NHS Portsmouth Major Incident Plan DRAFTv3.1

MajorIncidentPlanVersion 3 – July 2010Version 3.1Version 3.1 Page 1 of 144

Has a major incident been declared?If so go direct to:Section 5 “NHS Portsmouth Emergency Response”Have any of the following specificincidents occurred?HeatwaveDisruption to road fuelPublic health incidentFloodingRadiation outbreak at the dockyardIf so,In addition to following section 5 of this planLocate and follow the specific action card in annex13 of this plan (also available in the director on callpack)Version 3.1 Page 2 of 144

Version ControlVersion Date Reason AuthorVersion 1 2007 First version Emergency PlanningLiaison OfficerVersion 2 April 2009 Changes to reflect new EmergencyControl Room layout, newmemorandum of understandingbetween NHS organisation inHampshire & IOW, EPLO personnelchange, minor changes to majorincident roles.Emergency PlanningLiaison OfficerVersion 2.1July 2010 toMajor rewrite due to move to aEmergency Planningto 2.9Sep 2010commissioning only organisationLiaison OfficerVersion 3.0 Oct 2010 Final version post consultationprocessVersion 3.1 Nov 2010 Minor amendment to final versionfrom late consultation replyEmergency PlanningLiaison OfficerEmergency PlanningLiaison OfficerAmendments/comments:Emergency Planning Liaison Officer,NHS Portsmouth, Trust Headquarters, St James Hospital, Locksway Road,Portsmouth, Hampshire PO4 8LDEmail: majorincident.portspct@ports.nhs.ukVersion 3.1 Page 3 of 144

Foreword from the Chief ExecutiveThis document is the Major Incident Plan for NHS Portsmouth. It outlines theoperational arrangements to be undertaken by the Trust at the time of a majorincident or civil emergency. It has been prepared in the light of advice from theDepartment of Health (DH) NHS Emergency Planning Guidance 2005, CivilContingencies Act 2004 and through consultation and close liaison with otherrelevant agencies. This process ensures an integrated approach to emergencymanagement in line with the Hampshire and Isle of Wight Local Resilience Forum(LRF).A major incident is any occurrence that presents serious threat to the health of thecommunity, disruption to the service or causes (or is likely to cause) such numbers ortypes of casualties as to require special arrangements to be implemented byhospitals, ambulance trusts or primary care organisations.It is important that we consider the wide range of events that we may be called uponto deal with. A ‘Big Bang’ major incident, such as the London bombings on the 7thJuly 2005 placed real pressure on NHS services. A national incident such as adisruption to road fuel supply or a severe weather incident can disrupt the continuityof NHS services across the country. Similarly ‘rising tide’ major incidents, such asinfection disease outbreaks can have a catastrophic impact of the health of thepopulation which may need a prolonged coordinated response.A major incident can occur at any time of the day or night. It is vital that we areprepared and can respond at short notice to provide a coordinated range ofemergency, medium and long term services to patients, relatives and friends, and ourown staff.As the Chief Executive, I acknowledge that final responsibility for emergencyplanning rests with my appointment. However, all relevant staff must familiarisethemselves with the contents of this plan, not only to monitor their individual areas ofresponsibility as preparation for their response to an incident, but to feed back usefulinformation and suggested improvements to the Emergency Planning Liaison Officer.I am satisfied that this plan ensures that NHS Portsmouth has effective arrangementsin place to respond to a major incident.…………………………………………………NHS Portsmouth Chief Executive……………………………DateVersion 3.1 Page 4 of 144

Contents1 Introduction.................................................................................................. 81.1 Aim ................................................................................................................ 81.2 Objectives...................................................................................................... 81.3 Legal responsibilities ..................................................................................... 81.4 Definition of an emergency ............................................................................ 91.5 Category one and two responders ............................................................... 102 Emergency Hazards and Risks................................................................. 122.1 Hampshire and Isles of Wight community hazards and risks ....................... 122.2 Local hazards and risks ............................................................................... 132.3 Types of incidents........................................................................................ 133 Emergency Preparedness......................................................................... 153.1 NHS Portsmouth responsibilities.................................................................. 153.2 NHS Portsmouth preparedness arrangements ............................................ 163.3 Communication preparedness ..................................................................... 173.4 Role of NHS Hampshire as the lead PCT .................................................... 173.5 Role of Solent Healthcare ............................................................................ 193.6 Role of Portsmouth Hospitals NHS Trust ..................................................... 193.7 Role of Independent Treatment Centre........................................................ 193.8 Role of Primary Care contractors................................................................. 193.9 Social care................................................................................................... 203.10 Residential and care homes ........................................................................ 203.11 Role of non-NHS healthcare facilities and services...................................... 203.12 Portsmouth Health and Social Care mutual aid arrangements..................... 223.13 Hampshire and the Isle of Wight Local Resilience Forum (LRF) .................. 223.14 NHS emergency planning ............................................................................ 234 Alerting....................................................................................................... 254.1 Major incident alert cascade ........................................................................ 254.2 Requests for support ................................................................................... 254.3 Independent plan activation ......................................................................... 264.4 Alerting routes ............................................................................................. 264.5 Alert escalation levels .................................................................................. 274.6 Alerting messages ....................................................................................... 274.7 Warning cascade system............................................................................. 285 NHS Portsmouth Emergency Response .................................................. 295.1 Major Incident Standby ................................................................................ 295.2 Declaring a major incident and activation..................................................... 295.3 Action cards................................................................................................. 305.4 NHS Portsmouth response actions .............................................................. 305.5 Internal command and control...................................................................... 335.6 Internal command and control structure diagram ......................................... 365.7 Executive Incident Team.............................................................................. 375.8 Emergency control room.............................................................................. 385.9 Completion of logs....................................................................................... 415.10 Conference calling ....................................................................................... 415.11 Incident assessment and situation report form............................................. 425.12 Stand down.................................................................................................. 425.13 Debrief......................................................................................................... 425.14 Recovery actions ......................................................................................... 42Version 3.1 Page 5 of 144

6 NHS Response........................................................................................... 446.1 NHS coordination......................................................................................... 446.2 Reporting structure in the NHS .................................................................... 456.3 Regional NHS response .............................................................................. 467 Multi-Agency Major Incident Response ................................................... 477.1 LRF strategic framework.............................................................................. 477.2 Management of the combined response to an emergency........................... 477.3 Levels of command, control and coordination .............................................. 477.4 The operational level (bronze) ..................................................................... 487.5 The tactical level (silver) .............................................................................. 487.6 Tactical health cell ....................................................................................... 497.7 The strategic level (gold).............................................................................. 507.8 Scientific and Technical Advisory Cell (STAC)............................................. 517.9 Mass casualties ........................................................................................... 528 Annex - Director on Call Role and Responsibilities ................................ 549 Annex - Responsibilities of NHS Portsmouth Directorates .................... 569.1 Chief Executive............................................................................................ 569.2 Designated executive and non executive directors of the board................... 569.3 Finance directorate...................................................................................... 579.4 Performance and development directorate .................................................. 579.5 Commissioning directorate .......................................................................... 579.6 Public health function................................................................................... 589.7 Primary care function................................................................................... 589.8 Corporate and support service..................................................................... 599.9 Estates and facilities directorate .................................................................. 599.10 Information communication and technology function.................................... 609.11 All employees .............................................................................................. 619.12 NHS Portsmouth responsibilities to its staff.................................................. 6110 Annex - Solent Healthcare Response and Responsibilities ................... 6310.1 Alerting ........................................................................................................ 6310.2 Executive management team and control centre ......................................... 6310.3 NHS Portsmouth liaison............................................................................... 6310.4 SHC major incident plan .............................................................................. 6310.5 Role overview .............................................................................................. 6311 Annex - Responsibilities of Primary Care Contractors ........................... 6612 Annex - Multi-Agency Roles and Responsibilities .................................. 6712.1 Main roles of category one responders ........................................................ 6712.2 Main roles of category two responders ........................................................ 6912.3 Main roles of other supporting groups.......................................................... 6913 Annex – Response Action Cards.............................................................. 7113.1 List of action cards....................................................................................... 7113.2 Initial response to a major incident – action card.......................................... 7313.3 Media and communication – action card...................................................... 7513.4 Public health and STAC – action card.......................................................... 8013.5 Radiation incident at dockyard (PORTSAFE) – action card ......................... 8213.6 Heatwave – action card ............................................................................... 8513.7 Flooding – action card ................................................................................. 8913.8 Disruption to road fuel – action card............................................................. 9613.9 Pandemic influenza – action cards .............................................................. 97Version 3.1 Page 6 of 144

14 Annex - Vulnerable People...................................................................... 10814.1 Responsibilities.......................................................................................... 10814.2 Collaboration ............................................................................................. 10814.3 Identifying vulnerable people ..................................................................... 10814.4 Further guidance........................................................................................ 11115 Annex - Data Sharing............................................................................... 11215.1 Guidance and protocol............................................................................... 11215.2 Key principles ............................................................................................ 11215.3 Recoding decisions.................................................................................... 11315.4 Additional advice........................................................................................ 11315.5 Flowchart of key principles for information sharing..................................... 11316 Annex - Supporting Information ............................................................. 11516.1 Plan review and audit ................................................................................ 11516.2 Consultation and dissemination ................................................................. 11516.3 Training ..................................................................................................... 11516.4 Exercises................................................................................................... 11716.5 Supporting documentation ......................................................................... 11816.6 Useful websites ......................................................................................... 11816.7 NHS Portsmouth supporting plans............................................................. 11816.8 Multi-agency complementary plans............................................................ 11916.9 Distribution list ........................................................................................... 12016.10 Glossary of terms ...................................................................................... 12217 Annex – H&IOW NHS Memorandum of Understanding......................... 12418 Annex - Opening the Emergency Control Room ................................... 13118.1 Layout of NHS Portsmouth emergency control room ................................. 13618.2 Role cards ................................................................................................. 13719 Annex - National Reserve Stocks ........................................................... 13819.1 Department of Health guidance ................................................................. 13819.2 Further information .................................................................................... 13920 Annex - Executive Incident Team Template Agenda............................. 14121 Annex - Incident Assessment and Situation Report ............................. 142Version 3.1 Page 7 of 144

1 Introduction1.1 AimThe aim of this plan is to establish the framework for NHS Portsmouth’s preparationsfor, response to and recovery from a major incident regardless of its cause.1.2 ObjectivesThe objectives of this plan are:• To outline the organisational responsibilities for emergency planning and those ofspecific directorates and staff members• To define what constitutes a Major Incident• To outline the structures, systems, processes and procedures that are in place toensure that NHS Portsmouth in collaboration with partner agencies are preparedfor, can respond to and recover from emergencies• To outline the roles and responsibilities of partner organisations• To outline the national, regional and local NHS response and how this dovetailswith other multi-agency partners through multi-agency command and control• To outline the role and responsibilities of NHS Portsmouth in the event of a MajorIncident including arrangements for the establishment of internal command andcontrol and collaboration arrangements with partners• To identify key actions to take in the event of an incident1.3 Legal responsibilitiesThe main purpose of the plan is to ensure compliance with the Civil ContingenciesAct 2004 and NHS Emergency Planning Guidance 2005. NHS Portsmouth isclassified a category one responder under the Civil Contingencies Act 2004. As acategory one responder the NHS Portsmouth is subject to a full set of legal duties.These duties fall into six specific areas:• Assess the risk of emergencies occurring and use this to informcontingency planning;• Put in place emergency plans;Version 3.1 Page 8 of 144

• Put in place Business Continuity Management arrangements;• Put in place arrangements to make information available to the publicabout civil protection matters and maintain arrangements to warn, informand advise the public in the event of an emergency;• Share information with other local responders to enhance co-ordination;• Co-operate with other local responders to enhance co-ordination andefficiencyIf NHS Portsmouth fails to plan for, or respond effectively to, a major incident, it couldlead to at best, adverse publicity and criticism at an inquest or public inquiry and atworst, a breach of civil or criminal law and subsequent prosecution. To minimise therisk of litigation, NHS Portsmouth must ensure that all of the requirements of this planare met and in particular, that staff who are required to respond to a major incidentare properly trained, briefed and supported.1.4 Definition of an emergencyThe Civil Contingencies Act (CCA) 2004 defines an emergency as “an event or asituation which threatens serious damage to human welfare in a place in the UK, theenvironment of a place in the UK, or war or terrorism which threatens seriousdamage to the security of the UK”.To put the CCA definition in context, for the NHS, a major emergency is defined asany occurrence that presents serious threat to the health of the community,disruption to the service or causes (or is likely to cause) such numbers or types ofcasualties as to require special arrangements to be implemented by hospitals,ambulance trusts or primary care (Emergency Planning Guidance 2005).A major incident can be sudden (known as a “Big Bang” incident) such as a majortransport accident or a series of smaller incidents which, cumulatively, test thecapacity of the NHS to respond.A major incident can also develop over a period of time (known as a “rising tide”incident). Examples of a rising tide incident are a developing infectious diseaseoutbreak or progressively more serious flooding in an area.NHS organisations are accustomed to significant fluctuations in the daily demand forservices. Whilst at times this may lead to facilities being fully stretched, suchfluctuations are managed without activation of special measures by means ofestablished management procedures and escalation policies. Major incidentVersion 3.1 Page 9 of 144

management in NHS Portsmouth is therefore concerned with exceptional events andincreases in the demand for services.1.5 Category one and two respondersThe Civil Contingencies Act 2004 has categorised responding agencies into twogroups; Category one and two responders. Category one responders are those at thecore of the response and all have the same six duties as outlined in section 1.3above.Category two responders are known as co-operating bodies and are less likely to beinvolved in the heart of planning work but will be heavily involved in incidents thataffect their sector. The duties of Category two responders are less than category oneresponders and include co-operating and sharing relevant information with otherCategory one and two responders.Those organisation or agencies with category one responsibilities in Hampshire &Isle of Wight include;• Hampshire Constabulary• Hampshire Fire & Rescue Service• South Central Ambulance Service• Hampshire County Council• Portsmouth City Council• Southampton City Council• Isle of Wight Council• Hampshire’s 11 District & Borough Councils• NHS Hampshire• NHS Southampton• NHS Portsmouth• NHS Isle of Wight• Basingstoke & North Hampshire NHS Foundation Trust• Portsmouth Hospitals NHS Trust• Southampton University Hospital NHS TrustVersion 3.1 Page 10 of 144

• Winchester & Eastleigh Healthcare NHS Trust• Environment Agency,• Maritime & Coastguard Agency• Health Protection AgencyThose organisation or agencies with category two responsibilities in Hampshire & Isleof Wight include;• Gas, water, electric companies• Transport companies• Airport operators• Highways Agency• South Central Strategic Health AuthorityVersion 3.1 Page 11 of 144

2 Emergency Hazards and Risks2.1 Hampshire and Isles of Wight community hazards and risksA formal risk assessment of hazards and risks is undertaken by a multi-agency groupevery year as required by the Civil Contingencies Act 2004. The Health assessmentsfeed directly into the Community Risk Register for Hampshire & Isle of Wight which iscompiled by Hampshire & Isle of Wight Local Resilience Forum which is availablefrom: http://www.hiow-localresilienceforum.org.uk/index/communityriskregister.htmA summary of the top risks on Hampshire & Isle of Wight’s Community Risk Registeras at November 2009 include:Ref Hazard Category Overall RatingH9 Large toxic chemical release VERY HIGHHL2Localised industrial accident involving large toxicrelease (e.g. from a site storing large quantitiesof chlorine)VERY HIGHH18 Low temperatures and heavy snow VERY HIGHH19Flooding: Major coastal and tidal floodingaffecting more than two UK regions.VERY HIGHH21Flooding: Severe inland flooding affecting morethan two UK regionsVERY HIGHHL16Local coastal / tidal flooding (affecting more thanone Region)VERY HIGHHL17 Local coastal / tidal flooding (in one Region)VERY HIGHH23 Influenza-type disease (pandemic) VERY HIGHH43 Telecommunications infrastructure – human error VERY HIGHVersion 3.1 Page 12 of 144

