
TRUST MAJOR INCIDENT PLAN
Version No: 4.1
Issue Date: January 2010
Purpose of this document
The purpose of this document is to provide a framework
for managing the response of the Trust to a
Major Incident which cannot be dealt with by
normal procedures
VERSION HISTORY
Version
Date
Issued
Brief Summary of Change
Owner’s Name
2a
12/03/03
Second Version
Philip Bircham, Senior Site Manager
3.1
6/09/06
Third Version
Steve Jupp, Head of Emergency Planning
4.0
24/02/09
Steve Jupp, Head of Emergency Planning
4.1
05/01/10
Fourth Version (draft) rewrite following
changes to HCT, HIC and MI exercises
Fourth Version approved by all groups
and consulted upon, comments
received back and incorporated
Formal Review
Steve Jupp, Head of Emergency Planning
January 2011
Major Incident Plan v 4.1 January 2010
Page 1 of 94
Contents Section 1
1. All Staff ...................................................................................................................... 6
Responsibilities for all staff during a Major Incident .................................................................... 6
1.2
Roles for all staff during a Major Incident ....................................................................... 6
1.3
Activities for all Staff ....................................................................................................... 7
1.4
Reporting and Access to the Royal London Hospital ..................................................... 7
1.5
Staff reporting Areas ....................................................................................................... 8
2. Locations and Telephone numbers by Department ............................................... 9
3. Internal Contact Numbers by Individual ................................................................ 10
4. External Telephone Numbers by Organisation ..................................................... 11
5. Major Incident Triage Sieve and Sort and Patient Flow ........................................ 12
6. Major Incident Action Card Structure & Action Cards.......................................... 13
Trust GOLD Commander – Pager reference BTLAC1 .............................................................. 14
Trust SILVER Commander ........................................................................................................ 15
Medical Incident Consultant....................................................................................................... 16
Site Manager.............................................................................................................................. 17
Media Liaison Officer ................................................................................................................. 18
Hospital Support Team Leader .................................................................................................. 19
Administrative Support Team Leader ........................................................................................ 20
Administrative Support Team .................................................................................................... 21
Facilities Co-ordinator ................................................................................................................ 22
Site Coordinator St Bartholomew’s Hospital .............................................................................. 23
Site Coordinator London Chest Hospital ................................................................................... 24
ED Commander (Consultant in Charge of Emergency Department) ........................................ 25
Nurse in Charge (NIC) of Emergency Department .................................................................... 26
Triage Officer ............................................................................................................................. 27
Triage Nurse .............................................................................................................................. 29
Triage Receptionist .................................................................................................................... 31
Resuscitation Room Team Leader ............................................................................................ 32
Theatre Commander .................................................................................................................. 34
Anaesthetics Lead ..................................................................................................................... 35
Majors Team Leader .................................................................................................................. 36
Minors Team Leader .................................................................................................................. 38
Paediatric Team Leader ............................................................................................................ 40
ED Admin Manager / ED Reception Supervisor ........................................................................ 42
Senior ED Porter on Duty or Bleep 1158 out of hours .............................................................. 43
Emergency Department Porter .................................................................................................. 44
Main Receiving Ward (Cambridge Ward) and other Wards ...................................................... 45
Hospital Surgical Officer ............................................................................................................ 46
Hospital Medical Officer ............................................................................................................. 47
Walk In Centre Receptionist ...................................................................................................... 48
Theatre Coordinator ................................................................................................................... 49
ICU Commander ........................................................................................................................ 50
Bearsted Lecture Theatre Leader .............................................................................................. 51
Contents Section 2
Purpose of the Trust Major Incident Plan (MIP) ........................................................ 53
Underlying Principles of the Plan ............................................................................................... 53
Principles of Departmental Sub Plans ....................................................................................... 53
Storage and use of Trust Major Incident Plan ........................................................................... 53
PRINCIPLES OF CARE ............................................................................................... 54
1. Background ............................................................................................................. 55
1.1
1.2
Definition of a Major Incident ........................................................................................ 55
Classification of Major Incidents ................................................................................... 55
2. Alerting Procedure Internal and External Major Incidents ................................... 57
2.1
2.2
2.3
2.4
2.5
Sources of an Alert ....................................................................................................... 57
How a Major Incident Is Declared within the Trust ....................................................... 57
Messages that Switchboard Cascade .......................................................................... 57
Receiving Hospitals ...................................................................................................... 57
Internal Major Incident and Major Incident Initial Actions Diagram .............................. 58
Major Incident Plan v 4.1 January 2010
Page 2 of 94
2.6
2.6
Major Incident Terminology .......................................................................................... 58
Major Incident Terminology .......................................................................................... 59
3. Internal Major Incidents & “A&E Diverts”.............................................................. 60
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
Definition ....................................................................................................................... 60
Introduction ................................................................................................................... 60
Principles ...................................................................................................................... 60
Actions for Gold Commander to consider ..................................................................... 61
Actions for Silver Commander to consider ................................................................... 62
Possible Locations for the HCT during an Internal Major Incident ............................... 62
A&E or Blue Light Diverts resulting from capacity issues ............................................. 62
A&E or Blue Light Diverts resulting from infrastructure issues ..................................... 63
4. Hospital Control Team ............................................................................................ 64
4.1
4.2
4.3
4.4
4.5
Team Makeup ............................................................................................................... 64
Responsibilities ............................................................................................................. 64
Location ........................................................................................................................ 64
HCT Meetings ............................................................................................................... 65
Others located in the HCR ............................................................................................ 65
5. Summary of Activity Responding to the Major Incident ....................................... 66
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
Hospital Control Team .................................................................................................. 66
Emergency Department ................................................................................................ 66
Theatres ........................................................................................................................ 67
Intensive Care Team .................................................................................................... 67
Hospital Support Team ................................................................................................. 67
Mortuary ........................................................................................................................ 67
Pharmacy ...................................................................................................................... 67
Runners / Loggists / Marshalls / Security ..................................................................... 67
6. Contracted Services ............................................................................................... 69
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
Switchboard (Carillion) .................................................................................................. 69
Porters (Carillion) .......................................................................................................... 69
Security (Carillion) ........................................................................................................ 69
Catering (Carillion) ........................................................................................................ 69
Central Sterile Services Department (CSSD) (Synergy) .............................................. 69
Estates (SFS) ............................................................................................................... 69
Supplies (Receipt and Distribution) (Carillion) .............................................................. 69
Domestic Services (Carillion)........................................................................................ 69
Transport (Carillion) ...................................................................................................... 69
7. Police Documentation Team (PDT) ........................................................................ 70
8. Media........................................................................................................................ 71
8.1
8.2
8.3
8.4
Principles Underlying Press Officer Role ...................................................................... 71
Telephone Enquiries ..................................................................................................... 71
Location For Media ....................................................................................................... 71
Media Briefings ............................................................................................................. 71
9. Children ................................................................................................................... 72
9.1
9.2
9.3
9.4
Application to Children .................................................................................................. 72
Background ................................................................................................................... 72
Differences from Adult MIP ........................................................................................... 72
Equipment ..................................................................................................................... 72
10. Mass Casualty Event ............................................................................................ 73
10.1
10.2
10.3
10.4
10.5
10.6
Definition ....................................................................................................................... 73
Hospital Response ........................................................................................................ 73
Clinical Care.................................................................................................................. 73
Priority 3 – Walking Wounded Casualties .................................................................... 73
Priorty 4 – Expectant .................................................................................................... 73
Use of Other Hospitals .................................................................................................. 73
11. St Bartholomew’s Hospital Response ................................................................. 74
11.1
11.2
11.3
11.4
Background ................................................................................................................... 74
Site Coordinator St Bartholomew’s Hospital ................................................................. 74
Patients ......................................................................................................................... 74
Major Incident Supporting Activities ............................................................................. 75
12. LCH Response ...................................................................................................... 77
12.1
12.2
12.3
Local Cascade of the Major Incident ............................................................................ 77
Site Co-ordinator London Chest Hospital ..................................................................... 77
Prepare the Wards to Receive Patients ....................................................................... 77
Major Incident Plan v 4.1 January 2010
Page 3 of 94
12.4
12.5
12.6
12.7
12.8
12.9
12.10
12.11
12.12
Staffing .......................................................................................................................... 77
Patient Flow .................................................................................................................. 77
Receiving wards ........................................................................................................... 78
Outpatients Department (OPD) .................................................................................... 78
Heart Attack Centre (HAC) ........................................................................................... 78
MRI Unit ........................................................................................................................ 78
Communication ............................................................................................................. 78
Media ............................................................................................................................ 78
Updates and Stand down ............................................................................................. 78
13. Documentation and Record Keeping................................................................... 79
13.1
13.2
13.3
Documentation .............................................................................................................. 79
Situation Reports .......................................................................................................... 79
HCT meetings ............................................................................................................... 79
14. Debrief, Reporting, Review, Training and Exercising ......................................... 80
14.1
14.2
14.3
14.4
14.5
Hot and Cold Debrief .................................................................................................... 80
Major Incident Report ................................................................................................... 80
Review Process ............................................................................................................ 80
Training Programme ..................................................................................................... 80
Exercise Programme .................................................................................................... 80
Contents Section 3
1
Trust Resilience Team ........................................................................................ 82
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
Introduction ................................................................................................................... 82
Team Make Up ............................................................................................................. 82
Role ............................................................................................................................... 82
Press ............................................................................................................................. 82
Security and Police ....................................................................................................... 82
Trust Staffing Continuity ............................................................................................... 82
Equipment and Supplies ............................................................................................... 83
Staff Communications ................................................................................................... 83
THPCT and NHS London ............................................................................................. 83
VIP Visits....................................................................................................................... 83
Relatives ....................................................................................................................... 83
Worried Well and Members of the Public ..................................................................... 83
Trust Activity ................................................................................................................. 83
Contents Section 4
External Situation Report ........................................................................................... 85
Internal Situation Report Major Incident ................................................................... 86
Suggested Draft Agenda for a HCT meeting ............................................................. 87
Generic Debrief Agenda ............................................................................................. 88
Glossary of Terms ...................................................................................................... 89
Responsible organisations covered under the Civil Contingencies Act (2004) ..... 92
Contents Section 5
Local Major Incident Plans ......................................................................................................... 94
Business Continuity Plan ........................................................................................................... 94
Local Business Continuity Plans................................................................................................ 94
HazMat Plan .............................................................................................................................. 94
Pandemic Flu Plan ..................................................................................................................... 94
Hospital Evacuation Plan ........................................................................................................... 94
Major Incident Plan v 4.1 January 2010
Page 4 of 94
Section 1
This section of the plan includes Action Cards
Telephone numbers and other items to be used During a
Major Incident
Major Incident Plan v 4.1 January 2010
Page 5 of 94
1. ALL STAFF
Responsibilities for all staff during a Major Incident
During a Major Incident both clinical and non-clinical staff may have additional responsibilities to
aid the Trust in the coping and recovery processes. Staff should also be aware of necessary
actions which need to be taken in the event of a Major Incident.
Due to the unpredictable nature of a Major Incident, there is the potential for many of the Trust
employees not being at work when the incident occurs. Employees may also learn of the incident
through national media rather than directly from the Trust. There are some specific actions which
staff should undertake and be aware of when this situation occurs:



Communicate with your manager as soon as you are aware of a (potential) Major
Incident and identify when/if your services will be required
Staff may be asked to work outside of their ‘normal’ hours, this will be agreed by
negotiation. Major Incidents are frequently not resolved quickly and ‘odd’ hours of work
can be expected during the initial phase of the incident and during the recovery phase of
the response.
In cases where it is not possible for staff to come directly to work, due to childcare
arrangements, staff should inform their manager when they will be available.
If staff do not have specific a specific role as outlined in the Major Incident Plan or local Major
Incident Plans they should continue with their usual daily tasks. Staff will be notified by their
managers if extra responsibilities are required or if volunteers are needed.





1.2
During a Major Incident there may be a requirement to carry out additional activities on a
24/7 approach. This may include some non clinical activities which traditionally only occur
during normal working hours.
Staff welfare should not be compromised in such situations and appropriate measures
will be taken to ensure staff have sufficient rest periods
Staff will be compensated for their efforts when the incident has been resolved
During a Major Incident the Trust will be running on a higher state of alert than usual,
which could result in a lockdown. Levels of security will be increased, it is essential for all
staff to ensure that they have staff ID badges and correct tools for access into and out of
the hospital.
Security will have to conduct best practice at all times and operate at a zero tolerance
state to ensure the safety of the hospital and its staff. Additional security staff will be
drafted to aid with general security, and there may also be police presence within and
around the hospital for specific tasks such as crowd control, or close protection of a
suspect, victim or VIP.
Roles for all staff during a Major Incident
The Major Incident may involve a response where members of staff have a particular skill e.g.
language, ICT skills, previous clinical experience. Volunteers with specific skills may be
requested by the Hospital Control Team. Additionally members of staff may be required to assist
with the Major Incident response as a Marshall, Runner, Security or Loggist.
Marshalls
Marshalls will be required to help direct relatives friends or patients from one area of the hospital
to another ensuring that they are not “lost” enroute through the identified Major Incident care
pathways.
Runners
Runners will be used to transport important decision making data from point to point within the
Trust should normal lines of communication become broken during the Major Incident. A runner
must have reasonable familiarity of the location that they are providing support to and have a
normal level of fitness.
Loggists
Major Incident Plan v 4.1 January 2010
Page 6 of 94
Loggists will be needed in the Hospital Control Room (HCR) and in other locations to log all
relevant information going in and out of the hospital and all actions and decisions taken during the
Major Incident. (This role is more fully described in Section 2 Part 14 of this plan – Documentation
and Record Keeping)
Security
Staff will be paired with existing security and used to secure the Trust site during an extended
period of lockdown.
1.3
Activities for all Staff
It can be expected that during a Major Incident that there will be problems with communication.
Mobile phone systems are designed to cope with normal levels of traffic. The communication
systems necessary to continue to respond to a Major Incident have a number of layers of
resilience but these do not extend to every phone system within the Trust. Additionally the Trust
can expect the switchboard to be incredibly busy. On 7 July 2005, in response to the London
Transport bombing the Trust received 12,500 more phone calls than the day before.
Upon joining the Trust staff are therefore asked to:
 Advise relatives / loved ones that during a Major Incident you will be working in an
environment where communication may be difficult and that they should only contact you
if urgent.
 Advise relatives/loved ones that you will be able to communicate to them but that you and
the Trust will need to keep communication to a minimum to aid the overall Major Incident
response.
 Advise loved ones that you will be working in a safe environment and that the Trust will
look after your well being.
During a Major Incident staff must:
 Keep phone use to a minimum both mobile and Trust land lines.
 To inform one person that you are safe and ask them to inform all other friends and
relatives on your behalf, rather than you contacting everyone yourself.
 If you are available and do respond out of hours, before you come into the Trust please
inform a relative/loved one where and what you are doing.
1.4
Reporting and Access to the Royal London Hospital
Responders to the Major Indent call out whether on or off site, must report to the Hospital Main
Entrance Reception.
All responders must
 Fill in a colour coded sticky label with their name, grade and normal duty (this should be
worn at all times.) The colour coding for the stickers is shown below.
 Enter their name and time of arrival on the appropriate list.
 Collect their Action Card (if appropriate).
 Proceed to their holding area (see section 1.5`).
Staff without specified duties should remain at their holding areas until required.
Major Incident Plan v 4.1 January 2010
Page 7 of 94
1.5
Staff reporting Areas
Personnel
Holding Area
Sticker Colour
Board to sign
Consultants
White
Sign white board
Other Medical Staff
Junior Doctors
Emergency Dept
Coffee Room
Bearsted Lecture
Theatre
Blue
Sign blue
board
Anaesthetic staff
Theatre Rest rooms
Orange
Sign orange
board
Theatre Staff
Theatre Rest rooms
Red
Sign red
board
A&E Staff
A&E normal place of
work
Intensive Care Staff
Intensive Care rest
room
Qualified Nurses
Bearsted Lecture
Theatre
Green
Sign green
board
Managers /Clerical
Staff
Bearsted Lecture
Theatre
Grey
Sign grey
board
All other staff
Bearsted lecture
Theatre
Gold
Sign gold
board
Students(all)
Bearsted Lecture
Theatre
Yellow
Sign yellow
board
Volunteers
Bearsted Lecture
Theatre
Pink
Sign pink
board
Major Incident Plan v 4.1 January 2010
Page 8 of 94
2. LOCATIONS AND TELEPHONE NUMBERS BY DEPARTMENT
Major Incident Area
Normal Usage
Extension(s) 14 -
Priority 1 (Critical injuries)
Resuscitation Room
2521 or 2004
Priority 2 (Major injuries)
ED Majors (Trolley Area)
2404 / 2325 /
2871 or 3624
Priority 3 (Minor injuries)
Minors and streaming
2320 / 3085 /
3050 / 6346
Priority 3 (minors expansion)
Orthopaedic Fracture Clinic
ED Reception
ED Reception
3099 / 7437 /
2321 or 7470
7781 / 3595 or
2323
Hospital Control Team
Renal Seminar Room
SBH Control Room
LCH Control Room
Site Managers Office
2nd Floor KGV
Discharge Lounge Main Block
Fax 020 7943 1400 (14 x 6400)
15 2143 / 15 2396 / 15 2826 / 15
2842
16 2395 – Bleep 1945
Ambulance Liaison Officer
Renal Seminar Room
As HCT
Theatre Control Point
Front block theatres reception
7224 or 2396
Emergency Surgery
Front Block Theatres
7224 / 2396
Hospital Administrative Support
Renal Seminar Room
As HCT
Media / Press Liaison Point
Raised platform in front of
Temporary Restaurant, adjacent to
Walk In Centre or as directed by the
on-call Press Officer
14 3890
External Number 020 7655 4909
Press Officer
In the event of holding a press
conference the Physicians &
Surgeons Room may be used
2226
Renal Seminar Room
As HCT
Relatives Waiting Area
Hospital Dining Room
2711
Patients Dead on Arrival
Mortuary Facilities
60190
Patients Dying in Hospital
Mortuary Facilities
60190
Police Documentation Area
Consultants
ED secretaries
office
ED Coffee room
7728
7161 Fax 7014
Nil
Junior Doctors
Bearsted Lecture Theatre
2410
Volunteers / Students Awaiting
Duties
Hospital Support Team
Bearsted Lecture Theatre
2410
Catherine Gladstone Lounge and
Hospital Dining Room
2088 / 2711
Major Incident Plan v 4.1 January 2010
Page 9 of 94
3. INTERNAL CONTACT NUMBERS BY INDIVIDUAL
Name
Contact Details
Comments
Gold on call
08448 222 888 Pager reference BTLAC1
Gold is the only person within the
Trust who can declare an Internal
Major Incident.
Silver on call
07659 105480
RLH Site Manager
Bleep 1111
SBH Co-ordinator
Barts Site Manager 0287
LCH Co-ordinator
Bleep 1945
Facilities Co-ordinator
Available through Switchboard
Capital Hospitals
Via Facilities co-ordinator
Duty ED Consultant
Bleep 1115 and Aircall
ED Registrar
Bleep 1273
ED Senior Nurse
Bleep 1612
Duty Security Manager
Bleep 1134 or ext. 14-7691
Duty Pharmacist
Bleep 1212 or aircall OOH
Duty Consultant Microbiologist
Aircall
Trust Infection Control Doctor
Aircall
Duty Press Officer
Aircall
Duty Portering Manager
Bleep 1158 or ext. 14-7350
Duty Public Health Doctor
Aircall
Occupational Health
Department
Duty Engineer
Ext. 15-8070
Office hours only
Bleep 1123
If required e.g. decon tent needs
to be erected
Major Incident Plan v 4.1 January 2010
Page 10 of 94
4. EXTERNAL TELEPHONE NUMBERS BY ORGANISATION
NAME
CONTACT DETAILS
COMMENTS
London SHA
Pager Bureau
0844 822 2888 pager reference NHS 01
To be contacted always where
actual or potential major
incidents, major incident standbys, adverse or high profile media
interest events, or other threats
occur.
Tower Hamlets PCT Director
On call
City and Hackney PCT
07779 345652
London Ambulance Service
Local Health Protection Unit
020 7827 4555
020 7220 4500
Not for public circulation
NE & Central London
Guys Poison Centre
Via Switchboard or 0870 243 2241
Clinical Advice
HPA Chemical Hazards
London
HPA Chemical Hazards and
Poisons Divison (CHAPD)
HPA Centre for Infections
0207 639 8999
Incident Reporting
0844 892 0555
24 hour National Hotline for
incidents
Incident Reporting
HPA Radiation Protection
01235 831600 (daytime)
01235 834590 (OOH)
020 7780 2400 (switchboard)
London Independent Hospital
Pager Bureau 0844 822 2888 pager
reference “CHC280”
0208 200 4400
Thames Water
01189256610 (telephone)
0118925661 (fax)
E-mail:
operational.control@thameswater.co.uk
Environment Agency
0118 953 53 53
Major Incident Plan v 4.1 January 2010
Incident Reporting
Switchboard - Ask for on call
Director
Thames Water Operations
Control Duty Manager (OCDM)
Page 11 of 94
5. MAJOR INCIDENT TRIAGE SIEVE AND SORT AND PATIENT FLOW
MAJOR INCIDENT TRIAGE SIEVE AND SORT
MAJOR INCIDENT TRIAGE SIEVE
Y
WALKING
N
PRIORITY 3 (Delayed)
Patients whose treatment
can be delayed
MINORS
< 10
> 30
CAPILARY REFILL
TIME OR HEART
RATE
Y
PRIORITY T1 (Urgent)
MAJORS
> 2 sec
> 120
< 2 sec
< 120
MASS CASUALTY
EXTENSIVE INJURIES
This category can only
be used after a decision
and order by a HCT Gold
Commander
N
PRIORITY 1 (Immediate)
Patients with high priority for
immediate life saving
emergency care
RESUS
PRIORITY 2 (Urgent)
Less severely injured who
need urgent medical care
MAJORS
PRIORITY 4 (Expectant)
Injuries so severe either
cannot survive or require
excess treatment that would
seriously compromise the
treatment of large numbers
of others
TBA by HCC
Y
PRIORITY T1 (Delayed)
MINORS
TRTS SCORE 12
MORTUARY
Y
10 to 29
N
PRIORITY 5 (Dead)
After airway
opening
REPIRATORY RATE
PRIORITY T1
(Immediate)
RESUS
Y
TRTS SCORE 1-10
TRTS SCORE 11
N
BREATHING
MAJOR INCIDENT TRIAGE SORT
N
Y
PRIORITY T5 (Dead)
MORTUARY
TRTS SCORE 0
MASS CASUALTY
EXTENSIVE INJURIES
PRIORITY T4
(Expectant)
HCT to advise
Y
This category can only be
used after a decision and
order by a HCT Gold
Commander
TRIAGE REVISED TRAUMA SCORING SYSTEM
Physiological Variable
Measured Variable
10-29
>29
6-9
1-5
0
Score
4
3
2
1
0
Systolic Blood Pressure
>90
76-89
50-75
1-49
0
4
3
2
1
0
Glasgow Coma Scale
13-15
9-12
6-8
4-5
3
4
3
2
1
0
Respiratory Rate
PATIENT FLOW
All Patients arriving in the A&E Department will enter via Ambulance Bay Entrance
All Patients being discharged will leave via the main entrance Out Patients Building
Cambridge Ward is the designated admitting ward for Adults
Children will be admitted to the appropriate children’s wards
A&E INSTRUCTION
DO NOT check patient’s property or wait for main hospital notes
All requests for Medical / Nursing resources via Nurse in Charge A&E to Site Manager Hospital Control Room
All requests for further supplies / equipment via the Hospital Control Team Facilities Co-ordinator
ESSENTIAL NUMBERS
A&E Majors
14-2404 14-2325
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
SBH Control Room 15-2143
15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Major Incident Plan v 4.1 January 2010
Page 12 of 94
6. MAJOR INCIDENT ACTION CARD STRUCTURE & ACTION CARDS
Site Coordinator
LCH
ED Resus and Theatre Co-ordination
Site Coordinator
SBH
ICU Commander
All marked in Yellow Box, as well as



