TRUST-WIDE NON-CLINICAL
MAJOR INCIDENT PLAN
NON RESTRICTED
Policy Number:
SA31
Scope of this Document:
Recommending Committee:
Approving Committee:
All Staff
Executive Committee
Trust Board
Date Ratified:
January 2016
Next Review Date (by):
January 2018
Version Number:
Lead Executive Director:
Lead Author(s):
2016 – Version 3
Ray Walker
Director of Nursing
Jayne Bridge
Senior Nurse and Head of
Emergency Palnning Risk and
Resilience
TRUST-WIDE NON-CLINICAL
Quality, recovery and
wellbeing at the heart
of everything we do
SA31 – Major Incident Plan – v 3
1
TRUST-WIDE NON-CLINICAL
MAJOR INCIDENT PLAN
Further information about this document:
MAJOR INCIDENT POLICY SA31
Document name
This plan covers the following:



Document summary

A major incident which affects the local community.
A major incident which affects the local community.
A major incident which threatens the continuity of
critical Trust services.
A major incident which affects the health services in
Merseyside and/or beyond.
A multi-agency major incident requiring a coordinated
health service response in Merseyside and/or
beyond.
The plan is supported by additional major incident plans and
business continuity plans at divisional and local levels.
Jayne Bridge
Senior Nurse and Head of Emergency Planning Risk and
Resilience
Telephone: 0151 330 4142
Mobile: 07814 014 508
Email: jayne.bridge@merseycare.nhs.uk
Author(s)
Contact(s) for further
information about this document
Published by
Copies of this document are
available from the Author(s) and
via the trust’s website
Mersey Care NHS Trust
V7 Building
Kings Business Park
Prescot
Merseyside
L34 1PJ
Your Space Extranet: http://nww.portal.merseycare.nhs.uk
Trust’s Website www.merseycare.nhs.uk
Health, Safety and Welfare SA07
Fire Safety SA08
To be read in conjunction with
This document can be made available in a range of alternative formats including
various languages, large print and braille etc
Copyright © Mersey Care NHS Trust, 2015. All Rights Reserved
SA31 – Major Incident Plan – v 3
2
Version Control:
Version History:
Version 1
Document presented to Policy Group
Version 2
Equality and Human Rights Analysis
Version 3
Trust Board
22nd December
2015
th
29 December
2015
th
27 January 2016
A controlled numbered copy of this plan will be issued to selected appointments
within NHS Mersey Care Trust and other relevant organisations and external partners.
A copy of the plan (without confidential and sensitive contact information) will be
published on the public Internet site at URL required.
SA31 – Major Incident Plan – v 3
3
SUPPORTING STATEMENTS
this document should be read in conjunction
with the following statements:
SAFEGUARDING IS EVERYBODY’S BUSINESS
All Mersey Care NHS Trust employees have a statutory duty to safeguard and promote the welfare of
children and vulnerable adults, including:
 being alert to the possibility of child/vulnerable adult abuse and neglect through their observation
of abuse, or by professional judgement made as a result of information gathered about the
child/vulnerable adult;

knowing how to deal with a disclosure or allegation of child/adult abuse;

undertaking training as appropriate for their role and keeping themselves updated;

being aware of and following the local policies and procedures they need to follow if they have a
child/vulnerable adult concern;

ensuring appropriate advice and support is accessed either from managers, Safeguarding
Ambassadors or the trust’s safeguarding team;

participating in multi-agency working to safeguard the child or vulnerable adult (if appropriate to
your role);

ensuring contemporaneous records are kept at all times and record keeping is in strict adherence
to Mersey Care NHS Trust policy and procedures and professional guidelines. Roles,
responsibilities and accountabilities, will differ depending on the post you hold within the
organisation;

ensuring that all staff and their managers discuss and record any safeguarding issues that arise
at each supervision session
EQUALITY AND HUMAN RIGHTS
Mersey Care NHS Trust recognises that some sections of society experience prejudice and
discrimination. The Equality Act 2010 specifically recognises the protected characteristics of age,
disability, gender, race, religion or belief, sexual orientation and transgender. The Equality Act also
requires regard to socio-economic factors including pregnancy /maternity and marriage/civil
partnership.
The trust is committed to equality of opportunity and anti-discriminatory practice both in the provision
of services and in our role as a major employer. The trust believes that all people have the right to be
treated with dignity and respect and is committed to the elimination of unfair and unlawful
discriminatory practices.
Mersey Care NHS Trust also is aware of its legal duties under the Human Rights Act 1998. Section 6
of the Human Rights Act requires all public authorities to uphold and promote Human Rights in
everything they do. It is unlawful for a public authority to perform any act which contravenes the
Human Rights Act.
Mersey Care NHS Trust is committed to carrying out its functions and service delivery in line the with
a Human Rights based approach and the FREDA principles of Fairness, Respect, Equality Dignity,
and Autonomy
SA31 – Major Incident Plan – v 3
4
STOP
1. IF A MAJOR INCIDENT HAS BEEN DECLARED AND YOU ARE
READING THIS PLAN FOR THE FIRST TIME, DO NOT CONTINUE.
2. GO DIRECTLY TO THE ACTION CARD IN APPENDIX A
3. SEEK OUT YOUR ACTION CARD AND FOLLOW IT
4. IF YOU DO NOT HAVE AN ACTION CARD THEN AWAIT FURTHER
INSTRUCTIONS FROM YOUR MANAGER
SA31 – Major Incident Plan – v 3
5
Contents
1
2
2.1
PURPOSE AND RATIONALE ..................................................................................... 10
OUTCOME FOCUSED AIMS AND OBJECTIVES ...................................................... 10
The aim of the plan is provide a framework for Mersey Care NHS Trust to respond
effectively, efficiently and proportionally to a major incident that has or is likely to occur
with the potential of affecting patients, staff, services and or estates. ......................... 10
3
SCOPE ........................................................................................................................ 10
4
DEFINITIONS.............................................................................................................. 11
4.1
The NHS defines a ‘major incident’ as follows:............................................................ 11
4.2
Examples of a major incident include: ......................................................................... 11
4.3
Definition of a Critical Incident ..................................................................................... 11
4.4
Risk Assessment Process ........................................................................................... 11
The risk assessment process involves reviewing the Merseyside Community Risk Register
(CRR) and the Local Health Resilience Partnership (LHRP) Risk Register, which
identify those risk and hazards that are relevant, the controls in place and further
actions required to mitigate the effects. The findings from the review of these
documents are then considered within the Trust risk assessment process. This
identifies the hazards and risks that may threaten the Trust, its’ key locations and
services and drive the development and maintenance of the Major Incident Plan,
associated plans, including business continuity and supporting arrangements. The
hazards identified, fall into the following categories: .................................................... 11
5
DYNAMIC RISK ASSESSMENT ................................................................................. 12
6
CRITICAL ELEMENTS OF THE BUSINESS............................................................... 12
6.1
The Secure Division is a clinical division providing the full spectrum of forensic and
secure mental health services, including: .................................................................... 12
6.2
The Local Services Division is a clinical divisions providing a range of community,
outpatients and inpatients services, including: ............................................................ 12
6.3
The Corporate Division supports the two Clinical Divisions day to day operations,
including: ..................................................................................................................... 12
6.4
Definition of Business Continuity ................................................................................. 12
6.5
Business Continuity ..................................................................................................... 12
6.6
Financial Authority ....................................................................................................... 13
7
DUTIES ....................................................................................................................... 13
7.1
Trust Roles and Responsibilities ................................................................................. 13
7.2
Trust Gold Commander (Executive Director on Call) .................................................. 13
7.3
Trust Silver Commander(s) (Local Services Division & Secure Division) .................... 13
7.4
Trust Bronze Commanders ......................................................................................... 14
7.5
Crisis Management Team (CMT) ................................................................................ 14
7.6
Incident Response Team ............................................................................................ 14
7.7
Recovery and Restoration Team ................................................................................. 15
7.8
Administrative Support ................................................................................................ 15
7.9
Loggist ......................................................................................................................... 15
7.10 Switchboard................................................................................................................. 16
7.10.1 Switchboard (Media/Communication) .......................................................................... 16
7.10.2 Communications & Media Representative .................................................................. 16
8
PROCESS ................................................................................................................... 16
8.1
Alerts, Escalation and Declaration............................................................................... 16
8.2
Major Incident – Standby ............................................................................................. 17
8.3
Major Incident - Declared ............................................................................................ 17
8.4
Major Incident – Stand Down ...................................................................................... 17
SA31 – Major Incident Plan – v 3
6
8.5
Major Incident – Cancelled .......................................................................................... 17
8.6
Internal Escalation ....................................................................................................... 17
8.7
Normal Working Hours (0800 – 1700) ......................................................................... 17
8.8
Out of Normal Working Hours (1700 – 0800, Bank Holidays and Weekends) ............ 17
8.9
Internal and Critical Incident Escalation ...................................................................... 18
8.10 Activation of the Major Incident Plan ........................................................................... 18
8.11 Major Incident Standby/Declared ................................................................................ 18
8.12 METHANE Alerting Model ........................................................................................... 19
8.13 Contacting Key Locations and Staff ............................................................................ 19
8.14 Flowchart ..................................................................................................................... 20
8.15 Activation of the Incident Coordination Centres (ICCs) ............................................... 21
9
RESPONSE ................................................................................................................ 21
9.1
Trust Command and Control ....................................................................................... 21
9.1.1 Diagram - Trust Command and Control Structure ....................................................... 22
9.1.2 Multi-Agency & NHS Command and Control ............................................................... 22
9.1.3 Roles and Responsibilities of the NHS and Multi-Agency Responders ....................... 22
9.1.4 Diagram Multi-Agency and NHS Command and Control Structure ............................. 22
9.2
Interoperability - Joint Emergency Services Interoperability Principals (JESIP) .......... 23
9.3
Joint Decision Model (JDM)......................................................................................... 24
9.4
Information and Decision Logging ............................................................................... 24
9.5
Joint Decision Log ....................................................................................................... 25
9.6
Incident Log ................................................................................................................. 25
9.7
Report Forms .............................................................................................................. 25
9.8
Meeting Schedules ...................................................................................................... 25
9.9
Information Management & Information Sharing ......................................................... 26
9.10 Shift Arrangements ...................................................................................................... 26
9.11 Staff Welfare................................................................................................................ 26
9.12 Health and Safety ........................................................................................................ 27
9.13 Vulnerable Persons ..................................................................................................... 27
9.14 Friends and Relatives .................................................................................................. 27
9.15 VIPs ............................................................................................................................. 27
9.16 Lockdown .................................................................................................................... 28
10
COMMUNICATIONS & MEDIA ................................................................................... 28
10.1 General ....................................................................................................................... 28
10.2 Lead Officer ................................................................................................................. 29
10.3 Communications Methods ........................................................................................... 29
10.4 Media .......................................................................................................................... 29
10.5 Trust’s Media Protocol ................................................................................................. 29
10.6 Trust’s Key Messages ................................................................................................. 30
10.7 NHS England Media Support ...................................................................................... 30
10.8 Media Briefing Centres ................................................................................................ 30
10.9 Talking To The Media .................................................................................................. 31
10.10 Additional Media Considerations ................................................................................. 31
11
Stand-down and Recovery .......................................................................................... 32
11.1 Initial ‘Stand-Down’...................................................................................................... 32
11.2 Recovery ..................................................................................................................... 32
11.2.1 Recovery and Restoration Team ................................................................................. 32
12
Debriefing and Learning .............................................................................................. 33
12.1 General ....................................................................................................................... 33
12.2 Hot & Cold Debriefing .................................................................................................. 33
12.2.1 Hot Debrief .................................................................................................................. 33
12.2.2 Cold Debrief ................................................................................................................ 33
SA31 – Major Incident Plan – v 3
7
12.2.3 Internal Debriefing ....................................................................................................... 33
12.2.4 Post Incident Report .................................................................................................... 33
12.3 Multi-Agency Debrief ................................................................................................... 33
12.4 Post Incident Action Plan ............................................................................................ 34
12.5 Counselling.................................................................................................................. 34
12.6 Inquest Investigations and Inquiries ............................................................................ 34
13
Plan Review & Maintenance Process .......................................................................... 35
13.1 Scheduled Review Process ......................................................................................... 35
13.2 Post Exercise .............................................................................................................. 35
13.3 Post Incident................................................................................................................ 35
14
TRAINING SUPPORT AND EXERCISING ................................................................. 35
14.1 Training ....................................................................................................................... 35
14.2 Exercise & Exercise Schedule..................................................................................... 35
14.3 Training Records & Exercise Records ......................................................................... 35
15
MONITORING ............................................................................................................. 36
16
Appendix A – Action Cards ......................................................................................... 37
16.1 Gold Commanders Action Card................................................................................... 37
16.2 Incident Response Team Action Card ......................................................................... 43
16.3 Communications Media Action Card ........................................................................... 46
16.4 Administrative Support Action Card ............................................................................. 48
16.5 Loggist Action Card ..................................................................................................... 50
16.6 Switchboard Action Card ............................................................................................. 52
17
Appendix B – Report Forms ........................................................................................ 53
METHANE Alerting Model ..................................................................................................... 53
17.1 METHANE REPORT FORM ....................................................................................... 54
17.2 CRITICAL INCIDENT REPORT FORM ....................................................................... 55
17.3 SITUATION REPORT FORM - SITREP ...................................................................... 56
17.4 Agenda Template For Meetings .................................................................................. 58
17.5 ACTION LOG .............................................................................................................. 59
17.6 RESOURCE REQUEST FORM .................................................................................. 60
17.7 MEDIA ENQUIRY FORM ............................................................................................ 61
17.8 Handover/Takeover Form ........................................................................................... 62
17.9 Hot Debrief Form ......................................................................................................... 64
18
Appendix C - Definitions and references to Command & Control ................................ 67
18.1 Gold Command ........................................................................................................... 67
18.1.1 Silver Command .......................................................................................................... 67
18.1.2 Bronze Command ....................................................................................................... 67
18.1.3 Strategic Coordinating Group (SCG) ........................................................................... 67
18.1.4 Tactical Coordinating Group (TCG) ............................................................................. 67
18.1.5 Operational .................................................................................................................. 67
19
Appendix D - Supporting NHS Trusts & Responder Organisations ............................. 68
19.1 NHS Organisations...................................................................................................... 68
19.1.1 NHS England Area Team ............................................................................................ 68
19.1.2 NHS England Alert Levels ........................................................................................... 69
19.1.3 Clinical Commissioning Group (CCG) ......................................................................... 69
19.1.4 Acute Hospital Trusts & Foundation Trusts ................................................................. 69
19.1.5 North West Ambulance Service (NWAS) NHS Trust ................................................... 69
19.1.6 NHS 111 ...................................................................................................................... 70
19.2 Responder Agencies ................................................................................................... 70
19.2.1 Local Authority............................................................................................................. 70
19.2.2 Merseyside Police (MerPol)......................................................................................... 70
19.2.3 Merseyside Fire & Rescue Service (MFRS) ................................................................ 71
SA31 – Major Incident Plan – v 3
8
19.3 Regional & National Organisations.............................................................................. 71
19.3.1 Government Liaison Officer (GLO) .............................................................................. 71
19.3.2 Government Liaison Team (GLT) ................................................................................ 71
19.3.3 Public Health England (PHE) ...................................................................................... 71
19.3.4 The Military .................................................................................................................. 71
19.4 Science and Technical Advice Cell ............................................................................. 72
19.5 Third Sector – (Voluntary, Charity, Community, Faith &Humanitarian) ....................... 72
20
Appendix E – Local and National Plans and Associated Documents .......................... 72
20.1 National Documents .................................................................................................... 72
20.2 Local Documents......................................................................................................... 72
20.3 Internal Mersey Care Trust Documentation ................................................................. 73
20.4 Associated Plans ......................................................................................................... 73
20.5 Associated Guidance .................................................................................................. 73
21
Appendix F - Glossary of Terms .................................................................................. 74
22
Appendix G – Official Sensitive Operation PLATO ...................................................... 75
Reporting ............................................................................................................................... 75
Communications .................................................................................................................... 75
External Communications including Media ............................................................................ 76
23
Appendix H – Official Sensitive HAZMAT and CBRN.................................................. 76
23.1 Initial Operational Response (IOR).............................................................................. 77
24
Appendix K - Equality and Human Rights Analysis …………………………………….78
APPENDICES
A
B
C
D
E
F
G
H
I
J
K
Action Cards…………………………………………………………………………………..37
Report Forms…………………………………………………………………………………53
Definitions and References to Command & Control……………………………………..67
Supporting NHS Trusts & Responder Organisations…………………………………….68
Local and National Plans and Associated Documents…………………………………..72
Glossary of Terms……………………………………………………………………………74
Official Sensitive Operation PLATO………………………………………………………...75
Official Sensitive HAZMAT and CBRN…………………………………………………….76
N/A – Restricted Policy Only
N/A – Restricted Policy Only
Equality and Human Rights Analysis……………………………………………………...78
SA31 – Major Incident Plan – v 3
9
1
PURPOSE AND RATIONALE
1.1
Mersey Care NHS Trust must be prepared to respond to internal disruptions and externally as
part of a wider NHS and/or multi-agency response to major incidents. The Trust must have
the ability to recognise a major incident; establish an effective command, control and
communications framework across the Divisions, with the ability to respond proportionately,
consolidate and recover quickly from the incident/emergency. Whilst recognising the diversity
of operations across the Trust, it is essential that all staff are familiar with the arrangements
detailed within this plan. All members of staff play a vital role in ensuring a professional Trust
response to a major incident. It is therefore essential that all staff are familiar with the
procedures contained in this plan and with the support they will be asked to provide.
1.2
This plan has been prepared in line with The Health and Social Care Act 2012, the Emergency
Preparedness, Resilience & Response (EPRR) Guidance 2015 and the Civil Contingencies
Act (CCA) 2004. The plan provides an integrated approach to emergency management in line
with the Merseyside Resilience Forum (MRF) and the wider health economy plans. Although
not a Category 1 or 2 Responder under the CCA, the Department of Health (DH) and NHS
England expect the Trust to:
a)
b)
c)
d)
e)
f)
Fulfill relevant legal and contractual EPPR requirements.
Ensure a robust and sustainable 24/7 response to incidents and emergencies
Manage internal incidents and emergencies effectively.
Have the ability to escalate externally, where appropriate.
Collaborate with multi-agency partners.
Maintain critical services during periods of disruption.
1.3
As the Trust Executive with responsibility for emergency planning and business continuity, I
am satisfied that Mersey Care NHS Trust has effective arrangements in place to respond to a
major incident or service interruption impacting upon the Trust, directly or in-directly.
2
OUTCOME FOCUSED AIMS AND OBJECTIVES
2.1
The aim of the plan is provide a framework for Mersey Care NHS Trust to respond effectively,
efficiently and proportionally to a major incident that has or is likely to occur with the potential
of affecting patients, staff, services and or estates.
a)
b)
c)
d)
To provide the response and recovery framework for a major incident affecting the Trust
directly or in-directly.
To provide an internal command and control which dovetails with external responders.
To identify Trust roles and responsibilities.
To provide guidance to those with response and recovery responsibilities.
3
SCOPE
3.1
This plan covers the following:-
a)
b)
c)
d)
A major incident which affects the local community.
A major incident which threatens the continuity of critical Trust services.
A major incident which affects the health services in Merseyside and/or beyond.
A multi-agency major incident requiring a coordinated health service response in
Merseyside and/or beyond.
The plan is supported by additional major incident plans and business continuity plans at
SA31 – Major Incident Plan – v 3
10
divisional and local levels.
4
DEFINITIONS
4.1
The NHS defines a ‘major incident’ as follows:
‘Any occurrence which presents a serious threat to the health of the community, disruption
to the service or causes (or is likely to cause) such numbers or types of casualties as to
require special arrangements to be implemented by hospitals, ambulance trusts or primary
care organisations’.
4.2
Examples of a major incident include:






Internal incidents – death of a patient, hostage taken, loss of premises and power.
Multi-agency response – rail, road and air crashes, chemical incidents and terrorist
incidents.
Rising Tide – infectious diseases, pandemic flu and fuel shortages.
Headline news – health scare.
Safeguarding – closure of care/nursing home.
Severe weather – flooding, extremes of heat and cold.
This plan could be activated to support the scenarios incidents highlighted above.
4.3
Definition of a Critical Incident
A critical incident is any localised incident where the level of disruption results in the
organisation temporarily or permanently losing its ability to deliver critical services, patients
may have been harmed or the environment in not safe requiring special measures and support
from other agencies to restore normal operational functions
4.4
Risk Assessment Process
The risk assessment process involves reviewing the Merseyside Community Risk Register
(CRR) and the Local Health Resilience Partnership (LHRP) Risk Register, which identify those
risk and hazards that are relevant, the controls in place and further actions required to mitigate
the effects. The findings from the review of these documents are then considered within the
Trust risk assessment process. This identifies the hazards and risks that may threaten the
Trust, its’ key locations and services and drive the development and maintenance of the Major
Incident Plan, associated plans, including business continuity and supporting arrangements.
The hazards identified, fall into the following categories:
a)
b)
c)
d)
e)
External events and weather related incidents.
Human health issues.
Industrial technical failure.
Internal hazards and threats.
Loss or interruption in contractor services.
4.5
The threat to UK safety and security is not written into the MRF CRR however, the Chemical,
Biological, Radiological and Nuclear (CBRN) elements are contained within the NHS Core
Standards. http://www.england.nhs.uk/ourwork/eprr/hm/
4.6
The Trust Emergency Planning Forum is responsible for the review of the risk assessment
process relating to EPRR, ensuring that the MRF and LHRP risk registers are reflected when
updating making any changes to Trust plans.
SA31 – Major Incident Plan – v 3
11
5
DYNAMIC RISK ASSESSMENT
5.1
A dynamic risk assessment will be conducted by those with leadership responsibilities during
normal working hours and the Trust Gold and Silver Commanders outside of normal working
hours. The dynamic risk assessment forms part of the Joint Decision Model (JDM) found at
Appendix
6
CRITICAL ELEMENTS OF THE BUSINESS
6.1
The Secure Division is a clinical division providing the full spectrum of forensic and secure
mental health services, including:
a)
b)
c)
d)
6.2
The Local Services Division is a clinical divisions providing a range of community, outpatients
and inpatients services, including:
a)
b)
c)
d)
e)
f)
6.3
.
Adult mental health services.
Mental health services for older people.
Liaison and diversion services (i.e., local A&E hospitals, criminal justice services).
Learning disability services.
Acquired brain injury services.
Drug and alcohol addictions services.
The Corporate Division supports the two Clinical Divisions day to day operations, including:
a)
b)
6.4
High secure services (at Ashworth Hospital).
Medium secure services, including a step down facility (at Scott Clinic).
Low secure and community forensic services.
Prison mental health services.
Coordinate the management of systems and processes which allow the trust to operate
(e.g. finance, corporate governance, estates, Freedom of Information (FOI) requests,
human resources, Information Management & Technology (IM&T), payroll, procurement,
etc).
Provide assurance to the Trust Board, commissioners and regulators.
Definition of Business Continuity
An event or occurrence that disrupts, or might disrupt an organisation’s normal service
delivery, below acceptable pre-defined levels, where special arrangements are required
implementation until services can return to an acceptable level.
6.5
Business Continuity
The Trust has a number of divisional and location business continuity plans which can be
invoked in isolation or as part of a wider Trust response, dependent upon the incident, e.g,
severe weather, IT failure, an infectious disease, a fuel shortage or industrial action. Other
disruptions include, loss of water, power, premises and staff.
The Trust will be required to maintain critical services whilst providing advice and support to
hospital and community trust patients who need specialist psychological support. Trust staff
may also be deployed to Survivor Reception Centres (SRCs) and Humanitarian Assistance
Centres (HAC) either in the immediate aftermath or after an un-specified period of time. The
Trust is also prepared to respond to a range of malicious emergencies and human health
threats, with the focus on protecting patients, the public and staff.
SA31 – Major Incident Plan – v 3
12
6.6
Financial Authority
The Trust will delegate authority to incur any necessary expenditure to the Trust Gold and
Silver Commanders to use in an emergency. This is done via the Scheme of Delegation.
It will be the responsibility of the Executive Director of Finance to establish a procedure for
processing, recording and monitoring such expenditure in compliance with the requirements of
the Standing Financial Instructions and reporting such expenditure accordingly.
7
DUTIES
7.1
Trust Roles and Responsibilities
In order to deliver an effective and efficient response to both internal and external major
incidents, the Trust has identified a number of roles with clear responsibilities that provide a
coherent command and control structure.
7.2
Trust Gold Commander (Executive Director on Call)
During a major incident or large scale disruptive event, the Executive Director on-call assumes
the role of the Trust Gold Commander, responsible for strategic control of the Trusts’ overall
response. For the purpose of this plan, the Executive Director will be referred to as the Trust
Gold Commander.
The Trust Gold Commander will:











Assume strategic control of the Trusts’ overall response.
Conduct an initial assessment using the Critical Incident Form, METHANE Form and the
Joint Decision Model (JDM).
Escalate to NHS England via NWAS Regional Health Control Desk, where appropriate.
Confirm a Major Incident Standby/Declared to NHS England.
Inform the local Clinical Commissioning Group (CCG) on call.
Oversee and co-ordinate the Trust’s media response. See Section 5.
Activate any response teams (Crisis/Incident) as appropriate.
Activate/inform the Trust Silver Commander(s), as appropriate.
Identify and activate the Incident Coordination Centre (ICC) or alternative location.
Convene a meeting of the appropriate response team(s), confirming the time of the first
meeting.
Agree roles, distribute action cards and identify initial tasks.
The Gold Commander is also responsible for cooperating/consulting with the NHS Strategic
Commander and/or Tactical Commander from NHS England, other NHS providers and
Responder agencies.
The Trust Gold Commander Action Card can be found at Appendix A.
Note: The Trust Gold Commander will be required to maintain contemporaneous notes until
such times as a dedicated Loggist assumes this activity on their behalf.
7.3
Trust Silver Commander(s) (Local Services Division & Secure Division)
The Trust’s Silver Commander(s) is/are responsible for the tactical coordination of resources
within their respective division(s). They are required to cooperate/consult with the Trust Gold
SA31 – Major Incident Plan – v 3
13
Commander and any response teams that may be formed, where appropriate. The Trust
Tactical Commander(s) will:









Assume tactical coordination of their respective Division(s) response.
Conduct an initial assessment using the Critical Incident Form, METHANE Form and the
Joint Decision Model (JDM).
Escalate to the Trust Gold Commander via Switchboard, where appropriate.
Request a Major Incident Standby/Declared to the Trust Gold Commander.
Declare a Major Incident Standby/Declared in the absence of the Trust Gold
Commander.
Activate Divisional major incident plans and business continuity plans, as appropriate.
Activate/inform divisional Bronze locations, as appropriate.
Identify and activate the Divisional Incident Coordination Centre (ICC).
Agree roles, distribute action cards and identify initial tasks.
Note: Trust Silver Commander(s) will be required to maintain contemporaneous notes until
such times as a dedicated Loggist assumes this activity on their behalf.
The Trust Silver Commander Action Card can be found at Appendix A.
7.4
Trust Bronze Commanders
The Trusts Bronze Commanders will be located at the scene of the incident, their role and
responsibilities are to:








Manage the working elements of the response to an incident.
Lead a team carrying out specific tasks within a service area.
Liaise with and provide regular updates to the Chief Operations Officer (COO) or
Divisional Silver Commander.
Identify resources need and communicate this to the COO or Divisional Silver
Commander.
Implement tactical direction.
Report upwards using the Critical Incident Form, METHANE Form.
Liaise and coordinate with all the other agencies at the scene.
Manage health and safety of Trust responding staff.
Note: Trust Bronze Commanders will be required to maintain contemporaneous notes.
Action Cards for Bronze Commanders will be held within Divisional Major Incident Plans.
7.5
Crisis Management Team (CMT)
A Crisis Management Team (CMT) can be established to deal with a prolonged crisis which
could result in financial, legal and reputational damage to the Trust, but does not require a
major incident response. The CMT will comprise of a number of senior members of the Trust
who will convene at a pre-determined frequency. The members of the CMT also support the
NHS Gold Commander role and provide input to the Incident Response Team, therefore
careful planning is required to ensure capabilities are not affected.
7.6
Incident Response Team
An Incident Response Team (IRT) could be established to support the Trust Gold
Commander. The IRT can convene at the location identified by the Trust Gold Commander to
assess the situation and:
SA31 – Major Incident Plan – v 3
14













Provide operational advice to the Trust Gold Commander.
Carry out tasks as requested by the Trust Gold Commander.
Activate internal policies and plans as requested.
Clarify with other managers throughout the Trust that arrangements are in place to
ensure the safety of staff, patients and visitors.
Ensure that information is collated to identify and prioritises vulnerable persons.
Liaise with internal and external stakeholders, providing feedback to the Trust Gold
Commander.
Consider who else needs to be involved.
Provide financial support.
Start and maintain a financial log.
Consider the welfare of response staff.
Arrange suitable relief for response staff.
Contribute to internal and external debriefs.
Nominate an individual to produce a detailed post incident report.
The IRT Action Card can be found at Appendix A
A generic agenda for meetings and teleconferences can be found at Appendix A
7.7
Recovery and Restoration Team
The Trust recovery and restoration arrangements from an incident will form a vital component
of the overall response. Whilst the IRT is dealing with the immediate issues affecting the Trust
or its partner agencies, the Recovery and Restoration Team (RRT) will focus upon the
consequence management of the incident including the identification of issues that could
continue to disrupt the services provided by the Trust.
The Recovery and Restoration Team would work closely with the Incident Response Team by
holding regular briefing sessions.
Note: The establishment of any of the teams highlighted above must be considered carefully
due to limited number of resources within the Trust.
7.8
Administrative Support
Once Administrative support has been identified, the person(s) would move to the location
identified by the Trust Gold Commander and establish the Incident Coordination Centre (ICC),
including:




Laying out the room in the pre-determined manner.
Test all equipment (electronic, phones, etc).
Ensure the provision of enough stationery.
Access to the Incident Control Centre during the silent hours
The Administrative Support Action Card can be found at Appendix A
Note: for a sustained response, the Trust will need to consider how staff will rotate through
the Administrative Support role.
Trust Silver locations may also establish similar
rooms/functions at their respective locations to assist with coordination.
7.9
Loggist
The Loggist will be required to:
SA31 – Major Incident Plan – v 3
15





