OPERATIONAL POLICY & PROCEDURE
(Ops Policy No 14)
A&E OPERATIONS ESCALATION POLICY
DOCUMENT INFORMATION
Authors:
Mark Ainsworth – Divisional Director
Tony Peters – Head of EOC
Consultation & Approval:
08/12/2011 – 21 days consultation
This document replaces:
New document
Notification of Policy Release:
1. “All Recipients” email
2. Staff Notice Boards
3. Intranet
Date of Issue:
March 2012
Next Review:
March 2013
Version:
1
Registered Headquarters: Unit 7 & 8, Talisman Business Centre, Talisman Road, Bicester, Oxfordshire, OX26 6HR
Contents
1. Terminology
..................................................................................................2
2. Introduction
..................................................................................................2
3. Level 1 Escalation
..................................................................................................3
4. Level 2 Escalation
…………………………..............................................................4
5. Level 3 Escalation
…………………………..............................................................6
6. Level 4 Escalation
…………………………..............................................................8
7. Level 5 Escalation
………………………...............................................................10
8. Equality Impact Assessment
……………………………………………………..11
Registered Headquarters: Unit 7 & 8, Talisman Business Centre, Talisman Road, Bicester, Oxfordshire, OX26 6HR
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1. Terminology
1.1 Organisational Time
Time spent by SCAS staff on organisational issues rather than responding to emergency
calls (e.g. line management, admin, paperwork, etc)
1.2 Despatch
The immediate response of a unit to an emergency or urgent call
1.3 On Duty
Rostered shift times for those who follow a shift pattern or normal working times for those
who do not follow a rostered shift pattern
1.4 Off Duty
Away from work, outside of a rostered shift pattern or normal working time. Includes flexi
time, annual leave or stood down bank holidays.
1.5 Response Officer
An officer who has a marked or unmarked vehicle which is provided for response to
emergencies (or where temporary arrangements have been made to facilitate a vehicle
for individuals’ response).
1.6 Staff Responder / Community and Co Responder
A staff responder is a member of SCAS staff who is part of the Community First
Response network and responds when off duty in a SCAS owned vehicle using blue
lights and sirens provided by the Trust. Community Responders are volunteers who
respond from home or work in their own transport. Co Responders are trained personnel
who can respond on emergency to incidents such as Fire responders
1.7 Deployment
The movement of resources into the deployment plan ready for despatch to an
emergency or urgent call. Units must be in, or very near to, Operational area before being
considered as deployable.
2. Introduction
2.1 This policy establishes the system of escalation to meet the demand for resources
placed upon emergency operations during periods where the ability of an area or the trust
to respond effectively has been, or is likely to be, compromised.
Policies and Procedures Superseded
2.2 This procedure supersedes all other policies and procedures relating to escalation of
response including those implied.
Implementation Date
2.3 This procedure will take effect from March 2012.
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Staff Groups Affected
2.4 The detail in this document specifically applies to the following staff groups:
 EOC Managers and Shift Officers
 Civil Contingencies Rota Members (Duty Bronze, Silver and Gold)
 Area Managers
 Emergency Services Managers
 Team Leaders
 Staff Responders (Community Response Team)
 Community Responders
 Co Responders
 Other Response Officers
3. Level 1 Escalation
Definition
3.1 The ability of a dispatch area within SCAS, or a county area, to respond to demand
for emergency calls is reduced due to the level of operational commitment. Some
additional resources are required for a short period to provide response to demand with
minimum impact on internal organisational activity.
Criteria
3.2 Four or fewer units available for deployment across the status plan for the area
affected
3.3 Consideration of:
 Length of time before next resources are likely to become available, including clearing
at hospital, new shifts starting etc
 Ongoing incidents which may require more resources
 Resources delayed at hospital – current and expected
Decision
3.4 The decision to escalate to level 1 is taken by the EOC Shift Officer. This decision is
to be recorded in the EOC log.
