royal united hospital bath nhs trust command and · pdf fileroyal united hospital bath nhs...

Royal United Hospital Bath NHS Trust Royal United Hospital Bath NHS Trust

COMMAND AND COORDINATION Section

77.1 Context 7.1.1 In order to achieve a combined and coordinated response to a Major

Incident, the management of the response is divided at Trust level into three levels, Operational (Bronze), Tactical (Silver) and Strategic (Gold). The requirement to implement one or more of those management levels will depend upon the nature of the incident; however an operational level of command will always be established and possibly a tactical level if required.

See Section 4- Great Western Ambulance Service

7.1.2 Operational and Tactical command and co-ordination will be delivered from

two facilities. • Operational Control Room (Bronze) - Patient Admissions Centre and

Nurse Bank • Tactical Control Room (Silver) - Directors Offices

7.2 Operational (Bronze) Coordination 7.2.1 Operational (Bronze) coordination will be achieved, firstly by the ‘Site’

Manager and secondly by a Senior Manager. The latter will undertake regular operational hospital management, will receive regular orientation and training and will be completely familiar with the Major Incident Plan. Each team will have action cards to ensure the Trust response is identical, irrespective of the hour or day. The roles are named as: • First Responder (Site Manager) • Operational Coordinator (On-call Manager 1st line contact)

See Appendix 34- First Responder Action Card See Appendix 35- Operational Coordinator Action Card

7.3 Operational Control Room (OCR) 7.3.1 The OCR is located on the south corridor and is in close proximity to

Switchboard, the Staff Volunteers and Rest Centre and a short distance from the Relatives Reception Centre. The OCR normally provides accommodation for Site Management and through an adjoining door the Nurse Bank office. This entire complex will be used for the OCR with the Nurse Bank office used as an Operational Planning Room and for Ambulance Liaison.

7.3.2 The following staff will work directly from the OCR:

• First Responder (Site Manager) • Operational Coordinator (1st line On-call Manager) • Bed Manager (Bed Manager)

See Appendix 36- Bed Manager Action Card



7• Critical Care / Theatres / Clinical Support • Services Coordinator

• Admin & Clerical support and runners • Ambulance Liaison • Emergency Planning Lead

See Appendix 37- GP Liaison Action Card See Appendix 38- Critical Care/Theatre/Clinical Support Services Coordinator Action Card See Appendix 39- Administration and Clerical Support Action Card

7.3.3 The resources for the OCR includes:

• Direct dial telephones • 12 telephone extensions + 6 additional available if required • Fax lines • E-mail account [email protected], mirrored

in each office • Document boxes for plans and action cards • Wipe board and dry marker pens

See Appendix 40- Bleep/Useful Numbers

7.4 First Responder 7.4.1 Members of the First Responder (FR) team

• Site Manager (Patient Access Team) • Night Nurse Practitioners

7.4.2 The First Responder will be:

• Available on-site 24/7 • Informed by voice bleep ‘Team 25’

• Issued the alert message and repeated x 3



77.4.3 The FR will be responsible for completing the actions detailed on the ‘First

Responder’ action card. Critical actions include: • • Completing required documentation • Deploying Emergency Department Forward Observer • To fax the bed state to the Ambulance Service • Finding help

See Appendix 41 Alert Record See Appendix 42- Response Check List See Appendix 43- Emergency Department Forward Observer Action Card See Appendix 44- Division Bleep Holders Action Card See Appendix 45- Risk Assessment See Appendix 46- Bed State Pro-Forma

7.4.4 Initiate in a ‘Declared’ alert the 1st stage of the ‘capacity expansion plan’. 7.5 Operational Coordinator

7.5.1 Members of the Operational Coordinator (OC) team

• Assistant Director of Nursing, Medicine • Assistant Director of Nursing, Surgery • Assistant Director of Nursing, Corporate Division • Senior Nurses from the Medical and Surgical Division • Speciality Managers • Assistant Divisional Manager Medical Division • Assistant Divisional Manager Surgical Division • Assistant Divisional Manager Specialties Division • Members from the 1st Line On-call managers

7.5.2 Operational Coordinator

One Operational Coordinator will be:



7• Available 24/7 • Informed by radiopager/ mobile telephone/ bleep • Issued the alert message • On-site or on-call • Able to arrive at the hospital within 30 minutes of alert

7.5.3 The OC completes the instructions as detailed on the ‘Operational

Coordinator’ action card.