Attend the pre-determined location.
Support the respective commander or group as required.
Accurately record contemporaneously:
o
Date
o
Time
o
Situation
o
Internal/external requests
o
Options available to the commander/team
o
Hazards and risks
o
Option chosen, reasons why; by whom (individual/team).
Use best practice when recording information.
Secure periodic confirmation by the respective commander of entries including a
signature.
Note: The Loggist is not a minute taker, other resources should be identified if this is required.
If located at an Incident Coordination Centre (ICC), the Loggist will be required to record the
collective decision making in the same way as indicated above.
Further guidance notes and the Loggist Action Card can be found at Appendix A
7.10
Switchboard
Switchboard act as the initial point of contact for external agencies. Upon receipt of an initial
message, the Switchboard Operator will:





Take down as much information as possible using the Critical Incident report form or the
METHANE report form and Action Card.
Contact the Trust Gold Commander immediately (keep trying until contact is made).
Relay and confirm the information with the Trust Gold Commander.
Confirm if the Trust Gold Commander requires any further assistance.
Standby to record further information and provide support, as required.
The Switchboard Action Card can be found at Appendix A.
7.10.1 Switchboard (Media/Communication)
All media enquiries MUST be directed towards either the Communications Lead during normal
working hours or the on-call Gold or Divisional Silver Commander, out of normal working
hours.
7.10.2 Communications & Media Representative
The Communications & Media Representative will be responsible for the collation,
development and coordination of all Trust media and public messaging activities. This person
will be allocated at the time of the incident. The Communications & Media Representative
Action Card can be found at Appendix A
8
PROCESS
8.1
Alerts, Escalation and Declaration
To avoid confusion about when to implement major incident plans, it is essential to use these
standard messages:
SA31 – Major Incident Plan – v 3
16
8.2
Major Incident – Standby
‘’Major incident standby’’ alerts NHS organisations that a major incident may need to be
declared and is likely to involve the participating NHS organisations in making preparatory
arrangements appropriate to the incident.
8.3
Major Incident - Declared
‘’Major incident Declared’’ - This alerts NHS organisations that they need to activate their plan
and mobilise additional resources immediately.
8.4
Major Incident – Stand Down
‘’Major Incident Stand Down’’ alerts NHS organisations that the incident has been dealt with
and they can implement their internal Stand Down procedures.
8.5
Major Incident – Cancelled
This message cancels either of the first two messages at any time. Non-NHS Responders do
not recognise this term.
8.6
Internal Escalation
Internal escalation differs during normal working hours (0800 – 1700) and outside of normal
working hours, including weekends and public holidays, including:
8.7
Normal Working Hours (0800 – 1700)
1.
2.
3.
4.
5.
During normal working hours a member of staff should inform their duty manager/bleep
holder.
The duty manager/bleep holder to the Chief Operating Officer (COO) of their respective
division (local/secure) using SBAR/METHANE.
The COO will then immediately assess the situation, provide immediate advice to the
caller and then inform the Divisional Silver Commander.
The COO will retain oversight and only relinquish control to the Divisional Silver
Commander if the incident has the potential to become a major incident or a major
incident has been declared.
The COO may also inform the local CCG.
Note: If the Divisional COO cannot be contacted, the manager/bleep holder should contact
their respective Divisional Silver Commander.
8.8
Out of Normal Working Hours (1700 – 0800, Bank Holidays and Weekends)
1.
2.
3.
4.
5.
6.
Out of normal working hours In the event of an incident, a member of staff should inform
their duty manager/bleep holder.
The duty manager/bleep holder should notify Switchboard, providing as much
information as possible using SBAR/METHANE.
Switchboard will inform the Divisional Silver Commander.
The Divisional Silver Commander will contact the caller, assess the situation and provide
immediate advice to the caller.
The Divisional Silver Commander will then coordinate the internal incident response.
The Divisional Silver Commander will inform the Trust Gold Commander and CCG on
call, where appropriate.
SA31 – Major Incident Plan – v 3
17
8.9
Internal and Critical Incident Escalation
SBAR is a structured method for communicating critical information that requires immediate
attention and action contributing to effective escalation and increased patient safety.
Internal Escalation Report (SBAR)
Describe the situation/incident that has occurred
Situation
Background
Explain the history and impact of the incident on services/patient
safety
Confirm your understanding of the issues involved
Assessment
Recommendation
Explain what you need, clarify expectations and what you would
like to happen
Ask caller to repeat information to ensure understanding
The SBAR report form can be found at Appendix B
8.10
Activation of the Major Incident Plan
This plan can be activated upon receipt of information, either internally or externally, from:
Internal



Any member of the Trust.
The Trusts’ Silver Commander(s) on call.
The Trusts’ Gold Commander on call.
External




NHS England (1st on call - NHS Tactical Commander or 2nd on call - NHS Tactical
Commander).
A CCG on behalf of NHS England.
An NHS Provider declaring ‘’Major Incident Standby/Declared’’.
Any Category 1 Responder as defined within the Civil Contingencies Act 20004 (CAA).
Or; in response to a national or regional major incident, e.g. the Ministry of Justice (MoJ).
Note: These organisations will make contact via the Mersey Care switchboard at V7, Prescot
asking for the Trust Gold Commander/Executive on Call. The Trust Gold Commander will
then conduct the steps for Major Incident Standby/Declared below.
8.11
Major Incident Standby/Declared
The Trust Gold Commander is ultimately responsible for activating the Major Incident Plan and
determining whether the Trust is to establish a posture commensurate with ‘’Major Incident
Standby’’ or ‘’Major Incident Declared’’. This will usually have taken place following liaison
with the relevant Divisional Silver Commander(s) and Managers, as appropriate.
The Trust Gold Commander will:
1.
2.
3.
4.
Undertake a dynamic risk assessment using the Joint Decision Model (JDM)
Declare Major Incident Standby and notify staff, or
Declare a Major Incident and activate the Major Incident Plan and/or the Business
Continuity Plan
Contact relevant internal staff via switchboard, including the:
o
Divisional Silver Commanders, as appropriate
o
Support Services (Loggist/Administrator/Communications) as appropriate
SA31 – Major Incident Plan – v 3
18
o
Support teams, as appropriate.
The Trust Gold Commander will then notify the NHS England (Cheshire/Merseyside) 1st on call
(NHS Tactical Commander) and the local CCG on call using the following procedure:
1.
2.
3.
4.
5.
6.
7.
8.
Call NWAS Regional Health Control Desk (RHCD) Telephone Number at Appendix J.
(Restricted Policy Only)
Ask for the ‘’ NHS England (Cheshire/Merseyside) 1st on call’’ (NHS Tactical
Commander)
Give full name (including rank/position where appropriate)
Organisation
Contact telephone number
Reason for call
Call North Mersey CCG on call, providing the same information as above.
Call Mid Mersey CCG on call on, providing the same information as above.
NWAS will then contact the ‘’NHS England (Cheshire/Merseyside) 1st on call (NHS Tactical
Commander), who in turn will call the Trust Gold Commander and then facilitate the necessary
representation/support required.
8.12
METHANE Alerting Model
The agreed alerting model for all Responders is METHANE:






Major Incident declared?
Exact Location
Type of incident Hazards present or suspected
Access - routes that are safe to use
Number, type, severity of casualties
Emergency services present and those required
When receiving the Major Incident Standby/Declared message, all those involved within the
Trust, including managers/bleep holders, Switchboard, Divisional Silver Commanders and the
Gold Commander will use the METHANE report form at Appendix B
8.13
Contacting Key Locations and Staff
Each clinical Division and department is responsible for providing and maintaining a record of
key staff, who will be required to assist in the event of an emergency.
Day time and ‘out of hours’ contact details will be kept by Switchboard staff at V7, Prescot.
The Incident Response Team will have access to the information to assist in the identification
of immediate staffing requirements and those staff who will be asked to be available on standby.
The lists of key staff will be updated quarterly and tested every 6 months. Divisions are
responsible for conducting their own tests and recording the findings. Records to be made
available to the Head of Risk.
Initial internal contact numbers of key locations and staff can be found at Appendix I.
(Restricted Policy Only)
NHS Trusts contact information can be found at Appendix J. (Restricted Policy Only)
SA31 – Major Incident Plan – v 3
19
8.14
Flowchart
SA31 – Major Incident Plan – v 3
20
8.15
Activation of the Incident Coordination Centres (ICCs)
The Activation of the ICC(s) will be determined and directed by the Trust Gold Commander or
in their absence the respective Trust Silver Commander(s). Staff allocated will then establish
the centre(s), conduct a functional test of all equipment and declare the centre(s) as open and
operational to the respective Gold and Silver Commanders.
The ICCs provide 5 broad tasks, including:





Coordination – Matching capabilities to demands.
Policy Making – Decisions pertaining to the response.
Operations – Managing as required to directly meet the demands of the incident.
Information Gathering – Determining the nature and extent of the incident ensuring
shared situational awareness.
Dispersing public information – Informing the community, news media and partner
organisations.
The Trust primary ICC is located at:
The alternative ICC is located at:
Room 12,
V7 Building
Kings Business Park
Prescot
Merseyside
L34 1PJ
Silver Room
Mersey Care NHS Trust
Switch House
North Perimeter Road
Netherton
L30 7PT
Access via Samson Security Telephone
Number at Appendix J (Restricted Policy Only)
V7 building operates a ‘remote’ locking /unlocking process. This means that instead of
someone with keys coming out to lock up and set the alarm this will be done from a control
centre. The building is unlocked between 6:45 am and 22:15 pm each evening. If there is a
requirement for the ICC to operate outside of these timings, The Trust Gold Commander will
need to inform Samson Security.
The following resources are available in the primary ICC:









The Trust Major Incident and Business Continuity Plans
Relevant MRF and National Plans
Telephones
Computers
Action Cards
Emergency Log Books
Report Forms
Site plan
Stationery
Electronic copies of all plans – Trust, MRF or National Plans will be available to all on a central
repository. The Trust Major Incident Plan is also available on the Trust website.
9
RESPONSE
9.1
Trust Command and Control
SA31 – Major Incident Plan – v 3
21
In accordance with national guidance, the internal command layers within the Trust are
referred to as
Gold, Silver and Bronze:
Definitions of the terms Gold, Silver Bronze can be found in Appendix C.
9.1.1
Diagram - Trust Command and Control Structure
Gold Commander
Incident
Coordnaition
Centre
9.1.2
Corporate
Local Services
Secure
Silver Commander
Silver Commander
Liverpool
Sefton & Southport
Rathbone Hospital
Scott Clinic
Ashworth
Bronze
Commander
Bronze
Commander
Bronze
Commander
Bronze
Commander
Bronze
Commander
Multi-Agency & NHS Command and Control
In accordance with national guidance, the external NHS and multi-agency command layers are
referred to as Strategic, Tactical and Operational. Full explanations of these can be found at
Appendix C.
9.1.3
Roles and Responsibilities of the NHS and Multi-Agency Responders
An overview of the roles and responsibilities of the wider NHS and multi-agency Responders
can be found at Appendix D, whilst more detailed information can be found in the MRF
Merseyside Emergency Response Manual (MERM).
9.1.4
Diagram Multi-Agency and NHS Command and Control Structure
This diagram overleaf depicts the two command and control structures that can be
implemented ether in isolation are concurrently, and also shows the flow of information
between the structures.
SA31 – Major Incident Plan – v 3
22
Command and Control structures
9.2
Interoperability - Joint Emergency Services Interoperability Principals (JESIP)
In order to improve a multi-agency response JESIP establishes five principles which the Trust
need to be aware of, including:
1.
2.
3.
4.
5.
Co-location of commanders as soon as practicable at a single, safe, and easily identified
location near to the scene.
Communicate clearly using plain English.
Coordinate by agreeing the lead service. Identify priorities, resources and capabilities
for an effective response, including the timings of further meetings.
Jointly understanding risk by sharing information about the likelihood and potential
impacts of threats and hazards to agree potential control measures.
Establish shared situational awareness by using METHANE and the Joint Decision
Model (JDM).
If the principles are followed then the result should be a jointly agreed working strategy where
all parties understand what is going to happen when and by who, this strategy should include:






What are the aims and objectives to be achieved?
Who by – police, fire, ambulance and partner organisations?
When – timescales, deadlines and milestones
Where – what locations?
Why – what is the rationale? Is this consistent with the overall strategic aims and
objectives?
How are these tasks going to be achieved?
SA31 – Major Incident Plan – v 3
23
9.3
Joint Decision Model (JDM)
The Joint Decision Model will be used by multi-agency partners and the Trust Gold and Silver
Commanders to ensure a consistent approach to assessing the situation and planning the
response to an incident.
9.4
Information and Decision Logging
It is essential that the Trust Gold and Silver Commanders record their decisions
contemporaneously. All Commanders must record as a minimum, the:



Date
Time
Situation
SA31 – Major Incident Plan – v 3
24




Hazards and Risks
Options Available
Option Chosen
Rational for Option Chosen and those Not Taken
Each responsible manager should also keep their own records, whether personally or assisted
by a trained Loggist.
9.5
Joint Decision Log
A Joint Decision Log provides an option to reduce the number of Loggists required and
improve sustainability. Should a Joint Decision Log be written at either a Gold or Silver
location then this MUST be shared to all partners.
9.6
Incident Log
An Incident Log will be opened, acting as the centralised log for the incident. This will capture:








Date and Time
Information Received (Who from and by what means)
Situation
Hazards and Risks
Actions Required
Actions Allocated (with responsibility)
Actions Outstanding
Actions Closed
Additional information is available in Appendix B Report Forms.
9.7
Report Forms
There are a number of Trust report forms, including:









METHANE Report Form
Critical Incident Report Form
Situation (SitRep) Report Form
Meeting Agenda
Action Logs
Resources Request Form
Media Enquiry Form
Handover/Takeover Form
Hot Debrief Form
The Report forms can be found at Appendix B Report Forms.
9.8
Meeting Schedules
The frequency of meetings must be established at the earliest opportunity, as this will drive the
process to enable the timely receipt of information from the Bronze and Silver locations to be
collated and considered, so that the Trust Gold Commander can develop the Trust strategy
and response in support of the incident.
SA31 – Major Incident Plan – v 3
25
9.9
Information Management & Information Sharing
All conversations, notes (handwritten or electronic), personal or collective should be logged in
an incident log, whether operating from a remote location or a pre-determined command
location. These notes and papers must be made available to the authors during any
subsequent debrief or inquiry.
It is important that a nominated manager be made responsible for overseeing the keeping and
storage of records and files created during the response and also for ensuring the retention of
those that existed before the emergency occurred. It is essential to ensure that all records
and data are captured and stored in a readily retrievable manner.
All records including personal notes made will be collected following a major incident and
retained by Mersey Care NHS Trust in accordance with local policy. These records form
part of a definitive record of the response and may be required to support the development of
a post incident report and support an inquiry
Information sharing will be in accordance with existing policies and the MRF Information
Sharing Protocol.
9.10
Shift Arrangements
In the event of a major incident continuing for an extended period, it may be necessary to
continue command and control for a number of days or weeks 24/7. Responsibility for
deciding on the scale of the response, including maintaining tactical and operational teams
overnight, rests with the Trust Gold Commander.
A robust and flexible shift system will need to be in place to manage an incident through each
phase. These arrangements will depend on the nature of the incident and must take into
consideration any requirements to support external battle rhythm and activities.
Staff shifts should not extend beyond 8-12 hours maximum, otherwise there is an increased
risk of stress and fatigue, impacting upon non-technical skills and decision making. Shift
patterns should ideally marry up with the other Responders.
9.11
Staff Welfare
Responding to incidents puts staff under more pressure than normal. It is therefore vital that
staff welfare issues are given a high priority. In order to achieve this, those staff with
management responsibility will ensure that the following issues are continually addressed:







