre and should be the medical point of contact for Senior Hospital Management in coordinating the hospital response to the incident. On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". 1. Contact Ambulance Control (Duty Officer) to obtain detailed information of the incident (Tel: ). 2. Work with Nursing Controller and ascertain present bed state via Capacity Manager. 3. Inform Clinical Controllers of bed state and details of the incident. 4. Ensure adequate medical staffing of:- Emergency Department Ward 410 Admissions Ward Critical Care Unit Theatres Ambulatory Care level 0 CDU Wards 5. Authorise cancellations of Theatre lists, TCI's, Outpatient Clinics as discussed and agreed by Control Centre Manager. 6. Liaise with Nursing, Management and Clinical Controllers to agree the point at which stand down is called. Page 30 of 104

31 LOGGIST Tabard in Command and Control Centre Loggist This role will be undertaken by designated personnel The role of the Loggist is to record all key decisions taken or not taken by the decision maker On receipt of the instruction:- MAJOR INCIDENT DECLARED- ACTIVATE PLAN 1 Report to the Major Incident command and control room (Education Centre Level 1 seminar room 17) 2. Meet with control centre manager to ensure that clear guidance is given on what they want you to log during the incident 3 Take out the Loggist box from the Major Incident cupboard 4 Commence Emergency Log book 101 (this may have initially been commenced by whoever has opened the Command and Control centre, but will not be in any official format) 5. Refer to Loggist training manual for best practice 6. Use abbreviation list provided in Loggist box as required 7. After the incident or change of Loggist enter into a debrief with decision maker and go through the log carefully ensuring this is signed off at the end 8. Following the debrief at the end of the incident ensure that all logs are locked away and secured in the designated area Page 31 of 104

32 CLINICAL STAFF CONTROLLER) (DUTY MEDICAL CONSULTANT.) Tabard in Command and Control Centre Clinical staff controller This role will be undertaken by the Duty Medical Registrar until relieved by the Duty Medical Consultant. On receipt of the instruction:- MAJOR INCIDENT DECLARED- ACTIVATE PLAN 1. Receive details of the incident from Command and Control centre. 2. Report to the Main Library Level 1, swipe access will be opened. 3. Co-ordinate all Medical staff to appropriate/priority areas during the incident. 4. Contact off duty Consultants in specialties relevant to the type of suspected injuries from information pertaining to the incident, to ascertain their availability and request their attendance to the Main Library Level Designate and support the call out of all off-duty specialty Doctors to an assistant supplied to you. 6. Co-ordinate all Medical staff as they attend from outside the Trust. 7. Liaise with the clinical controller, Emergency Department, for staffing requirement.(ext /21607 ) 8. Advise HR rep to check Trust ID and GMC numbers. # SEND A TRAUMA TEAM TO THE EMERGENCY DEPARTMENT AS A MATTER OF PRIORITY # Note: Doctors Call out numbers will be kept up to date (by the Data Management Team) in the Command and Control room, Major Incident cupboard..be aware that all Doctors on duty in the Hospital at the time of a Major Incident will automatically attend the Main Library Level 1, other than registrars who will have consultant tasks to perform until relieved by consultants. Page 32 of 104

33 CLINICAL CONTROLLER EMERGENCY DEPARTMENT Tabard in Command and Control Centre Clinical Controller Emergency Department This role will initially be undertaken by the Duty Emergency Department Specialist Registrar (SpR)/Middle Grade until relieved by the Duty Emergency Department Consultant. The Clinical Controller Emergency Department will be based in the Emergency Department On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN" 1. Ensure Emergency Department call out procedure is actioned for Doctors. Collect action card and tabard from Command and Control Centre (level 1 seminar room 17 education centre) and return to Emergency Department. 2. Commence or continue clearance of Emergency Department by admitting, discharging or transferring existing patients as appropriate. 3. Allocate available medical staff: To deal with immediate/urgent cases on a 1:1 basis where possible To Minor Injuries area (see and treat) To body holding area (as a consideration) Triage Officer 4. Give advice on individual patient management in the Emergency department in conjunction with the Triage Officer. 5. Liaise with Medical Controller to obtain updated details of the incident. 6. Liaise with Clinical Controllers Critical Care, Theatres and Wards 7. Attend the Bunker style meetings in conjunction with Trauma, Critical Care and Theatre Clinical Controllers. The initial meetings will be held within the Emergency Department, subsequent meetings will take place in the coordination centre, Theatres. Page 33 of 104

34 8. Liaise with Clinical staff controller (library) regarding Medical staffing requirements. 9. Receive the order to stand down from the Control Centre Manager and communicate this to other Emergency Department staff. Page 34 of 104

35 SENIOR NURSE EMERGENCY DEPARTMENT Tabard in Emergency Department Senior Nurse Emergency Department This role will be undertaken by the Senior Nurse on duty in the Emergency Department until relieved by the Emergency Department Nurse Manager. This Manager should not become involved with individual cases and will not co-ordinate the Emergency Department. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN. 1. Initiate Emergency Department Staff Call-Out procedure if not already done so by ED Nurse Coordinator 2. Support the clearing of the Department as follows:- Where admission or transfer has been arranged, admit or transfer. Admit or transfer urgent cases requiring medical intervention. Discharge non-urgent cases home or to Ward West 4 to await transport Support ED Nurse Co-coordinator in allocating/making announcement to ED waiting room patients (see script card) 3. Activate the lock-down of walking wounded entrance to Emergency Department ( BBW helpdesk 777) 4. Liaise with Lead Nurse Minor Injuries (See and Treat). Prepare to clear clinic / area if necessary. 5. Support the allocation of Senior Emergency Department Nursing Staff to:- Triage point (Ambulance entrance) Resuscitation Room Cubicles Holding Area (ED VIEWING ROOM) Minor Injuries Area ( See and Treat) Allocate any remaining staff delegate as required Page 35 of 104

36 6. Issue log sheets to staff when allocated to a patient / area 7. Liaise with Nursing Controller and assess extra staffing requirements 8. Supply immediate bed requirements and work in conjunction with ED support manager 9. Liaise with Clinical Controller Emergency Department. Arrange for nursing staff to work on a 1 to 1 basis with medical staff/ patients. 10. Liaise with Emergency Department Reception Staff and establish patient log / ledger. Assist in collating the information on the log sheets held by the ED Lead Nurses for all areas, onto the main ED Coordinators patient log. 11. Oversee staffing requirements for the ED during and post incident 12. The Police Documentation Team will be based in the ED Seminar room. They will require access to patients and any accompanying persons, from the incident. The Police Documentation Team will require Identity information to be released to them from the Department, in addition to the copy of the Patient registration document from ED Reception. Support staff during this process. 13. Receive stand down from Control Centre Manager and cascade to staff Page 36 of 104

37 CLINICAL CONTROLLER CRITICAL CARE Tabard in Control Room Clinical Controller Critical Care This role will be undertaken by the Critical Care Unit (CCU) registrar, until relieved by the duty CCU Consultant. On receipt of the instruction:- MAJOR INCIDENT DECLARED - ACTIVATE PLAN 1. Go to Command and Control Room to collect Action Card and Tabard 2. Receive details of the incident and current bed state. 3. Report to Critical Care and oversee all areas. 4. Assess patients, identify those suitable for transfer. 5. Liaise with Clinical Controller in the Emergency Department to estimate number of critical care beds required and assistance required and Clinical Controller of theatres to deploy staff between Critical Care, Emergency Department and operating theatres as requested. Discuss staffing requirements with the Clinical Staff Controller in Staff Reporting Centre. 6. Liaise with Medical Controller regularly. 7. Liaise with Clinical Controller of wards to estimate number of beds available for Critical Care transfers. 8. Arrange discharge and preferred destination for existing Critical Care patients to be transferred to general wards, other Critical Cares or other hospitals as appropriate. 9. Attend the BUNKER style meetings in conjunction with Emergency Department, Trauma and Theatre Clinical controllers, the initial meetings will be held within the Emergency Department, subsequent meetings will take place in the Co-ordination Centre, Theatres 10. Co-ordinate and participate in medical management of admissions to Critical care 11. Receive stand down from Control Centre Manager and communicate to other staff. Page 37 of 104

38 CLINICAL CONTROLLER THEATRES Tabard in Command and Control centre Clinical Controller Theatres This role will be undertaken by the first on-call anaesthetist for theatres until the duty anaesthetic consultant arrives or during the day by a senior anaesthetist present in the theatre suite. On receipt of the instruction:- MAJOR INCIDENT DECLARED - ACTIVATE PLAN. 1. Go to Control Room to collect Action Card and tabard. 2. Receive details of the incident and current bed state. 3. Report to theatres. Activate Local Action Cards in conjunction with Theatre Supervisor / Team Leader 4. Set up Theatre Co-Ordination centre in Office Consider suspending all operating except for previously booked lifethreatening emergencies following discussion with the Medical Controller in the Command and Control centre. 6. BBW will ensure that the Access Control will be De-activated in the event of a Major Incident. 7. Set up the Theatre Co-Ordination Point at Theatre / Recovery junction to allocate patients through to Theatres as they become available and staffed. 8. Clear recovery and liaise with Ward Controller who will allocate beds via Capacity Manager. 9. In liaison with Clinical Controller Critical Care (level 2), deploy the available anaesthetic staff between operating theatres, and Emergency Department. 10. Arrange for the anaesthetic staffing of further operating theatres as they are required, the Clinical Staff Controller will contact medical staffing as required. 11. Liaise with the Theatre Manager for Theatre suites regarding the call out of additional theatre and recovery staff (The initial command for doing this will come from the Command and Control Centre Manager) 12. Liaise with Medical Controller regularly. Page 38 of 104