2.2 Local hazards and risksTo support the H&IOW Community Risk Register a local Portsmouth multi-agencyrisk assessments and register will be produced. From this NHS Portsmouth willproduce a Health specific risk register for the City of Portsmouth. This risk process isoutlined in the following diagram.Hampshire & Isle of Wight Community Risk RegisterPortsmouth Multi-agency Risk RegisterNHS Portsmouth Risk RegisterA major incident could also be ‘internal’ to NHS Portsmouth e.g. a significant eventsuch as a fire or chemical exposure which significantly disrupts business.Most crises should be handled through extending normal day-to-day arrangementsand referring to business continuity plans and contingency arrangements. Theemphasis should be on responding to an emergency regardless of its cause. Thereis a vast range of possible scenarios and it is not possible to have specific plans forthem all.This major incident plan therefore is to be used flexibly to deal with a range ofsituations which are likely to increase in magnitude, duration or complexity, andwhich may affect areas covered by more than one health region. Specialistarrangements may be required in the event of unusual incidents for instancecommunicable disease, biological threats and radiation.2.3 Types of incidentsPossible incidents that would involve a response from NHS Portsmouth may start ina number of ways. Some of the external sources are listed below:• Major road traffic accident on M27, A3, A3(M), M275, Eastern Road etc• An incident involving a ferry or other large vessel in the Solent• An air disaster as Portsmouth is on the Gatwick/Heathrow flight pathVersion 3.1 Page 13 of 144

• A radiation incident at Portsmouth Naval base• A significant incident on the local rail network• A major infection or infectious disease outbreak (including epidemic andpandemic influenza)• Drinking water contamination• Headline news report sparking a public health scare• Deliberate release (terrorism) or accidental release of chemical, biological,radiological or nuclear (such as a toxic gas plume drifting over the city)• Coastal flooding or severe weather• Disruption to road fuel supply• HeatwaveIncidents that may start from an internal source include:• Loss of facilities, for example fire or flood• Loss of IT support• Serious untoward incident• Supply failure – fuel, power, water• Loss of key personnelVersion 3.1 Page 14 of 144

3 Emergency Preparedness3.1 NHS Portsmouth responsibilitiesAs part of NHS Portsmouth preparedness responsibilities we will ensure:• Requirements as a Category 1 responder under the Civil Contingencies Actare fulfilled• Co-ordinate the NHS response to a major incident in Portsmouth• Develop a command and control structure that allows appropriate linkages to,membership of, communication with and other responses to local resiliencearrangements including strategic, tactical and operational commands• We work closely with primary care and community services to ensure a highlevel of preparedness• Arrangements are in place to mobilise primary and community care resourcesto support acute trusts and non acute trusts• That our own staff, GPs, primary care and community care staff areappropriately trained and competent to plan for and to respond to a majorincident and specific guidance on planning and responding to major incidents• Contingency plans for business continuity in the event of a protracted incidentare developed• The resilience of estate, facilities and systems• Working relationships with other emergency services, local majororganisations and other key stakeholders are established and maintained• Training and exercises are in conjunction with local NHS partners andexternal multi-agency partners to an agreed schedule with the LocalResilience Forum• We take into account the needs of vulnerable groups of patients includingchildren. Particularly in the event of a sustained major incident• We participate in the local emergency planning forum• Internal capacity and emergency plans are maintained, tested and reviewedVersion 3.1 Page 15 of 144

• Work within the agreed lead PCT model with NHS Hampshire performing thelead PCT role and NHS Southampton and NHS Isle of Wight as fellowmembers of the model.• We have a major incident plan that meets the criteria set out in the NHSEmergency Planning Guidance 2005 and those above.• That key staff understand the plan and are trained and competent to fulfil theirroles• We provide appropriate resources for emergency planning• We provide the opportunity for skills development in emergency planning• That there is a thorough debrief after any major exercise or incident so thatlessons learnt may be analysed and if appropriate incorporated into this plan• That General Practitioners (GPs) and other primary care clinicians and staffare:oooEngaged in processes for planning, responding, ensuring continuity,recovery and restoration,Able to deliver GP services 24 hours a day either directly through GPsor through Out of Hours services through the development ofcontingency plans for Out of Hours services and existing escalationpoliciesAppropriately trained to enable delivery of services in the event of anincident3.2 NHS Portsmouth preparedness arrangementsThe Chief Executive of the PCT has overall responsibility for emergency planningand is accountable to the PCT Board for ensuring systems are in place to facilitate aneffective major incident response. Emergency Planning responsibilities are managedby the Director of Public Heath and Wellbeing who acts as the lead Director, theConsultant in Health Protection who acts as the lead manager and finally to theEmergency Planning Liaison Officer (EPLO). The responsibilities of these roles andall directorates across the Trust are outlined in annex 9.NHS Portsmouth has a Director on call system established which ensures anExecutive Director is available 24 hours a day, 7 days a week to be notified of aVersion 3.1 Page 16 of 144

major incident and implement the necessary action to activate the major incidentplan. An outline of the role and responsibilities of the Director on call are in annex 8.3.3 Communication preparednessNHS Hampshire, as the lead PCT, lead on coordinating the media andcommunications activities during a response to an incident for the NHS withinHampshire and Isle of Wight (H&IOW). A Multi-agency H&IOW Local ResilienceForum Warning and Informing group are established which ensures collaborativeplanning between category one and two responders. A LRF Media plan details thepreparedness, response and recovery arrangements for media and communicationsacross H&IOW.The following local communication preparations are in place:• A joint NHS Hampshire and NHS Portsmouth media and communications out ofhours on call manager is in place. This manager provides specialist media andcommunication advice to the Director on Call.• A full list of partner agencies emergency contact details are held by NHSPortsmouth.• Key contact numbers for NHS Portsmouth (including all directors and the Directoron call mobile) are in the process of being included on the Mobile TelecomsPrivileged Access Scheme.• The Trust has the use of a Satellite phone in the event that other methods ofcommunication become compromised.• A number of Executive Directors are identified as spokes persons to address themedia in the event of a major incident.The responsibilities of the NHS Portsmouth communications team are outlined inannex 9 and a media and communications action card is at annex 13.3.3.4 Role of NHS Hampshire as the lead PCTNHS Hampshire act as the lead NHS organisation across Hampshire and IOW andhave a memorandum of understanding (MOU) with the health organisation withinH&IOW of which NHS Portsmouth is included; the full MOU is included in annex 17.In this role as lead PCT NHS Hampshire undertake the following duties:Version 3.1 Page 17 of 144

• Send a Chief Executive or nominated director to attend the Local ResilienceForum (LRF) Executive• Send an Emergency Planning Manager to attend the LRF Delivery Group• Provide an emergency planner or alternative appropriate person to attend theappropriate LRF Sub groups• Lead a LRF health emergency planning group• Ensure that the local health economy plans fit with each other and those ofpartner organisations• Ensure that there are clear protocols to lead the coordination of the healtheconomy response• Coordinate arrangements for LRF emergency planning exercises includingdebrief and feedback from those exercises• Attend emergency planning meetings at the sites requiring statutory plans• Lead in the production of pan health economy plans• Work with the SHA to identify standards expected of all NHS organisations.• Ensure lessons learnt from exercises and major incidents are identified andappropriate action taken across the LRF area.• Be owners of the training and exercise calendar for their area• Ensure local action plans arising from exercises and major incidents areimplemented in a timely way. If actions remain outstanding the Lead PCT willinform the SHA.• Work with NHS organisations to develop an action plans as required by the SHAto achieve the required standard. These will draw on resources from within theNHSO, the Thames Valley or Hampshire and Isle of Wight Health EmergencyPlanning Group and HPA as required. The action plan will include timescales andlead names for achieving actions.• To cascade information directly to all NHS organisations through their nominatedemergency planning lead / manager or pandemic influenza lead / manager. Thelead PCTs will be owners of the e-mail distribution lists and responsible forkeeping these up to date.Version 3.1 Page 18 of 144

3.5 Role of Solent HealthcareSolent Healthcare provide a number of community based services including districtand community nursing, Out of hours General Practice and nursing, mental healthservices and a range of home based care packages.A full outline of the services provided can be found at www.solent.nhs.uk/ServicesSolent healthcare are responsible for ensuring they are prepared for, can respond toand recovery from major incidents. A full outline of their responsibilities is listed atannex 10.3.6 Role of Portsmouth Hospitals NHS TrustPortsmouth Hospitals NHS Trust is nominated under the civil contingencies act as acategory one responder and therefore is required to meet the duties placed on themby the act. The hospital provides many services and includes an Emergencydepartment which is open 24 hours a day all year. The Hospital has approximately1400 beds and some of the facilities include 27 operating theatres, 4 linearaccelerators, 2 MRI scanners and 3 CT scanners. A full list of the services providedby Portsmouth Hospital NHS Trust is available on their website www.porthosp.nhs.uk3.7 Role of Independent Treatment CentreThe Independent Sector Treatment Centre (ISTC) at St Mary’s Hospital provides anumber of services including a minor injuries unit that is open from 0800 to 2200.They may have a key role to play in a major incident. Areas for potential assistanceinclude acting as an ‘overflow’ site for acute hospital discharges, as a media liaisonpoint or redeployment of resources to support other areas of the health response.A full overview of the services and information about the centre can be found athttp://stmarys.users55.donhost.co.uk/3.8 Role of Primary Care contractorsPortsmouth has 29 General Practices operating within the city which provide a rangeof primary care services. An out of hours GP service is run by Solent healthcare, thisservice is based at Queen Alexandra hospital and provides out of hours urgentprimary care services. A number of dental services are offered within Portsmouthwhich includes a dental emergency service which is available 0830 to 2130 MondaysVersion 3.1 Page 19 of 144

to Fridays and 0800 to 2130 at weekends. The outline responsibilities during a majorincident of Primary Care Contractors are listed at annex 11.3.9 Social careSocial care is provided by a number of organisations including private, voluntary andlocal authority. Portsmouth City Council Social Care department coordinate socialcare services in the event of a major incident; their responsibilities include:• Maintaining services and the provision of alternative arrangements at anySocial Services residential establishment affected by the incident.• Coordinating residential admissions from the community where necessary,using public and private service providers.• Liaison with hospitals in the event of the accelerated release of patients intothe community and identifying subsequent requirement for domiciliarysupport.• Maintenance of support to vulnerable members of the community includingpsychological and social support.• Support the recovery to the new normality.• Maintaining normal services as far as practicable in accordance with businesscontinuity plans.A full list of social care services provided by Portsmouth City Council can be found ontheir website - http://www.portsmouth.gov.uk/living/20.html3.10 Residential and care homesResidential and care homes are provided by a number of council, voluntary andprivate organisation across Hampshire. For more information on the types of servicesand vacancies available at care homes across Hampshire can be found on thefollowing website - http://www3.hants.gov.uk/adult-services/care-services.htm3.11 Role of non-NHS healthcare facilities and servicesPortsmouth has a number of non-NHS healthcare facilities that could potentiallyprovide great assistance during a major incident. An overview of the servicesprovided and the potential role they can undertake in an incident is outlined below:Version 3.1 Page 20 of 144

The Rowans HospiceThe Rowans Hospice is a charitable organisation that provides a number of servicesfor people with life-limiting illnesses. Some of the services include an in-patientfacility, community care and bereavement services. A full list of services can befound on their website at www.rowanshospice.co.ukSpire HealthcareSpire Healthcare are a private organisation that provide a number of services basedat their hospital in Bartons Road, Havant, PO9 5NP. The facilities on site includeFacilityQuantityCritical care level 2 beds 2Single private rooms 48Consulting Rooms 13Operating theatres with laminar flow 2Operating theatres without laminar flow 1In addition the radiology department is equipped with state-of-the-art equipmentoffering a comprehensive imaging service including magnetic resonance imaging(MRI), computerised tomography (CT), Ultrasound, Doppler, x-ray andmammography.A full list of the services provided at spire healthcare are outlined on their websitewww.spirehealthcare.com/Portsmouth/University of PortsmouthThe University of Portsmouth has a number of student healthcare professionals anda large number of buildings that can potentially be used to support the response to amajor incident.Community FirstCommunity First for Portsmouth is constituted as a council for voluntary service; theyare a Local Infrastructure Organisation, umbrella and support agency for theVersion 3.1 Page 21 of 144

Voluntary and Community (Third) Sector in Portsmouth. They provide a focal pointfor liaison with the voluntary and third sector organisation within Portsmouth.Portsmouth City Council has a partnership plan with Community First to providesupport during an incident. Some of the services they can supply include:• Focal point for volunteer activity in support of a major incident and itsaftermath, includingooooLiaison between Portsmouth City Council and the voluntary sector.Maintenance of ‘Volunteer Bank’ information.Employee volunteeringPoint of contact for ad-hoc volunteers.• Focal point for commercial food donations in the event of a major incident.• Assistance with access to transport resources.• Focal point for longer-term third sector support to the community in theaftermath of an incident.• Assistance with the administration of appeals funds.3.12 Portsmouth Health and Social Care mutual aid arrangementsA memorandum of understanding (MOU) between Portsmouth Health and SocialCare providers is in place. Its key purpose is to have a common understanding andagreement on the key principles of and processes for invoking mutual aid in theevent of any major incident. The following organisations are specifically included inthe mutual aid MOU, NHS Portsmouth, Portsmouth Hospitals NHS Trust, PortsmouthCity Council, Solent Healthcare, NHS Hampshire, The Rowans Hospice, SpireHealthcare, Care UK, Community First, and the University of Portsmouth.3.13 Hampshire and the Isle of Wight Local Resilience Forum (LRF)Under the Civil Contingencies Act 2004 multi-agency emergency preparedness isundertaken in areas known as Local Resilience Forum based on Police serviceboundaries. The LRF provides an opportunity for the entire category one and twoagencies to meet, share ideas, discuss risks and create and test emergency planstogether. For a full outline of the role of the LRF and its meeting structure visit theLRF website www.hiow-localresilienceforum.org.ukVersion 3.1 Page 22 of 144

3.14 NHS emergency planningRegional planningThe regional level of planning is carried out by the Regional Resilience Forum Healthsub group which meets quarterly and comprises of:• South Central SHA• South East Coast SHA• Regional Director of Health Protection Agency• Regional Health Emergency Planning Advisor (HPA)• Ambulance Service representative – SE Coast• PCT representative – NHS Hampshire• Government Office South EastSouth Central SHA planningThe SHA level of planning is led by NHS South Central SHA who holds regularmeetings with NHS Hampshire and NHS Oxfordshire who represent the HIOW andThames Valley on their respective Local Resilience Forum, plus South CentralAmbulance Service which is the regional ambulance service.Hampshire and Isle of Wight planningThe H&IOW level of health planning is led by NHS Hampshire and is part of the LRFplanning structure. Quarterly LRF Health Emergency Planning Group include:• NHS Hampshire• NHS Isle of Wight• NHS Portsmouth• NHS Southampton• Hampshire Community Health Care• Portsmouth Hospitals NHS Trust• Southampton University Hospital NHS Trust• Basingstoke & North Hampshire NHS Foundation Trust• Winchester & Eastleigh Healthcare NHS TrustVersion 3.1 Page 23 of 144

• Hampshire Partnership NHS Foundation Trust• South Central Ambulance Service• Isle of Wight Ambulance Service• Hampshire & Isle of Wight Health Protection Unit• NHS South Central SHA• NHS Direct• LRF SecretariatUnitary level planningThere are 4 local health emergency planning groups across the LRF area whichensure local responders liaise and plan at local level. These are called the JointHealth Emergency Planning Group (JHEPG). NHS Hampshire is the lead PCT forH&IOW and attends all the area meetings to ensure continuity and consistency andto feed back into the LRF planning meetings. The 4 JHEPG are:• South East Hampshire chaired by NHS Portsmouth• South West Hampshire chaired by NHS Southampton• Hampshire chaired by NHS Hampshire• Isle of Wight chaired by NHS Isle of WightMembership of the South East Hampshire group which is chaired by NHSPortsmouth includes:• NHS Portsmouth• NHS Hampshire• Portsmouth Hospitals NHS Trust• South Central Ambulance Services• Portsmouth City Council Civil Contingencies Unit and Social Care• 3 rd Sector Organisations• Solent Healthcare• Independent Sector Treatment Centre• General Practice representatives• Media and communicationVersion 3.1 Page 24 of 144