Health and safety
The availability of food and other refreshments
Working hours
Rest breaks
Travel arrangements
Consideration of personal circumstances
Emotional support during and after the incident
To assist staff in the response to an incident, regular briefings will be given by senior staff,
particularly at the start of a shift at shift changes and handovers.
SA31 – Major Incident Plan – v 3
26
9.12
Health and Safety
A major incident may involve staff working in areas they are unfamiliar with. During the
response to an incident, members of staff will not be expected to compromise their personal
health and safety and the Trust policy will continue to apply.
9.13
Vulnerable Persons
Given the sensitive nature of attempting any pre-identification of those who may be considered
vulnerable, there is a reluctance to share specific details between agencies ahead of an
emergency. Also, in the case of the Trust, the vulnerability of patients in most cases is time
limited. Those who are deemed vulnerable will vary depending on the nature of the
emergency.
The Trust is able to and will share certain information with partner agencies in advance of an
incident including:







An indication of the type and indicative numbers of patients considered to be vulnerable.
The method and format in which specific information will be shared in an emergency.
During the early stages of an incident, the Trust will initially consider:
Residential patients.
Community patients.
Staff.
Visitors (including contractors).
To identify persons who are or could be vulnerable and identify prioritised and appropriate
care. More detailed analysis can include:





Those who have mobility difficulties, including people with physical disabilities or a
medical condition.
Those with mental health difficulties.
Pregnant women.
Others who are dependent, such as the elderly, babies and children.
Limited or no use of English
This information will be communicated via the respective Chief Operating Officer (COO) in
normal working hours and the Divisional Silver Commander(s), out of normal working hours,
whilst maintaining patient confidentiality. Any external requests for information about
vulnerable persons will be communicated in accordance with the MRF Information Sharing
Protocol.
9.14
Friends and Relatives
Each clinical Division will designate an area suitable for supporting relatives and friends on
each of their respective sites, which will be documented in their business continuity plans. If
the incident occurs at Ashworth Hospital relatives and friends of patients and staff will be
accommodated in the Indigo building.
9.15
VIPs
During the response to an incident or during the recovery stage, visits by VIPs can be
anticipated. VIPs can include:

Religious leaders.
SA31 – Major Incident Plan – v 3
27





Local MPs, mayors and local authority leaders.
A Government minister.
Prime Minister.
Royal Family members.
Foreign nationals - Ambassador, High Commissioner or other dignitaries.
Visiting ministers and other VIPs will require comprehensive briefing before the visit and will
require briefing before any meetings with the media. VIPs are likely to want to meet patients
who are well enough and prepared to see them. This will be dependent upon medical advice
and respect for the wishes of individual patients and their relatives. In the case of such visits
to hospitals it is common for VIP interviews to take place at the hospital entrance to cover how
patients and medical staff are coping.
9.16
Lockdown
A lockdown of individual buildings or a specific location may be required to either contain the
major incident or prevent an external threat from gaining access to Trust facilities. Lockdown
can only be effective if is conducted quickly, either in response to a localised incident or
intelligence received.
For a localised lockdown to be effective, standard operating procedures need to be
understood and practised by Trust staff. Any decisions to lockdown should be taken by the
Chief Operating Officers (COO) or Divisional Silver Commanders. Factors to be included are:




Risk.
Duration.
Communication.
Multi-agency involvement/liaison.
10
COMMUNICATIONS & MEDIA
10.1
General
The following extract from the Emergency Preparedness Guidance to the Civil Contingencies
Act illustrates the scope of the warning and informing duty –
PUBLIC AWARENESS (pre-event):
Informing and educating the public about risks and preparedness
PUBLIC WARNING (at the time of an event or when one is likely):
Alerting by all appropriate means the members of a community whose immediate safety is at
risk
INFORMING AND ADVISING THE PUBLIC (immediate and long-term post-event):
Providing relevant and timely information about the nature of the unfolding event:–

Immediate actions being taken by responders to minimise the risk to human or animal
health and welfare, the environment or property;

Actions being taken by responders to assist the recovery phase;

Actions the public themselves can take to minimise the impact of the emergency;

How further information can be obtained; and

End of emergency and return to normal arrangements.
In producing this strategy, the Trust has considered the information already in the public
SA31 – Major Incident Plan – v 3
28
domain, as a result of publication by partner agencies.
10.2
Lead Officer
The Trust Gold Commander based in the Incident Coordination Centre (ICC) will establish and
maintain contact with the NHS England Tactical/Strategic Commander throughout the
response phase. The NHS Tactical/Strategic Commander provide a communications route to
all other NHS and non-NHS Responders, e.g. Public Health England (PHE) at local, regional
and national levels, where appropriate.
If the Trust requires advice or support concerning an internal incident, contact should be made
with the appropriate agency. Contact details of appropriate agencies are included at
Appendix J (Restricted Policy Only); all agencies have 24/7 alert and response capability.
10.3
Communications Methods
Communications methods that the Trust could employ include:









10.4
Phones.
Mobile Phones.
Fax.
E Mail.
Face to Face.
Internet.
Staff briefings.
Staff bulletins.
Social Media.
Media
During an emergency, the Merseyside Resilience Forum (MRF) Merseyside Media Protocol
will be adopted by all agencies to provide advice and reassurance to the public.
The protocol provides for all agencies issuing their own media statements on matters within
their individual remit. Statements will be factually correct and restricted to confirmed
information.
10.5
Trust’s Media Protocol
This area of emergency management requires careful and expert handling and the Trust has
specific arrangements in place to manage communications during emergencies which are
likely to produce significant media attention. These arrangements are intended to supplement
national, regional and local arrangements defined in associated plans and protocols.
a)
All media enquiries and interview requests will be channeled through the Executive
Director of Governance & Communications. This is standard practice but the message
to staff in the event of a major incident should be strongly reinforced to prevent
unguarded and incorrect messages.
b)
The Executive Director of Governance & Communications will discuss these with the
Chief Executive or the nominated senior manager who may refer them to the Incident
Response Team for discussion before a response is given.
c)
The Trust Communications Team have a handbook which contains further information,
SA31 – Major Incident Plan – v 3
29
including draft media statements, a copy of this can be found in the Incident
Coordination Centre’s(ICCs).
d)
An action card for the Communications & Media Representative can be found at
Appendix A.
e)
Nominated spokespersons will be identified to ensure continuity in dealing with the
media. Only these staff and the Executive Director of Governance & Communications
will have any communication with the media. Where more than one person is identified
to act as spokesperson, contacts between these and the media should be strictly
controlled and co-ordinated. In the event of a major incident the spokesperson will
normally be the Director on-call.
f)
Briefing and background notes to inform the understanding of then media in relation to
the particular issue should be produced where relevant during the early stages of the
event or in any available lead-up
time to a likely event.
g)
A list of appropriate people/organisations who need to be informed of the incident prior
to and during media attention will be drawn up in the early stages and an outline of the
situation transmitted to them.
Where a patient is involved, the patient and/or family will be kept fully informed before
the media.
h)
i)
10.6
Early press statements will be prepared and press conferences arranged in order to take
the initiative in dealing with and controlling media activity.
Trust’s Key Messages
Because members of the Trust’s Communication Team are not on call, it is necessary to have
pre-prepared statements, until appropriate support can attend, including:



10.7
Holding Statements.
Position Statements.
Media Statements
NHS England Media Support
NHS England can provide media support and advice 24/7, via the North, Midlands and East
Communications Services (NME Comms). Any request for support should be directed through
the NHS England 1st on call (NHS Tactical Commander) via North West Ambulance Service
(NWAS) Regional Health Control Desk (RHCD).
10.8
Media Briefing Centres
The Trust has a number of key locations identified as Media Briefing Centres, including:




Indigo Building at Ashworth for press conferences.
Indigo Building for press use/wait.
Boardroom V7.
North Lodge Control for Police if appropriate.
The locations although identified may not be suitable at the time of the incident, so alternatives
may be used.
SA31 – Major Incident Plan – v 3
30
10.9
Talking To The Media
A senior manager will be designated to act as a communications officer with the purpose of
keeping other staff in the Trust informed of events and will accordingly be a member of the
Incident Response Team.
Talking to the media can be unsettling for those inexperienced at it, but it is important to
remember Mersey Care’s values when dealing with the media:






We will be open and honest in our dealings with the media
We will respond to enquiries as quickly as possible
We will protect the privacy and confidentiality of our patients and staff and will act in their
best interests at all times
We will share information as fully as possible, unless it concerns the release of personal
information about a patient, or aspects of security which could present a risk to the safe
running of the Trust
We will delegate a member of staff, usually a member of the communications team,
service director or chief executive to communicate with the media
Gold on call or a senior executive will approve any written statements or press releases.
10.10 Additional Media Considerations
The following bullet points must be a consideration when dealing with the communications
element of the emergency response and recovery phase:















Timely and accurate information being passed to the media by each agency.
The flow of information being coordinated between agencies.
Questions/panels - co-opt your experts.
Written media holding statements (prepared).
Media channels both internal and external.
Social Media - now impossible to avoid the story.
Citizen Journalism (including your employees).
Timing of message(s).
Accuracy of information; do not speculate.
Who, what, where, when and how.
Include two clear messages to communicate (opportunity not to be missed).
Message creation - tone/contents/empathy and understanding.
Clear goals already achieved and clear goals you are working towards.
Legal elements/investigations/enquiries/support.
Future communications - where/when and through what channel.
Emergencies are always about PEOPLE – victims, survivors, fatalities, families, livelihoods
and culprits. When communicating, ‘people’ should always be at the centre of the message.
An on-call briefing pack can be found in the Communications folder on the S-drive titled
“Comms On Call”.
It includes:





A press call log to make notes of every media enquiry and allow their input into Vuelio
(on-line media database) at a later date
Suggested responses for most media enquiries
A template for a Mersey Care press release
A template for an Ashworth-related press release
A media incident form to send around to Exec Board, NHS England etc
SA31 – Major Incident Plan – v 3
31






A confidential document explaining protocols for working with gold on call
An updated fact file of ISB (correct as of January, 2015)
Password protected document explaining protocol for high profile death or patient
transfer (Steve Murphy, Joanne Cunningham and Myles Hodgson have the password)
A list of important media contacts
Contact numbers for gold on call (will be needed for filling in media incident report)
Media Centre copy to be added to website in case of major incident.
11
Stand-down and Recovery
11.1
Initial ‘Stand-Down’
The decision to stand-down from the response to a Major Incident will be taken by the Trust
Gold Commander in consultation with the Chief Executive and external agencies, including
NHS England’s Strategic Commander. The Trust Gold Commander will:




Relay the stand-down message to all staff and external agencies involved in the
response.
Conduct internal hot and cold debriefs as soon as possible after the incident.
Identify individuals to form the Recovery and Restoration Team (if not already formed).
Identify Trust individuals to attend the MRF Recovery Coordinating Group (RCG) and
associated sub-groups where appropriate.
Note: The national guidance for recovery provides suggested groups, terms of reference and
agendas to aid organisations.
11.2
Recovery
11.2.1 Recovery and Restoration Team
The Trust recovery and restoration arrangements from an incident will form a vital component
of the overall response. Whilst the response effort is dealing with the immediate issues
affecting the Trust or its partner agencies, the Chief Executive will consider the establishment
of a Recovery and Restoration Team (RRT).
The Team responsibilities would involve the consequence management of the incident
including the identification of issues that could continue to disrupt the services provided by the
Trust. The effective management of these consequences should provide a successful
recovery and restoration process. The Team would identify a strategy for the recovery and
restoration stages by considering the consequences and the impact of the incident on the
Trust in the immediate and longer term.
The RRT would work closely with the Incident Response Team (IRT) by holding regular
briefing sessions. The RRT will consider the following issues:






Managing the return to normal service delivery.
Managing the restoration of any structural damage.
Consider the priority of elective services including the impact on targets.
Communication with patients affected by the incident including the rebooking of
cancelled appointments.
Staffing levels in the immediate future.
Management arrangements of beds occupied by patients decanted from other
sites/Trusts.
SA31 – Major Incident Plan – v 3
32



Support of staff welfare and counselling.
Re-stocking of supplies and equipment.
Audit issues.
12
Debriefing and Learning
12.1
General
Debrief must be about what actually happened as opposed to what can be recalled and as
such ALL reports, notes and papers prepared during the incident MUST be central to the
debrief.
12.2
Hot & Cold Debriefing
There are two main techniques for identifying lessons to be learned after an incident or
exercise; hot and cold debriefs.
12.2.1 Hot Debrief
A hot debrief is a lessons learned review carried out there and then after the incident or
exercise, when all the key people are still present and any lessons learned can immediately
influence future events. Minor details are not lost because of time delay, or a later emphasis
on the bigger issues. A Hot Debrief Form can be found at Appendix B
12.2.2 Cold Debrief
A cold debrief has the same basic objectives as a hot debrief, but it is convened at some
point after the incident and participants are allowed more time to identify the lessons to be
learned. The cold debrief should be a face to face meeting ideally held within a couple of
weeks of the event.
The person coordinating the incident needs to attend, as do key members of the incident
team, people responsible for preparing any plans used, and any other key stakeholders.
12.2.3 Internal Debriefing
Within two weeks of an incident stand down, Divisions and departments involved or affected
by an incident will hold a debrief meeting to identify issues within their areas of operation. A
formal Trust wide cold debrief will be held within four weeks of the incident. Those attending a
debrief, will be the key staff involved in the response. The meeting will be chaired by a
member of staff nominated by the Executive Director with responsibility for this plan.
12.2.4 Post Incident Report
A post incident report will be produced and distributed internally, so to maximise learning. The
report will be archived along with other incident documentation.
12.3
Multi-Agency Debrief
The Trust must be prepared to attend and contribute to external NHS and Where appropriate,
a multi-agency debrief will also be held at a later date allowing sufficient time for participating
agencies to hold internal debriefs. The objective of a multi-agency debrief is to:


Agree on the basic principles of the actions taken during the incident.
Identify the lessons learned.
SA31 – Major Incident Plan – v 3
33





Identify issues that may be subject to further review.
Identify positive points of good practice.
Identify areas of concern for future action.
Complete an Action Plan identifying agencies responsible and timescales.
Produce a Post Incident Report.
The Police often chair multi-agency debrief meetings but the chair could be provided by the
agency that declared the major incident or a senior officer of a lead agency who was not
directly involved in the response.
12.4
Post Incident Action Plan
The Trust Post Incident Action Plan will contain actions, recommendations, anticipated
outcomes, legal issues and timescales for concluding actions. The Trust Post Incident Action
Plan will be shared with partner agencies where appropriate.
12.5
Counselling
Those who have been involved in an incident either as victims or Responders may be
traumatised and suffering from shock intense anxiety and grief. Some may also need social
support such as contacting family and friends, transport, finding temporary accommodation
and financial assistance.
Trust staff, contractors, staff, patients and visitors may require support in the event of an
incident occurring on the Trust site.
Independent support organisations and their services include:





12.6
Samaritans – offer a 24 hour helpline for those in crisis – Tel; 116 123
Disaster Action – provide support and guidance – Tel: 01483 799066
Assist Trauma Care – offer telephone counselling and support to individuals and families
for post-traumatic stress disorders – Tel: 01788 551919
Internally Mersey Cares Staff Support Service – Tel No in Appendix J. (Restricted Policy
Only)
Talk Liverpool – Psychological Therapies Service – Tel: 0151 228 2300
Inquest Investigations and Inquiries
All conversations, notes (handwritten or electronic), personal or collective should be logged in
an incident log, whether operating from a remote location or a pre-determined command
location. These notes and papers must be made available to the authors during any
subsequent debrief or inquiry.
It is important that a nominated manager be made responsible for overseeing the keeping and
storage of records and files created during the response and also for ensuring the retention of
those that existed before the emergency occurred. It is essential to ensure that all records
and data are captured and stored in a readily retrievable manner.
All records including personal notes made will be collected following a major incident and
retained by Mersey Care NHS Trust in accordance with local policy. These records form
part of a definitive record of the response and may be required to support the development of
a post incident report and support an inquiry. The Hillsborough Inquiry could be used as an
indication of how long after a major incident an inquiry could occur.
SA31 – Major Incident Plan – v 3
34
13
Plan Review & Maintenance Process
13.1
Scheduled Review Process
The plan will be subject to internal and external audit and ongoing review and revision in the
light of learning from exercises, changes to partner agency plans and changes to NHS and
other appropriate national guidance. Initiated and owned by the Head of Risk & Emergency
Planning, the review will be aligned with the Trusts Risk Management Strategy (SA02).
13.2
Post Exercise
It is essential that following an exercise, any lessons learnt are acted upon and adjustments to
the MIP and supporting arrangements are made, ensuring that Trust staff are informed. The
Head of Risk & Emergency Planning is responsible for ensuring these activities are conducted
and recorded.
13.3
Post Incident
It is essential that following an incident or major incident, any lessons learnt are acted upon
and adjustments to the MIP and supporting arrangements are made, ensuring that Trust staff
are informed.
14
TRAINING SUPPORT AND EXERCISING
14.1
Training
Personnel expected to deliver this plan during an emergency should receive the appropriate
level of training in its use. They should be confident in working with partner agencies where
necessary for their role and be familiar with:






14.2
Their roles and responsibilities.
The strategic objectives for the Trust.
The workings of the Incident Coordination Centre.
The internal and external Command & Control arrangement.
The decision making processes and recording.
The integration points of other internal and external plan both response, business
continuity and recovery.
Exercise & Exercise Schedule
The Head of Emergency Planning Risk and Resilience will ensure that as a minimum, the
Trust will arrange and/or participate in:



14.3
A communications test every 6 months.
An annual desktop exercise.
A three yearly live exercise.
Training Records & Exercise Records
The details of personnel attending either a training session or are involved in an exercise
involving this plan must be recorded on a specific database that can be used for inquiry
purposes. Additionally, electronic personal training records should be updated with the same
information.
SA31 – Major Incident Plan – v 3
35
All staff should receive Trust initial role training, an annual refresher plus further development
through the attendance at briefings, workshops and exercises. Individuals are required to
identify any gaps in knowledge and seek appropriate support.
15
MONITORING
In addition to the exercising of the plan, random checks will be carried out by services
managers to ensure that action cards and procedures have been accurately maintained in
order to integrate effectively into the Major Incident Plan. These audits will also ensure the
Business Continuity Plans are current and fit for purpose.
The Trust plans are to be audited annually by Cheshire and Merseyside Commissioning
Support Unit (CSU) on behalf of the local Clinical Commissioning Groups (CCGS).
For summary of exercises see 14.2
SA31 – Major Incident Plan – v 3
36
Appendix A – Action Cards
16
16.1
Gold Commanders Action Card
NOMINATED PERSONS - Use this Action Card as a checklist
Role: The role of the Trust Gold Commanders is to provide strategic direction and commit
resources to support the Trust response, whilst maintaining liaison with the Trust Silver
Commanders, Incident Response Teams, NHS England and multi-agency partners.
Record Initial Information Using the SBAR/METHANE Report Form (Step 0)
If you have time complete the JDM process (Steps 1 – 5 incl)
If not, escalate to Major Incident Standby or Major Incident Declared (Step 6 onwards) then
conduct the JDM (Steps 1-5 incl).













Step
0
1
Step 0 – Complete SBAR/METHANE Report Form
Step 1 - Gathering Information and Intelligence
Step 2 - Assessing Threat and Risk
Step 3 - Power and Policies
Step 4 - Identify Options and Contingencies
Step 5 - Action and Review
Step 6 – Activate the Internal Response
Step 7 - Activate the External Response
Step 8 - Activate the Incident Coordination Centre
Step 9 – Warning and Informing
Step 10 – Convene Meeting of IRT/CMT/RRT (where appropriate)
Step 11 – Further Considerations
Step 12 - At the End of the Incident
Record Initial Information Using the METHANE Report Form
Major Incident Standby/Declared?
Exact Location?
Type of Incident (Hazards present/suspected)?
Hazards Present or Suspected
Access – Safe Routes?
Number – Type and Severity of Casualties?
Emergency Services on Scene/Route?
Gathering Information and Intelligence
What is happening/has happened?
What do you know so far?
What time did it begin?
Where is the incident?
Who has been informed already? Get their contact details
What are the immediate consequences?
Contact those Trust managers / staff already involved.
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
37
2
3
4
5
6
8
What is being done to mitigate / resolve the incident?
Outstanding problems?
Assessing Threat and Risk
Do you need to take action immediately?
Do you need to seek more information?
What could go wrong?
What could go well?
How probable is the risk of harm?
How serious would it be?
Is that level of risk acceptable?
Is this a situation for the Trust alone to deal with?
Are you the appropriate person to deal with this?
What are you trying to achieve?
Develop a working strategy to guide subsequent stages.
Power and Policies
What legislation applies?
Doe the Trust have the power to initiate action?
Is there any guidance covering this situation?
Do any NHS, LHRP or MRF plans or guidance apply?
Identify Options and Contingencies
What options are open to you?
Will the response be proportionate, legitimate and necessary?
Will the response be reasonable in the circumstances facing you at the
time?
What will you do if things do not happen as anticipated?
Action and Review
Implement option selected.
Does anyone else need to know what you have decided?
Record what you did and why?
Monitor.
What happened as a result of your decision?
Was it what you wanted or expected to happen?
Review your decisions using the JDM.
What lessons can you take from how things turned out?
What might you do differently next time?
Activate Internal Response (Where appropriate)
Identify appropriate structures and request call out via switchboard. This
could include:
 Trust Silver Commanders
 ICCs
 Loggist
 Admin Support
 Media Communications
 IRT/CMT/RRT
 Trust Bronze Commanders
 Staff
Decide on location(s) to be used and by whom
Activate External Responders (Where Appropriate)
NHS England Area Team (1st on call/2nd on call)
NHS England Communications
Merseyside Police
Public Health England
Other Health and Social Care Organisations
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
38
8
Activate the Incident Coordination Centre (Where Appropriate)
Ensure Room set up with log books etc
Telephones laid out for team, including one dedicated incoming line.
When ready, declare that the ICC is open.
Record all telephone communications in and out
All staff to record all information received and cascaded chronologically in
log books and on incident white boards.
9
Warning and Informing – Staff, Patients, Visitors and Public
Activate Trust Media Communications Representative(s)
Options to cascade warning and informing messages
What information needs to be and can be cascaded
Safety and welfare of public, patients and visitors
Media Engagement
Ensure key messages / communications are cascaded.
10
Convene a meeting of the IRT/CMT/RRT as Appropriate
Confirm details of incident
Agree on roles and initial tasks, ensure understanding and are able to
execute their roles, check that staff have Action Cards.
Confirm Incident Room layout and operating procedure.
Establish a multiple enquires telephone call centre if appropriate.
Identify and brief staff to operate the enquiry service
Agree on next actions
11
Further Considerations
Staff – information, rotas, welfare, health and safety, overtime
payments/time off in lieu
Stakeholders – Establish and maintain correct links (internal/external).
Identify normal operations to continue.
Agree local strategy and resources with NHS England on call.
Seek situation updates on a regular basis
Media liaison In office hours - The Executive Director of Governance &
Communications; Out of hours - The Trust Gold Commander.
12
At the end of the incident
Authorise ‘stand-down’
Activate Stand down procedure.
Cascade to all staff and key stakeholders
Conduct a hot debrief at the ICC
Close the ICC
Attend internal or external debriefs. Contribute to any reports
Compile the formal report on the incident, include lessons learnt.
All documentation to the Head of Risk and Emergency Planning
Log Book Record Notes – Ensure You Regularly Record
Situation – What, When, Where, Who, What Support
Hazards and Risks – To Patients, Visitors, Staff, Responders and Public
What Options are Available – Now and in the Future
Option Chosen and Reasons Why
Options Not Chosen and Reasons Why Not
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
39
SILVER COMMANDERS ACTION CARD
NOMINATED PERSONS - Use this Action Card as a checklist
Role: The role of the Divisional Silver Commanders are to develop tactical plans and
coordinate Trust Bronze Responders dealing with the incident, whilst maintaining liaison with
the Trust Gold Commander, Incident Response Teams and multi-agency partners, including
NHS England, where appropriate.
Record Initial Information Using the SBAR/METHANE Report Form (Step 0)
If you have time complete the JDM process (Steps 1 – 5 incl)
If not, escalate to Major Incident Standby or Major Incident Declared (Step 6 onwards) then
conduct the JDM (Steps 1-5 incl).
If the Gold Commander is not available you may need to make this decision locally.













Step
0
1
Step 0 – Complete SBAR/METHANE Report Form
Step 1 - Gathering Information and Intelligence
Step 2 - Assessing Threat and Risk
Step 3 - Power and Policies
Step 4 - Identify Options and Contingencies
Step 5 - Action and Review
Step 6 – Activate the Internal Response
Step 7 - Activate the External Response
Step 8 - Activate the Incident Coordination Centre
Step 9 – Warning and Informing
Step 10 – Convene Meeting of IRT/CMT/RRT (where appropriate)
Step 11 – Further Considerations
Step 12 - At the End of the Incident
Record Initial Information Using the METHANE Report Form
Major Incident Standby/Declared?
Exact Location?
Type of Incident (Hazards present/suspected)?
Hazards Present or Suspected
Access – Safe Routes?
Number – Type and Severity of Casualties?
Emergency Services on Scene/Route?
Gathering Information and Intelligence
What is happening/has happened?
What do you know so far?
What time did it begin?
Where is the incident?
Who has been informed already? Get their contact details
What are the immediate consequences?
Contact those Trust managers / staff already involved.
What is being done to mitigate / resolve the incident?
Outstanding problems?
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
40
2
3
4
5
6
8
Assessing Threat and Risk
Do you need to take action immediately?
Do you need to seek more information?
What could go wrong?
What could go well?
How probable is the risk of harm?
How serious would it be?
Is that level of risk acceptable?
Is this a situation for the Trust alone to deal with?
Are you the appropriate person to deal with this?
What are you trying to achieve?
Develop a working strategy to guide subsequent stages.
Power and Policies
What legislation applies?
Doe the Trust have the power to initiate action?
Is there any guidance covering this situation?
Do any NHS, LHRP or MRF plans or guidance apply?
Identify Options and Contingencies
What options are open to you?
Will the response be proportionate, legitimate and necessary?
Will the response be reasonable in the circumstances facing you at the
time?
What will you do if things do not happen as anticipated?
Action and Review
Implement option selected.
Does anyone else need to know what you have decided?
Record what you did and why?
Monitor.
What happened as a result of your decision?
Was it what you wanted or expected to happen?
Review your decisions using the JDM.
What lessons can you take from how things turned out?
What might you do differently next time?
Activate Internal Response (Where Appropriate)
Identify appropriate structures and request call out via switchboard. This
could include:
 Trust Gold Commander
 Staff Officer (Dependent upon Divisional arrangements)
 ICCs
 Loggist
 Admin Support/
 Media Communications
 Divisional Bronze Commanders
Decide on location(s) to be used and by whom
Activate External Responders (Where Appropriate)
NHS England Area Team (1st on call/2nd on call)
Ministry of Justice
NHS England Communications
Merseyside Police
Public Health England
Other Health and Social Care Organisations
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
41
8
Activate the Incident Coordination Centre
Ensure Room set up with log books etc
Telephones laid out for team, including one dedicated incoming line.
When ready, declare that the ICC is open.
Record all telephone communications in and out
All staff to record all information received and cascaded chronologically in
log books and on incident white boards.
9
Warning and Informing – Staff, Patients, Visitors and Public
Activate Trust Media Communications Representative(s)
Options to cascade warning and informing messages
What information needs to be and can be cascaded
Safety and welfare of public, patients and visitors
Media Engagement
Ensure key messages / communications are cascaded.
10
Convene a meeting of the IRT/CMT/RRT as Appropriate
Confirm details of incident
Agree on roles and initial tasks, ensure understanding and are able to
execute their roles, check that staff have Action Cards.
Confirm Incident Room layout and operating procedure.
Establish a multiple enquires telephone call centre if appropriate.
Identify and brief staff to operate the enquiry service
Agree on next actions
11
Further Considerations
Staff – information, rotas, welfare, health and safety, overtime
payments/time off in lieu
Stakeholders – Establish and maintain correct links (internal/external).
Identify normal operations to continue.
Agree local strategy and resources with NHS England on call.
Seek situation updates on a regular basis
Media liaison In office hours - The Executive Director of Governance &
Communications; Out of hours - The Trust Gold Commander.
12
At the end of the incident
Authorise local ‘stand-down’
Activate local stand down procedure.
Cascade to all staff and key stakeholders
Conduct a hot debrief at the ICC
Close the ICC
Attend internal or external debriefs. Contribute to any reports
Compile the formal report on the incident, include lessons learnt.
All documentation to the Head of Risk and Emergency Planning
Log Book Record Notes – Ensure You Regularly Record
Situation – What, When, Where, Who, What Support
Hazards and Risks – To Patients, Visitors, Staff, Responders and Public
What Options are Available – Now and in the Future
Option Chosen and Reasons Why
Options Not Chosen and Reasons Why Not
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
42
16.2
Incident Response Team Action Card
NOMINATED TEAMS - Use this Action Card as a checklist
Activated by the Trust Gold Commander - The composition of this Team will vary depending
upon the type and scale of the incident.
Role: The role of the Incident Response Team is to support the Trust Gold and Silver
Commanders, ensuring that the Trust is able to respond effectively whilst maintaining
business critical activities and services.
Record Initial Information Using the SBAR/METHANE Report Form (Step 0)
If you have time complete the JDM process (Steps 1 – 5 incl)
If not, escalate to Major Incident Standby or Major Incident Declared (Step 6 onwards) then
conduct the JDM (Steps 1-5 incl).













