RESPONDING TO EMERGENCIES: PART 1 INTRODUCTION NHSSCOTLAND 1.1 Whether manifesting itself as a sudden, unexpected peak in demand for its services, as an unpredicted loss in its operational capabilities or however, and whatever the cause may be, an emergency does not alter the statutory purposes of NHSScotland which remain the securing of improved health for people in Scotland and the prevention, diagnosis and treatment of illness. Under Scottish Ministers, overall responsibility for the management of NHSScotland to achieve its purposes lies with the Scottish Executive Health Department. Close contact is maintained with the other UK Health Departments, with professional bodies and others at the national level to enable co-ordination and mutual support both across the NHS as a whole, and with other public services in Scotland. 1.2 NHS Boards NHS Boards are accountable to the Scottish Executive Health Department for the overall assessment of health needs of all people within their geographic areas, and for arranging for those needs to be met. This strategic function, together with their specific responsibilities for public health within their geographic areas, and for the registration and inspection of private health care facilities, gives NHS Boards an overall leadership role in regard to health and the functioning of the NHS within their areas. It involves working in close partnership with local authorities and securing the collaboration of others with a part to play, both routinely and in emergency, in safeguarding and improving the health of people in the area. 1.3 Centrally Managed Services Certain specialist services needed either by NHS Boards to provide specialist or technical support, or by the Scottish Executive Health Department to furnish national objectives are managed on a central basis by Special Health Boards or by NHS National Services Scotland. As at para 1.3 above, these bodies' responsibilities include that of overcoming the effects of any emergency which might affect the demand for or continuity of the services they provide. EMERGENCY PLANNING 1.4 Aim The aim of emergency planning within NHSScotland is to ensure that essential health care needs are met effectively when normal services become overloaded, restricted or non- operational for whatever reason. 1.5 Scope An emergency is something which arises unexpectedly, and which requires urgent action to resolve. The NHS faces many emergencies in the course of its routine activities. While each separate instance requiring urgent NHS action might in itself be unexpected, that such emergencies will occur is an expected characteristic of meeting health care needs. To provide a basis for emergency planning it is thus necessary to differentiate between such "routine" emergencies and those which require abnormal action. 1.5.1 Routine Emergency A routine emergency is defined as one which can be met within the normal capacity and procedures of those faced with it. It is one which places no abnormal demand upon health care services. 1.5.2 Major Emergency A major emergency is defined as a situation, either arising or threatened, which requires the special mobilisation and/or redeployment of staff or other resources with consequent interruption to routine activities. 1.5.3 Major Incident This is a widely accepted term used by the emergency services to describe any emergency that requires the implementation of special arrangements by one or more of the emergency services, the NHS or the local authority. Note: While a major incident might constitute a major emergency, as defined above, for one or more parts of the NHS, it may have no or only limited health care implications. 1.5.4 While this guidance applies to the management of all emergencies, it concentrates on Major Emergencies and Major Incidents. Locally determined arrangements for dealing with Routine Emergencies should conform to the guidance to the maximum extent, so that should such an emergency escalate, the reinforcement and support of local arrangements from elsewhere will be the easier. 1.6 Planning Objectives Amongst the first to become aware that an emergency has arisen or is imminent are likely to be members of the NHS engaged on their routine activities. The process of emergency planning should: 1.6.1 Assist staff to react positively by providing them with specific instructions as to what to do. The scope and nature of these instructions will depend on an individual's particular role and position, but maximum benefit will be obtained by their issue in the form of a personal aide-memoire, check list or action card. 1.6.2 Provide advice and information to enable the NHS response to be appropriate, structured, co-ordinated and managed effectively from the outset of the emergency. 1.6.3 Enable the NHS response to be co-ordinated with the responses of others to form a single combined response to the emergency. PRINCIPLES 1.7 Focus Emergency planning and management should focus on what needs to be done to respond to the emergency rather than on its cause. Whatever, whenever and wherever the emergency, the NHS must be prepared to: 1.7.1 Deal with new patients whose number, condition or location precludes treatment under routine arrangements. 1.7.2 Take steps to safeguard the health of the population at large from possible adverse effects of the emergency. 1.7.3 Continue to provide necessary treatment, care and services for existing patients. 1.8 Integration While planning should be directed principally towards response to an emergency, that is not the start point. Planning should be based on hazard/risk assessment and be a continuous process. Study of past emergencies suggests there are four distinct but overlapping phases in successfully managing an emergency: 1.8.1 Prevention This phase encompasses measures adopted in advance of an emergency and which seek either to prevent it occurring or to reduce the severity of its effects. 1.8.2 Preparedness Identification and preparation of resources, the maintenance of skills and of alerting, mobilising and operating procedures must be underpinned by regular training and exercises. 1.8.3 Response The urgent action phase. Its priorities are to save life, prevent escalation, relieve suffering and to facilitate subsequent return to normality. 1.8.4 Recovery This phase will encompass all activities necessary to provide that return to normality, both for those affected by the emergency and for those responding to it. It should include identification and assessment of longer term, consequential or delayed effects of the emergency and planning for those to be effectively handled as routine activity. Analysis of the response and identification of lessons learned, which complete the management of one emergency, should contribute to the prevention and preparedness phases of the next. Thus emergency planning and management should not be regarded as activities relevant exclusively to emergency response but should be integrated into an organisation's overall planning and management arrangements. 1.9 Flexibility Emergency response will need to vary just as the nature, circumstances and effects of the emergency will vary. 1.9.1 To plan separately and in detail for each possible foreseen contingency is less effective than to develop a single plan providing a general framework for response to any emergency, foreseen or not. Amplification or variation needed for specific foreseen events should be incorporated within the general framework. 1.9.2 No emergency plan can cover every eventuality. Over-prescriptive emergency arrangements will constrain individuals' resourcefulness, initiative and improvisation which resolution of any emergency is likely to require. PLANNING RESPONSIBILITIES 1.10 Just as the assessment of routine health care needs and securing the provision of health care services to meet those needs are responsibilities of NHS Boards to lead, so too is planning for NHS response to potential needs consequent on major emergencies occurring within their areas. Similarly, routine responsibilities of and other operators of health care and support services for the detailed planning, management and operation of the particular services each is established, required by contract, or has otherwise undertaken to provide, includes responsibility for overcoming the effects of any emergency which might threaten the continued provision of those services, or which might require those services to be altered. 1.11 Thus while detailed operational emergency planning is a matter for the managers of individual operational units, each NHS Board is required to maintain an overall, strategic, plan for NHS response to a major emergency occurring in its area. This should: 1.11.1 Define the roles and tasks to be undertaken by each NHS organisation both generally and under specific circumstances. 1.11.2 Establish arrangements for the control and co-ordination of NHS emergency response. 1.11.3 Specify operational procedures to be used to the extent necessary to ensure smooth integration of plan components to be delivered by different units/sub-units/ NHS Trusts. 1.12 Inter-Agency Co-ordination It is important that NHS emergency planning is co-ordinated with that of the emergency services, local authorities and other organisations at the local level. The risks and consequences of different types of emergency should be assessed jointly. Such joint planning should, for instance, cover response to potential major incidents, contingencies consequent on large crowds at sports, entertainment or other events, and the handling of emergencies foreseen as a consequence of severe weather or of industrial or other local hazards. All agencies with a part to play in emergency response should practice together putting their plans into action so that they become accustomed to each other's working arrangements prior to an emergency. Particular attention should be given to the development, exercising and inter-service co-ordination of alerting mechanisms and flexible, resilient communications systems for use in an emergency. A combined response is likely to be more effective than a number of separate ones.