39 13. Attend the BUNKER style meetings in conjunction with Emergency Department, Trauma and Critical Care Clinical controllers, the initial meetings will be held within the Emergency Department, subsequent meetings will take place in the Co-ordination Centre, Theatres. 14. Receive stand down from Control Centre Manager and cascade to staff. Page 39 of 104

40 CLINICAL CONTROLLER MEDICAL Wards Tabard in Command and Control centre Clinical Controller Medical Wards. This role will be undertaken by the Duty Medicine Registrar until relieved by an available Medicine Consultant (NOT DUTY CONSULTANT) On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". 1. Report readiness to Clinical Staff Controller in Main library Level 1 and receive details of the incident and current bed state. 2. Initially have teams of medical staff assess for potential discharges/transfers. Once actioned by Medical Controller, Ensure discharge / transfer of patients is activated on all Wards using the teams of medical staff allocated to you by the Clinical Staff Controller. Command and Control centre will advise of the discharge facilities available for patients awaiting discharge medicines and transport. 3. Liaise with The Clinical Staff Controller regularly for staff deployment. 4. Liaise with Clinical Controllers Emergency Department, Critical Care Unit 5. Liaise with Hospital Command and Control Centre to manage bed state effectively. 6. Receive the order to stand down from the Control Centre Manager and cascade to staff. Page 40 of 104

41 All CONSULTANT STAFF EXCEPT CLINICAL CONTROLLERS On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". 1. Report to the Main Library Level 1, Education centre, QEHB. 2. Report to and liaise with the Staff Clinical Controller (Duty Medical Consultant) at all times 3. Areas which will require Consultant attention:- - Clinical Decisions Unit - Theatres - Main Wards - Secondary triage - Emergency Department - Imaging Department Level 1 - Admission ward Critical Care Unit - Theatre reception - Minor Injuries Area Emergency Department - Relief and support of colleagues Page 41 of 104

42 ALL JUNIOR DOCTORS AND MEDICAL STUDENTS ALL SPECIALITIES On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". IF OFF DUTY You will be contacted to attend the Trust and report to the Main Library Level 1 to await tasking/allocation. IF ON DUTY - 1. Report to Clinical Staff Controller in the Main Library Level 1 Education centre QEHB. 2. You will be allocated to one of the four areas:- - Main Emergency Department (immediate / urgent injuries) - See and Treat Area ED (minor injuries) - Holding area in Emergency Department - The main hospital under the direction of the Clinical Controllers. 3. Assist on management of patients in ED:- - Ideally there will be at least one Doctor and one Nurse for each patient. You may be required to act as a scribe for each of the ED teams. - Unless otherwise instructed, stay with the patient you have been allocated. - It is essential that ALL DRUGS AND FLUIDS administered to a patient are recorded on the appropriate charts. - Advice on patient management should be sought from the Triage Officer or the Clinical Controller, Emergency Department. ENSURE ALL DOCUMENTATION IS COMPLETED BEFORE LEAVING THE PATIENT. MEDICAL STUDENTS MAY BE ASKED TO ACT AS SCRIBES OR RUNNERS DURING THE INCIDENT 4. Please inform the Clinical Controller in your area should you need to leave your area before stand down is called. 5. The Clinical Controller in your area will inform you when the stand down is called. Page 42 of 104

43 EMERGENCY DEPARTMENT RADIOLOGY CO-ORDINATOR Tabard in Command and Control centre ED Radiology Co-Ordinator This role will be undertaken by the Group Manager or the most Senior/ Superintendent Radiographer available. On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". 1. Report to Medical Controller in Hospital Control Centre and then proceed to Emergency Department Imaging Department. 2. Make contact and identify a Lead Radiographer (ideally the Superintendent lead, alternatively the most Senior Radiographer available) in: Emergency Department Imaging level 1 Main Imaging Department level 0 3. Ensure that Departmental Major incident procedure has been implemented and that all Superintendents are aware. 4. Confirm staffing levels in each Department are adequate and able to be flexed according to demand including across site.out of hours, one or more of these roles may have to be combined according to numbers available and nature of the incident 5. Return to the Emergency Department and make contact with the Duty Consultant and Senior Nurse, Emergency Department. Agree a method of contact and establish a mechanism of regular communication. Page 43 of 104

44 6. As patients are triaged, continuously assess nature of injuries and therefore likely imaging requirements and by liaising with the Supt Leads, organise the flow of patients to and from Emergency Department to the Emergency Department Imaging, Main Imaging department as appropriate, as follows: Emergency Department Imaging major injuries/ highly dependant patients requiring plain film examinations Emergency Department CT scanner All major injuries requiring CT Main Imaging Dept. Level 0 all walking wounded, some agreed low dependency trolleys Imaging Main Dept CT scanner ( level 0) low dependency patients requiring CT Control numbers according to patient dependency 7. In liaison with Superintendents, assess ongoing staffing requirements for night and following day shifts. As necessary, send staff off duty in order to ensure continuity of cover. 8. Receive instruction to stand down from the Control Centre Manager. Page 44 of 104

45 CLINICAL CONTROLLER TRAUMA Tabard in Command and Control centre Clinical Controller Trauma This role will be undertaken by the duty Trauma Registrar until they are relieved by the duty Trauma Consultant. On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". 1. Record attendance in the Main Library Level 1, to the Clinical Staff Controller. Give an indication of the level and numbers of Trauma staffing you feel will be required initially to be called in. Report readiness to Medical Controller in Hospital Control Centre and receive details of the incident and current bed state. 2. Prepare to open the first emergency theatre by communicating with the Clinical Controller Theatres. 3. Ensure maximum discharge of patients from wards to the emergency discharge facility (ward west 4) by allocated SHO/ST1/ST2. Ward 410 will require early medical assistance to discharge or transfer patients to other bed capacity. The Capacity Manager will oversee Hospital capacity and the bed management team will liaise regarding capacity moves. 4. Report to Clinical Controller Emergency Department and assist with resuscitation until required in theatre. 5. Attend the BUNKER style meetings in conjunction with Emergency Department, Theatre and Critical Care Clinical controllers, the initial meetings will be held within the Emergency Department, subsequent meetings will take place in the Co-ordination Centre, Theatres. 5. Ensure supply and support of Trauma doctors to the Emergency Department team. 6. Receive stand down from Control Centre Manager. Page 45 of 104

46 CLINICAL CONTROLLER BURNS AND PLASTICS Tabard in Command and Control centre Clinical Controller Burns and Plastics This role will be undertaken by the duty burns and plastics registrar until relieved by the duty burns and plastics consultant. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN. 1. Report attendance in the Main Library Level 1 to the Clinical Staff Controller and then report readiness to Medical Controller in Hospital Control Centre and receive details of the incident and current bed state. 2. In the event of a burns incident, report to Burns Unit 3. The Duty Burns Consultant will liaise with the Command and Control Centre and instigate the Burns Major Incident Plan as appropriate. ( see Appendix C) 4. Prioritise patients for potential transfer to other wards or discharge where appropriate 5. Remain on Burns Unit until relieved by Duty Burns & Plastic Consultant, then report to Clinical Staff Controller in the Main Library, Level 1 Education Centre for appropriate tasking. 6. For non- Burns related incidents, The Burns and Plastics teams will work under the direction of the Trauma Clinical Controller. Page 46 of 104

47 VASCULAR CONSULTANT ON CALL This role will be undertaken by the Duty Registrar until relieved by the Vascular Consultant on call. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN. 1. Report to Clinical staff controller located in the Main Library Level 1 to register attendance. 2. Receive details of the incident and current bed state 3. Proceed to ED and report to ED Clinical Controller 4. Work as part of the multidisciplinary Resuscitation teams in ED, offering specialist assessment / advice. 5. Await requests for theatre Page 47 of 104

48 CAPACITY MANAGER THE ROLE OF CAPACITY MANAGER WILL BE ALLOCATED TO AN AVAILABLE ADN OR ON CALL MANAGER. Tabard from Command and Control centre Capacity Lead Manager This role will be established as staffing becomes available. This manager will be based in the breakout room within the control centre structure. 1. Co-ordinate the capacity across both hospital sites in liaison with the bed managers / Senior Nurses / Hospital At Night Teams. 2. Maintain up to date records / flow board of patient admissions and movements within the Hospital. 3. Liaise with the Control Centre Manager and update on capacity issues. 4. Liaise with the Nursing and Medical Controller in the Control Room and identify potential capacity needs (actual or potential) and staffing requirements. 5. Set up communication links with the bed managers to maintain up to date information on capacity within the Trust. 6. Await instructions to stand down from the Nurse controller in the Command and Control centre Page 48 of 104

49 BED MANAGER The role of the Bed Manager will be undertaken by the Site CoOrdinator (QEHB) or (at night) by one of the Hospital at Night Team. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN 1. Phone wards to obtain current bed situation, at the same time, notify wards of Major Incident. 2. Liaise with the CAPACITY MANAGER based in the Control Centre breakout rooms. (seminar rooms 16 & 18, Education Centre, Level 1) 3. By liaising with medical and nursing staff, obtain the following information: How many patients may be transferred to other Hospitals/Nursing Homes Availability of beds following discharges, making full use of discharge lounge 4. Inform the CAPACITY MANAGER in the Control Centre Break Out Rooms of any actual and potential issues regarding bed management. 5. Continue to work with Nurses In charge of wards to free beds and accommodate admissions. 6. Assess potential transfers from ward 410, and allocate beds accordingly ( as discussed with the Capacity Manager). 7. Receive stand down from Nursing Controller (QEHB) Page 49 of 104