Family and Acute, Divisional Director or
Divisional Nurse or Divisional General
Manager
Regional Divisional Director or Divisional
Nurse or Divisional General Manager
Circulatory Respiratory and Metabolic
Sciences, Divisional Director or
Divisional Nurse of Divisional General
Manager
Clinical and Diagnostics Divisional
Director or Divisional Nurse or Divisional
General Manager
Gold Commander
Work as a team to review patients within Resus
and prioritise the patients for surgery then
allocate sugeons and anaesthetists to the
patients briefing them on the procedures
required.
Theatre
Commander
Hospital Control Team Meeting Attendees

All marked in Green Box
Theatre
Coordinator
Anaesthetics Lead
ED Commander
Resus Team
Leader
Majors Team
Leader
Silver Commander
Minors Team
Leader
Triage
Receptionist
Triage Officer
Triage Nurse
Paediatric Team
Leader
Senior ED Porter
ED Porter
ED Admin
Manager
Walk In Centre
Receptionist
Site Manager RLH
Admin Support
Team Leader
Admin Support
Team
Facilities
Co-ordinator
Hospital Support
Team Leader
Media Liaison
Officer
Main Receiving
Ward
Nurse In Charge
ED
Bearsted Lecture
Theatre Leader
Medical Incident
Consultant
Hospital Surgical
Officer
Hospital Medical
Officer
Major Incident Plan v 4.1 January 2010
Page 13 of 94
Job Title
Incident Role
Location
On call Director
Trust GOLD Commander – Pager reference BTLAC1
Hospital Control Room
Action Card 01
ROLE DESCRIPTION
To lead the Trusts Strategic response to the Major Incident and support the Silver Commanders Tactical decision
making. The Gold Commander is responsible for analysing the overall impact of an incident on staff, patients and
services, ensuring that the Trust response is proportionate and planning the return to normality.
INCIDENT DECLARED
 Check details of incident with Silver Commander and ED Commander
 Report to Hospital Control Room (Renal Seminar Room, Ground Floor, West Wing, RLH)
 Commence incident log
 Contact London SHA via pager bureau 0844 822 2888 call sign NHS 01. London SHA should
always be contacted where actual or potential Major Incidents, Major Incident stand-bys, adverse
or high profile media interest events, or other threats occur. Inform them of the potential duration of
the Major Incident or next review period.
 Contact PCT in event of a Major Incident standby or declared. (contact Director on call by pager
08700
 Put on Trust Gold Commander tabard
 Agree with Silver a written strategy and adopt high level tactics to drive the resolution of the incident
 Receive regular briefings from Silver Commander
 Chair the Hospital Control Team meetings
 After each HCT meeting (or at otherwise agreed times) brief by exception the Trust CEO
 Support the Silver Commander decision making as necessary during the Major Incident
 Liaise with Ambulance Liaison Officer.
 Liaise with Senior Police Officer present.
 Liaise with PCT Director (should be present in Hospital Control Room)
 Approve Press releases from Silver Commander and Press Officer.
 Agree stand down with Silver Commander
 Lead Trusts resilience planning for the days and weeks immediately following the incident. (Set up
the Trust Resilience Team post incident)
INTERNAL MAJOR INCIDENT
Refer to Internal Major Incident (Section 2 part 3)
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact for all
media enquiries. They will provide updates to the media and the public via the Trust Internet. Additionally they
may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
Agree the stand down with the Silver Commander
Lead the hot debrief of the Hospital Control Team
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 14 of 94
Job Title
Incident Role
Location
On call Silver
Trust SILVER Commander
Hospital Control Room
Action Card 02
ROLE DESCRIPTION
To lead the Trust’s operational activity and free the On Call Director to take a strategic view as the Trust Gold
Commander. The Silver level operation is the supporting operation.
INCIDENT DECLARED
 Check details of incident with Trust Gold Commander and ED Commander
 Report to Hospital Control Room (Renal Seminar Room, Ground Floor, West Wing, RLH)
 Put on Trust Silver Commander tabard
 Commence incident log
 Contact other on call silver rota personnel and request assistance from the first two available. Appoint
one on call Silver rota to London Chest Hospital and one to St Bartholomew’s Hospital as Site Coordinators to support the site Managers and act as direct contacts between the HCT and LCH and SBH.
 Ensure the magnetic board is ready to track patients and that the additional phones and facsimile
machine from the Major Incident Cupboards are plugged in.
 Establish and open the EPLO email connection, the password for this is in a sealed envelope in the HCT
information file.
 If requested by NHS London / LAS HQ activate the HEMS Major Incident Pager
 Consider the level of response required / provided by all departments in the light of information received
from the incident scene.
 Consider Site / Trust / local lock down with Facilities Co-ordinator
 Consider with the Medical Incident Consultant, ED Commander, Theatre Commander and ICU
Commander whether it is necessary to cancel elective surgery and out patients clinics
 For more bed space contact the London Independent Hospital 020 7780 2400 (The London Independent
has 6 fully staffed and supported ICU beds)
 Work with Site Manager on the regular bed states brief Gold Commander on these.
 Maintain close contact with on call Press Officer (Press releases to be agreed with Gold Commander)
 Ensure that Trust wide communications explain the Incident and the nature of the Trusts Major Incident
response to all staff.
 Liaise with Facilities Co-ordinator to ensure Trust is supported by support services.
 When appropriate agree stand down with GOLD, on stand down inform all Major Incident cascade via
switchboard. Request that the Media Liaison Officer sends trust wide email informing all staff of stand
down
 Arrange Hot Debrief for all HCT staff and Cold debrief to be held within 48 hours
 Prepare post Incident Report with Emergency Planning Officer.
INTERNAL MAJOR INCIDENT
Refer to Internal Major Incident (Section 2 part 3)
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact for all
media enquiries. They will provide updates to the media and the public via the Trust Internet. Additionally they
may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will agree the stand down with the Gold Commander
Lead the hot debrief of the Hospital Control Team
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 15 of 94
Job Title
Incident Role
Location
ED Consultant (2nd responding ED Consultant once ED Commander
Action card filled)
Medical Incident Consultant
Hospital Control Room
Action Card 03
ROLE DESCRIPTION
To support the Silver Commander by providing clinical experience to the Major Incident response. This is a hands off
role and is based within the Hospital Control Room.
INCIDENT DECLARED
 Check details of incident with Trust Silver Commander and ED Commander
 Report to Hospital Control Room (Renal Seminar Room, Ground Floor, West Wing, RLH)
 Put on Trust Medical Incident Consultant tabard
 Ensure actions and decisions are document within the Major Incident log
 Provide support to the Silver Commander in all clinical decisions
 Consider the level of response required / provided by all departments in the light of information received
from the incident scene.
 Consider with the Silver Commander, ED Commander, Theatre Commander and ICU Commander
whether it is necessary to cancel elective surgery and out patients clinics
 Ensure that Cambridge ward implements its local Major Incident Plan.
 Ensure that the Hospital Medical Officer and Hospital Surgical Officer roles are carried out by the Duty
Medical SHO and Duty Surgical SHO.
 Provide support to them on clinical discharge decisions
 Ensure that rapid discharge of patients occurs as required within the Royal London Hospital and if
necessary at St Bartholomew’s and the London Chest Hospital
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact for all
media enquiries. They will provide updates to the media and the public via the Trust Internet. Additionally they
may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will agree the stand down with the Silver Commander
Participate in the hot debrief of the Hospital Control Team
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 16 of 94
Job Title
Incident Role
Location
Site Manager RLH
Site Manager
Hospital Control Room
Action Card 04
ROLE DESCRIPTION
Support the Silver Commander by providing them with information and support. The Site Manager will oversee the
Administrative Support Team (HCT) and the Hospital Support Team
INCIDENT DECLARED
 Collect your Action Card from Hospital Control Room (HCR) in Renal Seminar Room, Ground Floor
West Wing RLH.
 Act as the Silver Commander (following their action card) until relieved by the on call Silver. (Note: you
may be able to communicate with the on call Silver whilst they are travelling to the Trust if out of hours)
 Check incident details with the Silver Commander and the ED Commander.
 Keep a record of all actions and decisions taken during the incident.
 Delegate a member of staff to ensure all wards are aware that a Major Incident has been declared and
they are in a position to implement their local plan should it become necessary. Ensure that there is
documented feedback that this has been achieved.
 Nominate a senior member of staff from the wards or from Admissions to act as Administrative Support
Team Leader. Ensure they pick up their action card from the HCR.
 Nominate an RGN from the Emergency Mental Health Liaison Service to act as Hospital Support Team
Leader. Ensure they collect their action card from the RLH Main Hospital Reception and establish the
Support Team in the Discharge Lounge (patients discharge), Outpatients (Relatives and P3 Discharge)
area and Chapel.
 Nominate an available Senior Admin staff to the role of Bearsted Lecture Theatre Leader. (Action Card
and pack of items for this role available within the Hospital Control Room)
 Establish the hospital bed state (including all critical care beds).
 In conjunction with the Administrative Support Team ensure the bed state is clearly and accurately
indicated on the white bed board in the HCR.
 Assign an administrative member of staff to distribute non clinical information via the Hospital Support
Team to relatives in the Restaurant area.
 Receive information from reception, theatres, wards and the Hospital Support Team
 Ensure sufficient runners are available to relay information on patient flow.
 Ensure Hospital Administrative Support Team (located in the HCT) is adequately staffed.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact for
all media enquiries. They will provide updates to the media and the public via the Trust Internet. Additionally
they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will agree the stand down with the Silver Commander
Participate in the hot debrief of the Hospital Control Team
Collect local logs from main wards and support team at the end of the incident
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 17 of 94
Job Title
Incident Role
Location
Communications officer
Media Liaison Officer
Hospital Control Room
Action Card 05
ROLE DESCRIPTION
Prepare and distribute the Trusts communications to media and the public during a Major Incident
INCIDENT DECLARED
 Contact Head of Media Relations / press team to agree which members of the team take part in
emergency response (minimum of 2 needed at all times.)
 Ensure NHS London Communications On-Call Officer is alerted to incident via 0844 822 2888 pager
bureau reference NHS 01
 Report to the Hospital Control Room (HCR) to gain an overview of the incident. If there are two or more
media liaison officers on site agree roles to ensure there is one ‘information’ contact. The HCT will be
based in the Renal Seminar Room, Ground Floor West Wing. Collect ‘Press Officer’ tabard and
Dictaphone to record actions and decisions made during the incident
 Ensure that and all staff PC “Pop Up” message goes out via ICT help desk to all users logged into the
BLT network.
 With Security lead agree location for photographers and film crews. Expected to be the raised forecourt
area in front of the temporary staff restaurant/Walk-In Centre (the Whitechapel Road entrance to A&E).
 All telephone enquires from the media will be directed to the HCR. Ensure this is always staffed by a
member of the communications team to receive calls. If only one MLO on site arrange with switchboard
for pager number to be given out or calls to be diverted to pager.
 Prepare a press statement (PC in HCR or A&E Secretaries room opposite). Include: basic details about
the incident, the number of casualties received, general nature of injuries, whether HEMS has been
involved, and the fact that RLH is a major trauma centre with experienced A&E and critical care teams
and that the hospital/organisation has a well rehearsed Major Incident Plan that is put into effect in
these situations. Instructions on how to post statement on website in on-call pack. Same statement
should be distributed to all staff via email.
 Use the Restaurant for interviews/press conferences. If the nature of the incident means the temporary
staff restaurant forecourt is not appropriate for media, keep reporters in this room. Make yourself
known to film crews, photographers and reporters and establish a dialogue. It may be useful to collect
details on the ‘signing-in form’ from the on-call pack so you have a record of names and contact details.
 Identify a spokesperson. This may be the Chief Executive, Medical Director or Director of Nursing in
the early stages of a response, followed later by an A&E Consultant. Establish a timetable with
spokespeople and the media for regular press reports, and try to stick to it.
 Make contact with Police, Fire, Ambulance, NHS London, and local authority press officers where able.
 Keep in regular contact with the Silver Commander in the HCT and Site Coordinators at SBH and LCH.
Update press statement regularly to ensure information is as current as possible
 If appropriate ask a maximum of two patients with minor injuries to talk to the press, ensuring they are
happy to do this, complete the media consent form (copies in on-call pack) and ensure security provide
escort.
 Prepare all staff email (instructions in on-call pack) informing staff of response, progress and thanking
them for their ongoing efforts. Update the staff intranet with the same information
 Update the public via BLT switchboard introductory message of the Major Incident, our response and
how they should contact the Police Casualty Bureau (including Casualty Bureau telephone number) as
soon as it is published.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact for all
media enquiries. They will provide updates to the media and the public via the Trust Internet. Additionally they
may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
incident stand down
You will be informed of STAND DOWN by the Hospital Control Team
Inform all A&E based staff and conduct a Hot debrief feeding comments back to the Hospital Control Team
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 18 of 94
Job Title
Incident Role
Location
Team leader nominated by the Site Manager, usually from the
Emergency Mental Health Liaison Service.
Hospital Support Team Leader
Discharge Lounge / Restaurant / Out Patients / Chapel
Action Card 06
ROLE DESCRIPTION
The Support Teams functions are to ensure the safe discharge of Major Incident patients who have been declared
medically fit and to support the relatives of those seriously injured or dead.
INCIDENT STANDBY
INCIDENT DECLARED
 Assemble the following members of the Hospital Support Team
Multi faith chaplaincy team
RNs / RMNs
Social Worker
Duty Psychiatrist
Bereavement Officer…. and other available Senior non clinical staff
 Keep a record of all actions and decisions taken during the incident.
 Patients should be offered refreshments and reunited with their relatives or friends.
 Ensure that patients have the means to get home, arranging transport as necessary. The use of
ambulances should be avoided.
 Ensure the patient’s GP has been informed by completing one of the GP proforma letters (available
from the ED reception)
 Patients not registered with a GP should be given the telephone number of “Findadoc” 020 8223
8455 / 8220 or email findadoc@thpct.nhs.uk
 Ensure all patients that are ready for discharge have been interviewed by the PDT.
 Maintain a log of patients who have been discharged from the hospital handing a copy to the Site
Manager at regular intervals.
 Liaise with the member of the Administrative Support Team (in the HCT) who will pass information for
announcement to the relatives in the Out Patients area.
 Keep contact with all elements of the Hospital Support Team located in the Discharge Lounge /
Chapel / Out Patients Department and Restaurant area.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact for
all media enquiries. They will provide updates to the media and the public via the Trust Internet. Additionally
they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down