4 Alerting4.1 Major incident alert cascadeNHS Portsmouth Director on call may be alerted to a major incident by one of thefollowing:1. Normally a response led activation by• South Central Ambulance NHS Trust or• Portsmouth Hospitals NHS Trust2. Occasionally a top down activation by the Department of Health via• NHS South Central Strategic Health Authority (SHA) who alert• South Central Ambulance NHS Trust who follow the normal cascade3. Internal incident• Member of NHS Portsmouth’s staff• Solent Healthcare• Local GPs/OOH Provider or other health professionals4. Mutual aid• From a neighbouring LRF (Thames Valley, Sussex, Surrey, Dorset,Wiltshire)• Hampshire Partnership NHS Foundation Trust• Hampshire Community Healthcare• NHS Isle of Wight• NHS Southampton4.2 Requests for supportShould any member of NHS Portsmouth staff receive a request for support directlyfrom a receiving hospital or South Central Ambulance Service the person receivingthe call will immediately contact the Director on call who will make the decision onwhether to activate this Major Incident Plan.Version 3.1 Page 25 of 144

4.3 Independent plan activationAny Director on call may activate the major incident plan regardless of any formalalerting message.4.4 Alerting routesWhichever agency declares the major incident, the system of notification andcascade method is the same and, once declared, the organisation concerned willactivate its cascade notification system. Health organisation (PCT’s, Receivinghospitals, Health Protection Unit, Strategic Health Authority, and NHS Direct) will bealerted by the ambulance service. Below is a chart outlining the alerting route inHampshire and IOW emphasising NHS Portsmouth’s inclusion and onward cascade:KeyDepartment ofHealthPrimary NHSSecondary NHSLocal AuthorityNHS SouthCentralSouth Central AmbulanceTrustPoliceNHSHampshirePortsmouthHospital TrustHIOWHPUNHS PortsmouthPortsmouthCity CouncilGeneralPracticeOtherprimarycarecontractorsSt Mary’sMIUSolentHealthcareSocialCareVersion 3.1 Page 26 of 144

4.5 Alert escalation levelsThe agreed escalation policy for South Central Strategic Health Authority area is:LEVEL 1 – Host PCT• An incident occurs within a locality operational area and can be managed bythe PCT.• The PCT will lead the Major Incident response.LEVEL 2 – Lead PCT• The incident is too large for a single locality• The incident crosses PCT boundaries• At the request of the Strategic Health Authorityo NHS Hampshire will co-ordinate the NHS response across Hampshireo NHS Hampshire will send an executive director to the StrategicCoordinating Group (SCG)LEVEL 3 – Strategic Health Authority• The incident is large scale• The incident crosses county borders• The incident is a regional incident• Then the SHA leads with support from the Lead PCTs• The SHA will send an executive director to the Regional Civil ContingenciesCommittee4.6 Alerting messagesThe Agreed National alerting messages from NHS Emergency Planning Guidance2005 is:NHS MessageMajor incident standbyMajor incident declaredMajor incident cancelledApplicationAlerts the NHS that a major incident may need to bedeclared. Organisations should make preparatoryarrangements appropriate to the incident.Organisations need to activate their major incidentplan and mobilise additional resourcesMessage cancels either of the above messagesVersion 3.1 Page 27 of 144

Scene EvacuationcompleteMajor incident standdownMessage from the Ambulance Service to the Trusts toinform them that no more casualties are at the sceneIt is the responsibility of each Trust to determine whenit is appropriate for them to stand down4.7 Warning cascade systemAlerting BodySouth Central AmbulancePortsmouth Hospitals NHS TrustNHS South Central SHASolent HealthcareNHS Portsmouth Director on callChief ExecutiveOn-call CommunicationsPublic HealthEmergency PlanningPrimary care and medicinesmanagementSolent HealthcareGP’s and Out ofHoursOther independentcontractorsVersion 3.1 Page 28 of 144

5 NHS Portsmouth Emergency Response5.1 Major Incident StandbyThe Director on call will usually be the first person to be alerted to an incident and willlead on assessing NHS Portsmouth’s response. In the initial response to the incidentthe Director on call can put the Trust on standby, declare a major incident or notdeclare a major incident. The principle behind a major incident standby is that thereis a recognised heightened risk of a major incident for the Trust. The actions on theTrust at this stage are to make preparatory arrangements appropriate to the incident.The major incident declaration decision should be reviewed every 30 minutes; thisshould be continued until the Trust declares a major incident or declares a majorincident stand down.5.2 Declaring a major incident and activationThe Director on call has the authority to declare a major incident for the trust. At thepoint of declaring the major incident, and until designated otherwise, the Director oncall will assume the role of the Incident Director. A comprehensive list of actions forthe Director on call is detailed in the initial response to a major incident action cardincluded in annex 13.2 and available in the director on call pack, the emergencyplanning cupboard and on the internal T drive (T:\admin\EmergencyPlanning\3.Action Cards).The initial responsibilities in declaring a major incident will be:• The executive in charge will start an incident log to ensure an accurate account ofthe actions and decisions made.• To provide a point of contact to receive and pass information from and to:• Department of Health and NHS South Central SHA• Hampshire Police• South Central Ambulance Service• NHS Hampshire and neighbouring PCTs• Health care providers (Solent Healthcare, GP’s etc)• Receiving Hospital/sVersion 3.1 Page 29 of 144

• Be prepared to implement, due to an alerting message which may demand,preparatory measures or the coordination of primary care service response to amajor incident.• To receive notification of the implementation of emergency plans and proceduresby Acute Trusts.• To alert key staff of the PCT to the emergency, as appropriate• Consider activating the Executive Incident Team (EIT) to manage the NHSPortsmouth response and Emergency Control Room to support the EIT.• To confirm the PCT contact details to all agencies involved in the emergencyresponse.• Follow the initial response to a major incident action card in annex 13.2 and NHSPortsmouth response actions in section 5.3.5.3 Action cardsA number of action cards have been drawn up to support the initial response to ageneric major incident and a number of specific incidents. Action cards provide agood starting point and a prompt for the Director on call, executive incident team andemergency planning team to respond to a major incident. The initial response to amajor incident action card should be used for all major incidents. The other actioncards can be used to support the response depending on the type of incident.A full list of the action cards is included in annex 13; if the incident concerns any ofthe following scenarios locate and follow the appropriate action card in annex 13:Heatwave, Disruption to road fuel, Public health incident, Flooding, Radiationoutbreak at the dockyard, Pandemic influenzaThese action cards should be used in conjunction with the NHS Portsmouthresponse actions listed below.It is the responsibility of the EPLO to keep action cards up to date and accessible bythose who need them.5.4 NHS Portsmouth response actionsThe Trust may need to implement the following activities and responsibilities inresponse to an incident; these are not set in stone but are for the executive team’sconsideration:Version 3.1 Page 30 of 144

GeneralTo activate the Provider Services response according to nature of the incident.To inform independent practitioners of the incident, to provide support to thepractitioners and to request their services to support the PCT response to theMajor Incident. GPs and Community Pharmacists have a professionalresponsibility to take what action they can in contributing to the emergencyresponse whilst continuing to provide general medical care to the communitywithin the limited conditions imposed by the nature of the incident.Co-ordinate the NHS response to a major incident at PCT level.Provide support, advice and leadership to the local community on health aspectsof an incident.Continue to provide core business services. The Executive team may decide thatnon-urgent and routine services will be suspended during the major incident andpost incident recovery period.Co-ordinate activities and flow of information across each NHS Portsmouth’s ownmanaged services and its commissioned services including primary care,community and mental health.To contribute to the district and if necessary, Hampshire-wide incidentmanagement arrangements by, if requested, providing staff to attend and liaisewith Strategic, Operational and Tactical command posts.If deemed appropriate to the response establish a Tactical Health Cell to supportthe multi-agency tactical coordination group. Any decision on the establishment ofa Tactical Health Cell will need to be made in conjunction with the tacticalCommander; a specific health cell will either be established at the scene, in apredetermined location such as the Civic Offices or run as part of the NHSPortsmouth Control room.Provide situational reports to NHS Hampshire, Strategic Coordinating Group(SCG), Tactical Coordinating Group (TCG), Strategic Health Authority (SHA) andothers as required.Maintain liaison with and co-ordinate the response with the Strategic HealthAuthority or equivalent.Proactively communicate information to all PCT staff and ensure relevantguidance and advice is available, including private facilities where appropriateVersion 3.1 Page 31 of 144

Take into consideration NHS Portsmouth staff and not expose staff tounnecessary health and safety or other risks. For example we will ensure that ifprotective equipment is needed, it is provided, that staff are not expected to workor treat patients in dangerous or unsafe environments, that adequate shift androta breaks are built into prolonged incident management arrangementsTo work with providing organisation to ensure the best utilisation of the skills andresources to:oooooooProvide a 24 hour emergency management and clinical responseCo-ordinate the provision of appropriate clinical settings for thetreatment of people with minor injuries and conditions such asreception centres, minor injury centres, walk in centres, communityhospitals and general practiceEnsure the coordination of community hospital bed capacity in liaisonwith local acute hospitals and any available local bed managementsystemLiaise with Portsmouth Hospitals regarding arrangements for potentialdischarge of patients into the communityAssist acute trusts by providing staff where appropriate and supportingaccelerated dischargeSupport screening, epidemiology and long term assessment andmanagement of the effects of an incidentProvide psychological and mental health support to staff, patients andrelatives in conjunction with the appropriate providerTo work with providing organisation to assess the effect of any emergency, orcontingency measures invoked as a result of potential hazards, on vulnerablecare groups, such as children (e.g. premature babies), dialysis patients, elderly,medically dependent, physically or mentally disabled. Co-ordinate any immediateresponse required.To provide information and advice, as necessary, activating a helpline in liaisonwith others such as NHS Direct, for:ooothe special needs of childrenspecial care groupsthe needs of the frail and vulnerableVersion 3.1 Page 32 of 144

oearly proactive intervention to minimise psychological stressEstablish with local authority facilities for mass distribution of countermeasures;for example, vaccinations or antibiotics, administration of medications,prophylactics etcTo liaise with Community Nursing and Pharmacy teams to support any activatedlocal authority Rest Centre(s) if required. Staff will provide care and advice toevacuees, survivors and relatives, including replacement medicationTo examine any additional requirements for out of hours dispensingSupport the NHS management at Strategic Coordinating Group• Support NHS Hampshire in the provision of an Executive Director to the multiagencyStrategic Coordinating Group• Support NHS Hampshire in the provision of a communications lead to theStrategic Coordinating GroupPublic health response• In liaison with NHS Hampshire support the establishment of a Scientific andTechnical Advisory cell (STAC) which may include the Director of Public Healthas the chair, communications staff, admin and loggist support• Support arrangements for Public Health staff to support the NHS PortsmouthControl room as required• Support arrangements for Public Health staff to support the Portsmouth TacticalCoordinating Group as required by either the Portsmouth City Council or localPolice5.5 Internal command and controlNHS Portsmouth will support the multi-agency response at the strategic and tacticallevel as required by providing representatives to the appropriate SCG and TCG asdescribed in section 7. In addition to the multi-agency command and controlarrangements the Trust will form an internal executive incident team to manage theNHS Portsmouth response to the incident. To support the executive team anEmergency Control Room and a number of supporting teams can be established asdeemed necessary. The executive team will decide on the scale of the response andmobilise support teams as required; a summary of the teams (cells), their role,membership and location are outlined in the table below.Version 3.1 Page 33 of 144

Team (Cell) Role Membership LocationExecutiveIncident team• Oversee NHS Portsmouthresponse• Maintain decision log1. Incident Director2. Executive Directoror CEO3. Media and Commslead4. Public Health Lead5. Others members asrequiredGeneral: TrustHQ CommitteeroomMeetings:Director or CEOoffice or virtualvia conferencecall (see section5.9)• Provide the central hub forinformation and coordination ofactivities and actions.EmergencyControl roomteam• Maintains master log ofinformation including actions• Answers incoming calls• Maintains a commonlyrecognised Information Picture(CRIP)• Maintain communication withother independent contractorsand providers of healthcare (notspecifically covered by otherteams), including; St Mary’sMIU, Voluntary Sector, Rowans,Spire, University of Portsmouthand others as required1. Control Room andInformationManager2. Secretary3. Call takers (1-3)4. Decision log keeper5. ChronologicalLoggistTrust HQCommitteeroom (and room6 for additionalcall takers)Comms Cell• Maintain internal communication• Works closely with NHSHampshire and other multiagencypartners communicationleads• Monitor media and respond incollaboration with partners1. Media Manager(x2)Trust HQCommitteeroom (andcommunicationoffice ifrequired)Primary Care& MedicinesManagement• Alert General Practices and Outof Hours Services• Maintain information flow toPrimary Care• Support affected practices andpharmacies1. Associate Director(or deputy)2. Executive teamliaison Officer3. Support team (1-3)Liaison officer:Trust HQCommitteeroomTeam: normalofficesVersion 3.1 Page 34 of 144

Team (Cell) Role Membership LocationPublic Health• Advises executive team onpublic health issues1. Public Health lead2. Support team (1-3)PH Lead: TrustHQ committeeroomTeam: NormalofficesCare andNursing homeLiaison Team• Work with social care to informand maintain contact with careand nursing homes affected bythe incident1. Commissioninglead for Care andNursing Homes2. Support team (1-3)Normal OfficesAcute LiaisonTeam• Maintain contact with PHT• Report back to executive team(through the control room) withissues or requests1. Commissioninglead for plannedand unplannedcare2. Support team (1-3)Normal OfficesSolentHealthcareLiaison Officer• Provide advice to the executiveteam on SHC issues• Provide liaison between NHSPortsmouth and SHCSHC Senior ManagerTrust HQcommittee roomRecoveryTeam• Focus on recovery issues• Plan return to normal working1. Finance Manager2. Support team (1-3)Finance OfficesThe names and contact details of staff that have been trained to undertake the rolesrequired of major incident centre staff are held in the major incident cupboard. Thisincludes staff who have volunteered to be called out of normal office hours.Version 3.1 Page 35 of 144

5.6 Internal command and control structure diagramThe diagram below outlines the internal command and control structure that will beimplemented to manage the NHS Portsmouth response.Incident directorInformation and ControlRoom ManagerPublicHealthExecutive Incident TeamIncident DirectorSecretaryCall taker(s)An Executive DirectorMedia and CommsMedia teamPublic HealthDecision loggistMinute takerOthers as required fromsupport cells / teamsSupport cells / liaison officersPrimary Care &MedicinesManagementCare & NursingHomeCommissioningPlanned andUnplanned careCommissioningSHC Liaison OfficerEPLORecovery PlanningInfo GovernanceFinance HR Estates RiskVersion 3.1 Page 36 of 144

5.7 Executive Incident TeamLocation:• The Executive Incident Team (EIT) will be situated in the Trust HQ Committeeroom which will be called the Emergency Control Room (ECR); set-uparrangements for the room are detailed in annex 18.• For executive incident team meetings the team can either stay in the controlroom or break out to one of the Directors or Chief Executive Officer’s officeMembership: Membership of the executive incident team will, at a minimum be the:• Incident Director (Executive Director)• Another Executive Director or CEO• Media and Communications lead• Public Health Lead• Decision Loggist• Minutes takerThe following members are to be selected as deemed appropriate by the incidentdirector:• Emergency Planning Liaison Officer (for tactical advice)• Primary Care and Medicines Management lead• HR Lead• IT lead• Commissioning lead• Finance lead• Estates lead• Information governance lead• Recovery leadMeeting arrangements: A suggested schedule of meetings for the executiveincident team is a 2 hourly meeting lasting 15 minutes chaired by the incidentdirector. The primary function of the meeting is to raise issues and make keydecisions.Version 3.1 Page 37 of 144