50 EMERGENCY DEPARTMENT SUPPORT MANAGER. Tabard from Command and Control centre ED Support Manager. This role will be undertaken by the on-call manager once allocated by the Control Centre Manager. This Manager will be based in the Emergency Department and will respond to the requirements of the Emergency Department regarding capacity and patient flow issues. 1. Liaise with the Senior Nurse Controller ED and the ED Nurse Coordinator regarding issues of capacity and admissions of existing patients in the department. 2. Establish communications with the Capacity Manager regarding ED capacity for the incident. 3. Communicate the ED admission requirements to WARD 410, Critical Care, and Theatres etc directly to the Capacity Manager, who will update the Bed Managers and Control Centre Manager. 4. Collect copies of the ED Patient Registration Document from the ED Reception Ledger Clerk / basket labeled Control Room. Send these copies to the Command and Control Centre (via a runner if one assigned to you). 5. Support the Emergency Department Team, acting as a liaison to the Control Centre Management Team. Page 50 of 104

51 NURSE IN CHARGE OF HOSPITAL DISCHARGE AREA WARD WEST 4 OLD QEH Tabard from Control Room Discharge Area Lead Nurse A Senior Nurse will be delegated to take on this role by the Nursing Controller. After collecting the action card and Tabard from the Control room, the delegated nurse should proceed to Ward West 4 and prepare to receive patients from the wards. The nurse in charge will be responsible for:- 1 Providing care and refreshment for patients awaiting discharge or transfer. 2 Arranging for any medication to be provided either within the discharge area or to take home. 3 Liaising with relatives, Community Nursing, Social Services in matters concerning the discharge with the support of the REACT team. 4 Contact transport to arrange patients discharge and transfer as follows: hrs hrs Patient Transport QEHB Control ext 2098 / hrs 0730hrs Patient Transport Control Room Liaise with Nursing Controller regarding staffing requirements. 6 Await Stand Down from Nursing Controller. Page 51 of 104

52 NURSE IN CHARGE MAJOR INCIDENT ADMISSIONS (WARD 410) Tabard from Command and Control centre Major Incident Admission Lead This role will be undertaken by the Nurse in charge ward 410 until relieved by Senior Nurse for the area. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN 1. Prepare the ward to accept admissions. Inform staff on duty regarding the incident. Activate staff call-out procedure when instructed to do so by Nursing Controller (Control Centre) 2. Assess all patients on the ward and categorise them into the following bands: Patients able to go directly home Those able to go home, but some delay is necessary Those unfit for discharge, but not requiring specific burn/trauma care, that may be transferred to a different ward Those unfit for discharge and requiring continuing burn/trauma care within the unit. 3. Prepare patients in category A and B for discharge to ward West 4 old QEH Liaise with ward West 4 old QEH Senior Nurse and advise numbers of patients that could be discharged Handover details to Senior Nurse ward West 4 old QEH Liaise with bed manager for patient ward transfers 4. Ensure all available beds are prepared to receive Trauma 5. Provide a current bed state to the bed manager at QEHB 6. Liaise with the Nurse Controller regarding staffing requirements. 7. Await Stand Down from the Nurse Controller Page 52 of 104

53 INFORMATION OFFICER Tabard from Command and Control centre Information Officer This role will be allocated by the Control Centre Manager until relieved by the Medical Records Manager The Information Area will be set up in the Emergency Department Sisters Office. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN. 1. Report immediately to the Hospital Command and Control Centre (QEHB) and retrieve the Information manager box. 2. Establish the Information Centre in the Emergency Department Sisters Office. 3. Allocate Staff from the Medical Records Department to assist. 4. Designate a Manager for control of telephone enquiries regarding patients and recording details on filing cards. 5. Designate a Manager and Medical Records Clerk to Relatives Receiving Area to co-ordinate information (Therapies Services South Suite Treatment 7) 6. Establish and maintain a Patient Information Recording Sheet 7. Receive information and liaise with Control Centre Manager regarding patient information. 8. Liaise directly with the Police documentation teams in ED and transfer any gathered information to these officers. 9. Once Casualty bureau has been established (confirmed by Command and Control room) your role as information officer will be stood down and you will be redirected to other areas e.g. ED reception, Relatives Area. Page 53 of 104

54 TRUST SECURITY ADVISOR During Normal Hours The role of the Trust Security Advisor will be undertaken by the on site BBW Security supervisor until relieved by the Trust Security Advisor Outside Normal Hours The role of the Trust Security Advisor will be undertaken by the Trust Estates & Contracts Manager. Locations of the Security Office: Level 0, Main QEHB concourse On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN. 1. Report to the Hospital Command and Control Centre collect Action Card and Security Radio Handset 2. Ensure QPark and BBW are issued with their appropriate action cards and are responding accordingly Assist and support the areas affected by the Incident 4. Ensure CCTV coverage around the Trust is maintained wherever installed and ensure that it is monitored continuously throughout the incident and all available cameras are directed towards the incident. Ensure images from the incident are downloaded and stored in a secure location. 5. Liaise with the Trust Press Officer and assist in the controlling of press and media. 6. Liaise with the Police and other government departments on security issues. 7. Be available to assist any area with security issues. 8. Receive the order to stand-down from the Control Centre manager and cascade to staff. Page 54 of 104

55 MEDIA MANAGER Tabard from Control Room Media Manager This role is to be filled by the first available manager until the most senior Communications Manager arrives. The main Press centre will be the existing Post Graduate centre, old QE grounds. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN. 1. Report immediately to the Hospital Command and Control Centre, to collect Action Card and Tabard 2 Liaise with the Director of Communications for Trust. 3. Ensure that Press are directed to the Nominated Press Area. Parking for press vehicles will be as normal for visitors, except for Broadcast vehicles, which will park in Postgraduate car park. 4. Collate information from all available sources (including Police) 5. Prepare reports for radio / press / TV enquiries using pre approved press releases and prepare press conference facilities. Ensure that all messages given to the press are recorded 6. Access to information about patients should be limited to Control Centre and Information Room. 7. Liaise with Control Centre Manager, Information Officer and Chief Executive Page 55 of 104

56 STAFF RECEPTION CENTRE MANAGER Tabard from Command and Control room Staff Reception Centre Manager This role is to be filled by the Human Resource Manager with the assistance of a Senior Nurse nominated by the Nursing Controller. They should liaise with the Hospital Control Centre. On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". 1. Implement the departmental Call-Out procedure. 2. Proceed to Hospital Control room and collect Action Card and tabard. Staff Reception Centre Box is kept in Main Library Level 1, behind reception desk. 3. Inform the psychologist/staff support adviser. 4. Set up Staff Arrival Area in Main Library Level 1, including fast track: Emergency Department Critical Care Unit Theatres Ward One member of the team to report to and assist Clinical staff controller in Medical staff call out and reporting. Keep log of Doctors attendance and deployment. 6. Accept and log requests for employed staff / voluntary staff from all relevant areas: Patient Escort Catering Assistants Messengers / Portering etc Nursing Medical Page 56 of 104

57 7. Ensure that all employed staff &volunteer staff are logged in and their deployment recorded. 8. Assign staff against requests as supervised by ADN / Senior Nurse Manager and by Clinical Staff Controller 9. Issue temporary Identification Badges (stamped Approved ) to volunteers 10. Request staff to report back to volunteer co-coordinator or delegated officer when task complete. 11. Liaise with Control Centre Manager and Heads of Department to ascertain extra staff requirements. 12. Liaise with Nursing Controller regarding nursing requirements. 13. Liaise with Medical Controller regarding Medical Staffing requirements. 14. Receive stand down from Control Centre Manager and pass on to staff and volunteers. Page 57 of 104

58 ON CALL FACILITIES MANAGER Tabard from Command and Control Centre Facilities Manager The role of the on call Facilities Manager will be undertaken by the Duty Team Leader (from Portering or Domestic Team Leader) until relieved by the on call Facilities Manager. In the event of NO Team Leader being available, then the desk Porter will take on this role until relieved. The on call Facilities Manager will be based in the Major Incident Breakout Room. On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". Tabbard in Command and Control Room. 1. Implement the Department's Call-Out Procedure 2. Ensure that measures are taken to support the security of key areas involved in the Major Incident. 3. Report to Command and Control Centre. Liaise with Control Centre Manager. You will be allocated to a Major Incident Breakout Room 4. Delegate staff to assist with preparation of Emergency Department. This will include:- - Movement of patients - Movement of furniture - Provision of trolleys and wheel chairs to all areas In the Emergency Department 5. Delegate Staff to standby in:- Admissions Areas Discharge Areas 6. Provide support as required to security and car parking staff as recourses required. 7. Liaise with the contracted services manager if available, or seek reference from the contract services Action Card, for patient movements requiring transport / for distribution of services as they arrive in the Trust ie Linen, Pharmacy etc. Page 58 of 104