You will be informed of the Stand down from the Major Incident by the Hospital Control Team
Debrief all members of the Hospital Support Team and the main reception staff, passing comments back to
the HCT
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 19 of 94
Job Title
Incident Role
Location
Admissions Supervisor (out of hours role assigned by Site Manager)
Administrative Support Team Leader
Hospital Control Room
Action Card 07
ROLE DESCRIPTION
To support the Silver Commander and Site Manager by providing an accurate picture of the numbers and locations of
patients received from the Major Incident and the Trusts continuously changing bed capacity and resources. And also
to document the actions communications and decisions made by the HCT
INCIDENT STANDBY
INCIDENT DECLARED
 Maintain detailed logs of all actions, as directed by the Silver and Gold Commander. (log keeper)
 Assist in the setting up of the control room. (all)
 Once control room is set up, test fax machine and printers ensuring that printing cartridges are
functioning. (Communications support)
 Create an issues log as well as main event and information timeline. (log support)
 Using printed communications message pads record all incoming and outgoing messages from
email, telephone calls, faxes and runners and pass a copy top copy to Director on call or the
appropriate decision maker for their action, middle copy to the log keeper for notation on the log and
bottom copy to retain within Communications message pads. (Communications support)
 Update maps and diagrams as the incident develops. (log support)
 Ensure that the ED Secretaries room is open for the use of the Police Documentation Team
 Off duty admissions staff should be called in to help manage the information flow. (Contact telephone
numbers listed in Red Major Incident folder in Head of Admissions office).
 During office hours Monday to Friday telephone PALS office to inform that there is a Major Incident,
and liaise where necessary with the advocacy service, telephone extension 7495 or 6335 or 2232.
 Receive information from reception, theatres, wards and the Hospital Support Team.
 Ensure the bed state is clearly and accurately indicated on the white bed board.
 Plot patient movement on the magnetic board (using Incident Patient Numbers). Ensure this
information is available to the Silver Commander.
 Allocate runners to visit the Emergency Department, and Major Incident admitting wards to collect
patient information.
 Pass photocopies of the admissions register to the Police Documentation Team (in the ED
secretaries room).
 Check accuracy of information before making it available to the Silver Commander, Press Officer,
Patient Affairs Office and relatives.
 Assign administrative staff to distribute information to relatives in the Out Patients Department via the
Hospital Support Team
NB: The role of the log keeper is particularly onerous and where possible this role should be rotated
amongst admin support personnel.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact for
all media enquiries. They will provide updates to the media and the public via the Trust Internet. Additionally
they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team either directly
or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 20 of 94
Job Title
Incident Role
Location
Admissions staff / administrative staff / ED Clerical staff (if available)
Administrative Support Team
Hospital Control Room
Action Card 08
ROLE DESCRIPTION
The most senior admin person present manages the Admin Support Group, this role initiates the Log for the HCT
and reports to the Director on call.
The support to the Hospital Control Team should ideally be fulfilled by 4 people. The most senior administrative
person present should take the lead (or nomination from the Site Manager) and organise for the following roles: log
keeper, log support and two communications support personnel.
INCIDENT STANDBY
INCIDENT DECLARED
 Go to the Hospital Control Team
 Gather Information from:ED Reception
Theatres
Wards
Site Manager
ITU
Hospital Support Team – Patients discharged (incident patients)
 Information will be given out to:Silver Commander (HCT)
Police Documentation Team
Media Liaison Officer
Hospital Support Team (Relatives and staff)
 Information coming in must be disseminated to all relevant parties.
 Do not stand down until specifically instructed by the HCT.
 Keep a record of all actions and decisions taken during the incident.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 21 of 94
Job Title
Incident Role
Location
Soft FM Performance Manager / Trust Security Manager / Hard FM
Performance Manager / Head of Performance Monitoring
Facilities Co-ordinator
Hospital Control Room
Action Card 09
ROLE DESCRIPTION
Coordinates the functions of Portering / CSSD / Catering / Security / Switchboard / Engineers / Transport and
Accommodation during a Major Incident to ensure that these functions support the hospitals Major Incident
response both during and following the incident
INCIDENT STANDBY
INCIDENT DECLARED
 Report to HCT (Renal Seminar Room, Ground Floor, West Wing RLH) for briefing of type and scale
of incident.
 Pick up action card from Hospital Control Team.
 Contact Capital Hospitals team and other partners when possible to appraise them of the incident
and the need for the Trust to direct their services.
 Ensure that Security open the Out Patients Department for the use by the Police Documentation
Team (PDT) and ED Secretaries Office.
 Make contact with all FM Support Services under span of control
 Base with the HCT responding to requests as needed.
 Ensure that essential services are maintained to the rest of the hospital.
 Escalate any issues, requests or resources to the Silver Commander HCT
 Keep a record of all actions and decisions taken during the incident.
 Liaise with the Site Coordinators at LCH and SBH on a regular basis to ensure that their facilities
needs are catered for.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team
 Join the HCT hot debrief and ensure that a debrief occurs within all managed services.
 Ensure that the debrief for all managed services is reported through to the HCT and Capital Hospitals Ltd.
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 22 of 94
Job Title
Incident Role
Location
0287 Bleep holder until replaced by Silver on call rota
Site Coordinator St Bartholomew’s Hospital
Site Managers Office SBH
Action Card 10
ROLE DESCRIPTION
Site Coordinator SBH will support the Silver Commander by coordinating all activity at St Bartholomew’s Hospital.
They will be the single point of contact for the Silver Commander. They will lead the Major Incident response at
SBH. This role will be carried out by other Silver on call rota’d staff as available on the day
INCIDENT STANDBY
INCIDENT DECLARED
 Report to the Site Managers Office SBH (2nd Floor KGV). Collect your Action Card and tabard
from there.
 Keep a record of all actions and decisions taken during the incident.
 Obtain a briefing from the SBH Site Manager / out of hours equivalent.
 Obtain a briefing from the Silver Commander or Site Manager RLH.
 Mobilise a team of runners to transfer messages / marshal patients.
 Ensure that a Log of all activities is started and continues throughout the Major Incident.
 Mobilise resources / personnel to be transferred to RLH where required. Resources may include
surgical equipment packs blood supplies or drugs.
 Ensure that the MIU is equipped with additional supplies during the Major Incident.
 Check incident details with the Silver Commander and the ED Commander.
 Delegate a member of staff to ensure all wards are aware that a Major Incident has been declared
and they are in a position to implement their local plan should it become necessary. Ensure that
there is documented feedback that this has been achieved.
 Nominate a senior member of staff from the wards or from an administrative area to provide Admin
/ Logging service.
 Ensure that this role and others as necessary at SBH can be covered on a 24/7 basis if
necessitated by the Gold Commander.
 Liaise with the Media Liaison Officer and the Facilities Coordinator on a regular basis to ensure that
they are aware of necessary information and requirements at your site.
 Channel all resources, information or exception reporting direct to the Silver Commander.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will agree the stand down with the Silver Commander
Lead the debrief for St Bartholomew’s Hospital Staff. Ensure that this debrief information is communicated to the
Gold Commander
Collect any local logs from main wards and SBH support team at the end of the incident
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 23 of 94
Job Title
Incident Role
Location
1945 Bleep holder until replaced by Silver on call rota
Site Coordinator London Chest Hospital
Discharge Lounge, Front Block, LCH
Action Card 11
ROLE DESCRIPTION
Site Coordinator LCH will support the Silver Commander by coordinating all activity at The London Chest Hospital.
They will be the single point of contact for the Silver Commander. They will lead the Major Incident response at
LCH. This role will be carried out by other Silver on call rota’d staff as available on the day
INCIDENT STANDBY
INCIDENT DECLARED
 Report to the Security Office, collect the local MI Box, then move to the Discharge Lounge (LCH
Control Room). The Local MI Box will contain your Action Card and tabard.
 Contact the Hospital Control Room and obtain a briefing from the Silver Commander or Site
Manager RLH.
 Mobilise a team of runners to transfer messages / marshal patients.
 Ensure that a Log of all activities is started and continues throughout the Major Incident. Use the
whiteboard for communication.
 Mobilise resources / personnel to be transferred to RLH where required. Resources may include
surgical equipment packs blood supplies or drugs.
 Ensure that the London Chest remains open for as long as feasible for Heart Attack cases. Should
it not be possible to continue the HAC service ensure that LAS are immediately informed as per
local policy.
 Check incident details with the Silver Commander and the ED Commander.
 Delegate a member of staff to ensure all wards are aware that a Major Incident has been declared
and they are in a position to implement their local plan should it become necessary. Ensure that
there is documented feedback that this has been achieved.
 Nominate a senior member of staff from the wards or from an administrative area to provide Admin
/ Logging service.
 Ensure that this role and others as necessary at LCH can be covered on a 24/7 basis if
necessitated by the Gold Commander.
 Liaise with the Media Liaison Officer and the Facilities Coordinator on a regular basis to ensure that
they are aware of necessary information and requirements at your site.
 Channel all resources, information or exception reporting direct to the Silver Commander.
 Keep a record of all actions and decisions taken during the incident.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room RLH) will be the primary point of
contact for all media enquiries. They will provide updates to the media and the public via the Trust
Internet. Additionally they may also update the Trust switchboard message with further information for the
public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will agree the stand down with the Silver Commander
With the 1945 Bleep holder lead the debrief for the London Chest Hospital Staff. Ensure that this debrief
information is communicated to the Gold Commander
Collect any local logs from main wards and LCH support team at the end of the incident
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 24 of 94
Job Title
Incident Role
Location
ED Consultant
ED Commander (Consultant in Charge of Emergency Department)
ED Department
Action Card 12
ROLE DESCRIPTION
Lead the Emergency Departments response to the Major Incident, (this is a hands off role)
INCIDENT STANDBY
INCIDENT DECLARED
 Lead the Emergency Departments response to the Major Incident.
 Collect the megaphone ED Commander Tabard and log book from the ED Reception.
 Work with Nurse in Charge of Emergency Department to effectively manage the ED
response to the incident.
 At an appropriate time (given available resources) assign a member of staff to record all
actions and decisions taken by you and the NIC during the incident in the log book.
 Ensure that a senior Emergency Department doctor is allocated the Triage Officer Action
card and is in place to receive casualties with the Triage Nurse.
 Ensure that a Team Leader designated for:
ED Resus
ED Majors
ED Minors
ED Paediatrics
(These roles report to you and should escalate problems and resources requests for you to action)
 Assess whether further ED registrars are required, detail a member of medical staff to call in
more if necessary.
 Brief Team Leaders and Triage Doctor on type of incident and casualty information as
available
 Provide updates to Team Leaders and Triage Doctor when more information becomes
available, ensure that this is cascaded through their respective teams.
 Inform Hospital Control Team when the ED is fully manned and ready to respond to Major
Incident
 Provide regular updates to HCT Silver Commander throughout the Major Incident.
 Ensure that capacity for treating minors patients is assessed throughout the Major Incident.
Where necessary expand minors treatment into WIC and Outpatients. Ensure clinical teams
and equipment and supplies are allocated to these spaces as necessary. And inform the
Silver Commander if expansion of Minors is required.
 Assist HCT with providing Situation Reports to NHS London
 Request that Theatres ICU and other Bronze Commanders are provided with regular updates
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
incident stand down
You will be informed of STAND DOWN by the Hospital Control Team
Inform all A&E based staff and conduct a Hot debrief feeding comments back to the Hospital Control Team
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 25 of 94
Job Title
Incident Role
Location
Senior Nurse ED
Nurse in Charge (NIC) of Emergency Department
ED Department
Action Card 13
ROLE DESCRIPTION
Work with the ED Commander (Consultant in charge) to respond to the Major Incident
INCIDENT STANDBY
INCIDENT DECLARED
 Document incident details using set proforma next to MI Phone.
 Instruct switchboard to activate Major Incident Plan (dial 2222).
 Make Contact with the ED Commander (you will work as a single unit)
 Ensure that all actions of yourself and the ED Commander are recorded.
 Collect the Nurse in Charge tabard from the ED Reception
 Initiate cascade system of call out for ED nursing staff.
 Designate a nurse as Triage Nurse, give them the Triage Nurse Action Card for them to follow.
 Organise the clearance of patients from the Emergency Department. Ensure those in waiting area
given clear instructions to attend alternative health care facilities.
 Alert porters to collect equipment and documentation from the MI Clerical cupboard outside
reception and the MI equipment cupboard in the basement.
 Alert and ensure the following have their action cards found in the MI Documentation Boxes:
ED Doctor – Triage Officer
ED Receptionists
Walk In Centre Receptionists
 Clear Orthopaedic Fracture Clinic. Equip it to act as an additional minors area
 Designate nursing staff to the treatment areas - nominating a lead for the Resuscitation Room,
Trolley Area and Minors).
 Undertake role of the ED Admin / Service Manager until they arrive.
 Keep a record of all actions and decisions taken during the incident in the log kept by the ED
Commander.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
incident stand down
You will be informed of STAND DOWN by the Hospital Control Team
Inform all A&E based staff and work with the ED Commander to conduct a Hot debrief feeding comments back to
the Hospital Control Team
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 26 of 94
Job Title
Incident Role
Location
ED Registrar (initially to be replaced by ED Consultant as soon as
available)
Triage Officer
ED Ambulance Bay entrance
Action Card 14
ROLE DESCRIPTION
Triage all patients arriving at the Hospital through Ambulance Bay entrance.
INCIDENT STANDBY
INCIDENT DECLARED
 Work directly to the ED Commander and provide them with regular updates
 Collect from ED Reception and put on the “Triage Officer” tabard.
 If possible assist the senior nurse in the preparation of the department before patients arrive.
 Go to the ED ambulance entrance with the Triage Nurse and set up the Triage Point.
 Assess the severity of casualties on their arrival at the ED entrance using Triage Sieve and Sort
cards available from A&E reception. Direct them to the appropriate treatment area.
 Where possible assign a medical student to accompany each “Priority One” or “Priority Two”
casualty. One medical student may accompany five Priority Three patients.
 Check that the receptionist has completed two wrist bands for each patient, and completed
magnetic strips for the HCT. Attach the wrist bands to each patient.
 Ensure that the Triage Receptionist keeps a record of all actions and decisions taken during the
incident. If this proves difficult because of work flow ensure that this is given to another member of
staff to perform.
 Only stand down when instructed to do so by the HCT.
Category
Priority One (P1)
Priority Two (P2)
Priority Three (P3)
Clinical Need
Immediate
Serious
Walking wounded
Priority Five (P5)
Dead
Location
Resuscitation Room
Majors
Orthopaedic Fracture
Clinic
Mortuary
Priority Four (P4)
Expectant
To be agreed with HCT
P4 – Expectant, can only under extreme circumstances and approved by Silver / Gold Commander.
(Please refer to Triage Sieve Card)
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will be informed of the Stand down from the Major Incident by the Hospital Control Team either directly or via
the ED Commander
Join the Emergency Department hot debrief
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 27 of 94
MAJOR INCIDENT TRIAGE SEIVE
Y
WALKING
N
N
PRIORITY 5 (Dead)
After airway
opening
Y
REPIRATORY RATE
10 to 29
PRIORITY 3 (Delayed)
Patients whose treatment
can be delayed
MINORS
< 10
> 30
> 2 sec
> 120
MORTUARY
PRIORITY 1 (Immediate)
Patients with high priority for
immediate life saving
emergency care
RESUS
CAPILARY REFILL
TIME OR HEART
RATE
PRIORITY 2 (Urgent)
Less severely injured who
need urgent medical care
MAJORS
MASS CASUALTY
EXTENSIVE INJURIES
This category can only
be used after a decision
and order by a HCT Gold
Commander
PRIORITY 4 (Expectant)
Injuries so severe either
cannot survive or require
excess treatment that would
seriously compromise the
treatment of large numbers
of others
TBA by HCT
Major Incident Plan v 4.1 January 2010
Page 28 of 94
Job Title
Incident Role
Location
ED Nurse
Triage Nurse
ED Ambulance Bay entrance
Action Card 15
ROLE DESCRIPTION
Work with the Triage Officer to triage all patients arriving at the Hospital through Ambulance Bay entrance.
This role is assigned by the Nurse in Charge of Emergency Department
INCIDENT STANDBY
INCIDENT DECLARED
 Collect Triage Nurse Tabbard from ED Reception.
 Immediately go to the ED ambulance entrance with the Triage doctor and set up the Triage Point.
 Assess the severity of casualties on their arrival at the ED entrance. Direct them to the appropriate
treatment area.
 Where possible assign a medical student to accompany each “Priority One” or “Priority Two”
casualty. One medical student may accompany five Priority Three patients.
 Check that the receptionist has completed two wrist bands for each patient, and completed
magnetic strips for the HCT. Attach the wrist bands to each patient.
 Only stand down when instructed to do so by the HCT.
Category
Priority One (P1)
Priority Two (P2)
Priority Three (P3)
Priority Five (P5)
Clinical Need
Immediate
Serious
Walking wounded
Dead
Location
Resuscitation Room
Majors
Orthopaedic Fracture Clinic
Mortuary
Priority Four (P4)
Expectant
To be agreed with HCT
P4 – Expectant, can only under extreme circumstances and approved by Silver / Gold Commander.
(Please refer to Triage Cards)
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 29 of 94
MAJOR INCIDENT TRIAGE SEIVE
Y
N
N
BREATHING
PRIORITY 5 (Dead)
After airway
opening
Y
REPIRATORY RATE
10 to 29
CAPILARY REFILL
TIME OR HEART
RATE
MASS CASUALTY
EXTENSIVE INJURIES
This category can only
be used after a decision
and order by a HCT Gold
Commander
Major Incident Plan v 4.1 January 2010
PRIORITY 3 (Delayed)
Patients whose treatment
can be delayed
MINORS
< 10
> 30
> 2 sec
> 120
< 2 sec
< 120
MORTUARY
PRIORITY 1 (Immediate)
Patients with high priority for
immediate life saving
emergency care
RESUS
PRIORITY 2 (Urgent)
Less severely injured who
need urgent medical care
MAJORS
PRIORITY 4 (Expectant)
Injuries so severe either
cannot survive or require
excess treatment that would
seriously compromise the
treatment of large numbers
of others
TBA by HCT
Page 30 of 94
Job Title
Incident Role
Location
ED Receptionist
Triage Receptionist
ED Ambulance Bay entrance
Action Card 16
ROLE DESCRIPTION
Cascade the Major Incident Alert to the Walk In Centre and then record patient details as they enter the hospital.
INCIDENT STANDBY
INCIDENT DECLARED
 Telephone WALK IN CENTRE Receptionist on extension 7031, and request them to activate
their role in the Trust Major Incident Plan.
 Open the Major Incident (Clerical) cupboard outside reception, collect the patient
documentation boxes and take these to the Ambulance Bay entrance
 Go to the ED reception area to collect your tabard.
 Move to the area outside Resus where together with the triage nurse and doctor you will
receive and register patients.
 Documents must be issued in numerical order. Each patient is given:
Two numbered wrist bands
A set of prepared documents
Bodies must be documented in the same way and have a wrist band attached.
 If time and the clinical state of the patient allows take the details of each patient at the front
door. Write these on the allocated casualty card. Do not let the collection of personal details
interfere with clinical assessment.
 If time is short note the sex of the patient and their allocated MI number. This is the
minimum data set to be collected.
 The Sex, MI Number and Location of patient in ED should be marked on two magnetic
strips. These should be passed to the HCT Admin Support Group Team Leader in the
HCR
 On your board note the minimum data set and pass it to the other ED receptionist to
complete the ED register.
 Any cards from the scene must be kept with the patient’s documents.
 Any routine patients that arrive during the Major Incident should be documented using
the same procedure. Record these patients as ‘routine’.
 Do not stand down until directed by the Hospital Control Team.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down

You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 31 of 94
Job Title
Incident Role
Location
ED Consultant / Registrar
Resuscitation Room Team Leader
ED Resus
Action Card 17
ROLE DESCRIPTION
Co-ordinate the clinical care of all patients within the ED Resus. Work with the Theatre Commander and
Anaesthetics Lead to review and prioritise all Resus Patients for Surgery. Report directly to the ED Commander
and provide them with regular updates on care and capacity.
This role is assigned by the ED Commander
INCIDENT STANDBY
INCIDENT DECLARED
 Collect Resus Room Team Leader tabard and log from the ED reception
 Locate yourself in the Resuscitation Room.
 Do not get involved in patient management, but maintain an overview of the room.
 Work with the Theatre Commander and Anaesthetics Lead to review and prioritise all patients for
surgery
 Keep a log of all actions and decisions taken during the incident. Allocate a medical student to
scribe.
 Keep noise to an absolute minimum.
 Assemble as many resuscitation teams as possible from available medical / nursing staff.
Consultants
Emergency Department coffee room.
Medical staff
Bearsted lecture theatre. Ext. 2410.
Anaesthetic Staff
Theatre Control. Ext. 7224 / 2396
 Allocate a leader for each Resus team. Only anaesthetists should wear lead aprons. As staff
arrive allocate them to the various teams.
 Use Cluster Points outside of Resus for assembling of teams so that there aren’t too many
people in a confined space. Ensure that only required people are located in Resus.
 Ensure all blood samples are marked “Major Incident”.
 Allocate resources flow to each team as requested.
 Liaise with the Anaesthetic Co-ordinator within Theatre Coordination Team (Ext. 7224/2396) and
CT (Ext. 2440) re onward movement of patients to Theatre.
 Inform ED Commander of ALL patient movements.
 Escalate all problems and requests to the ED Commander.
 Only stand down when asked to do so by the HCT.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down

