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Role and responsibilities of the NHS in emergency response

Dominic MellonSpecialty Registrar – Public Health

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Role and responsibilities of the NHS in emergency response

NHS command, control and coordination The structure of the NHS Organisational roles and responsibilities NHS role in a chemical, biological, radiological

or nuclear response (HART) Hazardous Area Response Teams (HART) Scientific and Technical Advice Cell (STAC) NHS reorganisation

SUBJECT TO CHANGE

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Department of HealthCabinet Office

Civil Contingencies Committee

NHS South West(Strategic Health Authority)

Regional Coordinating Group

Primary Care Trust

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SHA representative

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Local Health responseLocal Strategic Coordinating

Centre

(‘Gold’)

Ambulance Executive

representative

PCT Executive representative

Operational Level management (Bronze Commanders)

Command and Control

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Strategic Health Authorities

Role of NHS South West:

Strategic leadership of the NHS

Ensuring the local NHS operates effectively and delivers improved health and healthcare performance

Development of NHS organisations and staff

Delivery assurance, e.g. Civil Contingencies A compliance

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Role and Responsibilities

Source: Information about the NHS in the Southwest, NHS Southwest, 2006

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Role and Responsibilities

Strategic Health Authorities: Strategic command and control for widespread

major incidents Support coordination of local NHS response Coordinate mutual aid/military assistance Liaise with the Department of Health Assure command of a local response if required Asses ongoing situation and identify emerging

issues

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Primary Care Trusts

Role of Primary Care Trusts: 14 Primary Care Trusts in the South West Primary Care health services:

General Practitioners; Public Health of the local population; walk-in centres/ minor injuries units; Community hospitals Community nurses;

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Role and ResponsibilitiesPrimary Care Trusts Represent the local NHS at Strategic

Coordinating Group Coordinate the implementation of the local

NHS response Implement arrangements for mass

prophylaxis Health monitoring and surveillance Manage local health media messages

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Role and ResponsibilitiesAcute Trusts Activate Major Incident Plans when alerted

by the Ambulance Service Establish a control room Provide a Medical Emergency Response

incident Team to the scene Lockdown hospital Decontaminate patients

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Ambulance Service Trust

Ambulance Service Trusts: Two ambulance services in the South West

Great Western Ambulance Service NHS Trust (GWAS)

South Western Ambulance Services NHS Trust (SWAST)

The saving of life …by instigate a triage process when required …by treat casualties …by transport casualties to hospital

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Role and Responsibilities

Ambulance Service Trusts

To instigate a command and control structure

To protect the health, safety and welfare of all health service personnel on site

To co-ordinate the NHS communications on site and to alert the main 'receiving' hospitals for the receipt of the injured

To carry out a health service assessment for the incident

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Specialist incident response

Special Incident Response Teams (SORT) provide clinical decontamination and support mass decontamination

Specialist equipment: National capabilities mass casualty equipment Multi-patient oxygen delivery

Ambulance service chemical, biological, radiological and nuclear incident response:

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NHS Zones

IncidentIncidentSiteSite

Hot ZoneHot Zone

MobileMobileDecon.Decon.

UnitUnit

De-De-robbingrobbing

areaarea

Modesty Modesty areaarea

Warm ZoneWarm Zone

Casualty Casualty ClearingClearing

Amb. Amb. Loading Loading

PointPoint

Cold ZoneCold Zone

HospitalsHospitals

Inner Inner CordonCordon

Outer Outer CordonCordon

Fire & RescueFire & Rescue Ambulance ServiceAmbulance Service

Triage Triage OfficerOfficer

Decon. Decon. operatorsoperators

Decon. Officer

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Hazardous Area Response Teams

The Hazardous Area Response Team (HART) is a new capability to Great Western Ambulance Service

Hazardous Area Response Teams are national assets

Provides a capability for ambulance services to save lives in CBRN or hazardous incidents

Improve the care provided by ambulance services inside the inner cordon of major incidents

Teams of six provide 24 hour cover

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HART provides an incident support capability to extend paramedic care into a range of challenging situations:

Complex/protracted incidents Urban Search and Rescue Incident Response Unit Incidents involving hazardous materials Working at height Inland water operations CBRN decontamination

Hazardous Area Response Teams

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NHS Blood & Transplant

Role of NHS Blood & Transplant Hold reserve national stockpile for Major

Emergencies on behalf of Department of Health Stockpile includes nerve agent antidotes and

other counter measures Activated by ambulance control to NHS Blood &

Transplant Only delivered to hospitals with a transfusion lab

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Scientific and Technical Advice Cell

Multi-agency expert group Provide advice to Strategic Coordinating

Group (SCG) on health, scientific and technical matters

Activated by SCG chair Commonly chaired by Director of Public

Health Ensures advice is consistence Liaison with national specialist advisors

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Scientific & Technical Advice Cell

Regional Civil Contingencies

Committee

Strategic Coordinating

Group

Tactical

Operational

Regional STAC

STAC

Scientific Advice for Government in Emergencies

Cabinet Office Briefing Room

(COBR)

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Scientific and Technical Advice Cell Members of the Scientific and Advice Cell may

include: Director of Public Health Health Protection Unit Environmental Health (Local Authority) Utility companies (water/gas/electric) Environment Agency Met Office Health & Safety Executive Site Operator Port Health

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NHS reorganisation April 2011 – provider services must be

independent from the Primary Care Trust March 2012 Abolition of Strategic Health

Authorities March 2013 Abolition of Primary Care

Trusts Creation of GP consortia Creation of Public Health Service Abolition of Health Protection Agency Implications for resilience?

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Department of HealthCabinet Office

Civil Contingencies Committee

NHS South West(Strategic Health Authority)

Regional Coordinating Group

Primary Care Trust

Acu

te T

rust

s

SHA representative

Pri

mar

y C

are

Am

bu

lan

ce

Ser

vice

Oth

er h

ealt

h

serv

ices

Local Health responseLocal Strategic Coordinating

Centre

(‘Gold’)

Ambulance Executive

representative

PCT Executive representative

Operational Level management (Bronze Commanders)

Command and Control

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NHS reorganisationDepartment of

Health

?

X GP consortia

17 Acute Trusts

2 Ambulance Service Trusts

6 Mental Health Trusts

National

Regional

Local

x Primary Care Provider Services

NHS Commissioning Board

(Including Public Health Service)

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Questions?

Jody James

Associate Director Regional Resilience

NHS South West

jody.james@southwest.nhs.uk