59 8. Ensure activation of catering services local action card to ensure facilities available to feed staff involved in the incident and relatives of patients involved 9. Identify Staff who are to act as "Runners" in the event of a communications breakdown. "Runners" are to be allocated to the following priority areas: - - Emergency Department - Therapies Services South Suite - Hospital Command and Control Centre - Reception, Ambulatory Care Centre - Critical Care Unit (level 2 QEHB) - Theatres (level 2) - Ward West 4 In Patient Discharge area. - Ward 410 Admissions Ward Note: Runners must be familiar with the Hospital's layout. They must report to the Senior Member of Staff on duty in the Department / Area to which they are being sent. Page 59 of 104

60 RCDM staff In the event of UHB activating a major Incident, RCDM staff will be notified in line with their departmental activation guidelines. RCDM will require notification in order to ensure that welfare and administrative support can be activated in line with the Trust response. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE PLAN 1. Contact Duty Executive and inform them that a Major Incident has been declared. 2. Duty Executive to be directed to report to Trust Control Room, Seminar Room 17, Level 1, QEHB. The Duty Executive will collect tabard, action card and radio. Duty Executive will return to RCDM briefing room and await further instruction. Duty Executive will inform Commanding Officer, OC Ops Wing and OC Nursing of situation and keep updated as necessary. 3. Once requested by Control Centre Manager, the Duty Executive will commence the cascade call out of the following DUTY STAFF. a. Duty Officer b. Duty Aeromed c. Duty Patient Admin d. Duty NCO e. Duty Military Discharge Coordinators (MDC) f. Duty Service Police g. Duty Military Liaison Officer (MLO) h. Padre i. Alexandra Wing Duty Mobile Phone Numbers Duty Executive Duty Officer Duty Aeromed Duty Patient Admin Duty NCO Duty MDC Duty Service Police Page 60 of 104

61 Duty MLO Padre Alex Wing RCDM Briefing Room Instruct Duty NCO to instigate departmental call out procedure. 5. Duty staff are to report to Duty Executive in RCDM Briefing Room on arrival and await further instruction. 6. RCDM clinical staff will be deployed in line with UHB directive. Duty Executive must liaise with the Control Centre Manager with regards to deployment of RCDM staff. All staff, when called in, must report to the Library, Level 1, QEHB and then report to Duty Executive in RCDM Briefing Room when directed by Control Centre Manager. 7. If UHB reaches maximum bed capacity the Duty Executive is to inform the Commanding Officer following direction from the Control Centre Manager. RAMP 2 Region wide response will be activated following consultation between Commanding Officer and the West Midlands SHA. Page 61 of 104

62 CHAPLAINCY This role will be filled by the on call Chaplain. On receipt of the instruction: MAJOR INCIDENT DECLARED ACTIVATE PLAN 1. Report to the Command and Control centre at QEHB 2. Implement Chaplaincy department call out procedure 3. Out of hospital Chaplains to report to the staff reception centre and register attendance in the Trust 4. Assemble in QEHB Chapel and await team leader to allocate to specific areas: Therapies Services South Suite Level 1 incident relatives area 410 incident admission area Critical Care Areas ( level2 QEHB) ED body holding area Temporary mortuary for staff support, Level -1 Equipment and Furniture store Chapel 5. Await instructions to stand down from Control Centre Manager. Page 62 of 104

63 SENIOR SOCIAL WORKER Tabard from Command and Control Centre Senior Social Worker The role of Senior Social Worker will be undertaken by the most Senior Social Worker. On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN 1. Implement the Department's Call-Out procedure. 2. Assign a Social Worker to Major Incident Patient Discharge area 3. Assign a Social Worker to Relatives Waiting Area (Therapies Services South Suite Level 1 ) 4. Liaise with Information Officer to assess any unmet patient needs. 5. Liaise with the Human Resources Manager regarding staffing requirements. 6. Receive stand down from Control Centre Manager. Page 63 of 104

64 BBW HELP DESK (777) This role will be undertaken by staff member manning the desk at the time a Major Incident occurs On receipt of the instruction:- MAJOR INCIDENT DECLARED- ACTIVATE PLAN The Helpdesk Operator answering the instruction will complete the Major Incident Activation Helpdesk Record 1. Contact BBW Security Control Room notify them of situation and instruct them to follow their action card 2. Inform Consort On Call Duty Manager 3. Inform Concession General Manager (During Core Hours), BBW On Call Duty Manager (Out of Hours) 4. Contact Q-Park Help Desk notify them of situation and instruct them to follow their action card 5. Contact Trust Security Adviser in hours only ( ) 6. Contact BBW Estates Team (Operations Manager - During Core Hours. Shift Supervisor - Out of Hours) notify them of situation and instruct them to follow their action card 7. Notify Retained Estates Team via Retained Estate Helpdesk during Core Hours and via BBW On Call Duty Manager (Out of Hours) 8. Have fully charged radio (Acute) available for use by BBW On-Call / Duty Manager upon arrival at Project Office, located in Operation Managers Office. 9. Liaise with BBW and Consort On-Call Duty Managers as and when required to receive further instructions regarding the major incident and any support needed. 10. Document all communications on the HELPDESK Activity Log Page 64 of 104

65 Consort On Call Manager The on call manager will be informed by the BBW help desk that a Major Incident has been declared On receipt of the instruction:- MAJOR INCIDENT DECLARED- ACTIVATE PLAN 1. Ensure Security is activating/deactivating as appropriate controlled access Education centre entrance, level 1 Seminar rooms in education centre, level 1 Library in education centre, level 1 Therapy services south side, treatment 7 level 1 2. Ensure BBW Security is placing temporary signage for directions for staff and relatives 3. Liaise with control centre manager and take direction where required 4. Instruct Q park to apply relaxation procedure for traffic infringement 5. Instruct Q park staff to activate traffic management procedure if directed by Command and Control Centre 6. Ensure Q Park, BBW are following their appropriate action cards. 7. Give instruction regarding managing routine calls to help desk and prioritise calls accordingly 8. Inform Kcom Noc to be aware of a Major Incident Declared 9. On receipt of instruction to stand down from control centre manager ensure the site continues to be managed appropriately until normal business can be resumed Page 65 of 104

66 Director of Communications Tabard for Command and Control Centre DIRECTOR OF COMMUNICATIONS This role will be undertaken by the Trusts Director of Communications or their appointed Deputy. On receipt of the instruction:- MAJOR INCIDENT DECLARED ACTIVATE YOUR PLAN The Director of Communications will be based in the Breakout Room The Director of Communications will work in close liaison with the Chief Executive of the Trust Prepare Press briefings and support the Trust personnel appointed to deliver these Press briefings. Liaise with Police for incident updates and for notifications of Police Press releases Liaise with the Command and Control Centre Management Team Offer guidance and direction to the Media Manager and the Press Officers for UHB Page 66 of 104

67 COMMERCIAL CONTRACTED SERVICES Outside of normal working hours the role of the Commercial Contracted Services Manager will be undertaken by the Trust Estates & Contracts Manager on call This Action Card relates to the following key Commercial Contracted Services. Patient Transport Sterile Instruments/Packs Linen and Laundry (patient linen & Sterile theatre linen) On receipt of the instruction: MAJOR INCIDENT DECLARED-ACTIVATE PLAN During normal working hours Monday to Friday the Commercial Contracted Services Management Team should be contacted internally on extension and advised of a major incident being declared and for the Senior Commercial Contracted Services Manager on duty to implement the department s call out procedure and report to the Major Incident Control Centre to await further instruction. Outside of normal working hours the on call Trust Estates & Contracts Manager will activate the Commercial Contracted Services Management Team Major Incident call out procedure, if available to attend work the Commercial Contracted Services Managers will be directed to the Major Incident Control Centre. Non Emergency Patient Transport (NEPT) The service is contracted to the West Midlands Ambulance Service for all patient movement to and from premises within 100 miles. In the event of a major Incident being declared the NEPT service will automatically come under the direct control of the West Midlands Ambulance Blue Light Service Control, this control centre will be in direct contact with UHBFT own Major Incident Control Centre. NEPT crews and vehicles will be used to support any patient movements during the declared incident, however consultation will take place between the Trust and West Page 67 of 104

68 Midlands Ambulance Services to prioritise patient appointments such as dialysis and radiotherapy, once the scale of the Major Incident has been fully assessed. West Midlands Ambulance Blue Light Service West Midlands Ambulance NEPT Control Sterile Instruments/Packs This Service is provided to the Trust by Bbraun Sterilog providing a 24/7 service. Bbraun have contingency plans in place to support any major incident, once they have been notified. Sterile instrument /packs are reprocessed, delivered and soiled instrumentation collected daily, Monday to Sunday by Bbraun Sterilog. The internal movement of soiled/sterile instrumentation on Trust premises is undertaken by Trust Materials Handling, directly to and from Trust user departments designated storage/collection points. In preparation for any additional requests for sterile instrument /packs the on call Facilities Manager should contact Bbrauns out of hour s management team as detailed below, advising that the Trust have declared a Major Incident and to be on standby for any additional requests for the processing and supply of sterile instrument packs to the Hospital. B Braun Production Area (Monday-Friday) B Braun On Call Manager (Weekends/Bank Holidays) Instrument Tray/Collections- Internal Duty Managers On Call Manager UHB Materials Handling /13391 Linen and Laundry (Patient linen and sterile theatre linen) Patient linen and sterile theatre products are delivered into the Hospital daily Monday to Sunday by Sunlight Healthcare. Sunlight Healthcare have contingency plans in place to support any major incident, once they have been notified. In addition a 24 hours stock of patient linen and sterile theatre packs are held within the linen store located on the lower ground floor within New Hospital, managed by Trust Materials Handling; to activate this stock please contact Material Handling on extension or Page 68 of 104