All key decisions should be logged in accordance with best practice by a trainedloggist and signed by the incident director at the end of the meeting. An exampletemplate agenda for an executive incident team is held in annex 20.Key actions of the Executive Incident Team:• Coordinate the Portsmouth health response to the incident• Ensure an assessment of the emergency situation is undertaken, assessingthe impact on the organisation and our commissioned services• Review status and resources of NHS Portsmouth and commissioned serviceswhere applicable• Maintain regular contact with NHS Hampshire as lead PCT• Ensure a recovery team starts to plan the strategy for recovery after the initialresponse is organised• To ensure the responsibilities listed above in section 5.1 and 5.3 areconsidered and actions undertaken as deemed appropriate5.8 Emergency control roomThe primary emergency control room is located in the committee room andsupporting offices in Trust Headquarters, St James Hospital.The major incident cupboard is situated in the corridor as you enter the trustHeadquarters offices opposite the Business Executive office.The staffing of the room is scalable according to the nature of the incident. Planshave been drawn up for a small scale and full scale opening of the control room.Details on setting up the control room are explained in annex 18.Function of the control roomThe main function of the control room is to• Provide the central hub for information and coordination of activities and actions.• Maintain a master log of information including actions• Answers incoming calls• Maintains a commonly recognised Information Picture (CRIP) using the incidentassessment and situation form in annex 21.• Support the executive incident team in managing the response to the incidentVersion 3.1 Page 38 of 144

• Maintain communication with other independent contractors and providers ofhealthcare (not specifically covered by other teams), including; St Mary’s MIU,Voluntary Sector, Rowans, Spire, University of Portsmouth and others asrequiredThe diagram below shows the role of the control room as a central hub forcoordinating communications, information flows and tracking actions betweenresponding health and social care organisations on behalf of the EIT.NHS Hampshire (lead PCT)PortsmouthCity CouncilExecutive incident teamPortsmouthHospitalsNHS TrustSocial CareUniversity ofPortsmouthIndependentProviders (i.e.Residential andnursing homes)NHS PortsmouthEmergency Control RoomCare UKThe RowansHospiceSpireHealthcareSolentHealthcareInternalNHSPortsmouthPrimary CareIndependentProviders (i.e.GP’s Dentist,Pharmacists)CommunityFirst3 rd SectorRole cardsA number of role cards outlining the functional roles within the control centre are keptin the emergency planning cupboard and will be used by the emergency control roomteam to guide and prescribe actions required of them in their particular roles.Email accountsA number of generic email accounts are available to be used in the event of a majorincident. Each nominated role in the emergency control room has a predefined emailVersion 3.1 Page 39 of 144

and user account. To access the accounts follow the instructions detailed in annex18. All external partners are advised to contact NHS Portsmouth control room via asingle generic email account; this account will be monitored throughout the incident.Back up control roomIn the event that the primary control room at St James Hospital is unavailable then anumber of options are available as follows:1. If St James site is still accessible then an alternative office space and meetingroom can be commandeered such as the offices in Trust Headquarters, Goddardunit or Beaton unit.2. Mutual aid arrangement with Portsmouth Hospital Trust can be put in place toutilise a meeting room in the education centre. This can be accessed by callingthe Portsmouth Hospital duty manager for approval. The hospital is accessible 7days a week 24 hours a day.All the role cards, phones and equipment etc can be obtained from the emergencyplanning cupboard and used as required. The Mitel phones should be used wherepossible because they keep the same numbers which are known to other agencies.Record keepingFollowing a major incident NHS Portsmouth may be required to provide evidence toan appropriate enforcement agency such as:• The Health and Safety Executive• A Judicial inquiry• A Coroner's inquest• The Police• A Civil Court hearingNHS Portsmouth may be obliged or advised to give access to documents producedprior to, during and as a result of the major incident. Documents could be paperdocuments, photographs, audio and videotapes, internal and external email, and anyinformation held on a computer. It is vital that all those who hold significantdocuments appreciate the need to preserve and protect. NHS Portsmouth, via theEmergency Planning Liaison Officer, will issue appropriate instructions and guidanceon procedures to be adopted in the immediate aftermath of a major incident topreserve all documentation.Version 3.1 Page 40 of 144

Under no circumstances must any document that relates to, or may in any way relateto a major incident be destroyed, amended, held back or mislaid.5.9 Completion of logsMaster logThe Control Room and Information Manager is responsible for ensuring that allinformation entering the control room during a major incident is logged. This includesall incoming phone calls, faxes and emails.Decision logThe Incident Director is responsible for ensuring that a record of the key corporatedecisions taken during a major incident is kept. This includes the rational for thedecision. The decision log is signed by the Incident Director after each key decisionis reached or at the end of a meeting where a number of key decisions have beenreached.Action logAll members of the Executive Incident Team and support cells must keep a record of:• Instructions received• Actions taken• Other relevant informationThe log should be handed on and signed off if the holder is relieved during theincident. At the end of the major incident the logs are given to the Control Room andInformation Manager.Logs must be kept with dated and timed entries by all staff making decisionson approved log sheets – no records no defence.5.10 Conference callingA conference calling system is available to use in the event of a major incident for theDirector on call or Executive Incident Team. The details on how to set-up theconference call are laid out in an action card held in the Director on call pack and inthe emergency planning cupboard.Version 3.1 Page 41 of 144

5.11 Incident assessment and situation report formTo support the management of information a standard form is included in appendix21. This form can be used to capture an initial assessment of the incident and can beupdated at selected intervals to ensure an accurate report of the incident. TheInformation Manager is responsible for completing this form on behalf of the IncidentDirector and all completed forms should be kept for auditing purposes.5.12 Stand downThe Executive Incident Team will determine the time for the declaration of the Trustto ‘Stand Down’ from emergency procedures. This decision will not necessarilycoincide with receipt of notification of stand down by other Trusts in the NHS.5.13 DebriefOperational managers should ensure that their staff are able to attend a debriefimmediately following an incident (hot debrief). This should be followed up by athorough debrief shortly after the incident. Staff involved in the Major Incident shouldbe given a chance to discuss their views and opinions to talk about their role and toidentify ways of modifying & improving the major incident plan and response. Thedebrief is also an ideal time to make staff aware of the counselling and supportservices available to them if required.5.14 Recovery actionsResponse and recovery are not two discrete activities and should not occursequentially; the Recovery team will begin to plan recovery activities at the onset ofthe incident. As soon as the initial response phase is over the main focus of themanagement of the incident will be on returning to the new normality. The Recoveryteam will be guided by the HM Government Response and Recovery Guidanceavailable on the Cabinet Office website -www.cabinetoffice.gov.uk/ukresilience/response.aspxThe initial recovery actions to be considered include:• To assess the medium term impact on the community and priorities for therestoration of normality• To consider the need for long term health monitoring with advice from the HealthProtection Unit.Version 3.1 Page 42 of 144

• Work with the local authority and community to support the recovery phase• To preserve all plans and documentation used or produced during the course ofthe emergency response.• To prepare a post-incident report for consolidation in the NHS report to beforwarded to the SHA.• To review the financial implications of the response on the Trust.• Occupational health and welfare of all staff and their families.• Bereavement affecting or involving NHS staff.• Physical reconstruction of facilities.• Reviewing key priorities for service provision and restoration.• Long term public health issues.• Financial implications, remuneration’s and commissioning agreements.• Staffing and resources to address the new environment.• Socio-economic effect of the incident on staff and the public.• VIP Visits.• Funeral, memorials and anniversaries.• Staffing levels and resilience.• Routine annual performance targets.• Ongoing needs for assistance from and to NHS partners or other agencies.• Equipment and supplies.• Rewarding, acknowledging the efforts of, and thanking staff.It may be necessary for the Trust to engage legal counsel to advise on preparationswith regard to any public, criminal or other inquiry.Version 3.1 Page 43 of 144

6 NHS Response6.1 NHS coordinationNHS Hampshire as the lead PCT will coordinate the NHS resources across thecounty in a large-scale incident or emergency. NHS Hampshire will liaise with allhealth organisations across the county including NHS Portsmouth and will have thedelegated authority of the SHA as the lead PCT.The NHS Hampshire Emergency Control Team will maintain close links with the SHAand the Executive Lead at the Strategic Coordinating Group (SCG).NHS Hampshire will provide the link for NHS Portsmouth to the Strategic CoordinatingGroup. The diagram below outlines the Hampshire and IOW major incident commandand control structure in particular showing the NHS links into the Multi-agencystrategic coordinating group:Version 3.1 Page 44 of 144

It may become necessary to command the total resources of the NHS for Hampshireand direct them to achieve the greatest good for the greatest number.NHS Hampshire will perform the lead for media and communications.6.2 Reporting structure in the NHSThe diagram below outlines the national, regional, and H&IOW strategic, tactical andoperational reporting structure for the NHS during a major incident.NHS PortsmouthSHC, GP, PharmacyVersion 3.1 Page 45 of 144

6.3 Regional NHS responseLarge scale incidentsIn the event of any major incident which crosses county borders or is of such sizethat the NHS in Hampshire & Isle of Wight would be overwhelmed and that wouldnecessitate special arrangements to be implemented to provide logistic support orcounter actual or potential threats in the provision of services, NHS South CentralSHA Emergency Control Centre will be activated to co-ordinate necessary contingencyarrangements.Regional Civil Contingencies Committee (RCCC)The SHA will represent the NHS at a regional level if the event is so large or itrequires regional coordination across several countiesVersion 3.1 Page 46 of 144

7 Multi-Agency Major Incident Response7.1 LRF strategic frameworkThe multi-agency response to an incident in Hampshire and Isle of Wight will becoordinated in accordance with the H&IOW LRF Strategic Response frameworkavailable from the following website:http://www.hiow-localresilienceforum.org.uk/index.htmThe section below provides a summary of the key multi-agency responsemechanisms taken from the H&IOW LRF Strategic Response framework. The rolesand responsibilities of multi-agency partners are detailed in annex 12.7.2 Management of the combined response to an emergencyIn an emergency or a major incident the range of response activities and support willbe complex. Coordination between different organisations will be necessary toprovide a timely, targeted and effective response. This will be achieved through theconcepts of command, control and co-ordination:• Command is the authority associated with a role or rank in an organisation todirect the use of resources and personnel• Control is the application of authority, combined with the capability tomanage resources, in order to complete a task. It includes the direction ofother agencies engaged in the completion of that task• Co-ordination is the integration of multi-agency resourcesSingle agency groups exercise command over their own personnel and assets. Multiagencygroups are convened to coordinate activities and define the strategy andobjectives for the overall multi-agency response. No single responding agency hascommand authority over any other agencies’ personnel or assets.7.3 Levels of command, control and coordinationThree management tiers can be put in place to manage the incident; Operational,Tactical and Strategic. The multi-agency co-ordinating groups at these levels are theTactical Coordinating Group (TCG) and the Strategic Coordinating Group (SCG). Inaddition to these levels of management a Scientific and Technical Advice Cell(STAC) may be established to provide specialist advice to the SCG.Version 3.1 Page 47 of 144

7.4 The operational level (bronze)The operational level is the management of immediate "hands-on" work undertakenat the site(s) of the incident. Operational commanders will concentrate their effortsand resources on specific tasks within their area of responsibility.As management of an incident becomes complex it may be necessary to establish anumber of functional and location Bronzes.7.5 The tactical level (silver)The tactical level deals with the overall management, tasking and resourcing of thefrontline response in accordance with the strategy set by the strategic level.The TCG will:• Determine priorities for allocating resources• Plan and co-ordinate how and when tasks will be undertaken• Obtain additional resources if required• Assess significant risks and use this to inform tasking of operationalcommanders• Ensure the health and safety of the public and respondersThe tactical level will usually comprise the most senior officers of each agencycommitted within the area of operations, who will assume tactical command of thesituation.Certain types of incident may require more than one tactical location or a specifictactical group dealing with a particular function, such as mass evacuation.In most instances the police will co-ordinate the multi-agency tactical level.In the initial stages of a major incident the tactical level will assume the strategicfunction.The TCG will meet at the Incident Control Point at a suitable place near to the scene.The group may move to premises that are better equipped, although further from thescene, as operations progress.MembershipThe Tactical Co-ordinating Group will normally include the following.Police: Police Incident Officer (Silver Police),Version 3.1 Page 48 of 144

Senior Investigating Officer, if this applies,Minute taker.Fire: Incident Commander (Silver Fire), and a scientific advisor if applicable.Ambulance: Ambulance Incident Officer (Silver Medic).Local Authorities: A senior representative (Incident Liaison Officer) from the localauthorities providing support to the emergency services.Public Health and NHS: A senior public health professional to give advice on issuesrelating to the health effects of the incident on the public and NHS response. Thisperson may need to be supported by a tactical health cell.Other: Other representatives will depend on the type of the incident. It may benecessary to have an inner core of permanent members and an outer group ofadvisors, specialists and others who could be called upon to attend as necessary.7.6 Tactical health cellTo support the health response at the tactical level the multi-agency tacticalcommander may require an NHS representative as part of the TCG. To support theNHS representative a health cell may be required which can be situated at the CivicOffices, Guildhall or operate from the NHS Portsmouth Control Room at St JamesHospital. The cell will operate during the response phase, and in the recovery phaseuntil other structures are established or residual tasks revert to individual agencies.The role of the Tactical Health Cell is to:• Liaise with the STAC about the implementation of public health countermeasures• Communicate public health messages in accordance with the decisions of theSCG/STAC.• Co-ordinate the local health response to the incident• Identify vulnerable groups who may require additional support, in conjunction withpartner agencies• Provide advice given by the STAC to local responders on the hazards to thepublic and the implementation of countermeasures.MembershipTypical membership includes:Version 3.1 Page 49 of 144

• NHS Portsmouth Consultant in Public Health (Chair)• NHS Portsmouth Communications officer• Solent Healthcare Senior Manager or Director• Portsmouth Hospital NHS Trust senior representative• 2 x support staff (loggist and admin support)7.7 The strategic level (gold)In those cases where it becomes clear that resources, expertise or co-ordination arerequired beyond the capacity of the tactical level it may be necessary to invoke thestrategic level of management to take overall command and set the strategicdirection. A Strategic Co-ordinating Group (SCG) will form, bringing together goldcommanders from relevant organisations.The purpose of the strategic level is to establish the policy and strategic frameworkfor the response and recovery. The SCG will:• Determine and promulgate a clear strategic aim and objectives and reviewthem regularly• Establish a policy framework for the overall management of the event orsituation• Prioritise the requirements of the tactical tier and allocate personnel andresources accordingly• Formulate and implement media-handling and public communication plans• Direct planning and operations beyond the immediate response in order tofacilitate the recovery processChairing the SCG will normally fall to the police. In some circumstances it may bemore appropriate for another agency to take the lead (for instance, the local authoritymay take the lead in the recovery phase).The strategic level is normally located away from the incident. For the HIOW LRFarea the SCG is normally held at Hampshire Constabulary’s Training and SupportHQ at Netley. Alternate sites may be used depending on the location and type ofincident.Version 3.1 Page 50 of 144

Depending on the nature, extent and severity of the emergency, either the regionaltier or central government may become involved. The SCG will then become theprimary interface with these other levels of response.Only the SCG will authorise the release of casualty figures.MembershipThe Strategic Co-ordinating Group will normally include the following.Police: Incident CommanderFire: Senior CommanderAmbulance: DirectorLocal authorities: A Chief Executive (or their representative) from the affected localauthorities providing support to the emergency servicesNHS: An NHS executive director from NHS Hampshire (and rotated betweenDirectors from NHS Portsmouth and NHS Southampton as required)Public Health / Health Protection Advisor providing the link with the Scientific andTechnical Advice Cell (STAC)Others: Other representatives will depend on the scale of the incident. It may benecessary to have an inner core of permanent members and an outer group ofadvisors, specialists and others who could be called on to go to the meeting.Recovery stage of the Strategic Coordinating GroupThe Chair of the SCG will pass to the appropriate Local Authority for the recoveryphase. There will still be a need for the NHS to be represented at SCG and adecision will be made on the most appropriate representation form HIOW NHS. Themeetings are likely to change to daily and then weekly as the recovery proceeds7.8 Scientific and Technical Advisory Cell (STAC)Early stages of the incidentIn the event of a Major Incident that threatens the health of the Public, the Hampshire& IOW Primary Care Trusts have a responsibility to establish a Scientific andTechnical Cell (STAC). The STAC would be set up at Netley and provide advice tothe Police Incident Commander, the multi-agency Strategic Co-ordinating Group. Asenior member of the Public Health team would chair the STAC in the early stages withsupport from a Consultant in Health Protection from Hampshire & IOW Health ProtectionVersion 3.1 Page 51 of 144