7.5.4 In a ‘Declared’ alert the OC deploys Forward

Coordinators: • Critical Care, Theatre and Clinical Support Services Observer • Transfer Lounge Manager • Forward Emergency Department observer • Casualty Enquiry Bureau + Police Documentation Team Coordinator • Relatives Centre Coordinator • Staff Reception / rest Centre Coordinator • Documentation Observer • Loggist

See Appendix 47- Discharge Centre Manger Action Card See Appendix 48- ‘Transfer Lounge Log Patients Discharged See Appendix 48- Transfer Lounge Log Patients Transferred

7.5.5 The OC initiates the ‘Expansion Plan’ if required to accommodate:

• Priority 1 = 10 patients for Critical Care • Priority 2 = 100 patients requiring a bed within 4 hours • Priority 3 = 100 + minor injuries • Other emergencies and GP admissions

7.5.6 The OC conducts frequent situational briefings with key staff including:

• Site Manager / Bed Manager • Divisional Bleep Holders • Forward Observers / Coordinators



7 • Casualty Enquiry Bureau • Communication team – information for the media briefings • Ambulance Liaison

7.5.7 The FR and OC must be completely familiar with the command and co-

ordination procedures detailed on the action cards.

7.6 Critical Care Services

7.6.1 In a declared alert the critical care forward observer for the critical care,

theatre, radiology, pathology and pharmacy will be based in the operational control room. They will: • Work with and report to the Operational Coordinator • Monitor the involvement and capacity of the critical care services • Problem solve for the critical care services • Support the emotional welfare of staff

7.7 Transfer Lounge

7.7.1 In a declared alert the transfer lounge forward coordinator will be based in

the Discharge Centre and will report to the operational coordinator. They will: • Open the Discharge Centre if necessary • Transfer existing patients to the Discharge Centre • Coordinate clinical services and transport to enable discharge home or

transfer to community hospitals to help generate Trust capacity

7.8 Casualty Enquiry Bureau + Police Documentation Team

7.8.1 In a declared alert the casualty enquiry bureau forward coordinator will be

based in the 1st floor management offices (complaints and litigation) they may also use the senior receptionist office in ED to gather accurate data about casualties and will report to the operational coordinator. They will: • Manage and coordinate all patient and relative documentation and

enquiries • Receive all Major Incident patient registration documents from

Emergency Department

See Appendix 49- Casualty Enquiry Bureau Coordinator Action Card See Appendix 50- Casualty Enquiry Bureau Contact Log



7• Receive all enquires from relatives and friends of patients • Provide for the operational, tactical, communication, receiving ward,

welfare and Police documentation team information regarding patient identity and relative information

• Provide a help desk function for the concerned

7.9 Relatives Reception Centre

7.9.1 In a declared alert the Relatives’ Reception Centre Manager will be based in the Postgraduate Medical Centre (PGMC) dining room and will report to the operational coordinator. They will:

• Receive all relatives and friends who arrive at the hospital • Transfer relative information to the casualty enquiry bureau • Keep relatives informed and comfortable • Repatriate relatives and patients • Manage identification of the dead patient with the mortuary and police

NB: The atrium reception staff will be required to receive and direct all people making enquires. The Friends volunteers will be required to escort all relatives to the PGMC

See Appendix 51- Relatives Manager Action Card See Appendix 52- Relatives Contact Information

7.10 Staff Reception Centre

7.10.1 In a declared alert the staff reception centre will be based in the Lansdown

Restaurant and report to the operational coordinator. They will: • Work with the Divisional Bleep Holders to allocate volunteer staff to

clinical areas as required • Receive volunteer staff • Establish the skills of each volunteer and allocate staff to tasks as

requests are received from the Operational Control Room • Provide rest and recuperation for staff, which will include catering and

rest areas • Document all actions and details of volunteer staff • Support the emotional welfare of staff

See Appendix 53- Staffing Centre Manager Action Card See Appendix 54- Staff and Volunteer Log

7.10.2 For staff alerted by bleep or pager or call-in, go direct to the area as

requested. Any member of staff not on duty who wishes to help is See Appendix 53- Staffing



7requested to go the Lansdown Restaurant where they will be received, their details recorded including the contribution they could best provide. All staff must observe the following: • Do not contact the hospital Switchboard unless critically urgent • Bring your security identification as all entrances will be patrolled by

security • Enter the site via Evelyn Road or Penn-lea entrances only. Both

barriers will be opened and patrolled by security. Do not enter via the Main or Emergency Department entrances

• For volunteers arriving at the reception centre state your name, role,

and if you speak a foreign language

Centre Manager Action Card See Appendix 54- Staff and Volunteer Log

7.11 Documentation Observer

7.11.1 In a declared alert the documentation forward observer will be available by

bleep and report to the operational coordinator. They will: • Check all areas are completely familiar with the documentation to be

used in the Major Incident • Ensure all completed documentation is direct to the required area • Check for completeness and legibility • Coordinate the security of all management documentation and

switchboard computer logs in relation to the Major Incident from all areas involved

7.12 Ambulance Liaison 7.12.1 Will be dispatched to undertake the role of Ambulance Liaison officer. They

will be located in the Nurse Bank office with an adjoining door to the Control Room. The room is provided with a fax and two direct dial telephones not routed through switchboard. In addition a Raynet terminal is available routed to a roof aerial.