69 In preparation for any requests for additional linen stocks over and above what is held on site the on call Facilities Manager should contact Sunlight s out of hour s management team as detailed below, advising that the Trust have declared a Major Incident and to be on standby for any additional requests for the supply and delivery of patient Linen and Sterile Theatre packs to the Hospital. Patient linen Sterile Theatre Packs Plant Manager Service Manager Logistics Manager Plant Duty Manager Plant Manager General Manager Page 69 of 104

70 PHARMACIST Tabard from Control Room Pharmacy Lead The role will be filled by the most Senior Pharmacist available. On receipt of the instruction:- "MAJOR INCIDENT DECLARED - ACTIVATE PLAN". 1. Report to the Control Centre where information on the nature of the incident will be obtained. 2. Ensure that sufficient Pharmacy Staff are available (A minimum of two people will be needed to attend immediately. Further Staff may be called in, after making an assessment of the situation). 3. Check Pharmacy stocks of drugs likely to be needed. 4. Contact UHB warehouse and / or other hospitals or wholesalers to replenish drugs in short supply. Liaise with Contract Services Management to establish transportation as required. 5. Liaise with Control Centre Manager (to secure a Police Escort if necessary for emergency supplies). 6. Liaise with the Human Resource Manager regarding staffing requirements. 7. When two or more Pharmacy Staff are present, dispatch one person to the Emergency Department and receiving Wards to see what Pharmaceutical help is required. 8. Ensure areas receiving Casualties i.e Emergency Department, ward 410, Theatres and Critical care and those discharging patients ward West 4 old QEH have sufficient drug supplies. As staffing resources available, populate ward West 4 old QEH as a priority to provide direct pharmacy contact for discharge drugs. Coordinate the placement of other staff as appropriate to facilitate discharges, supply requirements, clinical queries and deliveries. 9. Receive the Stand Down from the Control centre manager. Page 70 of 104

71 TRUST ESTATES & CONTRACTS MANAGER Tabard from Command and Control Centre Estates Liaison The on call Estates & Contracts Manager will be based in the Major Incident Breakout Room. On receipt of the instructions MAJOR INCIDENT DECLARED ACTIVATE PLAN. 1. Report to Command and Control Centre and liaise with Control Centre Manager. 2. Liaise and instruct the Consort On Call Manager as required. 3. Ensure that all actions required by the BBW Helpdesk, BBW Security personnel, Q-Park traffic,car park management and Contracted Services are carried out in accordance with the relevant Action Cards. 4. Liaise with BBW Estates team as required and as directed by the Command and Control Management team. 5. On receipt of instruction to stand down from Control Centre Manager ensure that Consort/BBW staff ensure the site continues to be managed appropriately until normal business can be resumed. 6. Initiate a debrief with Consort On Call Manager and appropriate BBW support staff immediately following the instruction to stand down. 7. In the event of a CBRN incident, communicate with GDS to instigate the GDS FRAMEWORK, which will advise and guide the Trust regarding the recovery of services following a CBRN incident.(specialist waste management collection companies) GDS 24/7 emergency number is , or contact via the Defra Duty Office General enquiries number is website has a series of Quick Guides on the GDS Publications page which you may find useful Page 71 of 104

72 PART III A SCHEME FOR THE SUPPORT OF STAFF FOLLOWING A MAJOR INCIDENT The primary purpose of this plan, together with appropriate training, is to enable staff involved in a major incident to cope and remain effective under extreme pressure; the trauma of events surrounding the emergency will take its toll on staff. This will result in stress and its related problems long after the incident is over. These problems are not confined to people immediately involved, staff held in reserve at home or who were not aware of the incident have been found to suffer from intense feelings of guilt and inadequacy, as profound as anyone directly involved. Managers must anticipate these problems in all Departments and take action to alleviate them. Much can be achieved by making time available to the individual for private discussion and counselling. Managers should also be aware of the role of staff support advisor who can co-ordinate de-briefing sessions in liaison with the Staff Support Team from Mental Health Unit. Managers should also be aware of the role and support the Occupational Health Department can offer, e.g. confidential counselling services for all staff and also the support offered by the Hospital Chaplaincy. Their help should be called upon where the individual feels it appropriate. Where students of any discipline are involved, it is important that their tutors visit and are available to supplement management support. All colleges should be informed. On a more formal note, it is essential that EARLY departmental debriefings are held. These should be arranged so that all staff will attend. The sessions should encourage discussion on all aspects of the department's role in the incident with the following objectives:- a) Enhancing peer support b) A learning opportunity c) A developmental opportunity for future policy changes. Page 72 of 104

73 Issues raised in the departmental briefings should culminate in a review of the hospital's role in the incident. This should be open to all levels of staff. The hope is that through these discussions, problems and disquiet will emerge, enabling appropriate support to be arranged. However, there will be those people who, despite the support and understanding of their peers and managers, still suffer through their experiences. This needs to be recognised and further help sought. This may be arranged through counselling services set up because of the emergency or within the hospital through Occupational Health Department. It is important that these issues surrounding the major emergency are acknowledged by staff at all levels and that people, deeply affected by their experiences do not become long term victims of the incident. Page 73 of 104

74 APPENDIX A Guidance for Staff Call-Out Not all staff will be required to attend during a major Incident. This decision will be made by the Control Centre manager in conjunction with Nursing and Medical controllers. Things that will be taken into account when calling out staff are: The nature of the incident The number of casualties expected The capacity within the Trust at the time of the incident Staffing levels within the Trust at the time of the incident How long the incident is likely to have an impact on the Trust NOTE ALL ED STAFF WILL BE CALLED IN FOR A MAJOR INCIDENT Procedure All wards and departments will keep an up to date call out list. This must be checked on a regular basis. Staff will only be called in when the wards and departments are asked to activate their call out procedure by the Command and Control Centre. All staff on duty at the time of the incident must be kept in their ward or department and not allowed to go off shift until told to do so by the Command and Control Centre. When told to do so off duty staff will be called in by the person/s allocated to do so by the most senior member of staff on duty. The following statement will be made: This is UHB calling (ward/department) this is not an exercise. A Major Incident has been declared. You are requested to attend work. Please report to the staff reporting area bringing your identification badge and uniform (if worn) if possible. Please confirm your ability to attend and time expected. Staff will be asked to report to the staff reporting area and not to their usual place of work. Staff will be asked to bring with them their identification badges. Staff will be informed of any restrictions of access to the Trust due to the vicinity of the incident. Page 74 of 104

75 APPENDIX B CBRN PLAN. 1. Introduction By definition, a CBRN (chemical, biological, radiological, nuclear) event is treated as a DELIBERATE (terrorist) event or release of an agent that would bring injury and or illness to the health of the community and possible environmental implications. Within this, a HAZMAT (Hazardous materials) event is treated as an ACCIDENTAL release of materials, which do include those substances which may be used for terrorist purposes. For the purpose of this document, both types of incidents will be addressed under the terminology of CBRN. It is of the utmost importance that in hazardous situations no patients, members of the public or staff are put at risk. Consequently, when it is known that a patient is contaminated; all precautions must be taken to ensure the safety of people and to maintain the capacity of the buildings to provide care. It is in nobody s interest to create extra casualties through foolish heroics or render the Emergency Department unfit/unsafe for the management of patients. 2. Procedure Patient Decontamination Unit(s) (PDU) will be sited close to the normally locked down entrance to ED See & Treat (minor injuries) It will be staffed by specially trained nurses, each equipped with personal protection equipment.(ppe) The Emergency Department Senior Nurse will assess the requirements for either a full team of nurses or an individual nurse to deploy to the PDU, dependant upon the numbers and mobility of the casualties. These arrangements will allow patients to be decontaminated BEFORE passing into the Emergency Department for treatment. The following Action Cards detail procedures to be followed by staff and the diagram below depicts the siting of the PDU and its connection to tapped water via inflow ports; effluent water will be collected within the PDU and then discharged to a waste holding container, directly from the PDU. Page 75 of 104

76 PDU Siting Diagram: Page 76 of 104

77 ED RECEPTION STAFF. SUSPICIOUS/CONFIRMED CONTAMINATION INCIDENT. For self presenting patients, registering at the ED Reception, where the patient/s CONFIRMS an involvement with exposure to a chemical, biological or other agent OR The Ed receptionist is suspicious by History, Smell or External Visual Appearance or several patients registering from same location (but may have different complaints). Reception staff must: 1. Obtain Major Incident Equipment Box (underneath reception desk) and put on gloves and face mask. 2. Request patient to step outside the department, advising them that medical assistance will be sent out to them. In the extreme case of a patient refusing to wait outside the main ED doors, ask them to wait in the paediatric waiting room. 3. Immediately notify the Nurse In Charge of ED ( if Assessment Nurse not present) outlining details / suspicions ( this will allow ED staff to carry out Supplementary PPE response) 4. Stay behind the reception desk security screens in case of further contaminated self presenters. Page 77 of 104

