National Institute for Health Research Service Delivery and Organisation Programme A scoping study of emergency planning and management in health care: What further research is needed? Alan Boyd,1 Naomi Chambers,1 Simon French,1 Russell King,2 Duncan Shaw,3 and Alison Whitehead4 1 Manchester Business School 2 Royal Free London NHS Foundation Trust 3 Aston University Business School 4 Wrightington, Wigan and Leigh NHS Foundation Trust Published July 2012 This project is funded by the Service Delivery and Organisation Programme Address for correspondence: Alan Boyd Manchester Business School Booth Street West Manchester M15 6PB Email: [email protected] This report should be referenced as follows: Boyd A, Chambers N, French S, King RA, Shaw D, Whitehead AS. A scoping study of emergency planning and management in health care: What further research is needed? Final report. NIHR Health Services and Delivery Research programme; 2012. Relationship statement: This document is an output from a research project that was funded by the NIHR Service Delivery and Organisation (SDO) programme based at the National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre (NETSCC) at the University of Southampton. The management of the project and subsequent editorial review of the final report was undertaken by the NIHR Service Delivery and Organisation (SDO) programme. From January 2012, the NIHR SDO programme merged with the NIHR Health Services Research (NIHR HSR) programme to establish the new NIHR Health Services and Delivery Research (NIHR HS&DR) programme. Should you have any queries please contact [email protected]. Copyright information: This report may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NETSCC, HS&DR. National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre University of Southampton Alpha House, Enterprise Road Southampton SO16 7NS © Queen’s Printer and Controller of HMSO 2012. This work was produced by Boyd et al. under the terms of a commissioning contract issued by the Secretary of State for Health. 2 Project 09/1005/01 Disclaimer: This report presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and not necessarily those of the NHS, the NIHR or the Department of Health. Criteria for inclusion Reports are published if (1) they have resulted from work for the SDO programme including those submitted post the merge to the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. The research in this report was commissioned by the SDO programme as project number 09/1005/01. The contractual start date was in September 2010. The final report began editorial review in November 2011 and was accepted for publication in July 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The SDO editorial team have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report documentation. However, they do not accept liability for damages or losses arising from material published in this report. © Queen’s Printer and Controller of HMSO 2012. This work was produced by Boyd et al. under the terms of a commissioning contract issued by the Secretary of State for Health. 3 Project 09/1005/01 Contents Contents ................................................................................................... 4 List of appendices ...................................................................................... 8 List of tables............................................................................................ 10 List of figures .......................................................................................... 11 Glossary of terms ..................................................................................... 13 Abbreviations .......................................................................................... 18 Acknowledgements .................................................................................. 22 Executive summary .................................................................................. 24 Background ............................................................................................. 24 Aims....................................................................................................... 24 Methods .................................................................................................. 24 Findings and recommendations .................................................................. 26 The Report .............................................................................................. 30 1 Background ....................................................................................... 30 1.1 Aims and objectives ...................................................................... 31 1.2 Structure of the report................................................................... 32 2 Emergency planning concepts and models ............................................. 34 2.1 Incidents, disasters and crises ........................................................ 34 2.2 Emergency planning ...................................................................... 37 2.2.1 Relationship between emergency planning and research .............. 43 3 Emergency planning policy and practice ................................................ 46 3.1 Risks to the UK ............................................................................. 46 3.1.1 Pandemic human disease ......................................................... 47 3.1.2 Flooding ................................................................................. 48 3.1.3 Severe weather ....................................................................... 48 3.1.4 Animal disease ........................................................................ 49 3.1.5 Major industrial accidents ......................................................... 49 © Queen’s Printer and Controller of HMSO 2012. This work was produced by Boyd et al. under the terms of a commissioning contract issued by the Secretary of State for Health. 4 Project 09/1005/01 3.1.6 Major transport accidents ......................................................... 50 3.1.7 Malicious attacks ..................................................................... 50 3.1.8 Community Risk Registers ........................................................ 51 3.1.9 Health care business continuity risks.......................................... 51 3.2 Organisation of emergency planning in the UK .................................. 55 3.2.1 Reorganisation of emergency planning in England ....................... 60 3.3 Risks and organisation of emergency planning in the USA .................. 60 4 Literature review ................................................................................ 63 4.1 Methods ...................................................................................... 64 4.1.1 Academic literature search ....................................................... 64 4.1.2 Grey literature search .............................................................. 66 4.1.3 Research registers ................................................................... 68 4.1.4 Filtering ................................................................................. 68 4.1.5 Data extraction ....................................................................... 69 4.1.6 Researcher survey ................................................................... 70 4.1.7 Analysis ................................................................................. 70 4.2 Previous scoping reviews ............................................................... 71 4.2.1 Health/Health care specific scoping reviews ................................ 71 4.2.2 Scoping reviews not specific to health care ................................. 75 4.2.3 Analysis of previous scoping reviews .......................................... 77 4.3 Analysis of journal article citations judged to be very relevant ............ 80 4.3.1 Comparisons with previous scoping reviews ................................ 80 4.3.2 Patterns in the UK-focused citations .......................................... 83 4.4 Analysis of articles found by the literature search of academically oriented databases ................................................................................ 86 4.4.1 Standards and levels of preparedness ........................................ 87 4.4.2 Priority and resourcing given to emergency planning and management ..................................................................................... 89 4.4.3 Training and exercises ............................................................. 90 © Queen’s Printer and Controller