7.13 Tactical Coordinator (TC) 7.13.1 When more than one agency is operating at the tactical level there must be

consultation between the various agency Tactical Coordinators (TC). The TC must not become involved with activities of the Operational Coordinator, but concentrate on the overall general management. In order to effect co-ordination, the TC will liaise with other Silver control areas in other Trusts and allied agencies. Establishment of inter-service communication links will support the effective running of the incident. The OC together with 2nd line on-call manager Duty Director (DD) will determine the need for a Tactical Control Room (TCR) to be established.



7 7.13.2 The tactical (Silver) level of command exists to:

• Liaise with the OC regularly for situational briefings • Complete the corporate risk assessment • Evaluate the implications for the Trust for the specific incident faced • Authorise as required the Operational Coordinator to cancel elective

surgery and outpatient clinics • Authorise any required re-allocation of resources to meet the incident

demands • Develop a plan to return the Trust to ‘normal’ operation as soon as

possible • With the support of the press officer provide media briefings with

information provided by the OC, Casualty Enquiry Bureau • Liaise with Silver Controls for other acute Trusts (mutual aid) the

Strategic Health Authority, PCT’s, local authorities and ambulance services

• Authorise and arrange to meet and conduct the reception of VIP’s

which is managed by the press officer • To keep staff informed regularly regarding the incident status and

information. The communication team has available to it radio pagers pager and voice bleeps, the intranet front page, E-mail and bulletins for long term incidents

7.13.3 If it becomes apparent that resources or expertise beyond

the level of the tactical commander are required, or should there be the need to coordinate more than one incident / scene (where tactical command has been established), it may be necessary to implement a strategic (Gold) level of management.

See Appendix 55- Tactical Coordinator Action Card See Appendix 56- Risk Assessment Log

7.14 Tactical Control Room (TCR) 7.14.1 The TCR is located in the Directors’ Offices on the first floor immediately

above and a short distance from the OCR. The facility contains a number of offices a meeting room, which will accommodate 12 people with an adjacent open office area accommodating four personal assistants. The meetings room and adjacent open office area will be used for the Tactical command and co-ordination. This will be established as required.



7 7.14.2 The following staff will work directly from the TCR:

• Duty Director (2nd line on-call manager) • Medical Director

• Facilities Manager (Director / Senior Manager) • Administration & Clerical support and runners (Chief Executive PA) • Director of Nursing

See Appendix 57- Medical Director Action Card See Appendix 58- Director of Nursing Action Card See Appendix 59- Facilities Manager Action Card See Appendix 60- Director of Facilities Action Card See Appendix 61- Facilities Response Checklist

7.14.3 The resources for the TCR includes:

• 1 direct dial telephone • 12 telephone extensions • 2 Fax lines • E-mail account [email protected] • Flip Chart

7.15 Strategic (Gold) 7.15.1 This is the Senior tier of management and will be based in the Local

Emergency Centre at the Headquarters of the Avon & Somerset Constabulary at Portishead or at Wiltshire Police Headquarters at Devizes, which has extensive communication facilities. ‘Gold Control’ would only be used in a large-scale incident to make strategic decisions about deployment of resources, managing populations, providing information and the restoration of normality. A member of the Strategic Health Authority would represent the Health Service.

7.16 Working with the Police 7.16.1 In the event that the Police request the preservation of forensic evidence,

Trust staff must take all reasonable steps to collaborate with this. Staff must ensure the patient is not adversely affected as a result of the efforts to preserve forensic evidence. Property should be handled as minimally as



7possible wearing gloves and placed in a sealed bag. The bag will be supplied in Emergency Department and labelled. Once sealed the bag must not be opened unless authorised by the Police. Patient Affairs staff will liaise with the Police regarding relevant patient property issues.

