Management of Public Health Incidents Guidance on the Roles and Responsibilities of NHS led Incident Management Teams October 2011 Updated July 2013 In collaboration with Index Page Glossary 3 Introduction 5 Definitions 8 Tiered response and hierarchy of guidance 8 Key principles 12 Organisational arrangements 13 Key functions of Incident Management 21 − Surveillance and reporting 21 − Identification and initial response 23 − Investigation 24 − Risk Assessment 26 − Risk Management 27 − Risk Communication 28 − Audit, evaluation and documentation 32 ANNEXES ANNEX A Statutory responsibilities 35 ANNEX B Organisational roles and responsibilities 38 ANNEX C Guidance and further information 54 ANNEX D Management of incidents in Healthcare Settings 55 ANNEX E Environmental Incidents 59 ANNEX F Role of HPN 64 ANNEX G Data Protection and information sharing 65 ANNEX H Agenda for IMT 67 ANNEX I Ministerial protocol 68 ANNEX J Criteria of assessing incident preparedness and response 71 ANNEX K Template for IMT Reports 73 ANNEX L Standardised Dataset for an IMT Report 74 ANNEX M SBAR Template 81 ANNEX N Membership of Working Group 82 GLOSSARY AQC Air Quality Cell AHVLA Animal Health and Veterinary Laboratories Agency AWE Atomic Weapons Establishment BCP Business Continuity Plan CRCE Centre for Radiation, Chemical and Environmental Hazards CBRNE Chemical, Biological, Radiological, Nuclear and Explosives CDI Clostridium difficile infection COBRA Cabinet Office Briefing Room CPHM Consultant in Public Health Medicine CHP Community Health Partnership CMO Chief Medical Officer CNO Chief Nursing Officer COMAH Control of Major Accident Hazards COPFS Crown Office and Procurator Fiscal Service CSA Common Services Agency DIM Detection identification and monitoring DPH Director of Public Health DSTL Defence Scientific and Technical Laboratory DWQR Drinking Water Quality Regulator EAT Emergency Action Team ECDC European Centre for Disease Control EHO Environmental Health Officer EST Emergency Support Team EWRS Early Warning Response System FAI Fatal Accident Inquiry FRA Fire and Rescue Service FSA Food Standards Agency GDS Government Decontamination Service GP General Practitioner HAI Healthcare Associated Infection HDL Health Directorate Letter HET Human Error Theory HIIAT Hospital Infection Incident Assessment Tool HOAG Hospital Outbreak Advisory Group HPA Health Protection Agency HPA CRCE Health Protection Agency Centre for Radiation, Chemicals and Environment HPNS Health Protection Nurse Specialist HPN Health Protection Network HPS Health Protection Scotland HPT Health Protection Team HSE Health and Safety Executive HSWA Health and Safety at Work Act 1974 IEM Integrated Emergency Management IHR International Health Regulations IMT Incident Management Team ICD Infection Control Doctor IP&CN Infection Prevention and Control Nurse IPCT Infection Prevention and Control Team IMT Incident Management Team 3 LA Local Authorities MCA Maritime and Coastguard Agency MIP Major Incident Plan MoD Ministry of Defence MOU Memorandum of Understanding NFP National Focal point NSS National Service Scotland PSoS Police Service of Scotland PAG Problem Assessment Group PHEIC Public Health Emergency of International Concern PHE Public Health England RABS Resilience Advisory Board for Scotland RAG Recovery Advisory Group SARS Severe Acute Respiratory Syndrome SBAR Situation, Background, Assessment and Recommendation SCG Strategic Coordinating Group SCSWIS Social Care and Social Work Improvement Scotland SEPA Scottish Environment Protection Agency SFRS Scottish Fire and Rescue Service SGORR Scottish Government Resilience Room SHORS Scottish HAI Outbreak Surveillance System SHPIR Scottish Health Protection Information Resource SG Scottish Government SGHD Scottish Government Health Directorate SGRPID Scottish Government, Rural Payments and Inspections Directorate SMO Senior Medical Officer SNH Scottish Natural Heritage SPSP Scottish Patient Safety Programme SORT Special Operations Response Team STAC Scientific and Technical Advice Cell WHO World Health Organisation 4 INTRODUCTION 1. When individuals find themselves in situations that may cause them harm they may be able to take action to protect themselves. However, circumstances can arise when the health of the population may be at risk because groups of individuals are exposed, or at risk of being exposed, to infectious disease, high levels of a harmful substance or adverse environmental conditions. These situations are public health incidents and NHS Boards must take action to protect public health. 2. This document provides guidance for the NHS in preparing for, and managing public health incidents in collaboration with partners, especially the Local Authorities. 