Unit. NHS Hampshire will coordinate the establishment of a STAC and will call upon NHSPortsmouth staff as required. The H&IOW STAC Plan details the purpose andarrangements for establishing the STAC.Later stagesAs the incident develops it will become clear that there is need for scientific andtechnical advice and the role of the STAC will evolve into a more technical referencegroup to advice the SCG on all matters related to the incident.RecoveryAs the incident moves into the recovery stage and the appropriate Local Authoritychairs the SCG, it is likely that advice from the STAC will still be required althoughthe meetings may reduce to daily or weekly as the need dictates.Infectious disease outbreakIn the event of an infectious disease outbreak then the PCT will follow the HIOWoutbreak plan. A control team comprising members of the PCT, Health ProtectionUnit and Local Authority Environmental Health Officers will form to manage the outbreakaccording to local agreements and protocols. The PCT will provide staff to assist in themanagement of the outbreak. If the incident becomes large scale then a Major Incidentmay be declared by the health service. A LRF Pandemic Influenza framework is in placewhich outlines the H&IOW response to a pandemic outbreak. NHS Portsmouth has aseparate Pandemic Influenza plan which details the local arrangements for managing apandemic influenza outbreak.CBRN(E) incidentsIn a deliberate release Chemical, Biological, Radiological, Nuclear or Explosiveincident specialists would be asked to attend the STAC to assist the standingmembers, the setting up and running of the STAC would remain the same. ThePolice would assume command over this type of incident.The Hampshire and Isle of Wight CBRN Memorandum of Understanding sets out theresponsibilities of each responding organisation and outlines their part of the multiagencyresponse to a CBRN(E) incident.7.9 Mass casualtiesA mass casualty incident is defined as “a disastrous single or simultaneous event(s)or other circumstances where the normal major incident response of several NHSorganisations must be augmented by extraordinary measures in order to maintain anVersion 3.1 Page 52 of 144

NHSLevelMajorMassCatastrophiceffective, suitable and sustainable response”. The table below outlines the differentresponse levels, triggers and response strategies.DescriptionIndividual trustshandle incidentwithin current andlong establishedmajor incidentplansLarger scaleincident withpossibility ofinvolving theclosure orevacuation ofmajor healthfacility orpersistentdisruption overmany days.Collective mutualaid responserequired fromneighbouringtrusts.An incident that isof suchproportions that itseverely disruptshealth & socialcare and othersupport functions(for example,water supply,electricity supply,transport etc).The requiredresponseexceedscollective localcapacityNo of Local NHS ResponseCasualties10’s Local NHSorganisations activatelocal command &control arrangements.Participate in localmulti-agency commandarrangements100’s Local NHSorganisations activatelocal command &control arrangements.Participate in localmulti-agency commandarrangements, SHAadvised.All trusts link in to SHAStrategic Commandarrangements. SHA coordinatesmutual aidacross the region.1000’s Local trust plansactivated. SHAadvised.All trusts link in to SHAstrategic Commandarrangements.SHA co-ordinatesmutual aid across theregionRegionalResponseSHA advised forinformation onlySHA command &control activatedto co-ordinate thehealth caresystem acrossthe region.DH EmergencyPreparednessDivision notified.Consider theimplementation ofrevised clinicaltreatmentprotocolsPotential for morethan one SHAregion to bedirectly affectedby the incident.Each SHAactivates theirStrategicCommandArrangements.SHA contributesto Regional CivilContingenciesCommitteeDH EPD notifiedA LRF Mass casualties plan will detail the multi-agency strategic preparedness andresponse to an incident of this magnitude. For further information refer to theDepartment of Health Mass casualties incidents: a framework for planning.NationalResponseDH EmergencyPreparednessDivision (DHEPD) informedDH EPDavailable tosupport SHA asrequired.Facilitaterequests fornational mutualaid support.Participate inthe crossgovernmentresponse.Brief ministersDH EPDnational MajorIncidentCoordinationCentreactivated.Nationalcoordination ofNHS strategicresponse andmobilisation ofnational mutualaid effortsParticipate incrossgovernmentresponseincludingDevolvedAdministrations.Version 3.1 Page 53 of 144

8 Annex - Director on Call Role and Responsibilities1. Role overviewThe Director on call (DOC) provides the first point of contact for the notification ofserious and major incidents which will impact on health. They provide an executivelevel input and decision making in the initial stages of an incident.The duty operates 24 hours a day including weekends and bank holidaysThe DOC has particular responsibilities for communications and membersengagement in the initial stages of an incident2. Responsibilities• Initial assessment of level of response and resources required• Declaring a major incident for the Trust and implementing the Major IncidentPlan and action cards in the event of a major incident• Authorising the opening of the Emergency Control Room if required• Notifying and briefing provider organisations and the other executive teammembers as required• Briefing Corporate Communications on situation and actions taken• Providing strategic direction and management of NHS Portsmouth activities insupport of an incident; including the level, range and priority of assistanceNHS Portsmouth and its commissioned services are able to provide.• Provide the focal point for health engagement• Requesting aid from other organizations/neighbouring NHS organisation• Representing (or organising a suitable NHS Portsmouth representative) at theStrategic Command Group (SCG) if requested by NHS Hampshire• Liaise with NHS Hampshire to organise representatives at STAC• Organise Health representation at a Tactical Command Group if requestedThe DOC is to be available and contactable by phone during the period of duty.The DOC should ensure that they can travel within 3 hours, given “reasonablecircumstances”, to Trust HQ or to the Police training site in Netley. A buddyarrangement can be established with another Director if you are planning to traveloutside of these boundaries.Version 3.1 Page 54 of 144

The DOC is to maintain a log of phone calls, messages, actions taken andexpenditure authorised during the period of duty3. Level of authorityThe director on call has normal executive levels of authority including the deploymentof resources on behalf of NHS Portsmouth and the power to implement service levelagreements or contract clauses with commissioned services where this isappropriately risk assessed and in line with the strategy for the response to theincident.4. Duty periodThe duty period is one week (7 days) commencing each Tuesday when the previousDOC had passed over the on-call phone and bag usually by 1000hrs.Version 3.1 Page 55 of 144

9 Annex - Responsibilities of NHS Portsmouth Directorates9.1 Chief ExecutiveThe Chief Executive is responsible for ensuring NHS Portsmouth:• Is able to comply with its duties as a Category 1 Responder under the CivilContingency Act 2004• Has a Major Incident Plan in place that is built on the principles of:• Risk assessment• Cooperation with partners• Emergency planning• Communicating with the public• Information sharing• Has a Major Incident Plan that meets the criteria set out in the NHS EmergencyPlanning Guidance 2005 and has appropriate major incident command, controland coordination arrangements in place• Has an Executive Director of the Board designated to take responsibility foremergency preparedness• Has a Non Executive Director nominated to support the designated ExecutiveDirector for emergency preparedness• Has an adequately resourced Emergency Planning Liaison Officer to support theExecutive Director in the discharge of their emergency preparedness duties• Board receives regular reports, at least annually, regarding emergencypreparedness to include reports on exercises, training and testing, and assurancethat adequate resources are available for the discharge of emergencypreparedness responsibilities.9.2 Designated executive and non executive directors of the boardThe Designated Executive and Non Executive Directors of the Board have delegatedresponsibility from the Chief Executive for ensuring NHS Portsmouth meets itsemergency preparedness responsibilities.Version 3.1 Page 56 of 144

9.3 Finance directorateThe Finance directorate is responsible for:• Ensuring that adequate resources are made available for the discharge ofemergency planning responsibilities• Recognising the need for a contingency budget• Ensuring that emergency cost codes are available• Leading the recovery following a major incident9.4 Performance and development directorateThis directorate is responsible for:• Ensuring all staff are aware of their responsibility to support in the Trusts response toan emergency• Providing access to staff support services occupational health and counselling asrequired• Ensuring senior HR staff are aware of their responsibilities in an emergency• Ensure robust sickness reporting information is available as demanded by theincident• Including emergency preparedness on induction programmes• Including a staff information leaflet in the induction pack given to all new staff• Ensuring staff records maintained reference skill levels and dependencies• Maintaining an up to date list of staff responding in an emergency• Providing staff support during and after an incident9.5 Commissioning directorateThe Commissioning directorate is responsible for:• Including emergency preparedness as part of the performance review of NHSTrusts where deemed appropriate• Including emergency preparedness as part of agreements with the independentsector and other commissioned services where deemed appropriateVersion 3.1 Page 57 of 144

• To provide a pool of senior managers who are trained to assist in the responsephase of incident if required, including:• Commissioning lead for care and nursing homes to support the executiveincident team• Commissioning lead for planned and unplanned care to support the executiveincident team• Support recovery management9.6 Public health functionThe public health function of the Trust is responsible for:• Ensuring the Director of Public Health and Primary Care is trained to act as STACChair and can respond to an incident if necessary.• Providing appropriately trained staff to support the PCT’s emergency response;specifically trained in Public Health issues.• Director of Public Health and Primary Care to act as lead director for emergencyplanning• Managing Emergency Planning resource• Participating in exercises as requiredThrough the Emergency Planning Liaison Officer:• Maintaining the on-call directors rotas• Ensuring major incident training is available for staff as appropriate• Providing representation on Local Resilience Forum Groups as required• Maintaining the Major incident plan and supporting plans on behalf of theTrust• To coordinate and arrange exercises• Act as the named link (Responsible Officer) with Portsmouth Hospitals NHSTrust9.7 Primary care functionThe primary care function of the Trust is responsible for:Version 3.1 Page 58 of 144

• Providing the main point of contact with Primary Care services (GP, Pharmacies,Dental Practices etc) during a response to an incident• Monitoring and ensure a high level of business continuity and preparedness inprimary care services.• If required providing guidance and support to the Executive Incident Teamregarding primary care services during an incident which may include theprioritisation of primary care activities to meet the response.9.8 Corporate and support serviceCommunications teamThe communications team is responsible for:• Working with NHS Hampshire to maintain the on-call communications rota• Working with NHS Hampshire to ensure attendance at the Local ResilienceForum communications group• Maintaining links with the SHA communications team as required during anincident• Maintaining the PCT communications plan• Ensuring that the PCT communication staff have had the appropriate training• Taking part in exercises as required• Maintaining links with other local NHS Trust communications leadsInformation governance and corporate riskThe information governance and corporate risk teams are responsible for:• Provide advice and support as required to the Executive Incident Team during theresponse• Provide advice and support to the EPLO on risk management and informationgovernance to support preparedness arrangements9.9 Estates and facilities directorateDuring a major incident, NHS Portsmouth Executive Incident Team, patients, staffand partners will require access to facilities, supplies and transport. Patients inVersion 3.1 Page 59 of 144

Portsmouth, staff and partners will need to obtain this access as quickly as possible.The Director of Estates and Facilities is responsible for:• Developing plans to ensure that facilities, supplies and transport are availableduring a major incident both inside and outside of office hours• Developing Business Continuity Plans (BCPs) for premises and support servicesthat ensure services can continue to be delivered in the event that a majorincident that effects estates service provision• Ensuring that the Estates and Support Services BCPs allow for the flexible use ofpremises during a major incident• Ensuring that there are clear plans in place to ensure robust communication withthe Executive Incident Team and partner agencies• Ensuring these plans are well communicated to Senior and Area Managers onCall, clinical and support staff• Developing mutually beneficial relationships with partner organisations to allowfor mutual aid9.10 Information communication and technology functionDuring a major incident, NHS Portsmouth Executive Incident Team, and other keystaff will require robust access to the Information Communication and Technological(ICT) systems. The Head of ICT is responsible for:• Developing a plans to ensure the NHS Portsmouth Executive Incident Team (EIT)and other key staff have access to ICT support during a major incident bothinside and outside of office hours• Ensuring there are Emergency Planning and Generic email accounts available tothe EIT to use within the Emergency Control Room• Ensuring there are Business Continuity Plans for ICT services• Ensuring these plans are well communicated to the Senior and Area Managerson Call, clinical and ICT staff• Developing mutually beneficial relationships with partner organisations to allowfor mutual aidVersion 3.1 Page 60 of 144

9.11 All employeesAll NHS Portsmouth staff are responsible for:• On appointment and periodically thereafter familiarising themselves with the NHSPortsmouth Major Incident Plan, Action Cards and their service’s BusinessContinuity Plan• Familiarising themselves with how they should report for duty should a majorincident occur, and their roles and responsibilities within a major incident• Attending major incident training, and for identifying any unmet training needs atsupervision and appraisal• Taking part in major incident exercises as required• Being vigilant to the security of premises and staff• If staff are included on major incident contact list to ensure that any change intheir home address or contact details is reported to the EPLO to enable up todate out of hours contact lists to be maintained• Co-operating with NHS Portsmouth during a major incident, undertaking theirduties within their scope of practice as and where requested, cooperating withredeployment into different roles at different sites, working flexibly to meet theneeds of their service, and for fulfilling their contractual duties wherever possible• Having up to date formal identification cards on their persons at all timesDuring a major incident NHS Portsmouth employees are expected to make everyeffort to attend work. If this is not possible e.g. for safety reasons employees mustreport this each day. If it is possible for employees to work at home they can do soas long as this is with the agreement of their line manager and they can arrangecover. If employees are unable to attend work and cannot work at home, they can,with agreement from their line manager, make up the hours subsequently, takeannual leave or take unpaid leave.9.12 NHS Portsmouth responsibilities to its staffA major incident may impact on the availability of NHS Portsmouth staff to undertaketheir normal duties. Similarly staff may be required to work longer hours than normal,and may be affected adversely either personally or professionally. NHS Portsmouthhas a responsibility to ensure that staff welfare is considered and promoted.Version 3.1 Page 61 of 144

NHS Portsmouth will ensure that:• Staff welfare is considered and promoted during and following a major incident• Occupational Health are informed of any staff involved in a major incident so thatany necessary follow up support can be given• Staff have access to an Employee Assistance Programme (which givesindependent advice, information and provides a counselling service)Version 3.1 Page 62 of 144

10 Annex - Solent Healthcare Response and Responsibilities10.1 AlertingSolent Healthcare (SHC) Director on call will be alerted to the incident by the NHSPortsmouth Director on call or NHS Southampton City Director on callThe SHC Director on call will implement an internal cascade as appropriate.10.2 Executive management team and control centreSHC will establish an internal executive management team and supporting controlroom if the SHC executive team deem it appropriate.10.3 NHS Portsmouth liaisonIn a Major Incident SHC will send a Senior Manager to both or one of the followingresponse levels:• NHS Portsmouth’s Emergency Control Centre at St James Hospital to act asLiaison Officer to ensure a coordinated response to an incident and maintainclose contact and communications with the commissioning PCT• The Tactical Health Cell located at Portsmouth Civic Offices to maintain multiagencylinks and a tactical level response within PortsmouthIn the event that an incident spans both Southampton and Portsmouth SHC may alsobe requested by NHS Southampton City to provide a liaison officer.10.4 SHC major incident planSHC have their own operational major incident plan which details their operationalresponse.10.5 Role overviewThe role of Solent Healthcare during a response includes the following:• Ensure that there are clear command and control arrangements (including anemergency control centre) which link with the wider NHS response;• Ensure that it provides all necessary co-operation and support to the CoordinatingCommissioner;Version 3.1 Page 63 of 144

• Ensure that it promptly provides all required information to the Co-ordinatingCommissioner during an emergency including the following;• Support the commissioning organisation with the assessment of the effects of anincident on vulnerable care groups, such as children, dialysis patients, elderly,medically dependent, or physically or mentally disabled. Vulnerable people (asdefined in Part 1 of the Civil Contingencies Act 2004 (Emergency Preparedness:guidance)) known to the Provider are identified as soon as practicable when anemergency/incident is declared and notified to the Tactical Co-ordinating Group(Silver) when established.• If required, during the response to an incident, be able to mobilise communitycare resources to support acute trusts, non acute trusts and other healthcareproviders with:ooooProvision of staffProvision of facilitiesProvision of capacityProvision of equipment• If required during the response to an incident be able to mobilise community careresources to support:oooooAccelerated discharge from acute trustsVictims of an incident including NHS StaffRest centresHumanitarian or evacuation centresThe administration of medications, prophylactics, vaccines and othermeasures including mass distribution of countermeasures such as:• The distribution of Potassium iodide tablets in the event of anuclear outbreak• A pandemic vaccination programme• Distribution of antiviral medication• Ensure that support mechanisms are in place for staff (for example, in terms ofrecording involvement in an emergency response and providing post incidentsupport to those affected by the incident);Version 3.1 Page 64 of 144