You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
RLH Theatres
Intensive Care Unit
14-2404 14-2325
14-7224 14-2396
14-7731 14-7732
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 32 of 94
On reverse
MAJOR INCIDENT TRIAGE SEIVE
Y
N
N
BREATHING
PRIORITY 5 (Dead)
After airway
opening
Y
REPIRATORY RATE
10 to 29
CAPILARY REFILL
TIME OR HEART
RATE
MASS CASUALTY
EXTENSIVE INJURIES
This category can only
be used after a decision
and order by a HCT Gold
Commander
Major Incident Plan v 4.1 January 2010
PRIORITY 3 (Delayed)
Patients whose treatment
can be delayed
MINORS
< 10
> 30
> 2 sec
> 120
< 2 sec
< 120
MORTUARY
PRIORITY 1 (Immediate)
Patients with high priority for
immediate life saving
emergency care
RESUS
PRIORITY 2 (Urgent)
Less severely injured who
need urgent medical care
MAJORS
PRIORITY 4 (Expectant)
Injuries so severe either
cannot survive or require
excess treatment that would
seriously compromise the
treatment of large numbers
of others
TBA by HCT
Page 33 of 94
Job Title
Incident Role
Location
Most Senior Surgeon on Site
Theatre Commander
ED Resus
Action Card 18
ROLE DESCRIPTION
Work with the Resus Team Leader and Anaesthetics Lead to review and prioritise all Resus patients for surgery.
Work with the Theatre Co-ordinator to lead the Theatres response to the Major Incident. Provide effective
communications link with the Silver Commander and the ED and ICU Commander.
INCIDENT STANDBY
Receive information on the number of Theatres working from the Theatres Coordinator and communicate this to
the Silver on call. Await further instructions
INCIDENT DECLARED
 Collect Theatre Commander Tabbard from the Major Incident Cupboard located in the 3rd
Floor Front Block Theatre Reception.
 Work with the Theatre Commander and Anaesthetics Lead to review and prioritise all Resus
patients for surgery.
 Assemble suitable Surgical teams for each patient requiring surgery
 Brief the teams on the procedures required for each patient.
 Ensure that resources are rationed in until it is confirmed that no further casualties are enroute
to the Trust.
 Inform Theatre Co-ordinator of patients requiring surgery so that theatres and teams can be
allocated.
 Request administrative support from the Hospital Control Team to assist with logging
 Obtain information from Silver Commander on the scale and type of Major Incident and
anticipated number of casualties that the RLH will be receiving.
 When advised by Silver Commander, cancel elective surgery, communicate this to the Theatre
Co-ordinator.
 Allocate anaesthetic staff to A&E and ensure adequate and appropriate staff to theatre. Any
surplus staff should remain in the Anaesthetics library until requested.
 Prioritise existing emergency patients who require surgery
 On receipt of information from the ED Commander, cases to be assigned to specific theatres
(in conjunction with Theatre Co-ordinator). Assign anaesthetists accordingly.
 Theatre Commander to log and record all cases assigned.
 Throughout the Major Incident the Theatre Commander should regularly review patient flow
with ED Commander and ICU Commander. This should be communicated to the Theatre Coordinator.
in house alert
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will be informed of the Stand down from the Major Incident by the Hospital Control Team
Inform all Theatre staff and anaesthetists and conduct a Hot debrief feeding comments back to the Hospital
Control Team
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 34 of 94
Job Title
Incident Role
Location
On call Anaesthetic Consultant (Bleep 1220)
Anaesthetics Lead
ED Resus
Action Card 19
ROLE DESCRIPTION
Work with the Resus Team Leader and Theatre Commander to review and prioritise all Resus patients for surgery.
Work with the Theatre Co-ordinator to lead the Theatres response to the Major Incident.
INCIDENT STANDBY
INCIDENT DECLARED
 Collect Aneaesthetics Lead tabbard from the Major Incident Cupboard located in the 3rd Floor
Front Block Theatre Reception.
 Work with the Resus Team Leader and Theatre Commander to review and prioritise all Resus
patients for surgery.
 Assemble suitable Anaesthetic teams for each patient requiring surgery
 Brief the teams on the procedures required for each patient.
 Ensure that resources are rationed in until it is confirmed that no further casualties are enroute
to the Trust.
 Assist the Theatre Commander with informing Theatre Co-ordinator of patients requiring
surgery so that theatres and teams can be allocated.
 Allocate anaesthetic staff to A&E and ensure adequate and appropriate staff to theatre. Any
surplus staff should remain in the Anaesthetics library until requested.
 On receipt of information from the ED Commander, cases to be assigned to specific theatres
(in conjunction with Theatre Co-ordinator). Assign anaesthetists accordingly.
in house alert
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will be informed of the Stand down from the Major Incident by the Hospital Control Team
Inform all Theatre staff and anaesthetists and conduct a Hot debrief feeding comments back to the Hospital
Control Team
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 35 of 94
Job Title
Incident Role
Location
ED Consultant / Registrar
Majors Team Leader
ED Majors
Action Card 20
ROLE DESCRIPTION
Lead the clinical care of all patients within ED Majors area. Work directly to the ED Commander and provide them
with regular updates on care and capacity.
This role is assigned by the ED Commander
INCIDENT STANDBY
INCIDENT DECLARED
 Collect Majors Team Leader tabard and log from the ED Reception
 Locate yourself in the Majors Area.
 Do not get involved in patient management, but maintain an overview of the area.
 Keep a log of all actions and decisions taken during the incident. A medical student may be
allocated to help.
 Keep noise to an absolute minimum.
 Allocate medical and nursing staff.
Consultants
Emergency Department coffee room
Medical staff
Bearsted lecture theatre. Ext. 2410
Nursing Staff Bearsted lecture theatre. Ext. 2410
 Ensure all blood samples are marked “Major Incident”.
 Ensure that resources flow to the area as required.
 Liaise with Theatre Coordination Team (Ext. 7224/2396) and CT (Ext. 2440) and the Site
Manager re onward movement of patients.
 Ensure the HCT Admin Support Team Leader is informed of all patients’ movements.
 Escalate all problems and requests to the ED Commander
 Only stand down when asked to do so by the HCT
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 36 of 94
On reverse
MAJOR INCIDENT TRIAGE SEIVE
Y
N
N
BREATHING
PRIORITY 5 (Dead)
After airway
opening
Y
REPIRATORY RATE
10 to 29
CAPILARY REFILL
TIME OR HEART
RATE
MASS CASUALTY
EXTENSIVE INJURIES
This category can only
be used after a decision
and order by a HCT Gold
Commander
Major Incident Plan v 4.1 January 2010
PRIORITY 3 (Delayed)
Patients whose treatment
can be delayed
MINORS
< 10
> 30
> 2 sec
> 120
< 2 sec
< 120
MORTUARY
PRIORITY 1 (Immediate)
Patients with high priority for
immediate life saving
emergency care
RESUS
PRIORITY 2 (Urgent)
Less severely injured who
need urgent medical care
MAJORS
PRIORITY 4 (Expectant)
Injuries so severe either
cannot survive or require
excess treatment that would
seriously compromise the
treatment of large numbers
of others
TBA by HCT
Page 37 of 94
Job Title
Incident Role
Location
ED Consultant / Registrar
Minors Team Leader
ED Minors & Fracture Clinic
Action Card 21
ROLE DESCRIPTION
Lead the clinical care of all patients within ED Minors area. Work directly to the ED Commander and provide them
with regular updates on care and capacity.
This role is assigned by the ED Commander
INCIDENT STANDBY
INCIDENT DECLARED
 Collect the Minors Team Leader tabard and log from the ED reception
 Locate yourself in the Minors Area.
 Keep a log of all actions and decisions taken during the incident. A medical student may be
allocated to help.
 Working with the ED Commander, consider the need to expand Minors into the Fracture clinic,
Walk in Centre and Out Patients Department (Ground Floor) as necessary (depending upon
patient volume and flow.)
 Communicate regularly with the Walk In Centre Lead Clinician / Manager to ensure a
synchronised approach to treatment of P3 casualties.
 Ensure that the Walk In Centre are provided with additional supplies to treat the patients being
sent to this area
 Do not get involved in patient management, but maintain an overview of the area.
 Keep noise to an absolute minimum.
 Allocate medical and nursing staff.
Consultants
Emergency Department coffee room
Medical staff
Bearsted lecture theatre. Ext. 2410
Nursing Staff Bearsted lecture theatre. Ext. 2410
 Ensure all blood samples are marked “Major Incident”.
 Ensure that resources flow to the area as required.
 Liaise with Theatre Coordination Team (Ext. 7224/2396) and CT (Ext. 2440), and Site Manager
re onward movement of patients.
 Ensure that all patients that are suitable for discharge are first sent to be interviewed by the
Police Documentation Team located in Outpatients Ground floor before being passed to the
Hospital Support Team for discharge.
 Ensure the HCT Admin Support Team Leader is informed of all patients’ movements.
 Escalate all problems and requests to the ED Commander
 Only stand down when asked to do so by the HCT
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 38 of 94
On reverse
MAJOR INCIDENT TRIAGE SEIVE
Y
N
N
BREATHING
PRIORITY 5 (Dead)
After airway
opening
Y
REPIRATORY RATE
10 to 29
CAPILARY REFILL
TIME OR HEART
RATE
MASS CASUALTY
EXTENSIVE INJURIES
This category can only
be used after a decision
and order by a HCT Gold
Commander
Major Incident Plan v 4.1 January 2010
PRIORITY 3 (Delayed)
Patients whose treatment
can be delayed
MINORS
< 10
> 30
> 2 sec
> 120
< 2 sec
< 120
MORTUARY
PRIORITY 1 (Immediate)
Patients with high priority for
immediate life saving
emergency care
RESUS
PRIORITY 2 (Urgent)
Less severely injured who
need urgent medical care
MAJORS
PRIORITY 4 (Expectant)
Injuries so severe either
cannot survive or require
excess treatment that would
seriously compromise the
treatment of large numbers
of others
TBA by HCT
Page 39 of 94
Job Title
Incident Role
Location
Paediatric On Call Registrar
Paediatric Team Leader
ED Paediatrics
Action Card 22
ROLE DESCRIPTION
Lead the clinical care of all patients within ED paediatrics area. Work directly to the ED Commander and provide
them with regular updates on care and capacity.
INCIDENT STANDBY
INCIDENT DECLARED
 Collect the Paediatric Team Leader tabard and log from the ED reception
 Locate yourself in the Paediatric Area.
 Assemble a clinical team in the Paediatrics area of the Emergency Department
 Keep a record of all actions and decisions taken during the incident within a log book
 If Paediatric ED is overwhelmed discuss with ED Commander the use of adult area and staff
 Keep noise to an absolute minimum.
 Allocate medical and nursing staff.
Consultants
Emergency Department coffee room
Medical staff
Bearsted lecture theatre. Ext. 2410
Nursing Staff Bearsted lecture theatre. Ext. 2410
 Ensure all blood samples are marked “Major Incident”.
 Ensure that resources flow to the area as required.
 Liaise with Theatre Coordination Team (Ext. 7224/2396) and CT (Ext. 2440), and Site Manager re
onward movement of patients.
 Ensure that all patients that are suitable for discharge are first sent to be interviewed by the Police
Documentation Team located in Outpatients Ground floor before being passed to the Hospital
Support Team for discharge.
 Ensure that ED Commander is informed of all patient movements
 After treating paediatric casualties, wait until told to stand down by the Silver Commander.
 Escalate all problems and requirements to the ED Commander
 Ensure that every paediatric patient that you treat and discharge, leaves the hospital with full
documentation, having seen a social worker and been booked out, with parent / guardians, to a
prepared community.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 40 of 94
On reverse
MAJOR INCIDENT TRIAGE SEIVE
Y
N
N
BREATHING
PRIORITY 5 (Dead)
After airway
opening
Y
REPIRATORY RATE
10 to 29
CAPILARY REFILL
TIME OR HEART
RATE
MASS CASUALTY
EXTENSIVE INJURIES
This category can only
be used after a decision
and order by a HCT Gold
Commander
Major Incident Plan v 4.1 January 2010
PRIORITY 3 (Delayed)
Patients whose treatment
can be delayed
MINORS
< 10
> 30
> 2 sec
> 120
< 2 sec
< 120
MORTUARY
PRIORITY 1 (Immediate)
Patients with high priority for
immediate life saving
emergency care
RESUS
PRIORITY 2 (Urgent)
Less severely injured who
need urgent medical care
MAJORS
PRIORITY 4 (Expectant)
Injuries so severe either
cannot survive or require
excess treatment that would
seriously compromise the
treatment of large numbers
of others
TBA by HCT
Page 41 of 94
Job Title
Incident Role
Location
ED Service Manager / ED Reception Supervisor
ED Admin Manager / ED Reception Supervisor
ED Ambulance Bay entrance
Action Card 23
ROLE DESCRIPTION
Cascade the Major Incident Alert to off duty ED reception staff and lead the admin response to the Major incident
within the ED.
INCIDENT STANDBY
INCIDENT DECLARED
 Liaise with Nurse in Charge of Emergency Department to determine the size and scale of the
incident
 Call in any off duty staff as required
 Nominate a member of staff to coordinate the ED patient register.
 Receive patient’s details from the Triage Receptionist.
 If detailed by the Triage receptionist use the runner nominated by the HCT to gather further
patient ID / details.
 Nominate a runner to take a photocopy of the register to the HCT at regular intervals (about
every 10 patients)
 Ensure that extra notes are made up as required.
 Allocate one member of staff to take all incoming calls in the A&E Secretaries room.
 As extra members of staff report for duty allocate them to Major Minors and Resus to update
patient personal information on their notes and allocate a runner to communicate all information
back to the ED Admin Manager.
 Ensure that the welfare of staff is appropriately taken care of with rotated breaks.
 Keep a record of all actions and decisions taken during the incident.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 42 of 94
Job Title
Incident Role
Location
A&E Porter
Senior ED Porter on Duty or Bleep 1158 out of hours
A&E Porters Desk at all times
Action Card 24
ROLE DESCRIPTION
Lead the Portering teams response to a Major Incident. Liaise with the facilities co-ordinator and the ED
Commander for information and instruction.
INCIDENT STANDBY
INCIDENT DECLARED
 Appoint a member of the team to work to the action card of “ED Porter”.
 Call in additional hospital portering staff once the scale of the incident is known (these are to be
directly managed by the Senior ED Porter). Request the most experienced porters and instruct
them to bring with them their personal radios and spares for existing ED porters.
 Instruct all portering staff to remain under the direction of the Senior Porter until Major Incident
Stand down when their assistance will still be required to reopen the Emergency Department.
 Receive confirmation that HCT equipment has been delivered from the ED Porter. If not received
within 15 minutes ensure that this action is carried out as an immediate priority.
 Ensure ED has sufficient wheelchairs, trolleys and oxygen cylinders.
 Report to the Facilities Coordinator or in their absence the Site Manager with the HCT. State any
additional staffing or equipment needs.
 Ensure other portering staff are allocated to Cambridge ward and ED Majors, Minors and other
areas to help decant patients.
 Ensure a safe service is maintained to the rest of the hospital.
 Keep a record of all actions and decisions taken during the incident
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team either
directly or via the ED Commander
 Join the Emergency Department hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 43 of 94
Job Title
Incident Role
Location
Emergency Department Porter
Emergency Department Porter
Emergency Department
Action Card 25
ROLE DESCRIPTION
Provide Portering service to Emergency Department as required by the Major Incident and under the direction of
the A&E Senior Porter
INCIDENT STANDBY
INCIDENT DECLARED
 Report to Senior ED Porter
 Collect MI key set from MI key cupboard in Resus (located on the wall beneath the Resus CD
cupboard). Key for MI Key Cupboard is on Resus key set. Spare MI key sets are available from
ED reception (1) and security (1)
 Open MI Equipment Cupboard in basement. Move the two clear boxes with blue lids (labelled
Major Incident – Hospital Control Team) to Hospital Control Room / Renal Seminar Room
(opposite A&E Secretaries Office)
 Confirm to the Senior ED Porter when the Major Incident Equipment has been delivered to the
HCR
 Liaise with the Senior Nurse on duty in A&E to receive instructions on preparing the department
to receive casualties.
 Keep a record of all actions and decisions taken during the incident.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will be informed of the Stand down from the Major Incident by the Hospital Control Team either directly or via
the ED Commander
Join the Emergency Department hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 44 of 94
Job Title
Incident Role
Location
Ward Sister
Main Receiving Ward (Cambridge Ward) and other Wards
Cambridge Ward
Action Card 26
ROLE DESCRIPTION
Lead the clinical care of all patients within ED Minors area. Work directly to the ED Commander and provide them
with regular updates on care and capacity.
This role is assigned by the ED Commander
INCIDENT STANDBY
INCIDENT DECLARED
 Prepare to receive admissions from ED/Theatres.
 With the Site Manager arrange to transfer existing in-patients to other wards.
 Request additional staff as required.
 Inform the Site Manager and the HCT when ready to receive patients.
 Inform the Hospital Support Team (via the HCT or distributed contact number) when the incident
patients are ready to receive visitors.
Generic Example for General Wards
 Prepare to receive internal hospital transfers as directed. These patients must be accepted
immediately on request and a nurse should be sent to Cambridge or other receiving ward to
collect them.
 Consider which patients may be suitable for discharge or transfer.
 Call in extra staff as required but ensure that subsequent shifts are not compromised.
 Contact on-call medical registrar to authorize discharge of identified patients.
 Keep a record of all actions and decisions taken during the incident.
 Keep a log of all patients transferred or discharged and pass this to the Site Manager
in house alert
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will be informed of the Stand down from the Major Incident by the Hospital Control Team either directly or via
the ED Commander
Join the Emergency Department hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 45 of 94
Job Title
Incident Role
Location
Duty Surgical SHO
Hospital Surgical Officer
Discharge Lounge / Restaurant / Out Patients
Action Card 27
ROLE DESCRIPTION
To provide first on call ward cover for all surgical specialties (except neurosurgery)
INCIDENT STANDBY
INCIDENT DECLARED
 Provide first on-call ward cover for all surgical specialities (except neurosurgery)
 Inform each ward of your bleep number.
 Should you require medical / surgical support discuss with the Silver Commander within the
HCT
 Keep a written log of any management changes to hand over to the teams concerned after the
incident and note the destinations of all patients.
 Keep a record of all actions and decisions taken during the incident.
 Do not stand down until told to do so by the HCT.
in house alert
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will be informed of the Stand down from the Major Incident by the Hospital Control Team
Join the Hospital Control Team Debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 46 of 94
Job Title
Incident Role
Location
Duty Medical SHO
Hospital Medical Officer
Discharge Lounge / Restaurant / Out Patients
Action Card 28
ROLE DESCRIPTION
To provide first on call ward cover for all medical specialties (except neurosurgery)
INCIDENT STANDBY
INCIDENT DECLARED
 Collect your action card from Front Reception.
 You will provide first on-call ward cover for all medical specialities.
 Inform each medical ward of your bleep number.
 Should you require medical / surgical support discuss with a member of the HCT.
 Keep a written log of any management changes to hand over to the teams concerned after the
incident and note the destinations of all patients.
 Keep a record of all actions and decisions taken during the incident.
 Do not stand down until told to do so by the HCT.
in house alert
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will be informed of the Stand down from the Major Incident by the Hospital Control Team
Join the Hospital Control Team hot debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 47 of 94
Job Title
Incident Role
Location
Walk In Centre Receptionist
Walk In Centre Receptionist
RLH Main Reception
Action Card 29
ROLE DESCRIPTION
To assist in directing all staff responding to the Major Incident cascade.
INCIDENT STANDBY
INCIDENT DECLARED
 Make your way to the reception area at the Front Entrance of Hospital.
 All the equipment you need is stored behind the desk at Front reception in a designated draw.
It consist of:
6 Signing in boards with pens
6 Sets of coloured stickers
Laminated action cards
 Put out “Signing-In” boards and pens. There is one board for each group of staff.
 As staff arrive they should declare their normal role and sign the appropriate board. They
should then put their name on an appropriate coloured sticker and use the sticker as a name
tag. Each member of staff should then review the action card list to ascertain if they have a
dedicated action card. If they don’t they should be instructed to make their way to the Bearsted
lecture theatre or the area nominated below.
 Ensure that any patients arriving from the Major Incident are redirected to the Emergency
Department Ambulance bay entrance.
 All patients arriving for elective surgery should report to Admissions for further direction.
 Direct any media arriving to the Restaurant
in house alert
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
You will be informed of the Stand down from the Major Incident by the Hospital Control Team either directly or via
the ED Commander
Join the Hospital Support Team Hot Debrief
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 48 of 94
Job Title
Incident Role
Location
Bleep Holder 1490
Theatre Coordinator
3rd Floor Front Block Theatre Reception
Action Card 30
ROLE DESCRIPTION
Working with the Theatre Commander, coordinate all Theatre activity in response to a Major Incident.
INCIDENT STANDBY
Establish how many theatres are working, document this and communicate it to the Theatre Commander. Await
further instructions.
INCIDENT DECLARED
 Collect Theatre Coordinator Tabbard from the Major Incident Cupboard located in the 3rd Floor
Front Block Theatre Reception.
 If advised by the Theatre Commander, cancel all elective Theatre (including obstetric theatre)
at RLH
 Advise teams with cases in progress to stop on completion of that case and await further
instructions.
 Prioritise existing emergency patients who require surgery
 Ensure appropriate level of staffing, include allocation of 5 Anaesthetic support staff to ED
Resus.
 Call in additional staff through emergency cascade if required.
 Ensure that Theatres remain adequately staffed and request staff support from SBH and LCH
as needed
 Allocate a Senior member of staff to liaise with the SBH and LCH Theatres
 Allocate a second member of staff to check stock levels and availability of instrument trays
sterile gowns drapes Theatres scrub suits liaise with Facilities co-ordinator for additional items
required. Obtain additional IV fluids from pharmacy.
 Prepare all theatres to receive casualties.
 Inform Theatre Staff to remain the Theatre rest areas to await further allocation instructions.
 On receipt of information from Theatre Commander, assign theatres and appropriate theatre
staff to cases.
 As incident progresses ensure continual check of all stock and equipment levels. Identify any
shortage to the Facilities Co-ordinator for urgent action.
 Escalate all problems and issues to the Theatre Commander
in house alert
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team
 Inform all Theatre staff and participate in a Hot debrief conducted by the Theatre Commander
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 49 of 94
Job Title
Incident Role
Location
Senior Sister / Senior Charge Nurse ICU
ICU Commander
Senior Sister / Charge Nurse Office ICU RLH
Action Card 31
ROLE DESCRIPTION
Lead the Intensive Care Unit (RLH) response to a Major Incident, coordinating with the ED Commander and
Theatres Commanders and the Silver Commander
INCIDENT STANDBY
INCIDENT DECLARED
 Collect ICU Commander Tabbard and log book from the Charge Nurse Office
 Contact the HCT to establish the basic fact of the incident from the Silver Commander (nature
of the incident, anticipated number of casualties etc)
 Communicate with all staff on the unit and the nurses in charge of the ICUs at SBH and LCH
St. Bartholomew’s ICU 15-7112 or 7728
London Chest ICU 16-2209 or 3228
 Begin ward rounds with the most senior ICU Anaesthetist on site to identify number of empty
ICU beds, number of beds that can be transferred to HDU or a ward, number of staff on duty
that shift and the number of staff on duty for the following shift.
 Agree with the medical staff a plan of action for all ICU patients
 Arrange for all empty / vacated beds to be prepared and checked for patient admission.
 Assess staffing levels, liaise with other units about transfer of staff and equipment.
 Call in extra staff if this appears necessary. On arrival all ICU staff must report to the ICU
Commander.
 Contact the ICU Technicians if out of hours
 Delegate a senior member of staff (usually Resource Nurse) to check stock levels of
ICU equipment
Pharmacy Stock
Consumables
CSSD Items
 Once the unit is ready to accept patients assess the staff available and assign an experienced
member of staff to each vacant bed area.
 Maintain contact with the Sister / Charge Nurse of SBH and LCH ICU’s to ensure planning of
staff, equipment and bed space can be coordinated.
 Ensure regular communication with ED Commander and Theatre Commander to ensure
patient flow is monitored within the hospital.
 Advise Silver Commander of any issues problems or resourcing implications within the
Department.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team
 Inform all Theatre staff and conduct a Hot debrief for the ICU team
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 50 of 94
Job Title
Incident Role
Location
Senior Admin Member of staff
Bearsted Lecture Theatre Leader
Bearsted Lecture Theatre
Action Card 32
ROLE DESCRIPTION
Nominated by the Site Manager, this role co-ordinates all requests for staff from around the Hospital.
INCIDENT STANDBY
INCIDENT DECLARED
 Go to the Bearsted Lecture Theatre
 Keep a log of all staff that arrive
 Staff arriving should be have been allocated a sticky label by Main reception
Junior Doctors / Medical staff - Blue sticky labels
Qualified Nurses - Green sticky labels
All other staff - Gold Labels
Students - Yellow
Volunteers – Pink
 Should staff not have registered at Main reception ensure that they do so before being
reallocated.
 Upon requests for additional clinical and non clinical staff allocated them to the respective area
within the hospital
 Note when and where staff are allocated.
 Keep staff noise to a minimum
 Provide staff with a regular update of events as available from the Site Manager
 Ensure that staff remain within the lecture theatre and do not randomly volunteer their services.
 If additional administrative staff are required contact a senior member of staff at Prescot Street
in hours or Site Manager Hospital Control Team out of hours.
PUBLIC ENQUIRIES
 The Trust Media Liaison Officer (based in the Hospital Control Room) will be the primary point of contact
for all media enquiries. They will provide updates to the media and the public via the Trust Internet.
Additionally they may also update the Trust switchboard message with further information for the public.
 All enquiries by the Press should be directed to the Media Liaison Officer.
 A public information hotline may be set up in response to the Incident this will be co-ordinated through the
Hospital Support Team. If this is done the telephone number will be distributed across the Trust.
Incident stand down
 You will be informed of the Stand down from the Major Incident by the Hospital Control Team
 Inform all staff and conduct participate in the Hospital Control Team hot debrief.
essential numbers
A&E Majors
14-2404 14-2325
Hospital Control Room
14-3890 or 020 7655 4909
Major Incident Plan v 4.1 January 2010
RLH Theatres
14-7224 14-2396
Intensive Care Unit
14-7731 14-7732
SBH Control Room
15-2143 15-2396 15-2826 15-2842
LCH Control Room
16-2395 Bleep 1945
Page 51 of 94
Section 2
This section of the plan describes the processes that
are adopted during the Major Incident.
This section should be read and understood in advance
of a Major Incident and should NOT be read when
response is required
Major Incident Plan v 4.1 January 2010
Page 52 of 94
PURPOSE OF THE TRUST MAJOR INCIDENT PLAN (MIP)
Working along side other agencies it is the purpose of the plan to:
 Save life.
 Relieve suffering.
 Minimise long-term effects on health.
 Protect health and safety of staff.
 Safeguard the environment.
 Maintain core hospital functions to the community wherever possible.
This plan will operate in conjunction with other blue light services and other Category 1
responders under the Civil Contingencies Act (2004).
Underlying Principles of the Plan