3. The vast majority of public health incidents do not require a response co- ordinated through the Strategic Co-ordinating Group (SCG) structure. However, if the incident escalates and requires a SCG response this should be based on the guidance provided in ‘Preparing Scotland’. 4. NHS Boards are accountable to the Scottish Government Health Directorate (SGHD) for protecting and improving the health of people living within their geographic areas. NHS Boards act to protect human health during incidents within the context of shared responsibility for improving health with Local Authorities and also within the multi- agency emergency planning structures. Both NHS Boards and Local Authorities are Category 1 responders under the Civil Contingencies Act 2004 and the Contingency Planning (Scotland) Regulations 2005. All organisations are required to work within an Integrated Emergency Management (IEM) approach incorporating police, fire and rescue services and other organisations. 5. The Public Health (Scotland) Act 2008 provides greater clarity over the roles and responsibilities of NHS Boards and Local Authorities and provides more extensive powers. Broadly, NHS Boards are responsible for people, and Local Authorities are responsible for premises. NHS Boards and Local Authorities have a duty to co-operate in exercising their functions under the Act, and to plan together to protect public health in their area. This includes the production of a Joint Health Protection Plan every 2 years. Background 6. The first version of this guidance ‘Managing incidents presenting actual or potential risk to the Public Health: Guidance on roles and responsibilities of Incident Control Teams’ was published in 2003. The revised guidance has taken into account a number of changes since that time including: Health Protection Agency Act 2004 and the establishment of the Health Protection Agency with powers related to Scotland especially on chemicals, poisons, emergency planning and radiation (to be continued in due course by Public Health England); Civil Contingencies Act 2004; International Health Regulations 2005 (IHR); Establishment of the European Centre for Disease Prevention and Control (ECDC) in 2005 and public health duties placed on member states through EC Directives including notification of outbreaks likely to cross borders; 5 Establishment of Health Protection Scotland (HPS) in 2005; and Public Health (Scotland) Act 2008. 7. A number of significant public health incidents have taken place in Scotland and elsewhere since 2003 and include: Buncefield explosion 2005; Polonium incident in England 2006; Anthrax Incidents in the Borders in 2006-2007 and amongst drug users in 2010; Outbreaks of measles in 2006 and 2009; Outbreak of Q Fever in Forth Valley in 2007; Outbreak of Clostridium difficile Infection at the Vale of Leven Hospital in 2009; Influenza Pandemic 2009/2010; Outbreaks of E. coli O157 infection in Fife, Borders, Aberdeenshire and Paisley plus significant outbreaks in Wales and England; Outbreak of E coli O104 in Europe in 2011; and White Powder and other potential bioterrorism incidents (including preparedness for the G8 summit). 8. A review of the evidence was undertaken to inform the development of this guidance, in collaboration with the Health Protection Network (HPN). 9. In revising this guidance the opportunity has been taken to move to an electronic version which will be updated every two years by Health Protection Scotland and reviewed by the SGHD as necessary. This will also allow the guidance to be revised as a result of lessons learnt from its use in incidents or exercises. Further Update to Guidance – July 2013 10. Following the review of this guidance in October 2011, the SGHD CMO and Public Health Directorate made changes to their internal arrangements for handling calls from NHS Boards out of hours. The new arrangements require all out of hours contact in relation to public health incidents to be made with Scottish Government via an on call mobile on 07824 087787. This alerts the on call member of staff who will then telephone the Board contact as soon as practicably possible to seek an overview of the incident. Aim of the Guidance 11. This guidance describes the generic organisational arrangements for managing public health incidents and the roles and responsibilities of Incident Management Teams (IMTs). It covers both planning and response based on a set of key principles and key functions. The guidance does not replicate that found elsewhere but sets out a hierarchy of existing guidance. It also illustrates how the response to an incident will change depending on the level and scale of that incident. It covers single and multi Board incidents and incidents where a national response is required. 6 12. In summary, this guidance should be regarded