Step
0
1
Step 0 – Complete SBAR/METHANE Report Form
Step 1 - Gathering Information and Intelligence
Step 2 - Assessing Threat and Risk
Step 3 - Power and Policies
Step 4 - Identify Options and Contingencies
Step 5 - Action and Review
Step 6 – Activate the Internal Response
Step 7 - Activate the External Response
Step 8 - Activate the Incident Coordination Centre
Step 9 – Warning and Informing
Step 10 – Convene Meeting of IRT/CMT/RRT (where appropriate)
Step 11 – Further Considerations
Step 12 - At the End of the Incident
Record Initial Information Using the METHANE Report Form
Major Incident Standby/Declared?
Exact Location?
Type of Incident (Hazards present/suspected)?
Hazards Present or Suspected
Access – Safe Routes?
Number – Type and Severity of Casualties?
Emergency Services on Scene/Route?
Gathering Information and Intelligence
What is happening/has happened?
What do you know so far?
What time did it begin?
Where is the incident?
Who has been informed already? Get their contact details
What are the immediate consequences?
Contact those Trust managers / staff already involved.
What is being done to mitigate / resolve the incident?
Outstanding problems?
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
43
2
3
4
5
6
8
What is being done to mitigate / resolve the incident?
Outstanding problems?
Assessing Threat and Risk
Do you need to take action immediately?
Do you need to seek more information?
What could go wrong?
What could go well?
How probable is the risk of harm?
How serious would it be?
Is that level of risk acceptable?
Is this a situation for the Trust alone to deal with?
Are you the appropriate person to deal with this?
What are you trying to achieve?
Develop a working strategy to guide subsequent stages.
Power and Policies
What legislation applies?
Doe the Trust have the power to initiate action?
Is there any guidance covering this situation?
Do any NHS, LHRP or MRF plans or guidance apply?
Identify Options and Contingencies
What options are open to you?
Will the response be proportionate, legitimate and necessary?
Will the response be reasonable in the circumstances facing you at the
time?
What will you do if things do not happen as anticipated?
Action and Review
Implement option selected.
Does anyone else need to know what you have decided?
Record what you did and why?
Monitor.
What happened as a result of your decision?
Was it what you wanted or expected to happen?
Review your decisions using the JDM.
What lessons can you take from how things turned out?
What might you do differently next time?
Activate Internal Response (Where appropriate)
Identify appropriate structures and request call out via switchboard. This
could include:
 Trust Silver Commanders
 ICCs
 Loggist
 Admin Support
 Media Communications
 IRT/CMT/RRT
 Trust Bronze Commanders
 Staff
Decide on location(s) to be used and by whom
Activate External Responders (Where Appropriate)
NHS England Area Team (1st on call/2nd on call)
NHS England Communications
Merseyside Police
Public Health England
Other Health and Social Care Organisations
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
44
8
Activate the Incident Coordination Centre (Where Appropriate)
Ensure Room set up with log books etc
Telephones laid out for team, including one dedicated incoming line.
When ready, declare that the ICC is open.
Record all telephone communications in and out
All staff to record all information received and cascaded chronologically in
log books and on incident white boards.
9
Warning and Informing – Staff, Patients, Visitors and Public
Activate Trust Media Communications Representative(s)
Options to cascade warning and informing messages
What information needs to be and can be cascaded
Safety and welfare of public, patients and visitors
Media Engagement
Ensure key messages / communications are cascaded.
10
Convene a meeting of the IRT/CMT/RRT as Appropriate
Confirm details of incident
Agree on roles and initial tasks, ensure understanding and are able to
execute their roles, check that staff have Action Cards.
Confirm Incident Room layout and operating procedure.
Establish a multiple enquires telephone call centre if appropriate.
Identify and brief staff to operate the enquiry service
Agree on next actions
11
Further Considerations
Staff – information, rotas, welfare, health and safety, overtime
payments/time off in lieu
Stakeholders – Establish and maintain correct links (internal/external).
Identify normal operations to continue.
Agree local strategy and resources with NHS England on call.
Seek situation updates on a regular basis
Media liaison In office hours - The Executive Director of Governance &
Communications; Out of hours - The Trust Gold Commander.
12
At the end of the incident
Authorise ‘stand-down’
Activate Stand down procedure.
Cascade to all staff and key stakeholders
Conduct a hot debrief at the ICC
Close the ICC
Attend internal or external debriefs. Contribute to any reports
Compile the formal report on the incident, include lessons learnt.
All documentation to the Head of Risk and Emergency Planning
Log Book Record Notes – Ensure You Regularly Record
Situation – What, When, Where, Who, What Support
Hazards and Risks – To Patients, Visitors, Staff, Responders and Public
What Options are Available – Now and in the Future
Option Chosen and Reasons Why
Options Not Chosen and Reasons Why Not
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
45
16.3
Communications Media Action Card
NOMINATED PERSON/TEAMS - Use this Action Card as a checklist
Activated by the Trust Gold or Silver Commander - The composition of this Team will vary
depending upon the type and scale of the incident.
Role: The role of the Communications Media Representative/Team is to provide specialist
communications and media support the Trust Gold and Silver Commanders and Incident
Response Teams by:



Preparing appropriate media and public communications messages
Establishing and maintaining liaison with internal and external media communications
teams
Ensuring any messages comply with the Lead Agency in accordance with the
Merseyside Media Protocol in an Emergency
Step Record Initial Information Using the METHANE Report Form
0
1
2
Tick When
Done
Major Incident Standby/Declared?
Exact Location?
Type of Incident (Hazards present/suspected)?
Hazards Present or Suspected
Access – Safe Routes?
Number – Type and Severity of Casualties?
Emergency Services on Scene/Route?
Agree roles and immediate action with Trust Gold or Silver Tick When
Commander and confirm?
Done
Who are you supporting
What support do they require and by when?
What media enquiries have been received already?
What warning and informing messages have been cascaded already
What warning and informing messages are required to who (staff,
patients. Visitors, public and partners) and by when?
Refer to the Communications Media Manual
Contact Relevant Internal and External Media Representatives
Head of Communications to identify members of his team and their
duties during major incident
Head of Communications to organise staff to attend the site of the
incident
Media Manager to inform and brief members of the communication
team
Media Manager to write and get an initial holding statement signed off
and look after further statements in accordance with trust policies and
procedures
Media Manager to liaise with Merseyside Police regarding media
interest and statements
SA31 – Major Incident Plan – v 3
46
Communications Officer to inform the service/facility of media interest
and advise on-site security team until the other members of the
communications team arrives.
Communications Officer to deal with any media that arrives on site
and make contact with switchboard regarding the incident.
Media Manager to brief Gold on call, who will brief Executive Board.
3
Attend the ICC Location
Tick When
Done
Identify the Trust spokesperson for the incident
Collect any Media requests that the Trust has received so far
Act upon the media requests
Remind all staff and locations that any media enquiries are to come to
the ICC
Establish links with appropriate media outlets (radio/TV/Papers)
Prepare holding and briefing statements as required
Statements to be developed in accordance with Trust policies and
procedures, including the contents of the Communications Media
Manual
Statements to conform to MRF Media Protocol during an Emergency
Statements to be released once approved by one of the following
(incident dependent):
 The Trust
 NHS England
 Tactical Coordinating Group
 Strategic Coordinating Group
Identify and prepare any media briefing locations to be used within
the Trust
Brief any spokesperson prior to any verbal media briefings
Log all your decisions and actions
Log Book Record Notes – Ensure You Regularly Record
Situation – What, When, Where, Who, What Support
Hazards and Risks – To Patients, Visitors, Staff, Responders and Public
What Options are Available – Now and in the Future
Option Chosen and Reasons Why
Options Not Chosen and Reasons Why Not
SA31 – Major Incident Plan – v 3
47
16.4
Administrative Support Action Card
ROLE
To set up the Incident Coordination Centre (ICC)
NOMINATED
To provide administrative and clerical support
PERSONS
To collect, collate and display information
To establish and maintain liaison with internal and external services
Having been alerted you now need to consider what actions are needed. Use this Action
Card as a checklist.
Step Record Initial Information Using the METHANE Report Form
Tick When
Done
0
Major Incident Standby/Declared?
Exact Location?
Type of Incident (Hazards present/suspected)?
Hazards Present or Suspected
Access – Safe Routes?
Number – Type and Severity of Casualties?
Emergency Services on Scene/Route?
1
Agree roles and immediate action with Trust Gold or Silver Tick When
Commander
Done
Insert agreed role and immediate actions:
2
Agree on ICC Location
Tick When
Done
Insert confirmed ICC location
3
Alert relevant staff as instructed – ask them to report to ICC
Tick When
Done
Insert Staff names required:
SA31 – Major Incident Plan – v 3
48
4
Call out the relevant staff to help with the ICC
4
Set up the ICC
5
6
8
9
Tick When
Done
Tick When
Done
With the Trust Gold and/or Silver Commanders confirm room layout,
set out communications system, log sheets, incident status boards.
Layout telephones for team members, including one dedicated
incoming line. Use mobile telephones for outgoing calls if necessary.
Supply of log books to be available.
Set up incident status boards. Record initial details – incident
location, brief statement of situation, names, organisations and
contact numbers of responders
Display any relevant maps where necessary
Create a file directory and give it the name of the incident. Use this
directory for all the documents relating to the incident.
Test all equipment
Declare the room operational to the Trust Gold and Silver
Commanders
Tasks
Tick
Done
Confirm the dedicated telephone numbers for calls to be received /
made, dedicated fax line.
Make list of the ICC staff and their telephone numbers (include direct
incoming lines and extension numbers)
Refer to a list of internal and external contacts. Add these as they call
in or as reported by Trust Silver Commanders
Incoming call taking
Tick
Done
Record caller’s details and time of call on your log book.
Record name, organisation and contact numbers. Check spelling of
unfamiliar names with caller. As well as their landline number, ask
for their mobile phone and pager numbers
Ask if email contact is possible. Take email details.
Answer queries or divert calls to appropriate person as necessary
Other tasks
Tick
Done
Where requested, provide secretarial support to Trust Gold or Silver
Commander
Where requested, arrange telephone and incident briefings
Delegate a colleague to reschedule the appointments and
commitments of the Trust Gold Commander
Take photos of any whiteboards before information is wiped off
Provide stationery / materials
Staffing
considerations
(with
Director-on-call/Divisional Tick
Manager)
Done
Consider staffing requirements to allow critical functions to continue
Arrange and maintain rota for the staff in the ICC
Ensure there are catering arrangements and refreshments
Make arrangements for the support of staff in the short or long term
SA31 – Major Incident Plan – v 3
When
When
When
When
49
10
At the end of your shift
Tick When
Done
Hand over this action card to your replacement.
Brief the replacement on the current situation, the ICC procedures
and on liaison needs.
Attend the debrief
16.5
Loggist Action Card
NOMINATED
PERSONS
ROLE
To maintain an accurate combined log of relevant information,
actions and decisions taken by the person(s) at the location/venue
you are assigned to.
Having been alerted you now need to consider what actions are needed.
Use this Action Card as a checklist.
Step Record Initial Information Using the SBAR/METHANE Report
Form
0
Major Incident Standby/Declared?
Exact Location?
Type of Incident (Hazards present/suspected)?
Hazards Present or Suspected
Access – Safe Routes?
Number – Type and Severity of Casualties?
Emergency Services on Scene/Route?
1
2
3
4
Agree roles and immediate action with Trust Gold or Silver
Commander
Confirm operating base
Confirm room layout, communications system, log books to be used,
log book collection system.
With the Team support – create a file directory and give it the name of
the incident. Use the directory for all the logs relating to the incident.
At a meeting of the Team
Confirm your role and that of others, staff locations, communications
system, log keeping system.
Ensure that all members of team are keeping and accurate
individual log.
Ensure that all details are being entered on the logMessages details – time of call, name of caller (check spelling), their
contact number, spelling of technical names, spelling of locations and
company names.
Actions taken
Challenge anything you are unsure about.
Compile a combined log of messages sent and received and
actions taken.
Collect, collate and store individual log books.
Record chronologically all information in the incident log
SA31 – Major Incident Plan – v 3
Tick When Done
Tick When Done
Tick When Done
Tick When Done
Tick When Done
50
5
6
7
At the end of your shift
Hand over this action card to your replacement. Brief them on the
current situation on incident room procedures and on liaison needs.
At the end of the incident
Collect all log books.
Collect any printed documentation, scraps of paper, etc containing
incident information
Collect camera/photos of whiteboards
Collect any marked imagery (maps, diagrams)
Complete the combined log for the ICC
Centralise and create an itemised index of all incident related
materials
All documentation to the Head of Risk and Emergency Planning
Attend the debrief
Applying Best Practice