The Trust Major Incident Plan (MIP) is the responsibility of the Trust Chief Executive
Officer (CEO) and the Chief Nurse (Executive Director with board level responsibility for
Emergency Planning.)
The Trust has a nominated Emergency Planning Officer (EPO) who is responsible
through the CEO and the Emergency Planning Steering Group (EPSG) for the plan.
The MIP exists as a core document that aims to provide the Hospital’s initial response.
It is supported by local Departmental sub plans that remain the responsibility of the
individual Clinical Divisions and Corporate Directorates and their Boards.
Any modifications to the MIP or local plans must be agreed by the EPO and the EPSG
and where necessary ratified by the Trust Management Executive and Trust Board.
The details of the plan are part of the induction process for all BLT staff.
The plan can be implemented any time, 24 hours a day 365 days a year.
The MIP or local plans do not rely on named individuals but permanent roles that are
present on a 24 hour basis.
The MIP is scalable and can cope with both Major Incidents and Mass Casualty Incidents
as was experienced on 7 July 2005. This plan is therefore also the Mass Casualty plan
for the Trust.
The MIP is shared with other Category 1 and 2 responders under the Civil Contingencies
Act (2004).
Principles of Departmental Sub Plans





Each Clinical Division and Corporate Directorate and their Boards are responsible for
local plans.
Local plans must subscribe to and integrate with the principles and operational details
laid down in the core MIP.
Each directorate should ensure every member of their staff is aware of their role or
potential role in the local plan through its Clinical Governance Programme and induction
process.
Each local plan must have a cascade system for calling in extra staff.
Each Clinical Division or Corporate Directorate should nominate a responsible officer to
annually update and review the local plan and regularly ensure details in the cascade
system are current.
Storage and use of Trust Major Incident Plan



This document is stored and available to all staff on the Trust Intranet.
All areas should hold a hard copy of this document.
All Action Cards as required by staff area should be laminated and available 24/7 for staff
to use.
Major Incident Plan v 4.1 January 2010
Page 53 of 94
PRINCIPLES OF CARE
Following the Trusts response to the 7 July 2005 London Transport Bombings and other Major
Incidents lessons best practice has been identified and lessons learned as to the principles under
which to operate during the initial confusing hours of a Major Incident event.
Whilst every event is different it can be expected that future mass casualty events result in rapid
casualty clearance from scene, and resulting over triage of casualties and a significant surge in
casualties to receiving hospitals. It can also be expected to have communication problems
between scene and between organisations.
Consequently the following principles of care should be considered by all clinical areas within the
Trust.




Surge capacity can be improved by increasing resource availability or reducing resource
utilization
Re-assessment reprioritization and redirection of patients at each stage and should occur
anywhere in the system where resources are constrained.
The principles of damage control should be applied to all aspects of the Major Incident
response e.g. access to CT scanner reduced by delaying all non urgent scans, requests
for blood typing and cross match limited to the most severely injured and significantly
limiting other laboratory tests.
Application of damage control principles should continue in the absence of on scene
information and further casualty numbers.
Major Incident Plan v 4.1 January 2010
Page 54 of 94
1. BACKGROUND
1.1
Definition of a Major Incident
A Major Incident is defined as “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 of
casualties as to require special arrangements to be implemented by hospitals, ambulance
services or Health Authorities”. The National Health Service requires hospital trusts to be able to
mount an effective response to any Major Incident.
1.2
Classification of Major Incidents
Major Incidents can be classified in several ways.
 By the number of victims.
 By the severity of injuries.
 By the ability of the local hospitals to cope with the patient load.
 By the degree of disruption to local communications (a simple disaster has little or no
communication breakdown. A compound disaster has complete communication
breakdown).
 By the nature of the incident e.g. earthquake, tanker explosion etc.
 By the nature and extent of the hazard(s) e.g. chemical, radioactive contamination, gases
- either as a cloud or introduced into an enclosed space.
 Terrorist/civil disobedience/war casualties.
Major Incidents start in a number of ways sometimes beginning in one category and evolving into
another. The response must also evolve appropriately.
‘Big Bang’
Most health service Major Incidents are triggered by a sudden major transport or industrial
accident. The ambulance service and receiving hospitals will be the first responders. Wider health
implications may not be immediately obvious, so the Strategic Health Authority (SHA) must be
notified of all Major Incidents. Some incidents begin as a small bang, but escalate into an everlarger series of incidents, as might occur with a crash on a fog bound motorway.
‘The Rising Tide’
Here the problem creeps up gradually. An example might be a developing infectious disease
epidemic or a winter bed crisis. There is no clear starting point for the Major Incident and the point
at which the outbreak becomes ‘major’ may only be clear in retrospect. Influenza pandemics
have occurred at intervals varying between 11 and 42 years. In 1957 the ‘Asian flu’ took six to
seven months from first being isolated in China to the peak of the pandemic in the UK where
there were an estimated nine million cases. Because of increased international travel, global
spread of the next pandemic could reasonably be expected to be faster. The World Health
Organisation (WHO) suggest that plans should be in place against a pandemic causing illness in
50% of the population.
A medical Major Incident almost resulted from a sudden release of allergens after a summer
thunderstorm, causing hundreds of patients with asthma to present to ill-prepared hospitals
without enough nebulisers.
'Cloud on the horizon’
An incident in one place may cause an incident “at a distance”. Preparatory action is needed in
response to an evolving threat elsewhere, even overseas. For example, a major chemical or
nuclear release, a dangerous epidemic or an armed conflict involving British troops. Extensive
planning for casualties for the 1991 and 2003 Gulf Wars took place because there was a real
possibility that the NHS would have to mount an exceptional response.
‘Headline news’
A wave of public or media alarm over a health issue (or a reaction to a perceived threat) may
create a Major Incident for the health service even when fears are unfounded. The issue may be
minor in terms of health risk (e.g. the side effects of the contraceptive pill) but can cause huge
public alarm. If well handled with clear instructions and accurate information, no Major Incident
will accrue; if mishandled, it probably will.
Major Incident Plan v 4.1 January 2010
Page 55 of 94
Internal incidents
The hospital itself may be affected by an internal Major Incident or by an external incident that
impairs its ability to work normally. A fire, breakdown of utilities, major equipment failure, hospital
acquired infections or violent crime may paralyse the provision of services and jeopardise safety
arrangements in the short term and erode staff morale and public confidence in the longer term.
Terrorism
Chief constables (usually the Commissioners of the Metropolitan Police) are required to consult
health authorities as soon as they become aware of a deliberate threat to the health of the public.
In the past, this has involved the deliberate release of chemical, biological radiological or nuclear
materials (CBRN). This may come from terrorist or dissident groups or disaffected individuals.
The threat could be real or a hoax. Directors of Public Health are responsible for informing the
hospital, although in practice, the hospital may already be affected by the incident.
Major Incident Plan v 4.1 January 2010
Page 56 of 94
2. ALERTING PROCEDURE INTERNAL AND EXTERNAL MAJOR INCIDENTS
2.1
Sources of an Alert
The London Ambulance Service will alert the Emergency Department through the designated
Major Incident Line (located in A&E Majors next to Resus). This is routed through one of two
separate exchanges and is monitored and recorded by switchboard. The most Senior Nurse on
duty should answer the telephone. All messages should be recorded on the appropriate form,
dated, timed, and signed by the recipient; they will be used for debriefing purposes later. Only
LAS and NHS London can declare a Health Major Incident.
2.2
How a Major Incident Is Declared within the Trust
The Trust can self declare both an Internal Major Incident or a Major Incident. An Internal Major
Incident should be declared if the impact of an internal incident is of significant proportions to the
Trust to require the Trust to put in place special arrangements. Additionally the Trust also has the
ability to declare a Major Incident. This would be an incident of significant proportions as to affect
not just the Trust but the wider health community or other Category 1 responders under the Civil
Contingencies Act. In this instance the Trust should declare the Major Incident by contacting the
SHA on call Director. (see diagram on next page for more details)
To declare an Internal Major Incident:
 Either in or out of hours the RLH Site Manager is initially contacted (bleep 1111)
 who escalate to the Silver on call manager (pager bureau number 07659 105481)
 who if necessary escalate to the Gold on call Director (pager bureau 0844 822 2888 call
sign BTLAC1).
The on call Director is the only person able to declare an Internal or Major Incident for the
Trust. They would contact switchboard and instigate the Major Incident on call cascade
2.3
Messages that Switchboard Cascade
To ensure clarity during a Major Incident four standardised messages are available for
Switchboard to send out on the Major Incident cascade.
These are as follows:
1.
Major Incident Standby (cause xxxxxxxxxx): stand by for more information
2.
Major Incident Declared: Please report to RLH Main reception
3.
Internal Major Incident Standby (cause xxxxxxxxxx): standby for more information
4.
Internal Major Incident Declared (cause xxxxxxxxx): Please report to RLH Main reception
Irrespective of the cause of an Internal or Major Incident the full Major Incident Plan should be
activated.
2.4
Receiving Hospitals
At the time the LAS advise the Trust that they should declare a Major Incident the hospital cannot
decline to be included as a “receiving hospital”, regardless of its bed state. (Subsequently, the
Hospital Control Team may request the Medical Incident Commander (MIC) at scene to direct
patients to other “receiving hospitals” if the patient load is too heavy.)
Once a Major Incident has been declared by the LAS they will contact a minimum of two hospitals
near the incident. They will be asked to activate their Major Incident Plan. At this point the
hospitals are known as receiving hospitals.
Further receiving hospitals may be asked to declare their plans by the MIC or Ambulance Incident
Commander (AIC) at the scene when more information on the number and type of casualties is
available.
Major Incident Plan v 4.1 January 2010
Page 57 of 94
2.5
Internal Major Incident and Major Incident Initial Actions Diagram
Internal Major Incident
Significant Incident who’s
affect is contained within
the Trust
Major Incident
Significant Incident which
will have a significant
affect on other health
organisations or other
Category 1 Responders
under the CCA*
Consider Internal Major
Incident Standby
If not suitable
Declare a Major Incident
within the Trust
Declare a Major Incident
within the Trust
If not requiring a clinical
response immediately
contact A&E / Main
Reception and Theatres so
that clinical teams are not
called in.** Send runners
into these areas to explain
the reason and necessary
actions
Follow the Action cards as
noted within the Major
incident Plan
Inform the SHA that an
Internal Major Incident
has been declared
Inform NHS London that
the Trust is declaring a
full Major Incident***
Respond to the Major Incident
* Category 1 responders under the Civil Contingencies Act includes: Police, Fire, Ambulance Services, Acute
Trusts, Primary Care Trusts, Local Authorities, Environment Agency and others.
** There is only one way of declaring a Major Incident (Internal or external) in the Trust. For internal non clinical
incidents the Major Incident cascade which needs to be used will still be the same as for a clinical incident.
*** In cases where an internal Major Incident is declared, and the hospital is unable to keep its ED open, then
the hospital will need to inform the LAS and NHS London Gold via NHS01. The ED will be considered as closed
and no further ambulance bourn patients will be brought to that ED until LAS is notified that the crisis has
passed. The on-call hospital director MUST then inform the LAS of the expected timescale of the closure/next
review
Major Incident Plan v 4.1 January 2010
Page 58 of 94
2.6
Major Incident Terminology
Major Incident Standby
In addition to being asked to declare a Major Incident the Trust may be asked to activate a Major
Incident Standby alert. The standby message allows Trust staff to prepare to respond. Further
information from the emergency services (or the hospital itself) allows the plan to be formally
declared or cancelled following a standby.
It is the responsibility of the person receiving the alerting call (either Gold on call if via NHS
London or ED Senior Nurse if via LAS) to ensure that the relevant form is completed and to
inform switchboard that the hospital is on “Major Incident Standby”. The switchboard operator will
then contact the relevant personnel as directed by the switchboard operator's action card.
Major Incident Cancelled
In the event that a Major Incident response is not required, the “Major Incident Standby Message”
will be superseded by a “Major Incident Cancelled Message”. This should be taken by the Senior
Nurse in ED on the appropriate form. The message is then conveyed to switchboard who contact
the relevant people who were originally given notification of the standby message.
Major Incident Declared
Further information from the Emergency Services may state that a Major Incident has been
declared or this may be the original call. Once again a Senior Nurse should take the call and
complete the appropriate form. Switchboard should then be contacted and asked to activate the
Major Incident Plan.
Major Incident Messages
Messages from the emergency services may be passed through the Major Incident phone before
the Ambulance Liaison Officer is in post in the HCT. The Senior Nurse should take the call and
write the message on the appropriate form. This should then be passed to a member of the HCT.
All the forms relating to information passed via the Major Incident phone should be held by the
HCT as they will constitute a formal part of the debriefing procedure after the event.
Major Incident Stand down
Once it has been determined by the Hospital Control Team that the response to the Major
Incident has finished the Hospital Control Team declare a Major Incident Stand down. This
informs all appropriate staff that they will be returning to their usual clinical and non clinical
practices and procedures. This stand down phase is described in more detail later within this
document.
Major Incident Plan v 4.1 January 2010
Page 59 of 94
3. INTERNAL MAJOR INCIDENTS & “A&E DIVERTS”
3.1
Definition
An incident which causes serious disruption to the normal function of the hospital, such that
patients and /or staff are at risk of morbidity and/or mortality as a result of the disruption. This
may prevent part or all of the hospital from performing its normal function.
A full Major Incident could be declared as a result of an Internal Major Incident. For example, an
Internal Major Incident may be declared as a result of the forced evacuation of a hospital building.
However should the evacuation be on a larger scale such as the full evacuation of a site then the
implications for other NHS Trusts and the LAS would be significant and therefore the evacuation
would warrant being declared as a full Major Incident.
3.2
Introduction
Many minor incidents occur on a day-to-day basis. These are common but easily countered.
Failures of power supply, steam shutdowns lift failures and the like are examples. They happen
commonly enough for the hospital response to be well rehearsed and effective.
Some incidents fall between the minor and the catastrophic. These may be predictable or
unpredictable.
 Fire may destroy part of the hospital.
 Power Failure of all or significant parts of the hospital.
 Loss of piped oxygen or medical air.
 Flooding may prevent effective normal function, placing patients at increased risk.
 Criminal activity may necessitate isolation of parts of the hospital.
 Chemical, biological or nuclear contamination, which may be partial or complete, may
restrict the use of the hospital.
 ICT failure may severely hamper all computer use.
There are an enormous number of possibilities which fall into this “middle” classification and
which require special arrangements by the Trust.
3.3
Principles
The incident should be managed and controlled by the HCT from a single control centre.
 The Royal London Hospital Control Room (Renal Seminar Room) would be the usual
focus for the control centre unless compromised to the extent that it was unable to
function normally.
 The control centre should normally be within the hospital site, providing disruption to
communications does not dictate otherwise.
 The same members of the team are used in the same roles as if a normal Major Incident
had occurred.
 Patients should be decanted to other areas within the Trust or other Trusts as required by
clinical need and the areas of the Trust that are disabled.
 Should hospital evacuation be needed the Rendezvous Points and Emergency Services
Control Points for the other blue light services will be placed as near to the HCT as
possible.
Major Incident Plan v 4.1 January 2010
Page 60 of 94
3.4
Actions for Gold Commander to consider