78 ED NURSING STAFF SUSPICIOUS / CONFIRMED CONTAMINATION INCIDENT From notification by the self presenting patient(s) of exposure to chemical, biological or other agent; or from suspicion to ED reception staff or Assessment Nurse by History, Smell or External Visual Appearance. OR Ambulance service arrival from an incident that has involved patient being exposed to a chemical, biological or other agent. And on further questioning raises Nurses suspicions.. Notify the Nurse In Charge of ED. The Nurse In Charge must: 1. If ambulatory patient, ensure patient has been asked to wait outside the main department. Direct to marked area outside of the ED.into the decontamination zone. 2. Ask Ambulance Crew to wait outside in vehicle with patient. 3. Delegate one member of staff to don the supplementary PPE Kit (located in assessment area and decontamination equipment store) and attend patient(s) for rapid history / assessment. 4. Await further information being sent back into department from the Nurse assessing the patient (s) 5. On confirmation of contamination risk, Nurse in Charge must initiate the ED CBRN Plan and instigate Decontamination Procedures. 6. Follow action card for Senior Nurse ED CBRN Plan. Page 78 of 104

79 ED NURSING STAFF SUPPLEMENTARY PPE ACTION CARD The Supplementary PPE Kit is to be used for supporting staff who are involved with procedures detailed within the CBRN Plan. The Supplementary Kit is also to be used in the process fro Decontamination of patients that have been contaminated with Radioactive sources. Supplementary PPE Kit contents. 1 x disposable Tyvek C suit. 1 x pair disposable Tyvek C overshoe covers. 1 x FFP3 valved filter mask (single use) 1 x pair eye protection glasses. Add 2 pairs disposable gloves from main ED department for over gloving. LOCATION OF KITS. ED Assessment Area ( 3 kits ) ED Decontamination Room ( main stock) Under instruction from Nurse In Charge ED : Put on overshoes, securing over own foot wear. Don overalls and zip suit to neck. Secure suit using over flaps.do not put up hood at this point. Put on gloves, use second pair to over glove. Put on FFP3 mask ( as per mask education in department) Put on Eye protection. Pull up suit hood. Have Buddy Check performed to ensure all protection worn and correct. Take out Disrobe / Rerobe kits ( ED Decontamination Equipment Store) and give out to the waiting casualties who must be corralled to the furthest point of the decontamination zone. Shout advisory instructions for them to put on Disrobe cape and undress underneath. Ask them to put all removed clothing and belongings into the large plastic sack inside the kit and seal with the bag-tie provided. Pass out packs of patient wipes and request that patients wipe faces and blow their noses. Advise they should dispose of soiled wipes in large yellow sack, that you will place near to them. Page 79 of 104

80 ED SENIOR DOCTOR The following are the tasks which the ED Consultant/ Middle Grade Doctor has to undertake prior to the arrival of patients and setting-up of decontamination facilities. 1. Identify Forward Triage Officer ( nurse or doctor), if required depending on numbers presenting and information from West Midlands Ambulance Service or information from Senior ED Nurse. 2. Liaise with Senior Nurse ED for information of incident/hazards/patient numbers. 3. Liaise with Senior Nurse ED in the appropriate deployment of ED Nurses and Doctors. 4. Liaise with ED Consultant on duty. 5. Act as Clean Area Triage Officer until relieved by ED Consultant. 6. Prepare for receiving and treatment of decontaminated patients 7. Allocate ED Doctors and supporting specialties into working teams. 8. Notify Middle Grade Doctors in Critical Care and Theatres. Page 80 of 104

81 SENIOR ED NURSE / COORDINATOR 1. Upon notification OR identification of an incident, Liaise with - the ED Consultant / Middle Grade Doctor Tanoy all ED staff to attend your location and inform them of incident West Midlands Ambulance Service On Call management Team, Division C managers. Ascertain - what chemical / agent is involved (if known), request faxed details (give ED Fax Number which is ) Estimated number of casualties and what decontamination action has been taken on scene if any. 2. Discuss with on-call ED Consultant and management team the requirement to call in extra department staff or instigate the Major Incident Plan if this event will effect the service provision of the Trust. When Major Incident Plan NOT actioned, then contact BBW HELPDESK 777 stating the words CBRN INCIDENT ACTIVATE YOUR PLAN Contact Hotel Services Team Leader (EXT 12667) and state CBRN PLAN IN ACTION.they will send ED Portering support whilst ED Porters dealing with Decontamination facilities. 3. Assign nurses to Decontamination and Receiving Teams, ensuring Patient Decontamination Procedure (CRBN Plan) is actioned. Issue Action Cards to staff. Deploy Decontamination Unit facilities in preparation for receiving patients with the assistance of Portering Staff. 4. Ensure porters and other staff are carrying out their allotted tasks (as detailed on appropriate Action Cards) 5. Delegate a doctor to obtain data on any identified substances (via TOXBASE and HPA manual on CBRN management) 6. Liaise with staff updating as information received Maintain department / patient care but identify capacity, dependant upon the requirements of the decontaminated patient symptoms /numbers. 7. Consider need for obtaining additional chemical protection suits kits via Mutual Aid from City Hospital ED / Emergency Planning Officer. 8. Once clean-up procedure is taking place, In Hours : Commercial Contracts will oversee specialist waste management. Out of hours, BBW / TRUST ESTATES AND CONTRACTS MANAGER (via switchboard) who will arrange external specialist waste management services. Page 81 of 104

82 FORWARD TRIAGE OFFICER (ED Doctor / ED Nurse) HOT ZONE WORKING. 1. Don PPE (with assistance in ED.) 2. Use the Triage Sieve in the Hot Zone in front of PDU to prioritise patient s clinical status for decontamination for more than 1 casualty. CBRN Triage Sieve: Page 82 of 104

83 CBRN Triage sieve WALKING YES T3 DELAYED T2 URGENT NO TOXIC SIGNS CHEMICAL RADIATION/NUCLEAR CYANOSIS DOSE>2SV(Gy) UNRESPONSIVE Hx VOMIT & DIARRHOEA EXCESSIVE SECRETIONS ERYTHEMA SEIZURES FASCICULATION BIOLOGICAL NON-THERMAL BURNS(>3%) PURPERIC RASH SIGNS OF TOXICITY Where resources permit Resus may be attempted On cases of respiratory Arrest with the early use of Antedote. BREATHING YES NO AFTER AIRWAY MANOEVERS DEAD NO RESPIRATORY RATE 10 or less 30 or more IMMEDIATE T PULSE RATE <40 - >120 >40 - <120 URGENT T2 Capillary refill test (CRT) is an alternative to pulse rate but is unreliable in the cold or dark: if it is used, a CRT of >2 seconds indicates PRIORITY 1 ANY CASUALTY UNABLE TO WALK THROUGH DECONTAMINATION FACILITY MUST BE TRANSPORTED ON A LONG-BOARD INTO THE UNIT. Page 83 of 104

84 SECONDARY TRIAGE OFFICER (ED Doctor and Nurse) WORK AT ED - DECONTAMINATION ENTRANCE 1. Wear gloves and apron. (Universal precautions) 2. Use the Triage SORT to priorities patients clinical requirements and allocation to department. 3. Leave a copy of the patient s Triage SORT with the casualty, as this will stay in patients notes as a record of the assessment and priorities assigned at the time of Triage. Page 84 of 104

85 Triage sort RESPIRATION HEART RATE SYSTOLIC B/P GCS FASICULATION BIOLOGICAL RADIOLOGICAL NUCLEAR per minute + 4 > 30 per minute +2 >30 per minute +cyanosis per minute + 0 Respiratory Arrest Immediate or expectant per minute or per minute + 2 < 40 per minute + 0 > 120 per minute + 0 Cardiac Arrest DEAD > 90 mmhg mmhg mmhg mmhg + 1 Cardiac Arrest DEAD or convulsions + 0 None + 4 Local / Intermittent + 2 General / Continuous + 0 Flaccidity + 0 If Purpuric Rash - 2 If Vomiting, Diarrhoea, Erythema, - 2 or Dose > 2 sv TOTAL SCORE OUT OF 20 = SCORE PRIORITY 20 DELAYED P URGENT P IMMEDIATE P1 Page 85 of 104

86 ED TEAM LEAD NURSE (HOT ZONE) DECONTAMINATION TEAM (Stretcher Unit) 1. Liaise with ED staff and Middle Grade Doctor in Department 2. Don PPE with the assistance of Decontamination Nurse 3 ( in ED) 3. Take position in Chemical Decontamination Unit (CDU) at head of patient 4. Assess and provide Basic Life Support (BLS) for the patient. 5. Ensure appropriate patient decontamination in CDU. 6. Hand over decontaminated patient to ED receiving team in Cold Zone (do not leave PDU handover verbally. 7. Ensure decontamination of yourself and team, as appropriate during decontamination procedures and on completion of patient procedures. Patient Decontamination Unit (PDU):- Nurse 2 OUT IN Lead Nurse Nurse 1 Nurse 3 Page 86 of 104

87 NURSE 1: Decontamination Team (HOT ZONE) (Stretcher Unit) 1. Don PPE with the assistance of Decontamination Nurse 2 ( in ED) 2. Enter PDU with washing equipment. 3. Position yourself on patient s right, level with his/her chest. 4. Assist Lead Nurse with Basic Life Support 5. Decontaminate patient s head/face/neck with appropriate substance. 6. Assist in log-rolling patient. 7. Assist in straight scoop/board lift. 8. Assist in transfer of patient on board into Cold Zone. 9. Ensure decontamination of self and team. WALKING CASUALTIES CAN HAVE DECONTAMINATION PROCEDURE OVERSEEN BY X1 NURSE INSIDE THE PDU. LEAD NURSE WILL ASSIGN DECONTAMINATION TEAM AS APPROPRIATE. Page 87 of 104