Actions –EOC Shift Officer
3.5 Initiate pager and text message to the pager group “Escalation” which reads:
“Escalation Level 1. All Team Leaders (TL’s) on duty to call EOC for deployment. Thank
you.”
3.6 Establish the availability of the TL’s including the priorities of any tasks they may have
ongoing.
3.7 Every effort should be made to keep the TL in the area they are currently working in
order to limit the organisational time lost to the escalation.
Actions – Team Leaders
3.8 Contact the EOC Shift Officer (or Dispatcher) for deployment as required.
3.9 Team Leaders with an ongoing priority task must establish their availability in a
conversation with the EOC Shift Officer. This task will be noted.
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Actions – Response Officers
3.10 No assistance is required at this time but note should be taken of the level 1
escalation and preparations made for potential response if escalation reaches level 2.
Stand Down
3.11 The EOC Shift Officer will make the decision to stand down the escalation in line with
the criteria defined earlier. This decision is to be recorded in the EOC log.
3.12 It may be prudent to hold the escalation at level 1 rather than stand down
immediately if a subsequent escalation is likely to reoccur in a very short period of time.
3.13 Stand down message to be paged and text to escalation group and read:
“Escalation Level 1 - Stand Down” once all level 1 resources have been stood down.
4. Level 2 Escalation
Definition
4.1 Despite further resources responding, the ability to meet emergency demand is still
reduced to an unacceptable level. More resources are required for a short period to
provide response to demand with as little impact on internal organisational activity as
possible.
Criteria
4.2 Level 1 escalation already in place and 2 or fewer units available for deployment
across the whole of the status plan for the dispatch area
4.3 Consideration of:
 Length of time before next resources are likely to become available, including
clearing at hospital, new shifts starting etc
 Ongoing incidents which may require more resources
 Resources delayed at hospital – current and expected
 TL’s availability from level 1
Decision
4.4 The decision to escalate to level 2 is taken by the EOC Shift Officer. This decision is
to be recorded in the EOC log.
Actions – EOC Shift Officer
4.5 Initiate pager and text message to the pager group “Escalation” which reads:
“Escalation Level 2. All Officers on duty to call EOC with their availability. Thank you.”
4.6 Initiate pager / text message to the off duty Staff Responders which reads:
“Escalation level 2. Any available off duty Staff Responder, Community Responder or Co
responder please call EOC for deployment. Thank you.”
Community Responders and Co responders should only contact EOC if they are not
already booked on available to respond
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4.7 In Hours - Establish contact with the Area Manager / Head of EOC and brief them on
the escalation situation.
Out of Hours – Inform Duty Bronze of current escalation. (Consider informing Duty Silver)
4.8 Establish and record the availability of the Officers including the priorities of any tasks
they may have ongoing.
4.9 Every effort should be made to keep the responding Officers in the area in which they
are currently working, in order to limit the organisational time lost to the escalation.
4.10 As it is likely that GP urgent admissions will be delayed, liaise with affected parties
(GPs, carers, patients) to advise of delays likely to be experienced in accordance with
current procedures.
Actions – Area Manager / Head of EOC
4.11 Contact the EOC Shift Officer and establish the situation and the likelihood of
escalation to level 3. Proceed to the EOC if this is likely to lend support to the EOC Shift
Officer and to take the decision to proceed to level 3, if required.
4.12 Liaise with Duty Silver (if out of hours). Inform the Area Director of the situation, if
required.
Actions – Duty Silver
4.13 Note the escalation level. Liaise with Head of EOC. Duty Silver must remain
available for Duty Silver tasks or response and not be deployed as part of the escalation
procedure.
Actions – Officers
4.14 Contact the EOC Shift Officer (or Dispatcher) for deployment, if not committed on an
ongoing priority task.
4.15 Officers with an ongoing priority task must establish their availability in a
conversation with the EOC Shift Officer. This task will be noted.
4.16 Training Officers not teaching on a course should ensure that a response car is
available and ready for deployment. Contact the EOC Shift Officer (or Dispatcher) for
deployment.