Action for Gold to consider
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Always consider activating Major Incident standby before declaring full Major
Incident if unsure whether situation warrants full declaration.
Gold to cascade Internal Major Incident alert to all appropriate staff by
switchboard. Silver to ensure that staff are available at the Major Incident muster
points (ED staff room, ED reception, RLH main reception and Bearsted Lecture
theatre) to fully brief staff that arrive in response to the Major Incident cascade.
Consider if the Internal Major Incident will have significant implications for other
category one responders. If it does, the Trust has the authority to declare a full
Major Incident. This should be done by communicating firstly to the SHA and
secondly the LAS.
Discuss with Silver whether a blue light divert (emergency cases) or full closure of
A&E to all LAS traffic is required. *
Where other areas of the Trust structure (e.g. ICT) are instrumental in resolving
the incident, ensure that they are appropriately staffed and managed to ensure as
speedy a resolution as possible. Consider co-locating with them if appropriate or if
not ensure that a member of the responding team is located in the HCR as a link
person
Consider what additional resources could be requested from the SHA or from
other Trusts to resolve the situation. Communicate to these organisations as early
as possible that their help may be requested.
Consider what additional resources could be requested from outside of the NHS,
determine lead times for these. Costs should not be considered as a determining
factor in the procurement of resources to resolve an Internal Major Incident.
Chair regular meetings of the Hospital Control Team, ensure that actions agreed
are followed up at the following meeting
Ensure that the Internal Major Incident response planning for the next week to 10
days is considered as soon as possible, and not on a day by day basis.
Ensure that where ever possible the Major Incident response continues on a 24/7
basis. This should include making allowances for staff returning home to rest
before coming back into the Trust out of normal working hours.
Consider the timing and any residual risks to the organisation of declaring Major
Incident Stand down.
Consider what resources will be needed to fully recover from the Internal Major
Incident for the period following the Internal Major Incident stand down
When appropriate Stand down the Trust from the Internal Major Incident
Ensure that appropriate messages of thanks are communicated to every person
that responded to the Internal Major Incident
Note
* Blue light call should only be requested when the hospital is unable to provide Resuscitation facilities due
to infrastructure failures, for example flood electrical failure or fire. Closure of an ED should only be
considered as a last resort as it may subject the most seriously ill of patients to increased clinical risk as a
result of travelling further to receive immediately life-saving treatment. GP calls will be expected to be sent
directly to a ward or Admissions Unit rather than via A&E, if practical given the nature of the infrastructure
failure.
In cases where an internal Major Incident is declared, and the hospital is unable to keep its ED open, then
the hospital will need to inform the LAS and NHS London Gold via NHS01. The ED will be considered as
closed and no further ambulance bourn patients will be brought to that ED until LAS is notified that the crisis
has passed. The on-call hospital director MUST then inform the LAS of the expected timescale of the
closure/next review.
The Chief Executive, or their nominated deputy, needs to notify the NHS London NHS01 of their intention to
close as a result of an internal Major Incident, the reason for this closure, and expected duration.
Major Incident Plan v 4.1 January 2010
Page 61 of 94
3.5
Actions for Silver Commander to consider

Action for Silver to consider
1
2
3
4
5
6
7
Gold to Cascade Internal Major Incident alert to all appropriate staff by
switchboard. Silver to ensure that that staff are available at the Major Incident
Muster points (ED staff room, ED reception, RLH main reception and Bearsted
Lecture theatre) to fully brief staff that arrive in response to the Major Incident
cascade
Determine whether the internal incident requires a direct clinical response. If not
consider how best to ensure that the clinical care is continuously risk assessed
as part of the internal Major Incident response. (This should be through the
Divisional Directors, Divisional Nurses and Heads of Operations.)
Discuss with Gold whether a blue light divert (emergency cases) or full closure of
A&E to all LAS traffic is required. *
Ensure that two members of the Silver on call rota are located at SBH and LCH as
the SBH and LCH Site Co-ordinators
Ensure that the RLH Site manager, LCH and SBH Site Co-ordinators are briefed
immediately following a meeting of the HCT.
Ensure that situational reports are gathered from all areas of the hospital
throughout the internal Major Incident, an internal situation report is included within
Section 4 of this plan)
Ensure that staff including Capital Hospitals are communicated with as soon as
possible. (This will be organised through the Duty Media Liaison Officer or another
member of the Communications Department
Note
* Blue light call should only be requested when the hospital is unable to provide Resuscitation facilities due
to infrastructure failures, for example flood electrical failure or fire. Closure of an ED should only be
considered as a last resort as it may subject the most seriously ill of patients to increased clinical risk as a
result of travelling further to receive immediately life-saving treatment. GP calls will be expected to be sent
directly to a ward or Admissions Unit rather than via A&E, if practical given the nature of the infrastructure
failure.
In cases where an internal Major Incident is declared, and the hospital is unable to keep its ED open, then
the hospital will need to inform the LAS and NHS London Gold via NHS01. The ED will be considered as
closed and no further ambulance bourn patients will be brought to that ED until LAS is notified that the crisis
has passed. The on-call hospital director MUST then inform the LAS of the expected timescale of the
closure/next review.
The Chief Executive, or their nominated deputy, needs to notify the NHS London NHS01 of their intention to
close as a result of an internal Major Incident, the reason for this closure, and expected duration.
3.6
Possible Locations for the HCT during an Internal Major Incident
Dependent upon the nature of the Internal Major Incident the location of the HCR may need to be
considered
 If possible this should remain in the Hospital Control Room (Renal Seminar Room)
 The First Floor Meeting Room John Harrison House has duplicate lines that are found in
the Primary Hospital Control Room (Renal Seminar Room) that would be used in a Major
Incident.
 Additionally locations at Barts and the London Chest have been identified. These are the
Site Managers office at Barts and the Education Centre at the London Chest Hospital,
these locations have some resilience in telephony and data communications however
currently not as good as at the Royal London site. Over the next year this will be
improved.
 Should none of these be suitable a mutual aid arrangement has been agreed with Tower
Hamlets PCT and Tower Hamlets Local Authority to make use of their facilities should
they not be required at the same time.
3.7
A&E or Blue Light Diverts resulting from capacity issues
Acute trusts cannot make a decision themselves to close to blue calls as a result of lack of ITU,
HDU, CCU, general or acute bed capacity. If a trust wishes to close its ED due to capacity issues
then the trust Chief Executive or Gold on call Director will need to request this personally from
Major Incident Plan v 4.1 January 2010
Page 62 of 94
NHS London Gold. * NHS01 can be contacted via 0844 822 2888 and ask for NHS01 then leave
your contact details.
Following agreement from NHS London Gold that a trust may close their ED as a result of
capacity issues then NHS Gold will inform LAS Gold.
3.8
A&E or Blue Light Diverts resulting from infrastructure issues
Please refer to section 3.4 and 3.5 and the note section within each.
Major Incident Plan v 4.1 January 2010
Page 63 of 94
4. HOSPITAL CONTROL TEAM
4.1
Team Makeup
This team is formed to manage the whole Trust’s response to the incident.
The Team consists of:








Gold Commander
Silver Commander
Facilities Co-ordinator
Media Liaison Officer
Family and Acute Representative (only present for HCT meetings)
Regional Representative (only present for HCT meetings)
Clinical Diagnostics Representative (only present for HCT meetings)
Admin Support Team Leader (for minuting the meetings)
The representatives from the Clinical Divisions should be either, the Divisional Director, Divisional
Nurse or Divisional General Managers. Only one person should represent each Clinical Division
and should only be present during HCT meetings.
When an incident occurs out of hours the initial staff taking on the roles as noted above may not
be the optimum designated people. As the identified on call members of staff arrive into the
hospital they will take over from those that have stood in. Additionally during the initial minutes /
hour of the incident on call members of staff may be carrying out their roles remotely as they
travel into the hospital site.
4.2
Responsibilities
During a Major Incident the Director on call (Gold Commander) will lead the Trusts response to
the incident in place of the Chief Executive. Should the Chief Executive wish to lead the response
then a change in Gold Commander should be noted within the Major Incident Log.
The Gold Commander will have overall responsibility for the Major Incident response but will
concentrate on leading the strategic decision making for the Trust and liaising with outside
organisations such as the PCT. The Silver Commander will oversee the operational response to
the Major Incident. They will be supported by the Gold Commander who has ultimate
responsibility.
Changes in personnel during a Major Incident can be made at any time with the agreement of the
person relinquishing and the person taking over the role. Changes will be necessary for incidents
of a protracted nature and where a 24/7 response is required. Changes should be documented
within the appropriate Major Incident Log.
The ED Commander, Theatre Commander and ICU Commander will lead the Operational
response within their respective areas and feedback progress, problems and issues to the Silver
Commander. Furthermore the Site Coordinator SBH and Site Coordinator LCH will lead the
response at St Bartholomew’s and London Chest respectively and also feedback progress,
problems and issues to the Silver Commander.
Action cards for the Gold Commander, Silver Commander, Facilities Co-ordinator, Medial Liaison
Officer and Admin Support team Leader are noted within Section 1 of this plan.
The Clinical Divisional representatives will continue to have responsibilities as noted within their
job descriptions and will provide feedback to the other members of the HCT on the Major Incident
response recovery and impact. They will not be based within the HCR but will attend all HCT
meetings.
4.3
Location
The primary location for the team is the Renal Seminar Room, Ground Floor, Alex Wing, Royal
London Hospital.
Major Incident Plan v 4.1 January 2010
Page 64 of 94
The secondary location is the Doctors on call Flat. (Please note this is likely to change by
Summer 2009 to the Ground Floor Meeting Room John Harrison House when the room is fully
commissioned a revision to this plan will be disseminated)
Telephone numbers and contact details for these locations can be found in Section 1 of this plan.
4.4
HCT Meetings
The HCT will meet formally to review progress. This meeting should be appropriately minuted, as
noted within the Documentation and Record Keeping section of this plan. This should be carried
out by the Admin Support Team Leader.
During meetings of the HCT the Site Manager and members of the Admin Support Team will
continue to run the incident. The Site Manager will have responsibility to make appropriate
decisions but will escalate to the Silver Commander if needed.
4.5
Others located in the HCR
A small team of staff will be needed to administratively manage the flow of information within the
control room. Their responsibilities are noted within the Admin Support Team Action card. Any
administrative member of staff should be able to carry out these instructions.
In order to best respond to the Major Incident other organisations will send representatives to the
Trust. Notably Tower Hamlets PCT will send a Director to the Trust throughout the duration of the
Major Incident or as long as necessary. Additionally a senior police and ambulance officer will be
present in the Control Room in order to assist with communications to the Police and Ambulance
services. The senior police officer will also oversee all the activities of the Police Documentation
Team and provide any interface between the Trust and the Central Casualty Bureau.
Major Incident Plan v 4.1 January 2010
Page 65 of 94
5. SUMMARY OF ACTIVITY RESPONDING TO THE MAJOR INCIDENT
5.1
Hospital Control Team
Gold Commander
To lead the Trusts Strategic response to the Major Incident and support the Silver Commanders
Tactical decision making. The Gold Commander is responsible for analysing the overall impact of
an incident on staff, patients and services, ensuring that the Trust response is proportionate and
planning the return to normality.
Silver Commander
To lead the Trust’s operational activity and free the On Call Director to take a strategic view as
the Trust Gold Commander. The Silver level operation is the supporting operation.
Media Team
The Media Liaison Officer will be responsible for managing the media. This will include ensuring
that they remain in their designated areas and providing regular statements, which have been
agreed by the Hospital Control Team. They will also be responsible for the provision of an on-call
service in the days following an incident to monitor and agree press activity, arrange interviews
and VIP visits.
Facilities Co-ordinator
Coordinates the functions of the FM services during a Major Incident to ensure that these
functions support the hospitals Major Incident response both during and following the incident the
Facilities Co-ordinator is based with the Hospital Control Team.
5.2
Emergency Department
Triage Team
Consisting of a Doctor a Nurse and a Receptionist, this team will Triage all patients arriving at the
Royal London Hospital.
Resuscitation Room Team
The Theatre Commander Resus Team Leader and Anaesthetics Lead roles work together within
the Resus Department to review the care and prioritise the necessary patients for surgery. These
roles will identify specific surgeons and anaesthetists to carry out specific procedures for each of
the patients. Consequently the roles of Theatre Commander and Anaesthetics Lead should be
undertaken by the most senior Surgeon and Anaesthetists available. Where more senior
surgeons and anaesthetists respond to the Major Incident call out they may replace the initial
action card holders.
The Theatre Commander will liaise with the Theatre Co-ordinator (who is based on the Third
Floor Theatres reception) on the timings and order of each patient being sent to Theatres.
The Resus Team Leader will organise the appropriate ED staff into resuscitation teams that will
care for one Resus patient. Each team will be led by a Team Leader, and also contain one
anaesthetist that will be organised by the Anaesthetics Lead.
ED Majors Team
The ED Commander will nominate a senior clinician to oversee the management of patients in
this area. This clinician will be the ED Majors Team Leader.
ED Minors Team
The ED Commander will nominate a senior clinician to oversee the management of patients in
this area. This clinician will be the ED Minors Team Leader. They will be responsible for any
expansion of the Minors area into the Fracture clinic and Out patients Department, Ground Floor
(west side). This expansion will be determined by the scale of the incident as well as the numbers
of casualties that are received. Expansion of the Minors area into the Fracture clinic and use of
the Walk In Centre should be reviewed and discussed with the ED Commander.
Paediatrics Team
Located in A&E this team will lead the care of all paediatric patients whilst within the ED.
Major Incident Plan v 4.1 January 2010
Page 66 of 94
5.3
Theatres
Theatre activity is supervised by the Theatre Coordinator in conjunction with the Theatre
Commander (who is located in Resus). The Theatre Co-ordinator is located in Theatre Reception
3rd Floor Front Block RLH. The will prepare Theatres and allocate staff to receive patients and
allocate Anaesthetic Support Staff to Resus.
5.4
Intensive Care Team
The Intensive Care Unit (ITU) will make available as many beds as possible. Satellite ITUs may
be set up in areas where patient ventilation is required. The ITU team in liaison with the
Anaesthetic coordinator and the duty nurse will assign medical and nursing staff to these areas.
The ITUs at St Bartholomew’s Hospital and The London Chest Hospital will be expected to make
space and take decanting patients or patients from the Major Incident. The LCH 1945 Bleep
Holder has pre identified locations for additional ventilated beds on site with piped oxygen and air,
wall suction and monitoring facilities. The ICU Technician will be called in to support this action.
5.5
Hospital Support Team
The Support Teams functions are to ensure the safe discharge of patients who have been
declared medically fit and to support the relatives of those seriously injured or dead. They are
located in the Out Patients Department, Restaurant and the Multi faith Chapel (Front block).
5.6
Mortuary
To ensure sufficient space is available in the event that the incident generates a high mortality
rate. The Royal London Hospital has capacity for 65 bodies. If necessary transfers can be
arranged to St. Bartholomew's Hospital (21 spaces), The London Chest Hospital (6), Mile End
Hospital (25), or through the external contractors to the Trust Cribbs, for 30 spaces. There is also
space within the grounds of the London Chest Hospital site to place a mobile mortuary (there are
two positions on site with external electrical hookup, each has a different electrical output.
Note: The Royal London Hospital is not a designated hospital for fatalities at the scene of an
incident. (The Chelsea and Westminster Hospital has spaces for 150 bodies)
5.7
Pharmacy
Access to stocks of antidotes and vaccines will either be by the Hospital Pharmacist on extension
14-7478, bleep 1441 or facsimile 14-7412 (Drug Information), Monday to Friday during office
hours, or by the on-call pharmacists via switchboard out of hours. In certain circumstances
dependent on requirements the Hospital Control Team will check that LAS have requested the
required antidotes/vaccine from the National Blood Service.
5.8
Runners / Loggists / Marshalls / Security
Volunteers or students have an important role to play and will be allocated to key areas by the
HCT. They can be used for any of the following roles:
Runners
Move information physically around the hospital, either to individuals or teams. They should be
co-ordinated by the HCT and can be made up of any member of Trust staff that is physically fit
and has knowledge of the site to which they are allocated. Runners will wear a Major Incident
tabard supplied by the HCT.
Loggists
Record and document the decisions information and actions of the people within the identified
area to which they are allocated within the Trust
Marshalls
Direct patients from one area of the hospital to another to ensure that the patient flow is
maintained during the Major Incident
Security
Major Incident Plan v 4.1 January 2010
Page 67 of 94
Where necessary volunteers can be used to bolster the number of security that the Trust has
available. Where this is the case they should be buddied with a fully trained member of the Trust
Security Team
All volunteers should sign in at the Main Hospital Reception and wait in the Bearsted Lecture
Theatre.
Major Incident Plan v 4.1 January 2010
Page 68 of 94
6. CONTRACTED SERVICES
During a Major Incident the Facilities Co-ordinator takes over responsibility for the direct
management of the services that are contracted to the Trust through Capital Hospitals, but
specifically:
6.1
Switchboard (Carillion)
Have a vital role to play in the Major incident Cascade procedure and managing the subsequent
influx of calls. Once a Major Incident is over they should send out the Major Incident Stand down
or Cancelled cascade. Additionally switchboard have the responsibility to check the accuracy of
contact details and regularly test the call out system.
6.2
Porters (Carillion)
Portering staff need to provide an immediate response to the ED Department in preparing the
department to receive casualties and their subsequent movements around the hospital. They will
respond to requests from the Facilities co-ordinator.
6.3
Security (Carillion)
Security staff are responsible for controlling the flow of staff, patients and relatives into the
hospital as well as the placement of appropriate warning signs and cordons as specified in their
action cards for both major and chemical incidents. They will also be responsible for opening in
hours only areas of the hospital should a Major Incident occur out of hours and be required (eg
Out patients department for the Police Documentation Team.
Where security require assistance from the Police this should be arranged through the Facilities
Co-ordinator.
6.4
Catering (Carillion)
Will ensure refreshments are available for relatives, patients who have been treated and staff in
key areas as well as maintaining a normal service for inpatients.
6.5
Central Sterile Services Department (CSSD) (Synergy)
Ensure sufficient instrumentation is available for A&E, theatres, ITU, HDU and the receiving
wards.
6.6
Estates (SFS)
To respond to requests from the Facilities Co-ordinator.
6.7
Supplies (Receipt and Distribution) (Carillion)
Stock items can be ordered from NHS Supplies Enfield, this is a 24-hour on-call service. The
Trust has its own Procurement Department.
6.8
Domestic Services (Carillion)
Will coordinate an appropriate response from the service, and initiate extra services within the
Emergency Department where necessary.
6.9
Transport (Carillion)
To respond to requests from the HCT.
Major Incident Plan v 4.1 January 2010
Page 69 of 94
7. POLICE DOCUMENTATION TEAM (PDT)
The PDT allocated to The Royal London Hospital will be based on the Ground Floor (West side)
Out Patients Department of the Royal London Hospital with an additional desk located in the ED
Secretaries Office,
Extensions 14-3370
or direct dial, 020 7377 7728 / 7161
Facsimile 020 7377 7014.
They will receive information from the HCR and disseminate information to the separate Central
Casualty Bureau which is equipped to answer large numbers of enquiries very quickly. Details of
casualties must be given to the police quickly and efficiently to allow the Police Information
Bureau to respond. The police will help establish the identity of casualties and transmit the
information to the Police Casualty Bureau. The police team require dedicated telephone lines,
including direct lines for facsimile use.
In the event of the death of a patient the Admin Support Team will inform the PDT who will be
responsible for collecting the relatives to identify the body. Once identification is confirmed the
PDT will ask the HCT to send an appropriate clinician to answer any questions the relative may
have about the patient’s treatments and injuries.
The team are also responsible for informing the coroner and involving the support team to
arrange the appropriate care for the relatives.
7.1
Forensic Evidence
Forensic evidence includes bandages applied at the scene of an incident, Blast fragments,
amputated limbs etc. All of these should be bagged and labelled in evidence bags supplied by the
Police Documentation Team and should remain with the patient until correctly claimed by the
Police.
7.2
Patients Property
Where necessary to remove patients property these should also be bagged and labelled as well
as photographed so that ease of return to the patient can be facilitated after the incident. Property
should remain with the patient. In the unfortunate circumstances where a patient dies the property
should be moved with the body to the mortuary department.
7.3
Disclosure of Information / samples
Staff may be contacted by the police for information concerning patients. It is important to
remember that the confidentiality of the patient is paramount, and no information should be
released without consent from the patient. When a patient is unconscious or incapable of
consenting, information should only be released by staff if deemed in the patient’s “best interests”
to do so.
However release of the information is required by law:
 Notifiable diseases must be reported under the Public Health (Control of Disease) Act
1984
 Some road traffic accidents when the identity of the driver must be provided. A request
under section 172 of Road Traffic Act 1988 will be required
 Prevention of Terrorism Act 1989
 In response to a court order or request from a Coroner
In the public interest:
 When a serious crime has been committed and the failure to disclose information may
expose the patient, or others, to the risk of death or serious harm.
Major Incident Plan v 4.1 January 2010
Page 70 of 94
8. MEDIA
Media handling must be seen as an integral part of emergency planning.
 relations with the media need to be managed so that the media can do their job
effectively and the hospital can concentrate unhindered on its core business.
 the media are the main - sometimes the only - source of information for the public in an
emergency. In the early stages, this will include families of those involved.
 the media reach millions of people - it is important to ensure they have accurate, timely
information.
Consequently the role of the Media Liaison Officer is vital, this is undertaken by an on call
member of the Communications Department to act as the Media Liaison Officer
8.1
Principles Underlying Press Officer Role