• As a provider of mental health services SHC are responsible for:oooCo-ordinating and directly providing the psychological and mental healthsupport to staff, patients and relatives in conjunction with Social Services;Advising on the long term effects of trauma on the casualties associatedwith the incident and recommend the appropriate level of psychologicalintervention required;Ensuring that mental health patients caught up in the incident aredischarged home with appropriate support in the community fromCommunity Mental Health Teams and Crisis Teams or their equivalent.• Continue to provide core business services and ensure the Co-ordinatingCommissioner is kept informed of any decisions made during an incidentwhereby service prioritisation results in service suspension / reallocation ofresources.• Ensure that planning is in place for the recovery phase of a major incident;• Preserve all plans and documentation used or produced during the course of theemergency response;• Prepare a post-incident report for consolidation in the NHS report to be forwardedto the commissioning organisation, the SHA or equivalent and other interestedorganisations;Version 3.1 Page 65 of 144

11 Annex - Responsibilities of Primary Care Contractors• To assess available staff resources within the practice.• To conduct an assessment of needs, including any relevant geographical factorsand to provide care in the community in respect of:ooooPatients who may be prematurely discharged from hospitalsVictims of an incident with minor injuries discharged to their homesAny concentrations of survivors within the communityAny concentrations of relatives and friends of victims• To conduct an assessment with the PCT of the likely impact of any emergency onNursing and Residential Homes.• To work closely with Solent Healthcare Community Nurses directly involved orwith specific interests associated with the geographical area of the emergency.• To maintain records of all action taken, including the personal details of all thosescreened.• To maintain communication links with the NHS Portsmouth’s Emergency ControlRoom or Tactical Health Cell.• To support Community Nurses deployed to Local Authority Prepared RestCentres (PRCs) to:oooooProvide some medical screening to ensure evacuees who have ordevelop medical problems receive necessary health careAssess any health needs of evacuated peopleArrange for the replacement of lost prescribed medicinesProvide medical advice and information on the consequences of theIncidentProvide a health contribution to the welfare support of evacueesVersion 3.1 Page 66 of 144

12 Annex - Multi-Agency Roles and Responsibilities12.1 Main roles of category one respondersPolice• Alert the other emergency services and local authorities;• Save lives by working alongside the other emergency services;• Co-ordinate the emergency services and other organisations during the responsephase;• Protect and preserve the scene;• Investigate the incident alongside other investigative organisations;• Collect and pass on information about casualties;• Identify those involved; and• Restore stability with the aim of restoring normality.Fire and Rescue Service• Alert the other emergency services and local authorities;• Save lives by working alongside the other emergency services;• Tackle fires or chemicals which have been spilt and other dangerous situations;• Rescue trapped casualties;• Make sure all personnel involved in the rescue work are safe;• Gather information and carry out hazard assessments;• Help the ambulance service get live casualties away from the scene;• Help the Police recover bodies; and• Restore stability with the aim of restoring normality.Ambulance Service• Alert the other emergency services and local authorities;• Save lives by working alongside other emergency services;• Provide a focal point for all NHS and medical resources;• Identify and alert the appropriate receiving hospitals and PCTs;Version 3.1 Page 67 of 144

• Set up a casualty clearing station;• Prioritise casualties so their injuries can be treated;• Prioritise which casualties must be evacuated using appropriate transport; and• Restore stability with the aim of restoring normality.Receiving hospitals• Provide and control a clinical response for managing a large number ofcasualties;• Maintain hospital services so patients can be cared for in a routine way;• Manage communications, the media, relatives, friends, general enquiries and VIPvisits;• Liaise with PCT’s to ensure a coordinated response• Liaise with the emergency services, other receiving hospitals, supportinghospitals and other agencies; and• Keep records of casualties by working with the Police.Local authorities (County, Unitary, District & Borough)• Support the emergency services;• Help people in distress;• Co-ordinate the activities of their various departments and other agencies;• Release information that has been agreed by the Police to the media and giveadvice to the public;• Keep local authority services going in as normal a way as possible; and• Restore stability with the aim of restoring normality.In Hampshire these roles are shared between the County Council and the district andborough councils.Hampshire & IOW Health Protection Unit• Provide expert advice on communicable disease• Provide links to national expertise in the Health Protection Agency• Provide and maintain the out of hours public health rotaVersion 3.1 Page 68 of 144

Environment AgencyThe Environment Agency has the responsibility for protecting water, land and air.These responsibilities cover direct action to:• prevent or deal with the effects of an incident;• provide specialist advice;• give warnings to those likely to be affected;• monitor the effects of an incident; and• investigate the cause of the incident.12.2 Main roles of category two respondersUtility companiesThe utility companies, gas, water, electricity and phone companies, play a centralrole in responding to a major incident, particularly during the recovery phase. Theymay also have to make working areas safe very early on. The main role of category 2responders is to cooperate and share information with category 1 responders.12.3 Main roles of other supporting groupsArmed ForcesThrough a system called Military Aid to the Civil Authority (MACA), the armed forcescan help in an emergency if there is danger to human life or if there is a breakdown inservices vital to the welfare of the community. The Police or Hampshire CountyCouncil will only ask for their help in line with MACA procedures. Within Hampshire,the Army will take the lead for the three services - Army, Navy and RAF.HM CoronerThe Coroner will liaise with the Police and Senior Supervising Pathologist to decide ifa temporary mortuary is needed. The Coroner will liaise with the receiving hospitalsand, if necessary, the coroners of the areas in which the receiving hospitals arebased, to make sure that any casualties from the incident who die (either in hospitalor while being moved) are moved to the Temporary Mortuary.The Coroner, Senior Identification Manager and Senior Supervising Pathologist willform the Identification Commission and decide on what criteria should be used toidentify those who have died.Version 3.1 Page 69 of 144

Voluntary AgenciesVoluntary groups such as St John’s Ambulance and British Red Cross have theresources to provide significant aid to category one responders during a majorincident, such as vehicles and highly trained personnel. Category one and tworesponders plan and exercise together to ensure there can be seamless partnershipworking during an actual incident.Religious GroupsLRF emergency planning and exercising schedules involve leaders from religiousgroups in order to ensure close links and an understanding of issues which may beraised during a major incident. Leaders of religious groups can provide crucialsupport and advice to category one responders which helps temper the response ofthose groups during the actual incident and afterwards during the recovery phase,helping communities return to the new normality.Version 3.1 Page 70 of 144

13 Annex – Response Action CardsAction cards are a useful reference to support the actions required to the response ofa number of major incidents. Action card 1 should be used for all major incidents bythe Director on call or lead for the incident. The other action cards are for specificpurposes or a specific response. The table below provides a list of the action cards.13.1 List of action cardsAC No. Name of action card Purpose1Initial response to amajor incidentAction card for Director on Call (DOC) to followwhen they have received an alert for a majorincident or potential major incident2Opening the EmergencyControl Room (annex 18)Action card detailing instructions on how to openthe Emergency Control Room. This action card hasa number of supporting role cards and diagrams forsetting up the room detailed in annex 18.3Media andcommunicationsOutlines the initial actions and role of the mediaand communication team4Public Health andScientific and TechnicalAdvisory Cell (STAC)This action card provides information on the type ofincidents that will require public health support andthe set-up of a STAC5PORTSAFE action cardSets out the role of NHS Portsmouth in the event ofan off-site nuclear emergency at Portsmouth NavyBase. This is supported by Solent Healthcare’sinformation pack for nursing team to support PITsdistribution and the Portsafe plan6Heatwave Provides an overview of the actions to take at the 4levels of a heatwave alert. This should be read inconjunction with the DH heatwave plan and NHSPortsmouth Heatwave planVersion 3.1 Page 71 of 144

7Flooding Provides an overview of the actions to take at the 4levels of flood warnings. This should be read inconjunction with the NHS Portsmouth Floodresponse plan8Disruption to road fuelProvides an overview of the response to adisruption to road fuel supply. This should be readin conjunction with the NHS Portsmouth disruptionto road fuel supply and LRF Fuel Plan9Pandemic InfluenzaProvides an overview of the response to apandemic influenza outbreak. It is split into 4progressive action cards according to the severityand timing of the outbreak. These should be usedin conjunction with the NHS Portsmouth PandemicInfluenza Plan.All action cards are available from the following locations:• Paper copies in the On-call bag held by the Director on call• On the memory stick held by the Director on call• Paper copies held by the EPLO and in the Emergency planning cupboard• On the Trust’s shared network drive “T”Version 3.1 Page 72 of 144

13.2 Initial response to a major incident – action cardThe Director on call is responsible for carrying out the actions on this card.1. Ascertain and assess the incident using the comprehensive incident assessmentand situation report in annex 21.2. Verify the incident with Portsmouth Hospitals NHS Trust and/or South CentralAmbulance Services and/or NHS Hampshire.3. Decide in conjunction with the Chief Executive and Director of Public Health theTrusts response and decide if the Trust should declare a major incident andactivate the Major Incident Plan.4. If a major incident is declared establish:• The Executive Incident Team and supporting teams (as required) as outlinedin section 5 of this plan.• The Emergency Control Room (if required) by requesting the emergencyplanning team to set-up the emergency control room as outlined as outlined inannex 18.5. If a strategic coordinating centre and/or a Scientific and Technical Advisory Cell(STAC) are established (usually at Netley) liaise with NHS Hampshire to organisestaffing arrangements.6. If a Portsmouth Tactical Coordinating Centre is established (usually atPortsmouth Civic Offices or Guildhall) and if requested by the Police orPortsmouth City Council organise staff to form the Tactical Health Cell.7. Notify the Emergency Planning Liaison Officer and/or the Consultant in HealthProtection.8. Ensure all relevant local health organisations (as you deem appropriate) arenotified of the incident and contacted for support if required, these include:• Portsmouth Hospital NHS Trust• Solent Healthcare via the Director on call• General Practice (through the Primary Care commissioning team)• Independent Sector Treatment Centre,• Rowans HospiceVersion 3.1 Page 73 of 144

• and other independent services as deemed appropriate9. In addition consider contacting the following people or organisations if you deemappropriate:• Hampshire and Portsmouth joint media and communications on call manager• NHS Hampshire• South Central SHA• Portsmouth City Council Civil Contingencies Unit or City Contact Officer• NHS Southampton City• NHS Isle of Wight• Hampshire Community Healthcare• Voluntary Organisations as deemed appropriate10. Ensure the actions listed in section 5 of this plan are considered and put intoaction as deemed necessary by the Executive Incident Team.Version 3.1 Page 74 of 144

13.3 Media and communication – action card1. Role of the departmentThe communications team will liaise with NHS and other agencies to co-ordinate therelease of information to the media, members of the public, GP Practices, StrategicHealth Authority, etc, and will provide communications bulletins for distribution withinNHS Portsmouth.2. Declaration of a major incidentThe Communications Manager/s will be notified of the major incident usually by theNHS Hampshire Director on call or NHS Portsmouth Director on call.3. Key initial actions1. Agree with NHS Hampshire the health media lead for the incident. Normally NHSHampshire will provide the lead for incidents that affect H&IOW, but for incidentsaffecting only Portsmouth then NHS Portsmouth will take the lead.2. Agree with other agencies which will take the lead on media enquiries. In the firstinstance, media enquiries should be directed to the Communications or MediaManager of an agreed lead agency that could be:a. Portsmouth Hospitals NHS Trustb. NHS Portsmouthc. NHS Hampshired. South Central Strategic Health Authoritye. Other, e.g. South Central Ambulance, Hampshire Constabulary orappropriate local authority (Hampshire County Council or Portsmouth CityCouncil)3. Agree a contact in lead media agency and telephone number4. Normally a PCT will not set up its own helpline. Such a facility can normally beprovided either by the appropriate local authority or by NHS Direct. Contact NHSDirect, Portsmouth City Council, or Hampshire County Council if appropriate toestablish who is providing a help line facilitya. Agree who will take the lead on providing a help line facilityb. Agree contact in lead agency and telephone number to keep up to datewith latest developments;Version 3.1 Page 75 of 144

c. Provide relevant public health information to the lead helpline agencyd. Liaise with NHS Direct on arrangements for providing information to thepublic via media broadcasts.5. Establish with Portsmouth City Council if they require a health mediarepresentative at the Tactical Coordinating Group for Portsmouth.6. The NHS Portsmouth Communications Manager/s will follow the Media Officer &Media Monitor Action Cards held in the emergency control room, some of thekey responsibilities are summarised below:(a) act as the first point of contact for press enquiries(b) establishing appropriate mechanisms with the media to provide advice to thepublic(c) (as appropriate) appoint a spokesperson who will take the lead incommunications with the media(d) liaising with the press /communications officers at the Strategic HealthAuthority(e) attend relevant health and multi-agency meetings(f) prepare press statements and deal with media enquiries(g) arrange on-site accommodation and beverages for the media (as appropriate)(h) prepare information for release to members of the public for dissemination viaCommissioned Services and/or GP Practices(i) prepare information bulletins about the incident for distribution to Independentservices, commissioned services and staff(j) monitor news and media coverage of the incident4. Overview of the media role and general informationStage 1: when an incident occursEarly notificationThe Communications lead for the organisation needs to be notified at the earliestopportunity. Where the Media and Communications lead for the organisation isunavailable due to sickness or annual leave, the back-up cover should be notified asVersion 3.1 Page 76 of 144

specified in the on-call contact details. He / she will then undertake the actions asoutlined on the Media and Communications Action Card identified above.Immediate media requirementsNews media invariably respond to an incident within 15 minutes of it starting. This isoften faster than health and other emergency services can respond. It is essential tobe responsive to media requests as failure to respond quickly and accurately canhave serious implications for the management of an incident and can jeopardise theability to get clear public health and operational information to the general public.Media contactIt is important to go by the following guidelines:• Establish a 'clear and dedicated number for media enquiries• Recognise the media’s legitimate role in providing and seeking information• Provide accurate and timely information for the media, preferably proactively• Identify trained spokespeople who will be available for interviews and pressbriefings• Explain honestly when it is not possible to meet a request for information, andwhen information is likely to be available• Recognise that media liaison may need to take place at the ‘scene’ as well as atkey health settings (e.g. hospitals receiving casualties). There may be a need toestablish a ‘media liaison point’ at one or all of these locationsStage 2: during an incidentEstablishing a media liaison pointIt is vital to work with other organisations to:• Identify a safe point near the scene, if there is one, where the media cancongregate• Identify a fixed point at which information will be provided in a planned way• Identify a location where press briefings can take place• Identify locations where individual interviews can take place• Ensure coherent approach to media liaison (e.g. messages and times ofbriefings)Version 3.1 Page 77 of 144

Working with other agenciesMost incidents will require good working relationships with partner organisations.It is essential to:• Liaise with other agencies dealing with media enquiries• Issue information only relating to health services unless clearly agreed with otherorganisations• Issue copies of press statements to partner organisations• Liaise with the media cell at Gold/ Strategic command where this is established• Share resources and information to ensure the best possible service to the publicand the media• Work co-operatively to provide 24 hour cover during long running incidentsPublic Health informationPCTs have a major responsibility to provide public health information in the event ofa major incident. In incidents in which a Strategic level has been established, thenature of the information will be agreed with the Scientific and Technical AdvisoryCell via the Media and Communications Lead at the Strategic level. Keyresponsibilities for the PCT will be to:• Compile and co-ordinate public health messages via the media• Respond quickly as the incident develops to ensure timely public healthmessages• Liaising with Strategic level to agree public health messages and ensure that theyare aware of the developing situation when making strategic decisions• Cascading public health information via NHS staff, particularly those in primarycare• Making public health information available through any telephone helplinesInforming staff and clarifying their roleKey responsibilities to staff, primary care contractors and associated NHS serviceswill include:• Cascading public health and other health information to staff so they are able todeal with public enquiries and are kept up to date as to the developing incidentVersion 3.1 Page 78 of 144

• Providing information to the media about the health services and their role in themanagement of the incident (e.g. describing the role of specific services intreating illness and injury, providing information on the number of casualtiesreceived).• Providing information to the media and the public on the role of primary andcommunity health services as a source of health advice (e.g. advising the publicto visit their GP if they have a concern)• Providing information to the media about the role of the health service on thescene (e.g. local GPs may be assisting at the scene).• Managing media requests to talk to staff and primary care contractors about theincident• Managing media requests to talk to patients receiving care and treatmentStage 3 after an incidentEvaluation and reportingIn the close down and review stages the Media and Communications lead shouldprepare a detailed overview of media and communications includingrecommendations for future action. Issues of media handling are to be included indebriefing reports and the lessons learnt shared with partner organisations and theStrategic Health Authority.Version 3.1 Page 79 of 144