Stand Down
4.17 The EOC Shift Officer will make the decision to stand down the escalation in line with
the criteria defined earlier. This decision is to be recorded in the EOC log.
4.18 It may be prudent to hold the escalation at level 2 rather than stand down to level 1
immediately if a subsequent escalation is likely to reoccur in a very short period of time.
4.19 Stand down message to be paged and text to escalation group and read:
“Escalation Level 2 - Stand Down. Now at Escalation Level 1” once all level 2 resources
have been stood down.
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5. Level 3 Escalation
Definition
5.1 Despite further resources responding, the ability to meet emergency demand is still
reduced to an unacceptable level. More resources are required for a short period to
provide response to demand. Internal organisational activity is now secondary to delivery
of patient care.
Criteria
5.2 A level 2 escalation is already in place and there are now 2 or fewer units available for
deployment across the affected area
5.3 Consideration of:
 Length of time before next resources are likely to become available, including
clearing at hospital, new shifts starting etc
 Ongoing incidents which may require more resources
 Resources delayed at hospital – current and expected
 TL’s/Operational Officers availability from level 1 and 2
 Demand trend – from experience and sources such as TVEA status (contact TVEA
on 087 123 74974)
 Availability of Mutual Assistance from neighbouring services.
Decision
5.4 The decision to escalate to level 3 can only be taken by the Duty Silver, Area
Manager or Control Duty Manager (CDM) in consultation with the EOC Shift Officer. This
decision is to be recorded in the EOC log.
Actions –EOC Shift Officer
Note: This is not the appropriate response to short periods of activity bursts such
as peaks on Friday and Saturday nights, as this is likely to be short lived.
5.5 Contact the Duty Silver or CDM and advise that a level 3 escalation may be required.
Hand over the decision to escalate and the subsequent command of the escalation to the
Duty Silver or CDM. Continue to liaise closely and advise on deployment and despatch
while maintaining the response to the demand.
5.6 Contact neighbouring Area / Services to determine the availability of mutual
assistance.
5.7 When directed, initiate pager / text message to the pager group “Escalation” which
reads:
“Escalation Level 3. All Officers on duty must call EOC for deployment. Thank you.”
5.8 Every effort should be made to keep the responding Officers in the area in which they
are currently working, in order to limit the organisational time lost to the escalation.
Actions – Duty Silver / CDM
5.9 Take command of the escalation situation in close consultation with the EOC Shift
Officer if warranted, attend EOC.
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5.10 Actively target Officers who had reported unavailable at level 2 to ensure they are
aware of the new escalation status.
5.11 Contact NEPTS, where appropriate, during their normal operating hours of 07.30 to
22.00 hours to assist with the movement of patients.
5.12 Notify the Thames Valley Emergency Access team and advise of situation. Maintain
regular communication and appraise the team of developments. (Berkshire,Oxfordshire,
Milton Keynes and Buckinghamshire only)
5.13 Ensure Duty Silver is aware and available for response. Formally notify the Area
Director of the escalation to level 3 and continue to keep them informed of the situation as
it progresses. This is to be recorded in the EOC log.
5.14 Consider media issues and notification to PR & Communications Officer.
Actions – Duty Silver
5.15 Duty Silver must remain available for duty officer tasks or response and report for
duty.
Actions – Officers
5.16 Contact the EOC Shift Officer (or Dispatcher) for deployment irrespective of current
commitments.
5.17 Officers should contact the Duty Silver if they feel their commitment is imperative.
The Duty Silver will make the decision on that commitment outweighing the delivery of
patient care.
5.18 Training Officers engaged on a training course should contact the EOC Shift Officer
and assess the feasibility of closing the course and reporting for deployment. If the
students on the course are trained to a suitable level consideration should also be given
to them being made available to respond.
Stand Down
5.19 The Duty Silver / CDM will make the decision to stand down the escalation in line
with the criteria defined earlier. This will be in close consultation with the EOC Shift Officer
and the decision is to be recorded in the EOC log.