Relevant information should always be recorded in this official log
















Tick When Done
Tick When Done
Tick When Done
book.
Write in permanent black ink. Write legibly; avoid blue ink.
Your log book must be contemporaneous.
Use a new log book for each incident.
Ensure you note dates, times (use 24 hour clock), places and people
concerned.
Record any non-verbal communication. Do not put your own
interpretation on the non-verbal communication.
Only note down facts. Do not assume anything, do not give your
own opinion or your own comments.
Entries in the log must be in chronological order.
Unused space at the end of a page must be ruled through with a
diagonal line, initialled by you, dated and timed.
Record all questions and answers in direct speech.
Unused spaces at the end of lines must be ruled out by you with a
single line.
Mistakes must be ruled through with a single line and initialled by
you.
Any mistake you make which you notice at the time of writing must
be ruled through by you with a single line, initialled and the correct
word(s) added after the mistake.
Overwriting or writing above the ruled through error must not be
made. Correction fluid must not be used under any circumstances.
If you notice a mistake or an omission in the log later, during any
debrief or at any other time, you must tell your senior Manager and
the mistake corrected or the omission made good. Cross reference
the mistake (in red ink) to the corrected entry on the next available
page using consecutive letters from the alphabet.
Make clear references to exhibits (such as maps, flip charts pages
etc) and other documents so that it is clear in the log which particular
exhibit is being referred to.
Each series of entries must be signed off, dated and timed at their
close. Loggists should sign off their notes at the end of their shift to
ensure the integrity of the log.
SA31 – Major Incident Plan – v 3
51
16.6
Switchboard Action Card
NOMINATED
PERSONS
ROLES
Take initial alert message or become aware of potential major incident.
Relay message immediately to the Executive Director-on-Call
Having been alerted or become aware of a potential major incident, you now need to consider what
actions are needed. Use this Action Card as a checklist, and keep an accurate record of messages
received or given.
Tick When Done
Step Record Initial Information Using the Critical Incident Report Form
0
Situation - Describe the situation/incident that has occurred
Background - Explain the history and impact of the incident on
services/patient safety
Assessment - Confirm your understanding of the issues involved
Recommendations - Explain what you need, clarify expectations and what
you would like to happen
Tick When Done
Step Record Initial Information Using the METHANE Report Form
0
Major Incident Standby/Declared?
Exact Location?
Type of Incident (Hazards present/suspected)?
Hazards Present or Suspected
Access – Safe Routes?
Number – Type and Severity of Casualties?
Emergency Services on Scene/Route?
Tick When Done
1
Before Letting the Caller Go Ensure You Know:
What has happened?
Where is the incident?
Time of alert or discovery?
Who has been informed already? Get their contact details.
What are the immediate consequences?
Are any Trust building / services are affected?
Are they requesting mutual aid?
Has a major incident been declared by another Trust?
Tick When Done
2
Alert others / activate the plan
Immediately contact the Trust Gold Commander and relay the information
taken.
Support the Trust Gold Commander throughout the incident – please see
Gold Commander Action Card for duties required to manage the incident.
Tick When Done
3
Additional Notes:
SA31 – Major Incident Plan – v 3
52
17
Appendix B – Report Forms
METHANE Alerting Model
When receiving the Major Incident Standby/Declared message, all those involved within the
Trust, including managers/bleep holders, Switchboard, Divisional Silver Commanders and the
Gold Commander will use the METHANE report.
METHANE is now the recognised common model for passing incident information between
services and their control rooms. All services have used similar models for passing
information in the past but Joint Emergency Services Interoperability Programme (JESIP)
has instigated the use of a common model which will mean information can be shared in a
consistent way, quickly and easily, whoever the information is
SA31 – Major Incident Plan – v 3
53
17.1
METHANE REPORT FORM
Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert
NIL or N/A.
Calling Organisation:
Date:
Name (completed by):
Time:
Telephone number:
Email address:
Authorised for release by
(name & title):
Major Incident
Stand By or Declared
Exact Location
Type of Incident
Hazards Present or
Suspected
Access Routes That Are Safe
to Use
Number, Type and Severity of
Casualties
SA31 – Major Incident Plan – v 3
54
Emergency Services Present
and Those Required
17.2
CRITICAL INCIDENT REPORT FORM
Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert
NIL or N/A.
Organisation:
Name (completed by):
Mersey Care NHS Trust
Date:
Time:
Telephone number:
Email address:
Authorised for release by
(name & title):
Type of Critical Incident
(Name)
Situation
(Describe situation/incident
that has occurred)
Background
(Explain history and impact
of incident on services and
patient safety)
Assessment
(Confirm your understanding
of the issues involved)
SA31 – Major Incident Plan – v 3
55
Recommendation
(Explain what is needed,
clarify expectations and what
you would like to happen)
Ask Receiver to repeat information to ensure understanding
17.3
SITUATION REPORT FORM - SITREP
Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert
NIL or N/A.
Organisation:
Name (completed by):
Mersey Care NHS Trust
Date:
Time:
Telephone number:
Email address:
Authorised for release by
(name & title):
Type of Incident (Name)
Organisations reporting
serious operational
difficulties
Impact/potential impact of
incident on services / critical
functions and patients
Impact on other service
providers
SA31 – Major Incident Plan – v 3
56
Mitigating actions for the
above impacts
Impact of business continuity
arrangements
Media interest
expected/received
Mutual Aid Request Made
(Y/N) and agreed with?
Additional comments
Other issues
Incident Coordination Centre
contact details:
Name:
Telephone number:
Email:
SA31 – Major Incident Plan – v 3
57
17.4
Agenda Template For Meetings
Actions
Owner
Comments
Completed
Time/date
Introductions
Appoint a Chair and consider the membership of the meeting.
Consideration should be made of the likely duration of the emergency and
partner expectations at other meetings, additionally, expert assistance
required to support the internal meeting
Set an aim and objectives for the group
Identify the extent of the emergency/crisis including any estimated
timescales of disruption
Identify the number of critical functions/activities within the Trust under
threat giving consideration to timescales for restoration
Receive situation reports (sit-reps) on the response element(s) to the
emergency
Scope the response, including Recovery Point (what will it/they look like?)
and Recovery Time (when can we achieve it?)
Formulate strategies for the response phase and the recovery phase and
identify communication channels
Make accurate minutes and task via an Action Summary
Complete a Joint Decisions Log and an Action Log (See Appendices)
Create a schedule of future meetings as necessary, including time, dates,
venue, ICT, refreshments, needs etc
Communicate the strategy and findings of meetings and inform internal
partners and external customers where necessary
Agree a stand-down message and process
SA31 – Major Incident Plan – v 3
58
17.5 ACTION LOG
No.
During any emergency phase it is important that all team members are kept informed of the situation. The Silver/|Gold On-call will determine the
information or actions that needs to be recorded and the level of detail to be captured for each issue. This document is a chronological record of
the actions taken and should be visible to all members at all times. It should also be stressed that this is NOT a Decisions Log.
Emergency – brief description
Response &
Time &
Further
Trust Area
Time & Date
Action Taken
Communication
Date
Action?
Channel issued
Cleared
Issue/Action
Raised by
1.
2.
3.
4.
5.
6.
7.
8.
Lines to be added as necessary
SA31 – Major Incident Plan – v 3
59
17.6
RESOURCE REQUEST FORM
Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert
NIL or N/A.
Division:
Date:
Name (completed by):
Time:
Telephone number:
Email address:
Location Resources Required
At and By When
Personnel Required
Role
Quantity
Operational Equipment
Required
Type
Quantity
Welfare Equipment Required
Type
Quantity
Action Assigned To:
Name
Department
Contact Details
Action Completed and
Closed:
Date & Time
By Whom
SA31 – Major Incident Plan – v 3
60
17.7
MEDIA ENQUIRY FORM
Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert
NIL or N/A.
Division:
Date:
Name (completed by):
Time:
Telephone number:
Email address:
Media Organisation Making
Enquiry
Contact Details of Person
Making Enquiry
Reason for Enquiry
Any Deadlines
Communicated
Action Assigned To:
Name
Department
Contact Details
Action Completed and
Closed:
Date & Time
By Whom
SA31 – Major Incident Plan – v 3
61
17.8 Handover/Takeover Form
Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert NIL or N/A.
Incident Name:
Date:
Handover Name:
Time:
Telephone number:
Email address:
Takeover Name:
Type in or write overview:
Initial Overview
Use METHANE info
Current Situation
Hazards and Risks
SA31 – Major Incident Plan – v 3
62
Issues
Priorities & Tasks
Supporting Information




Timings
Resources Deployed
Resources Required
Plans & Policies
Invoked
Incident Log
Decision Log
SA31 – Major Incident Plan – v 3
63
Handover Complete:
Sign
Name
Role
Department
Takeover Complete:
Sign
Name
Role
Department
Contact Details
Date & Time
17.9 Hot Debrief Form
Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert NIL or N/A.
Incident Name:
Date:
Name (completed by):
Time:
Telephone number:
Email address:
Brief Summary of Incident
SA31 – Major Incident Plan – v 3
64
Brief Summary of Trust
Involvement
What Went Well
What Could Be Improved
SA31 – Major Incident Plan – v 3
65
Any Immediate Lessons
Debrief Participant Names
Debrief Completed By:
Name
Role
Department
Contact Details
Date & Time
SA31 – Major Incident Plan – v 3
66
18
Appendix C - Definitions and references to Command & Control
18.1
Gold Command
The term ‘Gold’ refers to the person in overall executive command of Mersey Care NHS Trust
response and is responsible for formulating the strategy for the incident. The Gold
Commander has overall command of the resources of the Trust, but delegates’ tactical
decisions to the respective Divisional Silver Commander(s).
18.1.1 Silver Command
The term ‘Silver’ refers to those who are responsible for formulating the tactics to be adopted
by their service to achieve the strategic direction set by the Trust Gold Commander. The Trust
Silver Commander(s) will oversee but not be directly involved in providing the operational
response to the incident.
18.1.2 Bronze Command
The term ‘Bronze’ refers to the departments and teams who provide the main operational
response in an incident, (often closest to the scene), and control the immediate resources too
hand within a specific area of the incident. They implement the tactics defined by the Trust
Silver Commander(s).
18.1.3 Strategic Coordinating Group (SCG)
A multi-agency SCG is usually called by the Police Commander when an incident requires
strategic coordination of response across agencies. Other agencies can request the
establishment of a SCG, but it is usually Merseyside Police. The role of the SCG is:





To determine the aims and objectives for responding to the incident
Agree the strategy to achieve these
Prioritise and co-ordinate the actions taken by all agencies
Provide a link to central government
To manage all external communications
The SCG will be located at the Joint Command Centre (JCC), Bridle Road, Bootle.
18.1.4 Tactical Coordinating Group (TCG)
A multi-agency TCG is established at one of the Police Borough Command Units in
Merseyside or mobilised to a suitable location near to the, nearest to the scene of the
incident/emergency. The TCG provides the interface between the SCG and operational units,
whilst providing tactical direction and resources to operational units.
A TCG could be formed at any of the Secure Division locations as part of the pre-determined
response with Merseyside Police.
18.1.5 Operational
Operational Teams are near to/at the scene of the incident. This may include the Emergency
Services with an array of response capabilities. Fixed locations involved, could include any
health service (including Trust related) premises.
SA31 – Major Incident Plan – v 3
67
Overview of the Incident Structures
19
Appendix D - Supporting NHS Trusts & Responder Organisations
19.1
NHS Organisations
19.1.1 NHS England Area Team
When system pressure, an incident or emergency impacts on/or requires the resources of
NHS organisations outside local capacity the Area Team will:















Provide leadership and coordination (Strategic & Tactical command and control).
Provide a focal point for NHS and partner organisations.
Establish contact with all responding NHS organisations including providers, and CCGs.
Remain informed of the current status of relevant NHS organisation.
Mobilise mutual aid.
Cascade information across NHS organisations in partnership with CCG.
Inform and maintain dialogue with neighbouring NHS England Area Teams, as
appropriate.
Inform or escalate relevant issues to the NHS England Regional Team
Collate and submit regular situation reports to the Regional Team, as required.
If a multi-agency Strategic and/or Tactical Coordinating Group is called, provide the NHS
senior representation.
Provide leadership to incidents that attract high profile media attention (via the NHS
England regional communications support infrastructure).
Provide leadership to incidents that could jeopardise the reputation of the NHS.
Coordinate the recovery of NHS organisations following a large or widespread incident.
Provide support to DH in their role to UK Central Government response to emergencies.
Action any requests from NHS organisations for military assistance.
SA31 – Major Incident Plan – v 3
68
19.1.2 NHS England Alert Levels
Level 1
Level 2
Level 3
Level 4
Incident Levels
An incident that can be responded to and managed by a local health sector
provider organisation within their respective business as usual capabilities and
business continuity plans in liaison with local commissioners.
An incident that requires the response of a number of health providers within a
defined health economy and will require NHS coordination by the local
commissioner(s) in liaison with the NHS England local office.
An incident that requires the response of a number of health organisations
across geographical areas within an NHS England region.
NHS England to coordinate the NHS response in collaboration with local
commissioners at the tactical level.
An incident that requires NHS England National Command and Control to
support the NHS response.
NHS England to coordinate the NHS response in collaboration with local
commissioners at the tactical level.
19.1.3 Clinical Commissioning Group (CCG)





When system pressure, an incident or emergency impacts on/or requires the resources
of NHS organisations outside local capacity the Merseyside CCGs will:
Provide a 24/7 route of escalation 24/7 for providers.
Respond to reasonable requests to assist and co-operate.
Support the NHS Strategic and/or Tactical Commander(s) should any emergency
require wider NHS resources to be mobilised.
Maintain service delivery across their local health economy to prevent business as usual
pressures and minor incidents within individual providers from becoming significant or
major incidents.
19.1.4 Acute Hospital Trusts & Foundation Trusts
Acute Hospital Trusts and Foundation Trusts will provide hospital services for more severely
injured casualties and admit patients decanted from hospitals affected by the incident, subject
to available capacity.
Hospitals with AEDs (including Alder Hey) have limited decontamination facilities, primarily for
self-presenters, but most decontamination will be provided at the scene. They also have
arrangements in place for a mass casualties’ incident.
Some hospitals have mortuary facilities for people who die on NHS premises (Local
Authorities (LAs) having responsibility for people who die elsewhere). The Royal Liverpool
Hospital is the Forensic Pathology location for any mass fatalities incident in the North West.
Note: Any mass casualties’ or fatalities incident will probably result in an increase upon
Mersey Care NHS Trust services in the short medium and long term.
19.1.5 North West Ambulance Service (NWAS) NHS Trust
NWAS attend the scene(s), provide on scene healthcare, decontaminate casualties where
necessary and transport patients to hospital.
SA31 – Major Incident Plan – v 3
69
The NWAS Hazardous Area Response Team (HART) provides an extended capability to
work within the inner cordon at biological, radiological and nuclear (CBRN) and Hazardous
Materials (HazMat) incidents and other appropriate incidents e.g. train crashes, large scale
motorway accidents, building collapses, significant fires or flooding. HART assets include:




Mass oxygen delivery system which enables the team to provide oxygen to 48 people
simultaneously within the hot zone i.e. within the high hazardous zone of the incident
Self-help first aid packs
Triage sieve bands
Mass casualty treatment pack
Note: Merseyside Fire & Rescue Service can also provide mass decontamination capabilities
for those who are not ill or injured, at Acute and Foundation Hospitals with AEDs.
19.1.6 NHS 111
NHS 111 operates a 24 hour advice and health information service, providing confidential
advice to patients with presenting symptoms or seeking health information. Services include:





Out of Hours support for General Practices (GPs) and dental services.
Telephone support for patients with long term conditions.
Pre and post-operative support to patients.
24 response to health scares.
Remote clinics via telephones.
NHS 111 can also work in partnership with the Trust to provide a dedicated helpline for
specific purposes.
19.2
Responder Agencies
19.2.1 Local Authority
The primary roles of the Local Authorities include:








Support the emergency services and those engaged in the response to an incident.
Use resources to mitigate and relieve the effects on people, property and infrastructure.
Resource Reception Centres for the temporary accommodation of survivors/ evacuees
Activate and coordinate voluntary sector support via the Unity Protocol.
Arrange emergency mortuaries in consultation with the Lead Coroner.
Maintain the provision of essential services.
Establish and lead on humanitarian assistance.
As the emphasis moves from response to recovery, take the lead role to facilitate
recovery and the restoration of the environment.
19.2.2 Merseyside Police (MerPol)
The primary roles of MerPol include:





The saving of life in conjunction with other emergency responders.
Coordination and communication between the emergency responders and other
agencies acting in support at the scene of the incident or elsewhere during the response
phase.
Secure, protect and preserve the scene through the use of cordons.
Investigation of the incident and obtaining and securing evidence.
Collation and dissemination of casualty information.
SA31 – Major Incident Plan – v 3
70


Identification of the deceased on behalf of HM Coroner.
Short term measures to restore normality.
Note: The Police are party to a number of Divisional tactical plans.
19.2.3 Merseyside Fire & Rescue Service (MFRS)
The primary roles of MFRS include:





19.3
Fire-fighting and fire prevention.
Decontamination and mass decontamination of people.
Provide and / or obtain specialist advice and assistance where hazardous materials are
involved.
Provision of specialist equipment (pumps, rescue equipment and lighting).
Safety management within the inner cordon of an incident.
Regional & National Organisations
19.3.1 Government Liaison Officer (GLO)
The role of the Government Liaison Officer (GLO) is to:


Facilitate two-way communications between central government and local responders.
Facilitate the provision of support.
In most cases for Merseyside, the Government Liaison Officer (GLO) will be a member of the
Department for Communities and Local Government’s Resilience and Emergencies Division
(DCLG-RED) North and will carry out the role from either their office or through deployment to
the SCG. In some cases, an emergency may be managed effectively at operational or tactical
level but because of the nature of the incident (likely to generate a high level of media or
ministerial interest), a GLO may still be appointed.
19.3.2 Government Liaison Team (GLT)
Where the scale of the incident requires it, the Government Liaison Officer (GLO) may be
supported by other officials from DCLG-RED North and/or from a central government
department(s) to form the Government Liaison Team (GLT). In the event of a terrorist
emergency the Home Office will deploy a GLT and DCLG-RED North, will deploy a
Consequence Management Liaison Officer (CMLO). Where multiple SCGs are established,
GLO or GLTs will be provided for each SCG.
19.3.3 Public Health England (PHE)
PHE is a public sector body, but is not part of the NHS. PHE has responsibility for advising on
the protection of the health of the public in the face of sudden or long-term environmental
hazards. The agency has a particular role in infectious disease control and also chemical,
biological, radiological and nuclear (CBRN) incidents.
The PHE centre for Cheshire/Merseyside operates a 24/7 on call rota which is activated via
the Royal Liverpool Hospital Switchboard.
19.3.4 The Military
The Military is authorised to provide assistance in the response to an incident if there is a
threat to life. The level of assistance the Military is able to provide will depend upon the
SA31 – Major Incident Plan – v 3
71
resources available at the time.
Any requests for assistance will normally be made by the SCG via the Joint Regional Liaison
Officer (JRLO).
19.4
Science and Technical Advice Cell
A Science and Technical Advice Cell (STAC) can be formed as part of an incident response
where there is a threat to public health or the environment. The STAC can be formed at a
local or regional level, bringing together technical experts from all agencies involved in the
response.
19.5
Third Sector – (Voluntary, Charity, Community, Faith &Humanitarian)
The Third Sector in Merseyside can provide a wide range of support services to the incident
response. Any requests for support must be made via the Local Authority in accordance with
the Unity Plan. The Unity Plan, outlines the response capabilities of the Third Sector.
20
Appendix E – Local and National Plans and Associated Documents
20.1
National Documents
NHS Core Standards
http://www.england.nhs.uk/wp-content/uploads/2015/06/nhse-core-standards-150506.pdf
NHS EPRR Framework
https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf
Cabinet Office National Risk Register
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/419549/201503
31_2015-NRR-WA_Final.pdf
CCA 2004 Emergency Preparedness
https://www.gov.uk/government/publications/emergency-preparedness
CCA 2004 Emergency Response and Recovery
https://www.gov.uk/guidance/emergency-response-and-recovery
20.2
Local Documents
This plan should be read in conjunction with the following:




Mersey Care NHS Trust Infection Prevention and Control Policy & Procedure which
includes the Trust’s Major Outbreak Policy/Management of Outbreaks guidance
Contingency Plans for High Secure Services (restricted access)
Mersey Care Winter Preparedness Plan
Mersey Care Business Continuity plans for all trust services
Major incident plans of neighbouring trusts include:



NHS England Cheshire/Merseyside Area Team.
Liverpool Community Health Trust.
North West Ambulance Service.
SA31 – Major Incident Plan – v 3
72




20.3
Internal Mersey Care Trust Documentation





20.4
Aintree University Hospital.
Royal Liverpool and Broad Green University Hospitals.
St Helens & Knowsley Teaching Hospitals.
NHS North West Regional Mental Health Contingency Plan.
Risk Management Strategy & Policy (SA02)
Business Continuity Plans
Winter Preparedness Plan
Infection Prevention and Control Policy (IC01)
Health and Safety Policy (SA07)
Associated Plans
Associated Plans that can be found on Resilience Direct, e.g.















20.5
Cheshire and Mersey Critical Care Contingency Plan
Northern Burns Care Network Major Incident Plan
North West Divert and Deflection Policy
NHS England Business Continuity Plan
North West Locality escalation policy
Adverse Weather Plan
Heatwave Plan
Major Accident Hazard Pipeline Plan
Merseyside Emergency Response Manual (MERM)
MRF Mass Evacuation and Shelter Guidance
MRF Mass Fatalities Plan
MRF Warning and Informing Plan
MRF Merseyside Media Protocol
Arrangements on Merseyside in Response to Chemical Incidents (MERCHEM)
COMAH Plans for Merseyside & Cheshire
Associated Guidance



NHS England - Psychological Support during Major Incidents.
NHS England – Prevent Training and Competencies Framework
NHS England – Chemical Incidents: Planning for the management of self-presenting
patients in healthcare settings.
Associated Plans that can be found on Resilience Direct, e.g.












Cheshire and Mersey Critical Care Contingency Plan
Northern Burns Care Network Major Incident Plan
North West Divert and Deflection Policy
NHS England Business Continuity Plan
North West Locality escalation policy
Adverse Weather Plan
Heatwave Plan
Major Accident Hazard Pipeline Plan
Merseyside Emergency Response Manual (MERM)
MRF Mass Evacuation and Shelter Guidance
MRF Mass Fatalities Plan
MRF Warning and Informing Plan
SA31 – Major Incident Plan – v 3
73



21
MRF Merseyside Media Protocol
Arrangements on Merseyside in Response to Chemical Incidents (MERCHEM)
COMAH Plans for Merseyside & Cheshire
Appendix F - Glossary of Terms
Term/acronym
AED
CBRN
CCA
CCG
CMT
CMLO
COMAH
COO
CRR
DCLG
DH
EPRR
FOI
GLO
GLT
GP
HAC
HART
HazMat
IC
ICC
ICT
IOR
IM&T
IRT
JCC
JDM
JRLO
JESIP
LAs
LHRP
MoJ
MOU
MerChem
MERM
MerPol
METHANE
MFRS
MIP
MRF
NHS
NME Comms
NWAS
PHE
RCG
RHCD
Definition
Accident & Emergency Department
Chemical Biological Radiological Nuclear
Civil Contingencies Act 2004
Clinical Commissioning Group
Crisis Management Team
Consequence Management Liaison Officer
Control of Major Accident Hazards
Chief Operating Officer
Community Risk Register
Department for Communities and Local Government
Department of Health
Emergency Preparedness, Resilience and Response
Freedom of Information
Government Liaison Officer
Government Liaison Team
General Practitioner
Humanitarian Assistance Centre
Hazardous Area Response Team
Hazardous Materials
Infection Control
Incident Coordination Centre
Information Computer Technology
Initial Operational Requirement
Information Management & Technology
Incident Response Team
Joint Command Centre
Joint Decision Model
Joint Regional Liaison Officer
Joint Emergency Services Interoperability Programme
Local Authorities
Local Health Resilience Partnership
Ministry of Justice
Memorandum of Understanding
Merseyside Plan for Response to Chemical Incidents
Merseyside Emergency Response Manual
Merseyside Police
Major Incident Declaration
Merseyside Fire and Rescue Service
Major Incident Plan
Merseyside Resilience Forum
National Health Service
North Midlands and East Communications Service
North West Ambulance Service
Public Health England
Recovery Coordinating Group
Regional Health Control Desk
SA31 – Major Incident Plan – v 3
74
Term/acronym
RRT
SCG
SRCs
STAC
TCG
VIP
22
Definition
Recovery and Restoration Team
Strategic Coordinating Group
Survivor Reception Centre
Science and Technical Advice Cell
Tactical Coordinating Group
Very Important Person
Appendix G – Official Sensitive Operation PLATO
(PLATO is a National Response)
“Operation Plato” is the National response plan to a large scale incident resulting in a high
number of casualties in single/multiple location(s); whether occurring simultaneously, or in
close sequential/geographical proximity in Merseyside or across the North West. This
appendix has been developed to meet the Department of Health Requirements under
“Operation Plato” as a specialist mental health trust.
Locally, ‘Operation Plato’ can be activated by the Emergency Services in conjunction with
NHS England.
Actions
Upon receipt of the code word “Operation Plato”, the Trust will:






Activate Trust Major Incident Plan(s).
Open and staff the Major Incident Room(s).
Inform NHS England Tactical Commander that Incident Coordination Centre(s) is/are
operational.
Immediately send a ‘Situation Report’ up the local NHS command and control structure,
confirming:
Levels of activity
o
What staff with appropriate skills are immediately available to support the local
response
o
What trauma equipment is available for use, and
o
Business continuity issues
Consider decision to instigate a lockdown*
Note: *Lockdown preparations/activities, may/may not be required due to proximity to the
incident(s) and intelligence available relating to threat.
Reporting
The Trust will be required to provide a Situation Report every 2 hours up the local NHS
command and control structure, unless directed otherwise, providing an overview of activity
and any operational issues.
Communications
It is highly likely that mobile telephones could be disabled in the event of a Plato incident;
therefore a greater reliance will be placed upon landline, satellite phones, video-conferencing
and email systems for the transmission of information.
SA31 – Major Incident Plan – v 3
75
External Communications including Media
Any requests for external information from outside of the NHS, Local Authority or “blue light”
emergency services should be referred to the NHS England Strategic Commander. No
information should be released to the media, public or relatives without the express
authority of either the NHS England Strategic Commander or the Police through the Strategic
Coordinating Group (SCG).
23
Appendix H – Official Sensitive HAZMAT and CBRN
The NHS England Emergency Preparedness, Resilience and Response (EPRR) Chemical
incidents: Planning for the management of self-presenting patients in healthcare settings
documents provides generic guidance on the response expected from NHS Acute Trusts
(including Foundation Trusts) and other NHS funded organisations involved in a health
response to decontamination of self-presenting persons. It forms part of the NHS
Emergency Preparedness Framework 2013 published by the NHS England.
http://www.england.nhs.uk/wp-content/uploads/2015/04/eprr-chemical-incidents.pdf
The documents focusses on the flowing:





Planning for the management of self-presenters in a healthcare setting.
Initial Operational Response (IOR).
Preparation for incidents involving hazardous materials: guidance for primary and
community care facilities.
UK Reserve National Stock for Major Incidents – How to access stock in England.
Patient Group Directions.
Incidents involving hazardous materials and a CBRN event are no different in regards to the
symptoms been displayed by the casualty; the only difference between the two is the intent to
harm in a CBRN attack.
Front Line Responding Staff
Need to be aware that:




Patients may arrive with no prior warning
Their symptoms may be non-specific e.g. itching skin, watering eyes, respiratory
problems, dizziness or nausea
It may not be obvious that someone has been in contact with a hazardous material
History taking will identify if the patient believes they have been involved in:
o
An explosion, fire, cloud of smoke or gas
o
Being covered in dust, powder or liquid as the result of an accident
o
An industrial or agricultural incident; spillage or transport accident or something
similar
SA31 – Major Incident Plan – v 3
76
Staff should:






23.1
Carry out a dynamic risk assessment, include STEPS 1, 2, 3
Maintain a safe distance away from the casualty(s)
Gather intelligence – symptoms being displayed, physical effects and appearance of any
contaminant
Isolate the casualties and the room
Contact the emergency services
Seek advice on any appropriate emergency action that could be delivered to the
casualty(s), this could involve initial operational response (IOR)
Initial Operational Response (IOR)
IOR is the ‘First Aid’ of decontamination and includes non-caustic decontamination (dry
decontamination). Staff will identify a safe location for a person contaminated with non-caustic
chemicals. The person will be directed to disrobe to underwear only, removed clothing placed
into double plastic ‘’Clinical Waste’’ bags and secured; then conduct a dry decontamination
using an absorptive materials (cloth or paper towels), using a blotting not wiping motion. Hair
should be washed, taking care not to allow water run off to travel over the face or body. Once
completed, the person should be provided with clothing.
Wet decontamination is to only occur if there are signs and symptoms of caustic chemical
substances. This can involve using water from taps in buckets, showers, hose reels and
should be conducted for a duration of between 45-90 seconds. Waste water and specialist
advice are other factors to be considered.
Note: Existing local procedures for processes including, re-robing, handling of personal items
and management of hazardous waste.
SA31 – Major Incident Plan – v 3
77
24 Appendix K
Equality and Human Rights
Analysis
Title:
Major Incident Plan – Restricted and Non Restricted.
Area covered: Trust wide
What are the intended outcomes of this work?
This plan covers the following:•
A major incident which affects the local community.
•
A major incident which affects the local community.
•
A major incident which threatens the continuity of critical Trust services.
•
A major incident which affects the health services in Merseyside and/or beyond.
•
A multi-agency major incident requiring a coordinated health service response in
Merseyside and/or beyond.
The plan is supported by additional major incident plans and business continuity plans at
divisional and local levels.
Who will be affected?
All staff and service users. Partner stakeholders. Potentially members of the public also.
Evidence
What evidence have you considered?
Policy only.
Disability (including learning disability)
Page 28 sec9.1.3 Include within persons who are vulnerable ‘people who have communication
barriers including those with limited or no use of English’.
Sex
Nothing noted.
Race
Page 28 sec9.1.3 Include within persons who are vulnerable ‘people who have communication
barriers including those with limited or no use of English’.
Age
Page 28 sec9.1.3 Include within persons who are vulnerable ‘people who have communication
barriers including those with limited or no use of English’.
Gender reassignment (including transgender)
Nothing noted.
Sexual orientation
Nothing noted.
SA31 – Major Incident Plan – v 3
78
Religion or belief
Nothing noted.
Pregnancy and maternity
Reference noted in relation to vulnerability as above on page 28.
Carers
Nothing noted
Other identified groups
Nothing noted
Cross Cutting
Advise removal of the term ‘battle rhythm’ on pages 26 sec 9.8.
Human Rights
Is there an impact?
How this right could be protected?
Right to life (Article 2)
Policy is supportive of the protection of life.
Right of freedom from inhuman
Not engaged.
and degrading treatment (Article 3)
Right to liberty (Article 5)
Not engaged.
Right to a fair trial (Article 6)
Not engaged.
Right to private and family life
Policy is protective of personal confidentiality.
(Article 8)
Right of freedom of religion or belief
Not engaged.
(Article 9)
Right to freedom of expression
Not engaged.
Note: this does not include insulting
language such as racism (Article 10)
Right freedom from discrimination
Not engaged.
(Article 14)
Engagement and Involvement
No engagement or involvement within this process.
SA31 – Major Incident Plan – v 3
79
Summary of Analysis
Eliminate discrimination, harassment and victimisation
The policy seeks to ensure that all people within a major incident are protected. This includes
specific reference to staff who may be involved.
Advance equality of opportunity
Nothing indicated within policy.
Promote good relations between groups
Nothing indicated within policy.
What is the overall impact
Policy not noted to be directly or indirectly discriminatory and is respectful of people’s human
rights.
Addressing the impact on equalities
There needs to be greater consideration re health inequalities and the impact of each
individual development /change in relation to the protected characteristics and vulnerable
groups
Action planning for improvement
Detail in the action plan below the challenges and opportunities you have identified.
Changes identified as listed in action plan below.
For the record
Name of persons who carried out this assessment:
Meryl Cuzak Equality and Human Rights Lead
Andrew Monkman Modern Matron (Nurse Executive Team)
Julie Matthews Personal Assistant
Date assessment completed:
29th Dec 2015
Name of responsible Director:
Ray Walker
Date assessment was signed:
29th December 2015
SA31 – Major Incident Plan – v 3
80
Action plan template
Category
Actions
Target
date
Person responsible and their
area of responsibility
Communication
On page 28 Sec 9.1.3 Include within persons who are
vulnerable ‘people who have communication barriers
including those with limited or no use of English’.
29.12.15
Jayne Bridge
On page 26 Sec 9.8 remove both uses of phrase ‘battle
rhythm’.
29.12.15
Jayne Bridge
Ensuring focus on
health related
outcomes.
SA31 – Major Incident Plan – v 3
81