13.4 Public health and STAC – action cardThis Action Card is for guidance, and is not prescriptive. The instructions should betailored to meet the circumstances of the incident.1. Role of the service1.1 If the incident has public health implications/consequences, NHSPortsmouth’s Director of Public Health in liaison and consultation with other publichealth colleagues and external specialists and agencies, will provide adviceconcerning the release of information to the public about preventative, treatment andother measures.1.2 Incidents involving communicable disease, chemical and radiological hazardsand terrorist deliberate release require specialist input. These may includeEnvironmental contamination by radiation or toxic chemicalsDrinking water contaminationInfectious disease outbreaks/incidentsUntoward incidents liked with health care interventions e.g. systematic laberrorsPossibility of nosocomial transmission of serious pathogensFor such incidents, the Consultant in Health Protection from the Health ProtectionAgency and their team must always be consulted and in many instances will lead thePublic Health response on behalf of the Director of Public Health.2. Declaration of a major incident2.1 During office hours NHS Portsmouth’s Director of Public Health will benotified of the major incident by the normal alert routes. If out of hours, he/she mayalso be notified by the On Call Doctor for Public Health/Communicable Disease whowill be notified of the incident by Portsmouth Hospitals Switchboard or South CentralAmbulance Services.3. Role of key staff3.1 Public Health professionals in each PCT will liaise and take direction from theSTAC (see Section 4) to determine the potential public health implications of theincident and will advise the PCT(s) of the appropriate action required.Version 3.1 Page 80 of 144

3.2 The Health Protection Agency plan CBRN Incidents: A Guide to ClinicalManagement and Health Protection provides guidance on the management of CBRNIncidents and the Local Health Protection Unit can be contacted for support andadvice.4. Scientific & Technical Advice Cell (‘STAC’)The STAC is organised and managed by NHS Hampshire but may involve NHSPortsmouth staff. Full details can be found in the “LRF STAC Plan” and a copy isheld by the Director of Public Health (DPH), the EPLO and in the major incidentcupboard.4.1 Depending on the nature and scale of the incident, a STAC may be requestedby Police Incident Commander to the Strategic Health Authority DPH, who in turn willask the DPH of the lead PCT to convene the STAC. The STAC will normally beestablished at the Police Main Base Station (Strategic command centre at Netley)and meetings will consist of representatives of a range of organisations or specialists,some of whom will be core members and present whatever the nature of the incident.4.2 In the first instance, it is likely that the DPH for the Lead PCT will conveneand chair the STAC (although this will depend on the nature of the incident) andensure a rota is set up to provide on-going staffing as many emergencies willcontinue beyond a single shift. The rota will be drawn up in conjunction withRegional and Strategic DSPH.4.3 The STAC is a strategic group and its main purpose is to:Seek advice on the public health aspects of the incident from a range of expertsProvide advice to the Strategic Coordinating Group on the scientific and technicalaspects of the incidentAgree with the Police Incident Commander the advice on the public health andenvironmental consequences of the incident4.4 Again depending on the nature/scale of public health advice/presence mayalso be requested from the Health Protection Unit at Tactical commands.If thedemand on local DPHs exceeds the DPHs available it may be necessary to seeksupport from DPHs in neighbouring Districts/Counties.Version 3.1 Page 81 of 144

13.5 Radiation incident at dockyard (PORTSAFE) – action cardThis Action Card is for guidance, and is not prescriptive. The instructions should betailored to meet the circumstances of the incident.1. IntroductionPortsmouth City Council is responsible for the offsite plan called PORTSAFE whichdetails the arrangements for a multi-agency response to the declaration of an off-sitenuclear emergency at Portsmouth Navel Base. The full plan is held by the EPLO,Director of Public Health, in the emergency planning cupboard and on the Director oncall memory stick.This action card sets out the role of NHS Portsmouth in the event of an off-sitenuclear emergency.2. Cascade alertThe police will cascade the alert to South Central Ambulance Services who will thenalert NHS Portsmouth among other Healthcare partners. NHS Portsmouth will needto cascade the alert to Solent Healthcare and independent providers as deemedappropriate.3. Role of NHS Portsmoutha. Run a Tactical Health Advice Cell (THAC) located at the Portsmouth civicoffices. Details of a THAC are included in support annex B below and in thePortsafe plan. Typical membership includes:• NHS Portsmouth Consultant in Public Health (Chair)• NHS Portsmouth Communications officer• Tactical military co-ordinating authority health physicist (if available andnot already including in a military cell)• Solent Healthcare Senior Manager or Director• Portsmouth Hospital NHS Trust senior representative• Local authority environmental health officer• 2 x support staff (loggist and admin support)b. Liaise with NHS Hampshire to organise staff for a Scientific and TechnicalAdvisory Cell (STAC) located at Netley police training site. Details of a STACare included in support annex C below, in the Portsafe plan and in the LRF STACVersion 3.1 Page 82 of 144

plan. Typical health membership includes (a full membership list is included inannex C):• Director of Public Health as the chair• Consultant in Public Health as deputy chair• Loggist and admin supportc. Liaise with Solent Healthcare to organise nursing staff to attendDistribution Centres where Potassium Iodate Tablets (PITs) will bedistributed and to give advice about sensitivities, allergies or other medicalconcerns.• Alerting, opening and manning these Centres is the responsibility of LocalAuthority staff.• The Local Authority will contact the director on call or emergency planningteam to request nursing support and provide the details of the centre(s) tobe opened.• Each distribution centre will require a minimum of 3 nurses. A pack ofaction cards for these roles are held in the major incident cupboard, onthe director on call memory stick and taken to each distribution centre bythe council when PITs distribution centres are readied.d. Activate the NHS Portsmouth Major Incident Plan and supporting controlroomSupport Annex B - Tactical Health Advice Cell (THAC)The Tactical Health Advice Cell (THAC) forms part of the Tactical Co-ordinatingGroup. In the early stages of an incident the THAC may operate as the strategic levelof scientific and health advice until the SCG and STAC are established. The THACwill operate during the response phase, and in the recovery phase until otherstructures are established or residual tasks revert to individual agencies.The role of the THAC is to:• Liaise with the STAC about the implementation of public health countermeasures• Communicate public health messages in accordance with the decisions of theSCG/STAC.• Co-ordinate the local health response to an off-site nuclear emergencyVersion 3.1 Page 83 of 144

• Identify vulnerable groups who may require additional support, in conjunction withpartner agencies• Provide advice to local responders on the hazards to the public and theimplementation of countermeasures.Support Annex C - Multi-agency Scientific and Technical Advice CellThe Scientific and Technical Advice cell forms part of the SCG and provides timelyand co-ordinated advice on scientific and technical issues. The STAC will operateduring the response phase, and in the recovery phase until other structures (such asthe Recovery Co-ordinating Group) are established or residual tasks revert toindividual agencies.The role of the STAC is to:• Provide co-ordinated, consistent and agreed scientific and technical advice to theSCG.• On the evidence available, assess the impact of the emergency on public healthand the environment, how the situation might develop and likely effects ofmitigation strategies• Confirm the implementation of the PORTSAFE public health countermeasures• Liaise with national specialist advisors and wider scientific and technicalcommunity as required• Identify other agencies or individuals who should be invited to join the cellTypical membership of the STAC:• Director of Public Health (Chair)• Consultant in Public Health• Strategic military co-ordinating authority health physicists• Emergency service technical advisors• Health Protection Agency/ Health Protection Unit radiological advisers• Environment Agency, Food Standards Agency, DEFRA, Met Office, SouthernWater, Health and Safety Executive Nuclear Installations Inspectorate,Government Decontamination ServiceVersion 3.1 Page 84 of 144

13.6 Heatwave – action cardThis Action Card is for guidance, and is not prescriptive. The instructions should betailored to meet the circumstances of the incident. This action card should be used inconjunction with the NHS Portsmouth Heatwave Plan and the Department of HealthHeatwave Plan.1. Declaration of a heatwaveA ‘Heat-Health watch’ system operates in the UK from 1 June to 15 Septemberbased on Met Office forecasts which trigger levels of response to the heatwave plan.There are 4 levels of response to the Heat Health watch system:Level 1 Awareness – the minimum state of vigilanceLevel 2 Alert – this is triggered as soon as the Met Office forecasts that there is a60% chance of temperatures being high enough on at least 2 consecutive days. Thiswill normally occur 2-3 days before the event is expectedLevel 3 Heatwave – this is triggered as soon as the Met Office confirms thatthreshold temperatures (for the South East it is 31 degrees Celsius during the dayand 16 during the night) have been reached in any one region or more. This stagerequires specific actions targeted at high risk groups.Level 4 Emergency – this is reached when a heatwave is so severe and/orprolonged that its effects extend outside health and social care such as power orwater shortages and/or where the integrity of health and social care systems isthreatened. At this level illness and death may occur among the fit and health and notjust the high risk groups.2. Notification of changes in levels, escalation and stand down2.1 Notification of alertsThe Met Office provides weekly email alerts to NHS Portsmouth identifying theheatwave response level. It should also be noted that if a Level 2 / 3 or 4 Emergencyalerts are issued, it is also likely that NHS Portsmouth will be informed by a numberof agencies e.g. South Central SHA, NHS Hampshire as the lead PCT and LocalResilience Forum Partner agencies.2.2 Cascading alert notificationsEmergency Planning or the Director on Call will alert relevant commissionedservices, Portsmouth City Council Social care department and other agencies asVersion 3.1 Page 85 of 144

identified at the particular response levels identified in the response actions identifiedin the table below. Cascades will be via email, fax or phone as deemed appropriate.3. Important documentsIt is vitally important that the following documents are referred to for detailedguidance:Available on www.dh.gov.uk/publications, the internal network drive “T”, Director oncall memory stick and in the major incident cupboard• The Heatwave Plan for England (DOH, May 2010)• Heatwave advice for health and social care professionals 2010• Heatwave advice for care home managers 2010• Looking After Yourself and Others During Hot Weather – the latest advice• NHS Portsmouth Heatwave PlanIn addition the Emergency Planning team hold a number of printed DH leaflets“Looking after Yourself and Others during Hot Weather – the latest advice”4. Responsibilities for NHS Portsmouth (in conjunction with Social Service):National AlertLevelCommentaryResponse requiredLEVEL 1SummerpreparednessLong-termplanning toprotectvulnerablepeople duringheatwaves.Readiness forthe heatwaveseason (1 June–15 Sept).• Draw the attention of the local authority planning department tothe national heatwave plan.• Include the national plan and local response as an agenda itemfor the Joint Health Emergency Planning Group.• Ensure actions for level 1 responsibilities detailed in DH heatwaveplan for England (pg 25 to 27) are being undertaken locally• Copy the plan to Portsmouth Hospital Trust, Solent Healthcare,Health visiting lead, District nursing lead, Primary care lead,Pharmacy lead, The Rowans Hospice, Portsmouth City CouncilCivil Contingency & Social CareVersion 3.1 Page 86 of 144

LEVEL 2Alert andreadinessNational alertthat there is a60 per centchance of aheatwave in oneEnglish region –this normallyoccurs threedays before theevent.Determine whether there is a greater than 60 per cent chance of aheatwave occurring within Portsmouth within three days – if thereis:• Ensure the Met Office website is checked and respond to the levelof alert www.metoffice.gov.uk.• Notify leads listed above and ensure they and NHS Portsmouthare carrying out the actions for level 2 responsibilities detailed inDH heatwave plan for England (pg 32 to 33)• Consider calling a meeting of the Emergency planning team, theexecutive director on call and media. Also consider expanding it tothe Executive Incident Team (as detailed in section 5) dependingon the risk• Ensure Media Team briefed.LEVEL 3HeatwaveactionHeatwaveconditions inone region ormore. Aheatwave hasbeen declared ifthe ‘qualifying’temperaturesare exceeded.Determine whether heatwave conditions for level 3 coverPortsmouth and surrounding area – if they do:• Call a meeting of the Executive Incident Team (as detailed insection 5) if one has not already been held;• Notify leads listed above and ensure they and NHS Portsmouthare carrying out the actions for level 3 responsibilities detailed inDH heatwave plan for England (pg 34 to 36) are being undertaken• Identify priority risks in the Portsmouth area to act upon.• Ensure services prepare for stand down and recovery• Ensure the Met Office website is checked and respond to the levelof alert www.metoffice.gov.uk.LEVEL 4HeatwaveemergencyA heatwaveemergency iswhen othersectors, not justthe healthsector, areaffected duringa prolonged or• Major incident Executive Incident Team continue to meet;• Establish an Emergency Control Room if required• Ensure action cards for NHS Portsmouth (media and publichealth) and independent service providers / commissioned servicesare being carried out as required (these are contained within theNHS Portsmouth Heatwave plan)• Ensure appropriate membership at an H&IOW StrategicVersion 3.1 Page 87 of 144

seriousheatwave – amajor incidentwill be declaredlocally wherenecessary.Command Group and Scientific and Technical Advisory Cell ifestablished by the Police. NHS Hampshire will coordinate• Ensure appropriate membership at a Portsmouth TacticalCoordinating Group if one is established (NHS Portsmouth maychair the group as it is a health issue)• Obtain regular situation reports from frontline healthcare leads.• Public Health to advise partners of wider health risks to thepopulation.• Provide updates, and report any concerns to StrategicCoordinating Group and the SHA5. Summary of heatwave plan levels and actions.Version 3.1 Page 88 of 144

13.7 Flooding – action cardThis Action Card is for guidance, and is not prescriptive. The instructions should betailored to meet the circumstances of the incident. This action card should be used inconjunction with the NHS Portsmouth Flood Response Plan.1. IntroductionIt is likely that prior warning for a flood will be given, normally at least 3 days, butthere is also the potential that little warning will be given. The initial actions for thissituation will be managed by the Emergency Planning Liaison Officer or deputy if thewarning is given in hours and with some notice, if this is not the case then theDirector on call will need to lead on the initial response actions.For detailed instructions on the response see the “NHS Portsmouth Flood responseplan”2. Cascade alertNHS Portsmouth will be alerted of a potential or imminent flood risk normally by theMet Office or Environment Agency via email to the EPLO, Consultant in Public Healthand Director of Public Health. Flood warnings are also available on their websites:http://www.metoffice.gov.uk/weather/uk/se/se_forecast_radar.htmlhttp://www.environment-agency.gov.uk/homeandleisure/floods/31618.aspxThe Met Office uses the following 3 categories of warning:Advisories - Advisories are issued by 1100 daily as routine and indicateconfidence of expected severe or extreme weather. Early and flash warningssupersede advisories when confidence levels are 60% or greater.Early Warnings - An early warning of severe weather will normally be issuedseveral days in advance whenever the overall risk of widespread disruption inany UK region is 60% or greater.Flash Warnings - Flash warnings of severe weather are issued whenconfidence of an event reaching specified criteria is above 80% and shouldgive a minimum of 2 hours notice. Warnings are issued for every county orunitary authority.Version 3.1 Page 89 of 144

In addition to the 3 tier MetOffice Weather warning systemidentified above theEnvironment Agency have thefollowing 4 tier flood warningsystem – see oppositeThe NHS Portsmouth responsewill be different at each level;this is outlined in the followingpages:3. General role of NHS PortsmouthEssential issues will include:1. Ensure business continuity of NHS Portsmouth Services and CommissionedServices2. Ensure timely and accurate media and internal communications3. Working with partner organisation as part of a tactical command group and/ora strategic command group4. In liaison with partners ensure the protection of vulnerable people5. Ensure preparation for stand down and recoveryVersion 3.1 Page 90 of 144