5.20 It may be prudent to hold the escalation at level 3 rather than stand down to level 2
or level 1 immediately if a subsequent escalation is likely to reoccur in a very short period
of time.
5.21 Stand down message to be paged and text to escalation group and read:
“Escalation Level 3 - Stand Down. Now at Escalation Level 2” once all level 3 resources
have been stood down.
Registered Headquarters: Unit 7 & 8, Talisman Business Centre, Talisman Road, Bicester, Oxfordshire, OX26 6HR
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6. Level 4 Escalation
Definition
6.1 The ability of an Area to respond to demand is now compromised as there are no
more on duty resources available to deploy. Any organisational activity is secondary to
patient care delivery.
Criteria
6.2 Level 3 escalation already in place with no units available for despatch. No available
mutual assistance from neighbouring divisions / services which will meet demand.
6.3 Consideration of:
 Continual demand through escalation levels with no respite
 Length of time before next resources are likely to become available, including clearing
at hospital, new shifts starting etc
 Ongoing incidents which may require more resources
 Resources delayed at hospital – current and expected
 Response availability from level 3
 Demand trend – from experience and sources such as TVEA status.
6.4 Note: This is not the appropriate response to short periods of activity bursts
such as peaks on Friday and Saturday nights, as this is likely to be short lived.
Decision
6.5 The decision to escalate to level 4 is taken by the Duty Silver / Head of EOC in
consultation with Area Director or Duty Director. This decision is to be recorded in the
EOC log.
Actions – EOC Shift Officer
6.6 Initiate pager / text message to the pager group “Escalation” which reads:
“Escalation Level 4. Any available Officer please call EOC for deployment. This includes
those off duty. Thank you.”
6.7 Consider initiation of pager / text message to the Community Responders which
reads: “Escalation level 4. Any available Community Responder not already registered
available please notify EOC. Thank you.”
6.8 Every effort should be made to keep the responding Officers / Staff Responders in the
area in which they are currently working, in order to limit their time lost to the escalation.
Actions – Area Director / Duty Director
6.9 Obtain briefing from the Duty Silver / CDM. The content of the briefing is to be
recorded in the EOC log.
6.10 Consider reporting an “untoward incident” to the Strategic Health Authority and / or
SCAS Executive Team.
Actions – Duty Silver / CDM
6.11 If not already present, attend EOC.
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6.12 Consider crewing Staff Responders onto available Ambulances or NEPTS vehicles,
if need is transport rather than response.
6.13 Brief Duty Director (if situation currently being managed by Area Director)
6.14 Ensure that the Media Officer is aware and briefed on the situation.
6.15 Actively contact off duty Response Officers / Staff Responders to ensure they are
aware of the escalation status.
6.16 During normal working hours, with the assistance of the Scheduling Manager,
consider available off duty staff to attend and the availability of additional units and their
location.
Actions – Duty Silver
6.17 Duty Silver must remain available for Duty Silver tasks or response and report for
duty. Notify the TVEA team and advise of situation. Maintain regular communication and
appraise the team of developments. (Berkshire, Buckinghamshire, Oxfordshire and
Milton Keynes only.) TVEA to inform other trusts and SHA as appropriate.
Actions – Off Duty Officer / Staff Responder
6.18 Contact the EOC Shift Officer (or Dispatcher) for deployment if available. Off Duty
Officers or Staff Responders who have a duty commitment within the next 12 hours
should make the EOC Shift Officer (or Dispatcher) aware of this.
6.19 Off Duty Officers and Staff Responders will be remunerated for their response in
accordance with current Terms & Conditions of Service.
Stand Down
6.20 The Duty Silver / CDM will make the decision to stand down the escalation in line
with the criteria defined earlier. This will be in close consultation with the Area Director /
Duty Director and the EOC Shift Officer, and the decision is to be recorded in the EOC
log.