88 Nurse 2: Decontamination Team (HOT ZONE) (Stretcher Unit) Don PPE with the assistance of Decontamination Nurse 3 ( in ED) 1. Enter PDU 2. Position yourself on patient s left, level with his/her waist. 3. Cut off all patient s clothing and drop it into Griff Bin 4. Label eg # 1/2 etc. 5. Treat all patients valuables as contaminated and drop them into Griff Bin. 6. Decontaminate patient s chest/trunk/lower limbs with appropriate substance. 7. Assist in log-rolling patient and remove clothing from underneath him/her, then decontaminate back of patient as well as top of board/scoop. 8. Assist in straight scoop/board lift to allow decontamination of underside of board/scoop. 9. Assist in moving patient on board in Cold Zone. 10. Ensure decontamination of self and team. WALKING CASUALTIES CAN HAVE DECONTAMINATION PROCEDURE OVERSEEN BY X1 NURSE INSIDE THE PDU. LEAD NURSE WILL ASSIGN DECONTAMINATION TEAM AS APPROPRIATE. Page 88 of 104

89 Action card Nurse 3: Decontamination Team (HOT ZONE) (Stretcher Unit) 1. Assist ED Lead Nurse into PPE.( in ED) 2. Don PPE with the assistance of clean Receiving Nurse.(in ED) 3. Enter PDU 4. Position yourself on patient s right; level with his/her hips. 5. Cut of all patient s clothing and drop it into Griff Bin - Label # 1/2 etc. 6. Treat all patients valuables as contaminated and drop them into Griff Bin. 7. Decontaminate patient s chest/trunk/lower limbs with appropriate substance. 8. Assist in log-rolling patient and remove clothing from underneath him/her then decontaminate back of patient as well as top of board/scoop. 9. Decontaminate underside of board/scoop whilst other team members perform straight scoop/board lift. 10. Assist in moving patient on board into Cold Zone. 11. Ensure Decontamination of self and team. WALKING CASUALTIES CAN HAVE DECONTAMINATION PROCEDURE OVERSEEN BY X1 NURSE INSIDE THE PDU. LEAD NURSE WILL ASSIGN DECONTAMINATION TEAM AS APPROPRIATE. Page 89 of 104

90 ED Nurse: Receiving Team (Cold Zone) N.B. This nurse must be prepared /trained to don PPE and replace any of the Nurses in PDU. 1. Dress Decontamination Nurse 3 2. Don surgical gloves and plastic apron. 3. Collect radio from ED coordinator, ensure on same channel and use this to send casualty figures back to coordinator, send figures for numbers of casualties you see disrobing.(do not enter HOT ZONE to do this) 4. Wait in receiving area (cold zone / White Tent side of PDU) 5. Monitor the times that staff enter the PDU using Log-in-board for staff in PDU. Write down corresponding PPE suit ID number to the time into the PDU. Working time inside the PDU is no longer than 1 hour. Call PDU staff to self decontaminate at 1 hour prior to leaving PDU. Log In replacement team member as necessary. 6. Gown (use Rerobe pack) and blanket decontaminated patients as he/she exits PDU via the White Tent Rerobe area. 7. Transfer patient with Porter s assistant to ED main department via Decontamination entrance. 8. Return to post in cold zone to receive next patient. Page 90 of 104

91 ED NURSING ASSISTANT. P.D.U. PREPARATION. 1. Assist portering staff with the siting and setting up of the PDU 2. Advise security on cordoning area and stopping traffic/patients/visitors from using the drop off parking zone across the Hot and Cold zone set-up. 3. Collect Rerobe packs from decontamination equipment room and hold them in the receiving area of the Cold Zone / Rerobe White Tent area. 4. Collect buckets from the decontamination equipment room and fill with warm water from the allocated tap supply. Add HOSPEX washing up liquid to the bucket (3 squeezes). Place inside the unused PDU. 5. Collect crate containing sponges, scissors, 6 x litre bags of Saline, disposable bag-valve mask and Oropharyngeal airways from the decontamination equipment room and place in the unused PDU. 6. Collect pre-labeled Griff bins and lids from decontamination equipment room. If known at this stage the number of casualties involved, put into PDU corresponding number of Griff bins. If unknown at this time, put 2 into PDU and hold remainder in the Rerobe White Tent area/cold zone until more requested by the decontamination Nurse/team. 7. Place emergency resuscitation equipment on trolley in cold zone, next to the receiving nurse. ( i.e. Bag,Valve Mask supply) Page 91 of 104

92 PORTERING STAFF 1. Assist in setting up Patient Decontamination Unit.All relevant equipment held in the decontamination equipment room, in See & Treat, ED. Require Unlock external door from See & Treat Area leading out onto the ED canopy. Set up PDU in position guided by diagram and ED staff. Set up Red Tent at furthest point on the decontamination zone. Attach side and door panels. Have tent doors positioned as marked on framework. Set up White Tent at nearest point on the decontamination zone ( closest to the decontamination entrance to ED) Attach side and door panels. Have tent doors positioned as marked on the framework. Hoses and connectors for water taps. Connect YELLOW hosepipe to HOT water tap in the locked cupboard outside the ED, situated on the ed fenced area within the decontamination demarcation zone ( keys for this area held in the Decontamination Equipment Store, See & Treat, ED dept.) 2. Connect up waste pumps and RED hoses to WASTE COLLECTION PORTS. Prime the pump *1 with water first. Plug pumps into the identified electricity supply in locked cabinet on fence within the decontamination demarcation area. The key for this power and water supply box is held within the Decontamination Store room. 3. Provide spare patient trolley (without mattress) to the clean zone of the decontamination area. If requested by Receiving Nurse, assist in placing trolley into PDU,via the clean zone having first ensured that trolley s oxygen cylinder is full. 4. Obtain replacement spinal boards/scoops and leave in Cold zone. These will be passed into HOT Zone as required 5. Don surgical gloves and plastic apron then assist with transfer of the decontaminated patient to trolley and then to Emergency Department. FROM THE COLD ZONE. Page 92 of 104

93 6. Position a trolley at Cold Zone to receive decontaminated patient with receiving nurse. 7. Switch on canopy lights (outside ED). Switch located in Decontamination Store (See &Treat area ED) 8. Assist with clean-up at end of incident. Collect 1x 770L container for hazardous waste from central waste services yard and bring to the area of PDU. Page 93 of 104

94 BBW HELP DESK (777) This role will be undertaken by staff member manning the desk at the time of a CBRN incident occurring: On receipt of the instruction:- CBRN INCIDENT DECLARED The Helpdesk Operator answering the instruction will complete the CBRN Incident Activation Helpdesk Record 1. Contact BBW Security Control Room notifying them of situation and instruct them to follow their action card. 2. Confirm Security have distributed 6 radios to ED coordinators office and 24 to command and control. 3. Contact Q-Park Help Desk notifies them of situation and instructs them to follow their action card. Tel: (Ext 77114) 4. Inform Consort On Call Duty Manager 5. Inform Concession General Manager (in and out of core hours) 6. BBW On Call Duty Manager (Out of Hours) 7. Contact BBW Estates Team (Operations Manager - During Core Hours. Shift Supervisor - Out of Hours) notify them of situation and instruct them to follow their action card 8. Liaise with BBW, Consort On-Call Duty Managers and Trust Representative as and when required to receive further instructions regarding the CBRN incident and any support needed. 9. Document all communications on the Helpdesk Activity Log Page 94 of 104

95 CBRN INCIDENT ACTIVATION HELPDESK RECORD Date: WO Number: Time: Details to be taken from caller When a caller to the Helpdesk gives the instruction CBRN Incident Declared, Activate Plan The following information should be obtained from the caller Q1. Question Could you please confirm your Name? Name: Q2.Question - Can you confirm what is the best contact number for yourself? Contact Number: Q3. Question Can you please confirm the Nature of the Incident. Is it Chemical, Biological, Radiation or Nuclear? Answer: Q4. Question Can you confirm how many people are affected? Answer: Q5. Question Have the contaminated people entered the Building Y / N? If YES, Do you want the ventilation turned off to A&E Minor? Y / N Do you want the area locked down? Y / N Inform the Caller - Thank you for the information the plan will be activated Helpdesk Operator Tasks 1. Contact BBW Security Control and passes all the above information Time Name of Security Controller 2. Contact Consort On Call Duty Manager and passes all the above information Time Name of Consort On Call Duty Manager Page 95 of 104

96 3. Contact BBW Concession General Manager (During Core Hours), BBW Technical On Call Duty Manager (Out of Hours) and passes all the above information Time Name 4. Contact Q-Park Help Desk and passes all the above information Time Name of Operator 5. Contact BBW Estates Team (Operations Manager - During Core Hours. Shift Supervisor - Out of Hours) and passes all the above information Time Name 6. Record call on Maximo with the SLA starting at PSZ_5 Compliments, Complaints & Major Incident Maximo Ref No: The Instruction to Stand Down from the CBRN Incident will come from the BBW Operations Manager - During Core Hours (Duty Manager OOH) only at this point normal business resumes Stand Down Date: Stand Down Time: Advised to Stand Down By: Page 96 of 104