Plans are linked into any local multi-agency press briefing arrangements, run by police or
local authorities.
The on-call Press Officer has up-to date 24-hour contact numbers for Emergency Service
press officers, SHA on-call contact, Press Association, and other members of the
Communications Team.
Has a simple pre-prepared, easily digestible information handout about the hospital (e.g.
size, staff numbers, specialties, names and positions of key people).
The Press Officer does not have a remit to discuss or speculate how the incident occurred or to
comment on other people or agencies involved in the incident.
8.2
Telephone Enquiries
Switchboard operators should direct all enquiries through to the HCT.
8.3
Location For Media
The press will be located outside the hospital where possible. The location is likely to be the
raised walkway between the Walk In Centre and the Temporary Restaurant. This may vary due to
building works. Should an internal location be needed for a press conference, the Staff
Restaurant will be used. The Media Liaison Officer will give them regular updates and will put
appropriate staff up for interview.
8.4
Media Briefings
The first statement to the media should give the known casualty figures and confirm any details
that are known. Information “on behalf of other NHS bodies, (other receiving hospitals or the
ambulance service) must not be given unless authorised to do so. The Media Liaison Officer will
not comment on the response of other NHS or non-NHS organisations.
Major Incident Plan v 4.1 January 2010
Page 71 of 94
9. CHILDREN
9.1
Application to Children
The Major Incident Plan applies in general to incidents, which include children, however some
incidents may have a high proportion of children or be exclusively children. Children should be
treated by paediatric trained anaesthetists, surgeons, orthopaedic doctors, and ED nurses if
possible.
Bailey ward will be used for admitting Major Incident Paediatric patients.
9.2
Background
Differences between Children and Adults require some modifications to the plan:
 Physiological differences mean that triage must be adjusted, in order to prevent overtriage based on factors such as heart rate or respiratory rate.
 Psychological differences mean that Priority 2 and 3 children should be nursed whenever
possible by children’s trained nurses and protected from distressing scenes.
 Physical differences mean that sufficient equipment must be available to deal with a large
number of children of a similar age (e.g. incident in school classroom or bus).
In most instances the general MIP remains appropriate for a paediatric incident. Priority 1 children
are treated in the adult resuscitation area, Priority 2 children may be treated in ED Majors (see
below), preferably in cubicles with doors as well as in Paediatric ED. Movement to X-ray and
transfer to wards should be conducted expeditiously – avoiding unnecessary exposure of children
to injured adults.
9.3
Differences from Adult MIP