6.21 It may be prudent to hold the escalation at level 4 rather than stand down to level 3
or level 2 immediately if a subsequent escalation is likely to reoccur in a very short period
of time.
6.22 Stand down message to be paged / text to escalation group and read:
“Escalation Level 4 - Stand Down. Now at Escalation Level 3” once all level 4 resources
have been stood down
Registered Headquarters: Unit 7 & 8, Talisman Business Centre, Talisman Road, Bicester, Oxfordshire, OX26 6HR
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7. Level 5 Escalation – MAJOR INCIDENT
Definition
7.1 Declaring a major incident is the only way SCAS will meet the demand for emergency
calls which has sustained and is still overwhelming all the responses deployed through
levels 1 -4 of the escalation procedure.
Criteria
7.2 Level 4 escalation already in place with no units available for despatch. No available
mutual assistance from neighbouring Areas or services which will meet demand.
7.3 Consideration of:




– current and expected

bility from level 4
Decision
7.4 The decision to escalate to level 5 can only be taken by the Duty Director
Actions
7.5 Further action will be in accordance with the Major Incident Procedure, including a
formal request to neighbouring Ambulance Services for Mutual Aid and recall to duty of all
available staff.
Stand Down
7.6 The Duty Director will make the decision to stand down the escalation in line with the
criteria defined earlier and as per Major Incident Procedures. This decision is to be
recorded in the EOC log.
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Equality Impact Assessment Form: Section One – Screening
Name of Function, Policy or Strategy:
Officer completing assessment:
Telephone:
1.
SCAS Escalation Policy
Mark Ainsworth/Tony Peters/David Williams
01962 898102
What is the main purpose of the strategy, function or policy?
The purpose of this policy is to provide a framework to increase operational resources during
periods of high demand. The Policy also notifies managers and staff the levels of demand that
SCAS or an area within SCAS are experiencing.
2.
List the main activities of the function or policy.
The policy provides EOC with guidance on how to increase operational resources at what
trigger points. The policy is a SCAS standard so all EOC’s will work to the same policy. The
policy also contains actions for Managers in EOC and Operations to follow to ensure we
maintain critical services
3.
Who will be the main beneficiaries of the strategy/function/policy?
Patients will benefit from having additional Operational resources. Staff and Managers will
benefit from additional resource being available to respond to incidents.
4.
Use the table overleaf to indicate the following:
a.
Where do you think that the strategy/function/policy could have an adverse impact
on any equality group; ie, it could disadvantage them?
b.
Where do you think that there could be a positive impact on any of the groups or
contribute to promoting equality, equal opportunities or improving relations within
equality target groups?
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Positive
Impact
Negative
Impact
Women
N/A
N/A
Men
N/A
N/A
Asian or Asian British people
N/A
N/A
Black or Black British people
N/A
N/A
Chinese people and other people
N/A
N/A
People of Mixed Race
N/A
N/A
White (inc Irish) people
N/A
N/A
Disabled People
N/A
Yes
Lesbians, gay men and bisexuals
N/A
N/A
Older People (60+)
N/A
N/A
Younger People (17 to 25) and children
N/A
N/A
Faith Groups
N/A
N/A
Equal Opportunities and/or improved
relations
N/A
N/A
Protected Characteristic
GENDER
RACE
Reasons for impact
Staff off duty and volunteers can choose to make themselves available or
not
Staff covered by the DDA will consider their condition when booking
available
AGE
Notes:
Faith groups cover a wide range of groupings, the most common of which are Muslims, Buddhists, Jews, Christians, Sikhs and Hindus. Consider faith categories
individually and collectively when considering positive and negative impacts.
The categories used in the race section refer to those used in the 2001 Census. Consideration should be given to the specific communities within the broad
categories such as Bangladeshi people and to the needs of other communities that do not appear as separate categories in the Census, for example, Polish.
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5.
If you have indicated that there is a negative impact, is that impact:
Yes
No
Legal (it is not discriminatory under anti-discriminatory law)
X
Intended
X
Level of Impact
High
Low
If the negative impact is possibly discriminatory and not
intended and/or of high impact then please complete a thorough assessment after
completing the rest of this form.