7.16.2 The Police Documentation team will be based with the Casualty Enquiry

Bureau staff on the first floor management offices to the rear of Emergency Department. The Police will need access to the basic patient information, name, address and D.O.B for any Major Incident patient. The information will be recorded and forwarded to the Police Casualty Bureau.

7.16.3 In exceptional circumstances the Police may be able to assist with the

contacting and transportation of critical staff to the Trust. The circumstance of an incident cutting off or blocking a key staff member may be a scenario the police or military could assist with.

7.17 Volunteers 7.17.1 Any member of the public wishing to volunteer to help should be asked to

wait in the Atrium. The main entrance receptionists will record their details and thank them for the offer of help. It is standard practice to decline the offer of assistance.

7.18 Friends of the RUH 7.18.1 The Friends of the RUH lead will be contacted by the Control Room team

and briefed regarding support required. The Friends principle role is to guide relatives to the Post Graduate Centre as they arrive at the main entrance. In addition they will provide support in the established clinical areas with refreshment for patients and staff.

See Appendix 62- Volunteers Reception Action Card

7.19 Blood Donors 7.19.1 Any member of the public wishing to volunteer to provide blood will have

their details recorded thanked for the offer and re-assured the information will be passed to the blood transfusion service who will contact them if additional stocks are required.

7.20 Foreign Languages 7.20.1 The communications team will maintain a list of translators in the hospital. 7.21. NHS Direct 7.21.1 If required and appropriate NHS Direct offers a resource for assisting in the

provision of health advice / reassurance for the public. This will be around public health type scenarios resulting from a Major Incident. NHS direct national on call team can be contacted on the NHS Direct number 0845 46 47.



7 7.22 Supplies 7.22.1 The supply chain is critical to the effective management of an incident.

NHS supplies would be alerted and the normal process for delivery would apply. The supplies team will be available to process orders quickly with the chain or authority and authorisation assumed by the Operational Coordinator. For items over £1,000 the authority would be through Silver control. The contracts to manage breakdown for critical equipment must include the companies’ response time and method of contact.

The supplies department will be able to support contact information for equipment and supplies used on site. Managers must consider opportunities for emergency or mobile replacement for high-risk single items of equipment. For example a mobile CT scanner can be available within 12 hrs and forms part of the Radiology plan.

The Strategic Health authority Silver control team will coordinate any large scale or special supplies required for the health community and engage NHS supplies to manage the process.

7.23 Military Assistance 7.23.1 If military assistance was required the RUH Silver control would contact the

Strategic Health Authority Silver control team. They will access the required support on their behalf of the Trust and coordinate any required response across the Health Community. Military assistance is most likely required in an environmental and mass casualty incident.

7.23.2 Repatriation of military personnel will be coordinated through the strategic

health authority. The Trust will supply a mobile medical team to the air-head and make available the required number of beds.

7.24 Stand Down Procedure 7.24.1 The Ambulance Service will declare stand down by contacting the

Emergency Department Shift Coordinator. The Operational Coordinator will be informed a Stand down message has been received. A decision will be made when to issue this to the hospital through Switchboard contacting all staff previously alerted. The timing of this will be with consideration for:

• Have all the casualties arrived at the hospital • Is the full extent of the incident known



7 • Are all systems in place throughout the hospital to deal with the

ongoing situation 7.24.2 The team will then consider the impact and advise on the need for:

• Further patient movements around or out of the hospital • Information and arrangements for relatives and staff • Information for the media • Staffing needs throughout wards and departments • Arrangements for debriefing and support Once senior staff have been informed by switchboard they must inform their team as well as those who have been put on standby at home. It is essential that all staff who were notified of the alert are informed of the ‘Stand down’

• Phone people at home • Prepare defusing gatherings immediately before staff go off duty only

for them to talk if they wish about what happened that was positive. Ensure there is a list of names of all the staff who were involved to check all are considered and cared for after the incident

• Involve staff who were not on duty and ‘missed it’ • Access professional managed debriefing meetings, which will be

arranged by the welfare team

All Major Incident documentation no matter how small including scraps of paper must be taken to the control room and handed to the Operational Coordinator. These are vital as evidence of the Trusts effective response.

7.25 Key Points

• Operational Bronze Command and Co-ordination will be established • A First Responder (FR) will brief alerted staff from the Operational Co-

ordination Centre OCC and may initiate the 1st expansion and reception of patients

• The Operational Coordinator (OC) (Bronze) will be specially trained and

be responsible for the operational command and co-ordination of the incident following the ‘Escalation plan as detailed

• The Tactical Coordinator (TC) (Silver) will support the OC and establish a Tactical Coordination Centre if required in the Directors Office

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