97 Q - Park This role will be carried out by the most Senior Member of the Q - Park Team available at the time of activation On receipt of the instruction from BBW Helpdesk:- CBRN INCIDENT DECLARED Plan initiated In the event that Q - Park is informed of a CBRN incident ensuring the following must be carried out: Q-Park control to recall Q-Park hosts to Car Park F in order to be briefed and obtain postings. Q-Park Manager / Night supervisor to liaise with Senior ED Sister. Q-Park hosts to initiate pelican crossing emergency warning lighting. Q-Park hosts to distribute barrier apparatus or tape from Car Park F to ED apron, ED disable car park and ED drop off car park bays. Q-Park hosts to assist BBW security erect the perimeter barriers around the ED ambulance area, ED drop off car park and ED disabled car park. Q-Park hosts to remove all unwanted, obstructive vehicles from the ED ambulance bays, ED drop off zone and ED disabled parking bays. The destination of vehicles parked at the ED drop off would be BWH Lower Car park (space permitting) accessed via the gate, the destination of the vehicles parked on ED disabled bays would be Car Park F level 0 (space permitting). Q-Park hosts to control vehicle access around the ED apron, vehicle access points (ED Ambulance entrance and exit and the ED drop off car park entrance.) Await further instruction from senior Trust Management. Q-Park to await further instruction from Consort Senior management Page 97 of 104

98 BBW Security This role will be carried out by the most Senior Member of the Security Team available at the time of activation On receipt of the instruction from BBW Helpdesk:- CBRN INCIDENT DECLARED Plan initiated In the event that security is informed of a CBRN incident ensuring the following must be carried out: Security control to recall 3 CBRN security officers and Duty Manager to ED Security Office for plan initiation in order to be briefed, obtain postings and receive the required anti contamination PPE. Distribute 6 radios to ED Coordinator main dept and the 24 radios to the Trust command and control centre. BBW Duty Manager to liaise with ED Senior Nurse / Coordinator at the coordinators desk to await further instructions. CBRN security officers will lock down ED entrance, CDU side entrance near ED Ambulance entrance, ED See & Treat entrance, ED /CDU Main street entrance and ED staff room entrance from Main Street (Ref 1) CBRN Security officers will take up positions on the ED apron assisting clinical staff with crowd control, ED Ambulance entrance controlling access with clinical staff redirecting contaminated patients to decontamination area. Further CBRN Security officers will take up positions on the ED entrance off Main Street and the ED staff entrance limiting access for trauma teams. BBW Duty Manager deploys 1 CBRN security officers in (without PPE) to the main reception to lock revolving doors and act as re direction access control at disabled access door. BBW Duty Manger & CBRN Security team await further instructions from senior Trust Management / BBW/Consort Senior Management Page 98 of 104

99 BBW Estates This role will be carried out by the most Senior Member of the Estates Team available at the time of activation On receipt of the instruction from BBW Helpdesk:- CBRN INCIDENT DECLARED Plan initiated BBW Estates to assist BBW security to erect the perimeter barriers around the ED ambulance area, ED drop off car park and ED disabled car park. Check levels on the decontamination tank every 15 mins and Inform Trust Estates Duty Manager once the level of the tank is approximately ¾ full. On completion of the incident or once the level of the tank approximately ¾ full. Inform the Trust Estates Duty Manager who will decide when to call out Veolia ( ) to remove any waste materials. Await further instruction from Senior Management. Page 99 of 104

100 P.D.U. CLEAN UP PROCEDURE. 1. Wear supplementary PPE. (Kept in decontamination store room). 2. Request Portering Staff collect 770L hazardous waste container (HWC) from the central waste service yard. 3. Use soap and water to clean down flooring in PDU. Rinse off and lift out into the storage cage. Have the storage cage flooring lined with soak-up mats. The PDU pump will still be turned on and draining, so will continue to empty waste water from the PDU into the collection tank. 4. Detach the external water and hose supply to the PDU and place back into cage with PDU, before placing cage in decontamination store room. 5. Ensure all waste water is drained from the floor of the PDU.. 6. Ensure all the waste water is drained from the hoses into the collection ports. Remove hoses from the pumps and waste collection ports. Waste hoses to be stored in cage with pump. 7. Flush pump through with clean water, Remove the pumps from the PDUs drain and dry before storing with PDU and place back into cage with PDU before moving to decontamination store room. 8. The new PDU s require walls to be washed down with soap and water, dried and then collapsed into their closed positions. Place back into their carry bags, into cage and returned to the Decontamination Store room. 9. Detach the Velcro bands for the sides of the RED Disrobe tent. Once completely detached from the tent, collapse Red tent down and store with sides in its storage bag. Remove to decontamination store room. 10. Detach the Velcro bands for the sides of the WHITE Rerobe tent. Once completely detached from the tent, collapse White tent down and store with sides in its storage bag. Remove to decontamination store room. 11. Any other waste consumables from the decontamination incident e.g. sponges, soak-up mats, buckets, resuscitation devices must all be placed into clinical waste bags, tied and then labelled on outside of bag as to the contents. Place these clinical waste bags into the HWC. Page 100 of 104

101 12. Return all cages, pumps, clean consumables back to the decontamination store room. 13. Disrobe from the supplementary PPE, place into clinical waste bags, tie and label its contents and place inside HWC. 14. Place PRPS / PPE decontamination suits in box with related identification number and fill out paperwork contained in the box before contacting Emergency preparedness lead in corporate Nursing/ Senior Sister, ED lead for decontamination in ED. The suits will then be sent for service and safety check. Please ensure that the hydration unit and hard hat are also enclosed in this box. Page 101 of 104

102 EMERGENCY POD SUPPLIES There is a national stockpile of equipment and drugs for use in times of Chemical and Biological Incidents. They are available in a pre-packed format, known as PODS and are held at strategic sites around the United Kingdom. These PODS are to be accessed and used by all Acute Hospitals and Ambulance Services nationally, if required. The list below provides information about the contents, location and how to access the PODS. POD POD DESCRIPTION POD LOCATION / POD ACCESS NUMBER 1 Modesty Pod Held by 14 nominated Ambulance Service Trusts. Access via local Ambulance Service. (West Midlands Ambulance Service ) 2 Nerve Agent Pod These Pods are held by the National Blood Service in England. Access via local Ambulance Service. (West Midlands Ambulance Service ) 3 Equipment Pod Held by 14 nominated Ambulance Service Trusts. Access via local Ambulance Service. (West Midlands Ambulance Service ) 4 Biological Ciprofloxacin These PODS are held by the NHS Logistics Authority. Access via the UK Reserve Stock Hotline For Major Incidents. 5 Biological Doxycycline ( ) These PODS are held by the NHS Logistics Authority. Access via the UK Reserve Stock Hotline For Major Incidents. ( ) Should you require: 1. Obidoxime to treat nerve agent poisoning in patients that fail to respond to Pralidoxime chloride or Botulinium Antitoxin contact Blood Bank who will then ring the National Blood Service Issue Department to request this. Page 102 of 104

103 APPENDIX C - BURNS PLAN Major Incident declared UHB Major Incident Policy triggered Large number of burn victims reported UHB Burn Incident Office set up (Burns Centre Seminar Rm) On call burns consultant, Sister from burn ward, Sister from Critical Care, Sister from ward 408 Chairperson Team Leader from theatres Anaesthetist Command Centre nominate chairperson to set up and facilitate Burns Incident Office Burn Incident Office decide whether to call in additional staff consider Burns Dr s, Nurses, Theatre staff, Anaesthetists, Senior Nurse, Ops manager Decision communicated to UHB command centre by Burns Incident Office Chairperson Call in process starts Ward 408 Sister assesses capacity on ward 408 and produces an action plan to create capacity Burn Incident Office makes assessment of available capacity Burns Sister assesses capacity on Burns Centre and produces an action plan to create capacity Critical Care Sister assesses capacity on Critical Care and produces an action plan to create capacity Burns Incident Office brief Command Centre about capacity Command Centre decide how much capacity is to be created and what plans should be implemented Command Centre communicate with Incident Controllers and Burns Bed Bureau Capacity plans implemented Status of burns victims arriving in ED reported back to Burn Control Centre and logged Live capacity status fed into UHB Command centre Burns Incident Office continues to manage incident at a local level (this may continue well after command centre has been disbanded) including: Communication with operating theatres Communication with suppliers Communication with network Communication with ITU Communication with general wards Page 103 of 104

104 .APPENDIX D REFERENCE DOCUMENTS The Major Incident Response Plan has been prepared utilising the following guidance documents. Cabinet Office (2004) Civil Contingencies Act Cabinet Office UK Resilience. Emergency Response and Recovery. Cabinet Office (2005) Emergency Preparedness. Department of Health (2000) Deliberate Release of Biological and Chemical Agents: Guidance to help plan the Health Service Response. Department of Health (2002) Emergency Planning and Response to a Major Incident: Summary of roles and responsibilities. Department of Health (2005) Guidance of Psychosocial Care for the NHS. Department of Health (2005) Emergency Preparedness Division. The NHS Emergency Planning Guidance Department of Health (2007) Emergency Preparedness Division. Mass Casualties Incidents A Framework for Planning. Department of Health (2007) Emergency Preparedness Division. Strategic Command Arrangements for the NHS during a Major Incident. Department of Health (2008) NHS Resilience and Business Continuity Management Guidance. Interim Strategic National Guidance for NHS Organisations. Department of Health (2009) Planning for the Psychosocial and mental health care of people affected by Major Incidents & Disasters: Interim National Strategic guidance Health Protection Agency. Emergency Response Document. Health Protection Agency (2005) CBRN Incidents Clinical management and Health Protection. Home Office (2004) The Decontamination of People Exposed to Chemical, Biological, Radioactive and Nuclear substances or materials Strategic National Guidance. National Audit Office (2002) Facing the Challenge: NHS Emergency Planning in England. Page 104 of 104