6a)
Could you minimise or remove any negative impact that is of low
significance? Explain how below:
The policy allows off duty staff and volunteers to choose to book on for duty
6b)
Could you improve the strategy, function or policy positive impact? Explain
how below:
N/A
7.
If there is no evidence that the strategy, function or policy promotes
equality, equal opportunities or improves relations – could it be adopted so
it does? How?
N/A
Please sign and date this form, keep one copy and send one copy to the Trust’s
Equality Lead.
Signed:
Mark Ainsworth
Name:
Mark Ainsworth
Date:
7th December 2011
Registered Headquarters: Unit 7 & 8, Talisman Business Centre, Talisman Road, Bicester, Oxfordshire, OX26 6HR
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Equality Impact Assessment Form Section Two: Full
Assessment
Name of Function, Policy or Strategy:
A&E Escalation Policy
Officer completing assessment:
Mark Ainsworth
Telephone:
01962 898102
Part A
1.
Looking back at section one of the EIA, in what areas are there concerns that the
strategy, policy or project could have a negative impact?
Gender
Race

Disability
Sexuality
Age
Faith
2.
Summarise the likely negative impacts:Possible impact on staff / volunteers covered by the DDA through working longer hours
during high demand periods. This is mitigated by the individual having the choice to book
available for duty or not
3.
Using the table below, give a summary of what previous or planned consultation on
this topic, policy, function or strategy has or will take place with groups or
individuals from the equality target groups and what it noted about the likely
negative impact?
Equality Target Groups Summary of consultation planned or taken place
Gender
None – New SCAS Policy
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Equality Target Groups Summary of consultation planned or taken place
4.
Race
None – New SCAS Policy
Disability
None – New SCAS Policy
Sexuality/Transgender
None – New SCAS Policy
Older People
None – New SCAS Policy
Younger People
None – New SCAS Policy
Faith
None – New SCAS Policy
What consultation has taken place or is planned with Trust staff including staff that
have or will have direct experience of implementing the strategy, policy or function?
Standard 21-day consultation with all staff is planned prior to policy being approved and
signed off.
5.
Check that any research, reports, studies concerning the equality target groups and
the likely impact have been used to plan the project and guide or indicate what
research you intend to carry out:Equality Target Groups
Title / type of / details of research/report
Gender
N/A
Race
N/A
Disability
N/A
Sexuality/Transsexuality
N/A
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6.
Equality Target Groups
Title / type of / details of research/report
Older People
N/A
Younger People
N/A
Faith
N/A
If there are gaps in your previous or planned consultation and research, are there any
experts/relevant groups that can be contacted to get further views or evidence on the issues?
Yes (Please list them and explain how you will obtain their views)
x
No
Part B
Complete this section when consultation and research has been carried out
7a.
As a result of this assessment and available evidence collected, including consultation,
state whether there will be a need to be any changes made/planned to the policy, strategy
or function.
7b.
As a result of this assessment and available evidence, is it important that the Trust
commissions specific research on this issue or carries out monitoring/data collection?
(You may want to add this information directly on to the action plan at the end of this assessment form)
8.
Will the changes planned ensure that negative impact is:
Legal?
(not discriminatory, under anti-discriminatory legislation)
Intended?
Low impact?
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9a.
Have you set up a monitoring/evaluation/review process to check the successful
implementation of the strategy, function or policy?
Yes
9b.
No
How will this monitoring/evaluation further assess the impact on the equality target
groups/ensure that the strategy/policy/function is non-discriminatory?
Details:
Please complete the action plan below, sign the EIA, retain a copy and send a copy of the
full EIA and Action Plan to the Trust’s Equality Lead.
Signed:
Name:
Date:
EIA ACTION PLAN
Action
Issue
Required
Lead
Officer
Timescale
Resource
Implications
Comments
Please continue on another sheet if you need to.
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