The high-dependency ER room in paediatric ED may be considered an extension of A&E
Majors.
Priority 3 children are treated in the paediatric ED play area rather than the fracture clinic.
The Paediatric Registrar on duty in Paediatric ED will be contacted to move all patients
from the Ambulatory Care Unit, as this becomes the admission unit.
Grosvenor B Ward will be prepared and utilised.
Nursing staff from the paediatric surgical wards and HDU may be recruited to these
areas.
The paediatric Senior Nurse/Matron must be notified.
Initially, children requiring ventilation/PICU will be accommodated on RLH ITU if resources allow,
or transferred to Great Ormond Street or Guy’s Hospital. Families of children being treated, if not
requiring treatment themselves, should wait in the Ambulatory Care Unit.
The main responsibility of medical paediatric staff is to clear ward areas and to back up the
paediatric ED staff with Priority 2 and 3 children. Paediatric ED SHOs are responsible for treating
Priority 3 children in paediatric ED.
9.4
Equipment
Equipment in the MI equipment Cupboard is also capable of dealing with critically ill or injured
children.
Major Incident Plan v 4.1 January 2010
Page 72 of 94
10. MASS CASUALTY EVENT
10.1
Definition
The Department of Health defines a Mass Casualty as:
A disastrous single or simultaneous event(s) or other circumstances where the normal Major
Incident response of several NHS organisations must be augmented by extraordinary measures
in order to maintain an effective, suitable and sustainable response
10.2
Hospital Response
The hospital response, though similar to the usual Major Incident response, requires the provision
of more staff and equipment but most importantly a more pragmatic “no frills” approach to patient
management and the utilisation of resources at least in the short term.
This Trust MIP is designed to be scaleable and cope with an increasing number of casualties
over and above normal Major Incident numbers. Training and exercising is conducted regularly at
this scale.
10.3
Clinical Care
The approach to the critical care patient must change, as access to sophisticated equipment will
be limited for example, infusions should be replaced by longer lasting bolus agents. The normal
ratios of doctors and nurses to patients will change, one critical care trained nurse or doctor may
over see several critical care ventilated patients. Non-critical care trained personnel may be
required to look after critical care patients overseen by a critically care trained member of staff
acting as a team leader.
Space may have to be used more efficiently, shortages of trolleys may require the management
of patients on mattresses on the floor with the doubling up of cubicle spaces in the short term.
10.4
Priority 3 – Walking Wounded Casualties
During a Major Incident the numbers of P3 patients is likely to make up the largest proportion of
the casualties received. As such the ED Minors department is designed to be expanded into
firstly the Fracture clinic, then use the Walk In Centre and then the Out Patients Department.
10.5
Priorty 4 – Expectant
During a Mass Casualty event it may be necessary to use the Triage Category of P4. This would
be used for casualties whose injuries are so severe that they either cannot survive in the
circumstances or would require so much care that their treatment would seriously compromise
the treatment of large numbers of other less seriously ill casualties. In this set of circumstances
the decision would be made not to initially treat these patients in order that the resources can be
better utilised on patients who have a greater chance of survival.
The decision to utilise the P4 triage category will always reside solely with the Gold Commander
because of the extreme seriousness of the decision. They should be advised by the Silver
Commander and ED Commander but the ultimate decision will be made by them alone and
should be considered only as a last resort.
Patients who have been categorised as P4 expectant will be cared for in the Clinical Decision
Unit of Adult A&E.
10.6
Use of Other Hospitals
The identified activities noted in Sections 11 and 12 of this plan to receive casualties and provide
care for patients at the LCH and SBH site are synonymous with a Mass Casualty event and
should not be initially necessary within a normal Major Incident. Additionally the Trust has existing
arrangements with private hospitals such as the London Independent and their facilities should
also be used during a Mass Casualty event.
Major Incident Plan v 4.1 January 2010
Page 73 of 94
11. ST BARTHOLOMEW’S HOSPITAL RESPONSE
11.1
Background
Whilst the majority of any Major Incident response will take place at the Royal London Hospital,
St Bartholomew’s and the London Chest Hospital do have a role to play.
11.2
Site Coordinator St Bartholomew’s Hospital
The Site Manager St Bartholomew’s (or out of hours equivalent) will lead the St Bartholomew’s
response until an additional on call Silver rota staff is identified by the Silver Commander and
arrives to take over the Site Coordinator St Bartholomew’s Hospital role. The role will be based
within the Site Managers Office. The Site Coordinator role will assist the Site Manager and
provide continuity between the Silver Commander in the Hospital Control Room and the St
Bartholomew’s site.
11.3
Patients
The Trust’s Emergency Department is based at The Royal London Hospital, Whitechapel. There
is no Emergency Department at St Bartholomew’s Hospital. A nurse led Minor Injuries Unit (MIU)
is open from 08:00-19:00 hours Monday to Friday. This is a walk-in service only; the London
Ambulance Service do not carry 999 patients to this unit. There are no on site decontamination
facilities or equipment.
In view of the close proximity of St Bartholomew’s Hospital to the City of London there is a
likelihood that if there is a Major Incident the “walking wounded” will make their own way to the
hospital. This plan aims to ensure that patients are dealt with effectively and staff are not put
under unnecessary risk, particularly if the incident involves chemicals, bacteria, radiation or
nuclear warfare.
If a Major Incident has been declared within the City of London, Emergency Departments within
the area will either have declared a Major Incident or have been put on standby. Therefore they
will be in a state of preparedness to accept an influx of casualties.
Presentation of Casualties to St Bartholomew’s Hospital (non chemical)
When the Minor Injuries Unit is open casualties should be directed there. The Emergency Nurse
Practitioners will undertake a preliminary assessment and treat those with injuries, which fall
within their clinical protocols. Patients whom they are unable to treat will be transferred to the
Emergency Department either by taxi, ambulance or Trust transport if available.
When the MIU is closed (19.00 – 08.00, weekends and bank holidays) the Site Manager should
arrange immediate transfer of presenting patients to the Emergency Department. In some
circumstances this may not be possible and will require patients to be treated within the St
Bartholomew’s site. If this is the case the St Bartholomew’s Site Co-ordinator and the Silver
Commander should review staffing and equipment needs between sites so that alternative
arrangements for care can be provided.
Presentation of Potentially Contaminated Patients
These patients will be self presenting as the London Ambulance Service will not transport
contaminated patients to a hospital without an A&E, they should therefore be minor injuries only
Containment is the key to any contamination threat.
Potentially contaminated patients may walk in via the entrance in Giltspur St. In this case they
should be contained in the waiting area of the MIU (ground floor Out Patients). Security should be
contacted immediately to man the two doors to stop anyone else entering. The area should then
be locked down with both staff and patients remaining in the area and must not leave. They
should contact the Site Manger who will dial 999 and request the attendance of the Ambulance
Service who if necessary will bring their decontamination unit and erect it in the ambulance bay in
Giltspur Street.
If patients present at the vehicle entrance security staff should try to keep them at the gate and
Major Incident Plan v 4.1 January 2010
Page 74 of 94
Immediately contact the Site Manager who will evacuate the MIU and arrange for an escort to
take them via the walking entrance to MIU waiting area. The escort must remain in the MIU either
to be decontaminated or until the substance has been declared safe.
If it is deemed necessary, staff and patients will be escorted via the main entrance for the
decontamination process to take place.
The Site Coordinator SBH should
 Request modesty suits and footwear, available from the ED Commander via Silver
Commander, which will be sent by taxi or Trust transport.
 Request the attendance of an ED Doctor via the duty ED Consultant bleep 1115 or
registrar bleep 1273.
 Request the attendance of the on call Public Health Doctor.
 Once decontaminated, the patients should be taken to the Transport Office lounge. The
ED Doctor will prescribe antibiotics as per protocol and either discharge patients or
arrange admission to an appropriate bed.
 If potentially contaminated patients present in another part of the building the area should
be sealed and the same process followed.
11.4
Major Incident Supporting Activities
In addition to the potential to receive casualties from a local incident, St Bartholomew’s Hospital
may also be requested to provide resource assistance. This may be in the form of space, physical
resources or staff.
Space - Prepare the Wards to Receive Patients
After consultation with the Silver Commander the Site Coordinator St Bartholomew’s will liaise
with the SBH Site Manager and Senior Sisters / Charge Nurses and on-call medical staff to
identify categories of patients:
 Who are suitable for discharge
 Who are suitable to be moved to a lower dependency environment
Staff will prepare details of the number of potential beds available and if appropriate the Site
Coordinator St Bartholomew’s Hospital action card holder will cancel elective admissions for this
site. A risk assessment must be carried out on all patients discharged before their procedures
have been carried out. All inter-hospital transfers will be put on hold.
Staff will be required to:
 Prepare patients for discharge and transfer to waiting areas
 Taxis and other forms of transport will be made available to assist the patients in their
discharge. All patients will be given a written discharge letter for their General Practitioner
and their next of kin informed.
 Prepare bed areas to receive patients for admission / transfer
 Continue to care for patients who are unable to be discharged
Physical Resources
Physical resources can be provided by St Bartholomew’s to the Royal London to aid the Royal
London’s response. Items can include:
 Surgical instrument sets and other Theatre equipment
 Blood
 Drugs
 Oxygen
 Non clinical supplies
 Catering.
Upon a Major Incident being declared available the Site Manager should request the availability
of the above items from the appropriate managers and provide this information proactively to the
Silver Commander.
If required these items should be moved to the RLH ideally by BLT Transport and where
necessary with a Blue light escort which can be arranged by the Silver Commander.
Major Incident Plan v 4.1 January 2010
Page 75 of 94
Staff
Specialist Surgical teams can be relocated upon demand to the Royal London in order to carry
out the surgical procedures necessary. A decision to do this rather than relocate the patient to the
surgical team should be made by the Theatre Commander in conjunction with the Silver
Commander
Major Incident Plan v 4.1 January 2010
Page 76 of 94
12. LCH RESPONSE
Just as St Bartholomew’s hospital has specific actions during a Major Incident, so does the
London Chest Hospital. The following local processes and actions will be adopted at the London
Chest site so that they can provide support to the Royal London Hospital if required.
12.1
Local Cascade of the Major Incident
On receiving the alert the London Chest Hospital on call 1945 Bleep Holder will be contacted,
they will then in turn contact the CAU General Manager and relevant Senior Nurses for the
Circulatory & Metabolic Sciences CAU (CMS CAU).
The CAU General Manager will notify lead consultants as necessary, switchboard will have
notified all on call teams. The nurse in charge of the ICU’s at LCH / SBH will notify the on call
consultant.
12.2
Site Co-ordinator London Chest Hospital
The 1945 Bleep holder / Matron will lead the operational London Chest response. Support will be
provided to them through an additional on call Silver rota staff who will provide the co-ordination
between hospital sites and will be the single point of contact for the Silver Commander at the
London Chest. The Site Coordinator role will be based within the Discharge Lounge.
12.3
Prepare the Wards to Receive Patients
After consultation with the Silver Commander the 1945 Bleep holder / Matron will liaise with the
Senior Sisters / Charge Nurses and on-call medical staff to identify categories of patients:
 Who are suitable for discharge
 Who are suitable to be moved to a lower dependency environment
Staff will prepare details of the number of potential beds available and if appropriate the Site
Coordinator London Chest Hospital action card holder will cancel elective admissions for this site.
Within hours this should be carried out in coordination with the LCH Bed Manager and Service
Managers of all areas. A risk assessment must be carried out on all patients discharged before
their procedures have been carried out. All inter-hospital transfers will be put on hold.
Staff will be required to:
 Prepare patients for discharge and transfer to waiting areas
Discharge areas to be considered for use include – Staff Restaurant or the Outpatients
Department
Taxis and other forms of transport will be made available to assist the patients in their
discharge. All patients to be given a written discharge letter for their General Practitioner and
their next of kin informed.
 Prepare bed areas to receive patients for admission / transfer
 Continue to care for patients who are unable to be discharged
12.4
Staffing
All wards and departments will hold contact details of staff with their Major Incident plan. The
contact details will be updated monthly by a designated staff member. If required, off duty staff
will be contacted by their managerial; / professional lead and if able to attend the work place will
be given clear direction on which site and department they should report to. Staff will be allocated
to areas dependant on their appropriate skills. In the first instance staff should report to their
normal place of work.
It should be noted that the Major Incident may last for several days and therefore it is important to
consider a relief pattern and scheduling of staff following the initial declaration of a Major Incident.
12.5
Patient Flow
Initially non-acute patients will be transferred from the Royal London Hospital to St.
Bartholomew’s Hospital. Once St. Bartholomew’s Hospital is full patients will then be transferred
to the London Chest Hospital. Where possible, continuity of care will prevail, matching patient
Major Incident Plan v 4.1 January 2010
Page 77 of 94
needs with staff skills. If necessary, consideration will be given to increase bed capacity on each
ward.
12.6
Receiving wards
The first receiving ward for the London Chest Hospital will be Leander Ward and the second
would be Riviere Ward. There are action cards for both of these wards.
12.7
Outpatients Department (OPD)
Upon notification of a Major Incident the OPD nurse in charge will review the time remaining for
the clinic that is taking place and inform the 1945 Bleep holder. It will be the 1945 Bleep holders
decision whether to cancel the clinic taking place and any subsequent clinics for that day in order
to free up that area.
12.8
Heart Attack Centre (HAC)
The two Direct Acute Myocardial Infarction (DAMI) beds on CCU will be ring fenced to ensure that
the HAC service is maintained. This will be reviewed on a regular basis to assess any impact on
the Intensive Care Units bed capacity and Theatre slots.
12.9
MRI Unit
Upon notification of a Major Incident a review of all patients on the daily list will be carried out with
the patients consultant, the 1945 Bleep holder will be informed of any patients for whom this
procedure is not urgent. The London Chest Hospital Site Coordinator will inform the Silver
Commander of the availability of the MRI unit.
12.10
Communication
Wherever possible every effort must be made not to use the Hospital Switchboard as it is
essential to the Emergency response and will be inundated with calls. Direct dial, home and
mobile numbers will be used in the first instance before the Switchboard Aircall system.
12.11
Media
This will follow the same process as the rest of the Hospital. All enquiries should be forwarded to
the Media Liaison Officer at the Royal London.
12.12
Updates and Stand down
The London Chest Hospital Site Coordinator will be provided with updates from each Hospital
Control Team meetings for onwards dissemination. This will also be the route for the stand down
from the Major Incident or cancellation of the Major Incident Standby. Clinical areas of the London
Chest Hospital will only stand down from the Major Incident once the formal stand down has been
announced by the London Chest Hospital Site Coordinator
Major Incident Plan v 4.1 January 2010
Page 78 of 94
13. DOCUMENTATION AND RECORD KEEPING
13.1
Documentation
During a Major Incident it is necessary to document the information that is available, the decisions
and actions taken. This is to ensure that there is adequate records for decision making hand over
and if necessary an auditable record for inquests, enquiries or in defence of legal action. As such
a number of tools are used.
Major Incident Logs
At its simplest a Log is a date and time and action/ information or decision. The
Trust uses pre printed Emergency Log Books.
Communication Pads
Communications Pads are used to document all forms of incoming and outgoing
communications. These are triplicate pads with unique identifiable numbers on
each set of sheets.
Decision Log Sheets
In the main these will only be used within the Hospital Control Room by the Silver
or Gold Commander, however they are available for any decision maker to
document the decisions taken during a Major Incident, the reasoning behind the
decision and the options discounted.
These three forms of documentation form the majority of the record keeping
made during a Major Incident and should be retained along with all records for a
minimum of 10 years.
13.2
Situation Reports
During the course of a Major Incident the Strategic Health Authority will request Situation Reports
to be sent to them. Currently the format for these has yet to be agreed. In the future they will be
electronic and will be web based and enable information to be shared both vertically to and from
the SHA and horizontally between responding organisations. A sample Situation Report is
contained within the Appendices (Section 4)
13.3
HCT meetings
The Hospital Control Team will meet formally to review progress at agreed times during the Major
Incident (as noted within Section 2 part 4 of this plan). At this time the Administrative Support
Team Leader will minute the meeting. They should ensure that:
 The HCT agree a written strategy and adopt high level tactics to drive the resolution of
the incident.
 HCT meetings are formally convened and work to a published/agreed Agenda (draft
contained within Section 4 of this plan)
 Names of persons attending each meeting are recorded.
 Minutes taken and published
 Actions allocated against time-scales
 Decisions recorded
 Minutes are to be circulated ASAP in order that nobody should be left unsure of what is
required
 Additionally, in the case of events lasting over a period of several days it is useful to
produce a daily resume of progress and this is especially important on those occasions
when Gold/Silver roles change.
 Gold Commander briefs (by exception) the CEO after each meeting (or at alternative
agreed times) of the HCT progress.
Major Incident Plan v 4.1 January 2010
Page 79 of 94
14. DEBRIEF, REPORTING, REVIEW, TRAINING AND EXERCISING
14.1
Hot and Cold Debrief
Immediately following a Major Incident stand down a Hot debrief should be conducted by the
teams responding to the incident. These should be carried out locally by the Team Leader or
Commander within that space and should include as many of the people who participated in the
response as possible.
The purpose of this debrief is to capture the lessons identified and learning points from the
incident. It should not be a finger pointing exercise but rather identify processes to be improved,
equipment or kit that may be needed and knowledge that needs to be shared. A format for a
debrief is contained within the Appendices in section 3.
Once Hot debriefs have been concluded and the salient points captured a wider Cold debrief is
needed, to incorporate all the Commanders / team leaders within the Trust who responded to the
incident. This should be chaired by the Gold Commander who led the incident and should follow
the same format.
14.2
Major Incident Report
The detail captured within the Hot and Cold Debriefs should be included within a report which
also notes the cause and detail of the Major Incident and a summary of the Trusts response. This
will need to be produced by the Gold Commander, with the assistance of the Head of Emergency
Planning (if available). This report is likely to be sent to the Trust Board along with an action plan
of activities to resolve the lessons identified.
14.3
Review Process
The Trust Major Incident Plan will be reviewed every other year or sooner if any significant
information becomes available necessitating a full review. Additionally following either activation
of the plan for a real incident or an exercise, revisions would be incorporated. The plan will be
reviewed through the Emergency Planning Steering Group and the Healthcare Governance
Committee and be forwarded to the Trust Management Executive for final approval.
Furthermore this plan is also regularly benchmarked against other Major Incident Plans of other
Acute Trusts.
14.4
Training Programme
The Trust has a full Training Programme for the various roles contained within this plan. This
includes specific training for identified parts of the hospital such as the Emergency Department
and skills training for individuals carrying out roles within the plan.
14.5
Exercise Programme
Regular testing of the Trusts Major Incident Plan is carried out through various exercises.
Exercising is carried out both internally and externally with NHS and other organisations.
It is a requirement under NHS Emergency Planning Guidance 2005 that all NHS organisations
carry out
 A live exercise every three years
 A table top exercise every year
 A test of communications cascades every 6 months
Major Incident Plan v 4.1 January 2010
Page 80 of 94
Section 3
This section of the plan describes the processes that
are adopted after the Major Incident has been stood
down and but whilst recovery is still on going.
Major Incident Plan v 4.1 January 2010
Page 81 of 94
1 TRUST RESILIENCE TEAM
1.1
Introduction
Following the initial impact upon the Trust and the initial Major Incident response phases, which
includes the ED, Theatres, ITU, imaging, receiving wards, laboratories and support services.
Plans should be made to ensure that the Trust recovers to resume a full service as soon as
possible.
Dependant on the cause of the Major Incident, the following days may be severely disrupted. At
the end of the Major Incident initial phase the HCT will handover to the Trust Resilience Team,
which will lead and facilitate a Trust full recovery and normal working.
1.2
Team Make Up
Initially the team will consist of:
 Gold Commander
 Silver Commander (at the direction of the Gold Director other Silver on call may be coopted into the team).
 Trust Chief Operating Officer
 Site Manager
 Facilities Co-ordinator
 Head of Media Relations (or nominated Press Officer).
 Trust Security Manager
The team membership will be dependent on the actual Major Incident which occurred and the
subsequent challenges which were subsequently presented to the Trust. Membership can
change at any time.
1.3
Role
The team will meet after the initial phase of the Major Incident to draw together what has occurred
and the challenges which the Trust will face in the coming days, with the aim to ensure that
normality resumes for staff, patients and members of the public. The team will meet in the
Hospital Control Room (alternatives may be agreed), times to be agreed by the team based on
challenges identified and actions required (e.g. 8am and 5pm). During this phase of recovery the
Site Manager or Communications Team (as directed by the Gold Commander) will send out a
specific daily report which identifies what has occurred and actions being taken. The report may
include updated clinical details of the recovery of admitted patient’s.
1.4
Press
At this stage the times at which the media will be briefed are regularised. Because of the
tendency for the press to “get lost”, a check should be kept on which press are present. The Trust
Press Office will ensure that the information supplied to the press is available for all, with printed
copies available from the hospital main reception desk.
1.5
Security and Police
Dependent on the nature of the Major Incident and the aftermath it may be necessary to have
access to the hospital restricted. The police will when necessary set up a police office in the
Royal London Hospital. This will be for security and public order issues, and will work closely with
the Trust Security Manager and Security team. This presence would be separate to any police
identification team or police family liaison officers present. The Trust Security Manager will advise
on specific areas of concern and what actions will be required to maintain a secure and safe
environment.
1.6
Trust Staffing Continuity
Following the Major Incident it will be necessary to review and ensure that appropriate levels of
staff are available across the Trust in all areas of specialty. This will need to take into account the
effects the Major Incident may have had upon members of staff.
Major Incident Plan v 4.1 January 2010
Page 82 of 94
1.7
Equipment and Supplies
Once the Major Incident is stood down it will be necessary to review and ensure that appropriate
levels of supplies and equipment e.g. disposables, drugs, blood products, and specialist items not
normally used, but required subsequent to the Major Incident are available across the Trust in all
areas of speciality.
1.8
Staff Communications
Communication to staff should continue for some time following the Major Incident to inform staff
of the recovery process. This should be organised through the Communications Team.
1.9
THPCT and NHS London
Maintain SITREP reports to the SHA as required. Discuss current challenges for the Trust with
the PCT ensuring that where possible mutual aid is negotiated and achieved.
1.10
VIP Visits
All visits should be coordinated through the Press Office and security, who will liaise with the
Recovery Team and appropriate department. This will ensure that all aspects of the Trust Media
policies are adhered to at all times. Unscheduled and unauthorised visits must not be allowed to
take place. All visits should take place during regular day time hours, unless there are exceptional
circumstances.
Visits by members of the Government and Royal Family will involve significant planning and
protocol counsel.
1.11
Relatives
There may be Family Liaison Officers from the Metropolitan Police present in the hospital, who
will be supporting relatives. Suitable office accommodation may need to be identified for this
purpose. (The PALS office at the hospital main reception was used for this purpose in July 2005).
1.12
Worried Well and Members of the Public
Dependent on the type of Major Incident there may be a requirement for a ‘help line/information
line’ to be established. How to achieve this is in the Trust core policy, ‘Setting up a Trust
Helpline’. The duration of the helpline will be dependent upon the nature of the Major Incident,
and may not need to be run 24/7.
1.13
Trust Activity
TCIs and out patient clinics will be reinstated as soon as possible following the incident. However,
liaison with the Theatre Manager should be undertaken to establish if any theatres are to be out
of general use in the coming days. This may occur when significant numbers of patients admitted
from the Major Incident require daily visits to theatres for ongoing surgery and treatments. TCIs
should be discussed with the speciality groups management and clinicians, to ensure that
reinstated patients can be accommodated on proposed theatre lists, and where necessary the
availability of ITU and HDU beds.
Major Incident Plan v 4.1 January 2010
Page 83 of 94
Section 4
This section of the plan contains the Appendices
Major Incident Plan v 4.1 January 2010
Page 84 of 94
EXTERNAL SITUATION REPORT
(to be included once received from SHA)
Major Incident Plan v 4.1 January 2010
Page 85 of 94
INTERNAL SITUATION REPORT MAJOR INCIDENT
Site
Date
Clinical Area
Time
Lead Clinician within
Area
Contact telephone
number
Is clinical care compromised within your area (detail)
Resources available
Resources required
Issues (short term)
Issues Long term
Please email / fax to Hospital Control Room RLH eplo@bartsandthelondon.nhs.uk or 020 7943 1400. These should be
completed at the start of the Major Incident and every other hour on the hour for the duration of the Incident.
A nil return is still required.
Major Incident Plan v 4.1 January 2010
Page 86 of 94
SUGGESTED DRAFT AGENDA FOR A HCT MEETING
1. Any urgent decisions required
2. Minutes of last meeting
Matters arising not covered in the rest of this Agenda
3. Update on Actions tasked (at previous HCT meeting)
4. Progress updates (including new or additional risks)
a. Lead / Relevant dept first
b. Others
5. Re-task outstanding matters to named members of HCT and time scales
6. New tasks to named members of HCT and time scales
7. AOB
8. Review Strategy and Tactics (agree or amend)
9. Time of next meeting
Minutes of meeting to be circulated asap
Major Incident Plan v 4.1 January 2010
Page 87 of 94
GENERIC DEBRIEF AGENDA
Part One
Headlines of the Incident
Part Two
Debrief
1. Alerting
2. Command, Control and Co-ordination
3. Roles and responsibilities
4. Resources
 Staff
 Shift rota
5. Incident Tempo (Battle rhythm)
6. Forward look
7. Record keeping and documentation
8. Training
9. Security
10. Communication systems
11. Media communications
12. Partners input (listed as those present)
13. AOB
Part Three
Any Follow up activities to be agreed
Major Incident Plan v 4.1 January 2010
Page 88 of 94
GLOSSARY OF TERMS
A&E
AIC
ALO
Ambulance
Control Point
Ambulance
Liaison Officer
(ALO)
ATLS
Cascade system
Casevac [cazIvak]
Central Casualty
Bureau
Casualty label
Casualty
Receiving Station
CCDC
COMAH
sites
CIRS
Community
Services
Cordon (inner)
Cordon (outer)
CSSD
DEFRA
Designated
Hospital
DPH
ECV
ED
Emergency
Services
EOC
EPO
Environmental
Accident & Emergency (Department)
Ambulance Incident Commander – Ambulance officer with overall
responsibility for the work of the ambulance service at the scene of
major incident
Ambulance Liaison Officer
An ECV (Emergency Control Vehicle with a green and white checkered dome) is a mobile
communication facility, which is placed near the incident scene and is known as the Ambulance
Control Point. It is a focal point for NHS/medical and ambulance
resources attending the incident. Ideally, the point should be in close proximity to the Police and
Fire Service Control Point vehicles (subject to radio interference constraints)
At the receiving hospital, this Ambulance Officer is responsible for the provision of mobile radio
communications between the hospital and the ambulance service, and for the supervision of
Ambulance Service activity. Also responsible for liaison and supervision of ambulance activity at
the receiving hospital.
Advanced Trauma Life Support - A system of trauma care that follows predetermined protocols, to
allow rapid, orderly, and efficient assessment and life saving interventions, prior to patient removal
from the ED for definitive care. The RLH will always use
these protocols in dealing with any trauma.
System whereby one organisation calls out others, who in turn initiate other calls as necessary
Military-speak for casualty evacuation
Central bureau set up by the police to maintain a list of casualties resulting from a Major Incident,
including casualties dealt with at the site but not referred to
hospital. They also answer all initial enquiries. All telephone enquiries to the hospital are initially
directed to the PCB. The telephone numbers are published by the media.
Colour-coded label used by ambulance service and medical teams to identify the priority of a
casualty
May also be referred to as the ‘Casualty Clearing Area’ or ‘Triage and Treatment Area’. An area
designated by the AIC/MIC for ambulance crews and other forage teams to bring casualties. It
may be used for the initiation of life saving procedures, but is primarily
a central point from which casualties are dispersed to the receiving hospitals. In a complex
incident there may be several of these areas. They should be as sheltered as possible.
Consultant in Communicable Disease Control
Industrial sites which are subject to the Control of Industrial Major Incident Accident Hazards
Regulations 1984. From February 1999 these have been replaced by the Control of Major
Accident Hazards Regulations
Chemical Incident Response Service.
The range of services, including local authority social services, provided in the community.
Surrounds and provides security for the immediate site of the Major Incident
Seals off the controlled area to which unauthorised persons are not
allowed access -See Controlled Area
Central Sterile Supplies Department
Department for Environment Food and Rural Affairs.
A term no longer in use. If used, it refers to the first Receiving Hospital.
Director of Public Health (in a SHA or PCT)
Emergency Control Vehicle- The ambulance site control vehicle in which the Ambulance and
Medical Incident Officers are based.
Emergency Department – (Barts and the London NHS Trust) Located on Whitechapel Site
The Ambulance, Fire, Police and Coastguard Services. (Military personnel deployed in support of
the Civil Authorities are not included in this designation).
Emergency Operations Centre – The permanent office which receives all demands for the
Ambulance Service in a specified geographical area, co-ordinates and allocates them to stations
or vehicles. In London this is situated at Waterloo.
Emergency Planning Officer
Professional officers responsible for assisting people to attain environmental conditions which are
Major Incident Plan v 4.1 January 2010
Page 89 of 94
Health Officer
(EHO)
Evacuation (or
rest) centre
Gold command
GTPS
HCT
HEMS
Hospital Support
Team
ITU/ICU
conducive to good health. Most EHOs work for local authorities and are concerned with
administration, inspection, education and law enforcement
Building designated by local authority for temporary accommodation of people evacuated from
their homes – See also Survivor reception centre
Strategic command
Government Telephone Preference Scheme
Hospital Control Team
Helicopter Emergency Medical Service – A service capable of delivering a trained doctor and
paramedic to the scene quickly, evacuating seriously ill patients and delivering them to a hospital
capable of dealing with the injuries whilst maintaining full monitoring and carrying out advanced
medical interventions at all stages of the rescue. It may be used for delivering subsequent
MERIT’s to the scene from the RLH or other hospitals.
Health Emergency Planning Adviser
Hospital Information Centre – obsolete function now carried out by Admin Support Team within
HCT.
Hospital Medical Officer - A middle grade physician appointed by the Medical Director to problem
solves for existing medical inpatients. House officers may assist this doctor when staffing permits.
Hospital Surgical Officer - Middle grade surgeons appointed by the Medical Director to problem
solve for all existing surgical inpatients. House officers may assist this doctor when staffing levels
permit.
This team consists of two RGN’s, Social Workers, and a Psychiatric Registrar. All patients
medically fit for discharge are seen by this team before leaving the hospital.
Intensive treatment unit/Intensive care unit.
JHAC
Joint Health Advisory Cell. (now referred to as STAC see below)
LAS
London Ambulance Service - The emergency service responsible to NHS London for the
provision of ambulances and paramedical support in a Major Incident, and escorting the MIO and
MERITs to and from the scene in London. They will also task HEMS if an incident occurs during
operational hours.
Department which, in the event of major disaster/emergency, coordinates
central government activity.
HEPA
HIC
HMO
HSO
Lead Government
Department
Listed Hospitals
NBS
NHS Direct
NPIS
OECD
Hospitals listed by the Strategic Health Authority as adequately equipped to receive multiple
casualties on a 24 hour basis. They may be required to provide a Medical Incident Commander
and/or a Medical Emergency Response & Incident Team (MERIT). The Royal London Hospital is
a Listed Hospital.
Major Incident - Any emergency that requires the implementation of special arrangements by one
or more of the emergency services, the NHS or the local authority. For the NHS a major incident
is 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 services or health authorities.
Medical Evacuation Cell (military)
Medical Emergency Response and Incident Team - This is a front line medical team whose role is
either to set up a site medical centre for early triage and treatment, or to treat patients who are still
trapped.
Medical Incident Commander - The medical officer with overall responsibility, in close liaison with
the AIC, for the management of the medical resources at the scene of the Major Incident. He/she
should not be a member of any MERIT should refrain from treating patients and remain “HANDS
OFF”. The appointment of the MIC is the responsibility of the first receiving hospital. (this function
will always be carried out by a HEMS consultant and is part of the HEMS Major Incident Plan
Media Liaison Officer or Press Officer - A member of the hospital management empowered to
speak on behalf of the trust to the media. He/she carries overall responsibility for ensuring that
adequate, accurate, and appropriate information is passed to the media, and arranging regular
press statements in conjunction with the Silver Commander.
National Blood Service.
24-hour health telephone help line, staffed by nurses.
National Poisons Information Service.
Organisation for Economic Co-operation and Development.
Operational
command
Bronze Command, this is at the operational level and led by the ED Commander, Theatres
Commander and ICU Commander
MI
MEC
MERIT
MIC
MLO
Major Incident Plan v 4.1 January 2010
Page 90 of 94
Paramedic
PCB
PCT
PDT
PIC
RAMP
RAYNET
Receiving
hospital(s)
Rest centre
RIMNET
RPA
SMS
Silver
Command(er)
Strategic
command
Survivor
reception centre
Tactical
command
Temporary
mortuary
Theatre
Commander
Triage
Triage Point
VAS
WIC
Someone holding a current certificate of proficiency in ambulance paramedical skills issued by or
with the approval of the Secretary of State for Health.
See Central Casualty Bureau (CCB)
Local health commissioner, co-ordinating primary and community health care services
Police Documentation Team (hospital) - A police team who collate information from the HCT and
pass it on to the CCB.
Police Incident Commander
Reception Arrangements for Military Patients. Military plan for coping (with NHS help) with military
casualties evacuated to the UK from an area of conflict overseas.
Radio Amateurs Emergency Network
The hospital(s) selected by the Ambulance Service (from those listed by the Regional Health
Authority), to receive casualties during a particular Major Incident. The First Receiving Hospital
will usually be the nearest, and may be required to nominate the MIC and provide the first MERIT.
See Evacuation (or rest) center
Radioactive Incident Monitoring Network - The national response system (for overseas nuclear
accidents) operated by the Department of the Environment, Transport and the Regions
Radiation Protection Advisor
Short Message System/Service in Global Messaging System (GMS) cellular phones
Tactical command: Leads the Trusts response to a Major Incident
Gold Command(er): Oversees the Silver Commander and reviews the Major Incident Strategic
Response.
Centre set up by local authority or police where people not requiring acute hospital treatment can
be taken for shelter, first aid, interview and documentation. This is normally short-term
accommodation (i.e. operating for several hours) - See Evacuation (or rest) centre.
Silver command
Building accessible from a disaster area and adapted for temporary use as a mortuary in which
post mortem examinations can take place
Person in overall control of theatre activity, they will work closely with Theatre Co-ordinator
Process of assessment and allocation of priorities by medical or ambulance personnel prior to
evacuation of the injured. Triage may be repeated at intervals and on arrival at the receiving
hospital
An area either coincident with or adjacent to the Casualty Receiving Station. A Triage Officer
(nominated by the MIO) will attach Triage cards to a patient according to the nature of the
injuries. It should be noted that there are minor differences between the system in use at the
scene and the system used at the ED triage point.
Voluntary Aid Societies - St John Ambulance (St Andrew’s Ambulance in Scotland) and British
Red Cross Society
Walk In Centre – run by the PCT to provide Primary care to residents on a walk in basis.
.
Major Incident Plan v 4.1 January 2010
Page 91 of 94
RESPONSIBLE ORGANISATIONS COVERED UNDER THE CIVIL
CONTINGENCIES ACT (2004)
Category 1 Responders
Category 2 Responders
Local Authorities
Emergency Services
Metropolitan Police
British transport Police
River Police
London Fire Brigade
London Ambulance Services
Acute Hospitals
Primary Care Trusts
Health Protection Agency
Port Health Authority
Environment Agency
Utilities Companies
Transport Companies (rail bus etc)
Transport for London
London Underground
Airport Operators
Harbour Authority
Health and Safety Executive
Strategic Health Authorities
Major Incident Plan v 4.1 January 2010
Page 92 of 94
Section 5
This section Notes other Emergency plans, these are
either event specific Major Incident Plans or directly
reference the Trust Major Incident Plan
Major Incident Plan v 4.1 January 2010
Page 93 of 94
Local Major Incident Plans
Local Major Incident Plans have been created by each responding part of the Trust to a Major
Incident. They describe in detail the actions of a specific area of the hospital and of specific roles.
They will contain information that is specific to their response.
Business Continuity Plan
The purpose of Business Continuity Management (BCM) is to provide for the continuation of
critical business functions in the event of disruptions or to minimize their effects if disruptions do
occur. The preparation for handling disaster contingencies is generally called business continuity
planning or contingency management. Many potential disasters can be averted, or the damage
they cause reduced, if appropriate steps are taken early to control the event.
Local Business Continuity Plans
Local Business Continuity Plans have been created by each responding part of the Trust to a
Business Continuity event. They describe in detail the actions of a specific area of the hospital
and of specific roles. They will contain information that is specific to their response.
HazMat Plan
The Hazardous Materials (HazMat) Plan is intended to provide guidance on the management of
any incident involving chemical, biological, nuclear or radiological material. Casualties may have
been exposed to and/or contaminated with these materials and this presents an extra challenge
to the emergency response of the hospital. Casualties may also have significant conventional
injuries (combined injury) that will compound the medical management of these cases. The
HazMat Plan is intended to augment the Trust Major Incident Plan. In some cases, the Hazmat
Plan will be initiated as part of the Major Incident Plan.
Pandemic Flu Plan
The aim of this contingency plan is to provide a response to an influenza pandemic with clearly
described roles and responsibilities across the Trust. It is a specific stand alone plan describing a
set of circumstances largely unique within Major Incident response and on a scale larger and
more difficult to manage than anything the NHS has had to respond to in the past.
Hospital Evacuation Plan
The aim of this plan is to provide an operational approach to the management of a large scale
hospital evacuation that can be applied for any of the Trusts sites. The Hospital Evacuation Plan
does not replace the Trust Major Incident Plan (MIP) rather it acts as an event specific plan which
has specific associated actions extending above and beyond those noted within the Trust MIP.
However, the Hospital Evacuation Plan should be viewed as a stand alone document. This
document accepts that because of the repercussions Hospital Evacuation is seen as the last
available option and where possible partial, as opposed to full evacuation, should always be
considered.
Major Incident Plan v 4.1 January 2010
Page 94 of 94