4. Actions to take at flood watchNHS Portsmouth• Emergency Planning Liaison Officer or Deputy to notify the following people ofthe flood watch warning:ooooNHS Portsmouth Director of Public Health, Consultant in Public Healthand Director on CallSolent Healthcare Director and On Call ManagerPortsmouth Hospital NHS TrustAny other Health organisation deemed at risk• Emergency Planning Liaison Officer or Deputy to liaise with Portsmouth CityCouncil Civil Contingencies Unit• Emergency Planning Liaison Officer or Deputy Check the weather forecast forPortsmouth and assess the local risk. For further information or clarificationcontact The Flood Forecasting Centre 24 hours, 7 days a week on 0300 1234501 or via email: ffcenquiries@environment-agency.gov.uk• Check the forecasts at the following websites:http://www.metoffice.gov.uk/weather/uk/se/se_forecast_radar.htmlhttp://www.environment-agency.gov.uk/homeandleisure/floods/31618.aspx• Ensure Solent Healthcare monitor the situation and standby for furtherinformation. They should be prepared to gather data on vulnerable people at theaffected locationVersion 3.1 Page 91 of 144

5. Action to take at flood warningNHS Portsmouth• Emergency Planning Liaison Officer or Deputy Check the weather forecast forPortsmouth and assess the local risk. For further information or clarificationcontact The Flood Forecasting Centre 24 hours, 7 days a week on 0300 1234501 or via email: ffcenquiries@environment-agency.gov.uk• Check the following websites:http://www.metoffice.gov.uk/weather/uk/se/se_forecast_radar.htmlhttp://www.environment-agency.gov.uk/homeandleisure/floods/31618.aspx• Emergency Planning Liaison Officer or Deputy to notify the following people ofthe flood warning:NHS Portsmouth Director of Public Health, Consultant in Public Healthand Director on CallSolent Healthcare Director and On Call ManagerPrimary Care Commissioning Associate Director of Primary CareoWho in collaboration with the EPLO and Director of Public Healthdecide if it is necessary to inform all General Practice’s, Dentists,Optometrists at risk according to the flood plain maps and weatherforecast risk.Medicines Management Associate Director of Medicines ManagementoWho in collaboration with the EPLO and Director of Public Healthdecide if it is necessary to inform all Pharmacies at risk accordingto the flood plain maps and weather forecast risk• Emergency Planning Liaison Officer or Deputy to liaise with Portsmouth CityCouncil Civil Contingencies Unit and NHS Hampshire• Liaise with the Environment Agency and be alert to a flood warning escalating toa severe flood warning• Communications team to liaise with Portsmouth City Council Communicationsteam and provide any health input required in the Council’s media response• Ensure Solent Healthcare in collaboration with social care collate data onvulnerable people that are at risk from floodingVersion 3.1 Page 92 of 144

6. Actions to take at severe weather warning (storm surge/heavy rainfall)or a severe flood warningNHS Portsmouth• Emergency Planning Liaison Officer or Deputy Check the weather forecast forPortsmouth and assess the local risk. For further information or clarificationcontact The Flood Forecasting Centre 24 hours, 7 days a week on 0300 1234501 or via email: ffcenquiries@environment-agency.gov.uk• Check the following websites:http://www.metoffice.gov.uk/weather/uk/se/se_forecast_radar.htmlhttp://www.environment-agency.gov.uk/homeandleisure/floods/31618.aspx• Establish (if not already done so) the NHS Portsmouth Emergency Control Room(ECR) as indicted in the NHS Portsmouth Major incident Plan.• Emergency Planning Liaison Officer or Deputy to notify the following people ofthe flood warning• NHS Portsmouth Director of Public Health, Consultant in Public Health andDirector on Call• Solent Healthcare Director and On Call Manager• Primary Care Commissioning Associate Director of Primary Carea. Who in collaboration with the ECR organise informing all GeneralPractice’s, Dentists, Optometrists at risk according to the flood plain mapsand weather forecast risk• Medicines Management Associate Director of Medicines Managementb. Who in collaboration with the ECR organise informing all Pharmacies atrisk according to the flood plain maps and weather forecast risk• Liaise with NHS Hampshire about representation at Gold Command andinvolvement in the Scientific and Technical Advisory Cell (STAC)• Liaise with Portsmouth City Council about a health link at the PortsmouthMulti-agency Silver Command• There may be a risk of gastroenteritis and other illnesses occurring. NHSPortsmouth to consider requesting GP’s to increase surveillance for suchillnesses.Version 3.1 Page 93 of 144

• A set of question have been prepared to help the responding managementteam to assess the Health Response:ooooooooooooIs there a reception centre? Have the City Council requestedhealthcare staff to attend?Are there road closures? What does this mean for community staff?Are there any public health risks?Do you need to send information to GPs, Pharmacists? Whatinformation do you need to send?Are any staff affected?Are any healthcare facilities affected?Does the hospital need assistance?Are there any business continuity issues?Does the local authority need help?Is the media involved? Are we engaging with Portsmouth City CouncilMedia teamHave you informed all the relevant agencies?Do you need more information?• Liaise with Solent Healthcare to ensure they carry out the following actions:ooooooEstablish a bronze command management teamLiaise with social care and the multi-agency silver commandconcerning the response plans for vulnerable people that are at riskfrom the floodingAssess impact on your ability to provide services and consideralternative provisionProvide healthcare staff to support in rest centres if requested byPortsmouth City CouncilBe prepared to act on incidents as they occurAssess business continuity of critical servicesVersion 3.1 Page 94 of 144

7. All clearNHS Portsmouth• Emergency Planning Liaison Officer or Deputy to notify the following peopleof the all clear message:ooooNHS Portsmouth Director of Public Health, Consultant in Public Healthand Director on CallSolent Healthcare Director and On Call ManagerPrimary Care Commissioning Associate Director of Primary CareMedicines Management Associate Director of Medicines Management• Conduct a hot debrief of the incident and identify any key issues• Establish a plan for recovery and lessons learnt from the incident• Begin to close the NHS Portsmouth Emergency Control Room (ECR) asDirected by the Incident director.• NHS Portsmouth in collaboration with Portsmouth City Council'sEnvironmental Health Department and Health Protection Unit to issue generalhygiene advice to people returning to their homes after flooding. This wouldcover matters such as the cleaning and disinfection of food preparationsurfaces and refrigerators.• Liaise with Solent Healthcare to ensure they carry out the following actions:ooooBegin to close down the bronze commandConduct a hot debrief of the incident and identify any key issuesEstablish a plan for recovery and lessons learnt from the incidentIn collaboration with social care continue to monitor vulnerable peopleput at risk from the floodingVersion 3.1 Page 95 of 144

13.8 Disruption to road fuel – action cardThis Action Card is for guidance, and is not prescriptive. The instructions should betailored to meet the circumstances of the incident.1. IntroductionA road fuel disruption is not likely to be an immediate impact emergency and priorwarning is very likely. Therefore the initial actions for this situation will be managedby the Emergency Planning Liaison Officer or deputy. The Director on Call will beinvolved in establishing and chairing a NHS Portsmouth Executive Incident Team tomanage the situation. For detailed instructions on the response see the “NHSPortsmouth disruption to road fuel supply plan”2. Cascade alertNHS Portsmouth may be alerted of a potential or imminent fuel disruption by anumber of agencies including: South Central Ambulance, Strategic Health Authority,NHS Hampshire, Hampshire Constabulary, Hampshire and Isle of Wight LocalResilience Forum, Government Office for the South East (GOSE)During office hours and out of office Hours the NHS Portsmouth will be notified of theincident via an email or a phone call to the Emergency Planning Liaison Officer or theDirector on call (via the on call mobile phone).3. Role of NHS PortsmouthEssential issues will include:1. Establish an executive team to manage the response and decide on theactivation of the “NHS Portsmouth disruption to road fuel supply plan”2. Management of the logo system for the Portsmouth health economy includingthe identification of essential users who will receive logo’s to obtain fuel3. Ensure business continuity of NHS Portsmouth and Commissioned Services4. Ensure timely and accurate media and internal communications5. Working with partner organisation as part of a tactical command group and/ora strategic command group6. Director on call to potentially provide a point of contact for out of hoursverification of drivers identity if there is a dispute at a petrol station7. Ensure preparation for stand down and recoveryVersion 3.1 Page 96 of 144

13.9 Pandemic influenza – action cardsThe following 4 action cards provide a quick reference guide in the event of apandemic influenza for the different stages depending on the severity and timing ofthe outbreak. These action cards should be used in conjunction with the NHSPortsmouth Pandemic Influenza Plan.Pandemic influenza action card 1 – preparing & early stage of pandemicTo be activated when:A potential Pandemic Influenza has been identified by World HealthOrganisation (WHO) or Health Protection Agency (HPA)The early stages of a pandemic have been identified or declared and casesare likely in Portsmouth and the surrounding areasActions to be taken or considered:1. Ensure Management and Response Team (MART) team are initiated. Frequencyto be decided by the team. The following members should be considered:a. Director of Public Health or Chief Executive Officer (Chair)b. Emergency Planning Liaison Officer (and as support)c. Primary Care lead (GP or Primary Care Manager)d. Solent Healthcare (Director/ Associate Director or equivalent)e. Communications lead (Associate Director or equivalent)f. Pharmacist leadg. Acute Hospital representativeh. LA/Social Services representatives (Portsmouth City Council)i. Occupational Health representative (Associate Director or equivalent)j. Health Protection Agency (HPA)k. Human Resources representative (Director/ Associate Director orequivalent)l. Antiviral coordination team (NHS Portsmouth staff)Version 3.1 Page 97 of 144

2. Consider initiating the Emergency Control Room, in the first instance this may bea small scale team and can increase if/when the pandemic increases3. Ensure command and control arrangements are in place and that links withcontrol rooms or key planners from Portsmouth Hospital Trust, NHS Hampshire,NHS Southampton, NHS Isle of Wight, Health Protection Unit, Portsmouth CityCouncil, Independent Sector Treatment Centre, Portsmouth City Community andMental Health Services, other independent hospitals and hospices4. Ensure links with Primary Care (GPs, GDPs, community pharmacists andoptometrists) and keep informed of current situation on a frequency decided byMART5. Ensure links with voluntary sector organisation are established (use CommunityFirst and Community Network to establish links)6. Ensure Pharmacy antiviral collection points ACP’s are ready to be activated asdetailed in the ACP plan, including:a. Appropriate logistics functions readiedb. Flu friendless process readiedc. Monitoring and coordination mechanisms readied7. Ensure NHS Portsmouth ACP’s are ready to be activated and initiate training andexercises where required8. Ensure surveillance data is available and used for planning and decision making.Use European Centre for Disease Prevention and Control (ECDC) and HPA assources of data9. Ensure communication links with staff are established. Frequency and content tobe decided by MART10. Ensure national communication messages are distributed locally (includingmessages and guidance about self-care, where to seek advice and respiratoryhygiene)11. Take national advice about ordering essential supplies12. Ensure arrangements are in place to receive and distribute national supplies ofPersonal Protective Equipment (PPE) and vaccination materials13. Consider commissioning plans to reduced levels of service to prepare for theeffects of the pandemicVersion 3.1 Page 98 of 144

14. Ensure reporting mechanisms with NHS Hampshire, SHA and DH areestablished as required.15. Ensure downward and sideways reporting mechanism are ready to beestablished with Solent Healthcare, Portsmouth City Council Social Care andSchools Department, Portsmouth Hospital NHS Trust, Independent SectorTreatment Centre, other independent hospitals and hospices, General Practiceand Community Pharmacies16. Consider a table top exercise with key players from Portsmouth and surroundingarea17. Ensure occupational health are notified and staff sickness reporting mechanismsare ready for activation18. Ensure Human Resource plans are ready and begin to prepare a set of frequentlyasked questions for staff19. Activate the Tactical Coordinating Group (TCG) as directed by the LRF StrategicCoordinating Group (SCG)20. Ensure arrangements are in place for vulnerable and hard to reach groups21. Begin to consider a pandemic vaccination programmeVersion 3.1 Page 99 of 144

Pandemic influenza action card 2 – start of outbreaks in PortsmouthTo be activated when:A pandemic has been declared by WHOCases are in Portsmouth and the surrounding areasActions to be taken or considered:1. Ensure all actions in action card 1 are complete2. Management and Response Team (MART) team to meet on a daily basis or afrequency decided by the team.3. Emergency Control Room is activated and fully staffed4. Ensure command and control arrangements are in place5. Continue links with Primary Care (GPs, GDPs, community pharmacists andoptometrists) and keep informed of current situation on a frequency decided byMART6. Begin the initial stages of planning to utilize independent sector capacity7. Ensure pharmacy antiviral collection points are active and appropriatecoordination function established in accordance with the ACP plan8. Activate NHS Portsmouth ACP’s if required. If not activated, continuepreparations (including training and exercises where required)9. Continue communication activities with staff and public as detailed in thecommunication plan10. Ensure contingency in essential supplies11. Ensure arrangements are in place to receive and distribute national supplies ofPersonal Protective Equipment (PPE) and other national supplies to support theresponse12. Ensure daily or (frequency decided by MART) situational reports from SolentHealthcare, Portsmouth City Council Social Care and Schools Department,Portsmouth Hospital Trust, Independent Sector Treatment Centre, otherindependent hospitals and hospices, General Practice and CommunityPharmaciesVersion 3.1 Page 100 of 144

13. Ensure non-essential business is being reduced to meet pandemic demand, andbusiness continuity plans in operation where required.14. Update staff capacity planning and plan staffing rotas to cover essential services15. Continue planning a pandemic vaccination programme in accordance with DHguidance when availableVersion 3.1 Page 101 of 144

Pandemic influenza action card 3 – peak of outbreak in PortsmouthTo be activated when:There is a peak of cases in Portsmouth and surrounding areaHealth services are experiencing increasing difficulty to maintain servicesActions to be taken or considered:1. Ensure all actions in action card 1 and 2 are complete2. Management and Response Team (MART) team to meet on a daily basis or afrequency decided by the team.3. Emergency Control Room continues to operate and consideration should begiven to opening extending hours4. Continue situational reporting as required by SHA and NHS Hampshire5. Activate fast time sickness reporting6. When required issue the agreed communication to local population to avoidexcess admissions7. Stop all non-essential meetings8. Ensure critical business maintained in accordance with business continuity plans9. Review staff capacity planning and restrict staff movement as required10. Support Primary care and monitor GP and community pharmacy activity levelsclosely11. Support Acute Hospitals and monitor their activity levels closely.12. Implement contingency arrangements to support discharge planning and patientsexcluded from hospital who would normally be admitted13. Contact the independent sector about freeing up their capacity14. Continue to provide coordination for antiviral distribution15. Implement pandemic vaccination programme as requiredVersion 3.1 Page 102 of 144

Pandemic influenza action card 4 – recoveryThe plan for recovery is set below and is based on the following assumptions:• It may take months or even several years for some national services torecover to normality.• Many people are likely to suffer ongoing health problems.• Backlog demand for healthcare is likely.• Long-term effects associated with virus may be possible.• Personnel, equipment and supplies are likely to be exhausted.• A pandemic virus may evolve in a second wave.• In subsequent waves the impact may be less or even greater than first phase.• Response may be affected by the level of recovery achieved following the firstwave.SurveillancePCT actions Activity LeadEnsure surveillance systemsare in place to detect possiblere-emergence.Continue monitoring in liaison withHPA.MART andHPAMitigating the impactPCT actions Activity LeadFuture wavesPrepare systems and services for anyfuture wave.DPHIdentify vulnerable groupsPatients with existing illnesses couldhave been exacerbated by flu mayrequire increased care to supportrecovery and prepare for potentialsecond wave.Providerservices/generalpractices/social careVersion 3.1 Page 103 of 144

Review policies for secondwave, or subsequentseasonal influenza, due tothe pandemic strain in lightof experience and resources.Complete a review of lessons learnt byorganisations across PCT and ensureappropriate distribution of results.Monitor incorporation of significantlessons into local pandemic influenzaplansDPH/EPLOReview antiviral/other pharmaceuticalneeds/suppliesHPA/ Headof MMDevelop and implement recoveryprogramme, assuming that furtherwaves – or severe seasonal influenza –possible.DPH/EPLOPandemic specific vaccine -The UK will secure sufficientvaccine to protect thepopulation as soon as it isavailable (likely to be at least6 to 12 months, i.e. well afterthe first wave strikes theUK). Delivery would makeclinical prioritisationinevitable.Prepare to implement vaccinationstrategies on instruction from DH if notalready in place.Lead forPandemicFlu /Director /GeneralPracticePCTs and GPs to activateplans for “population wide”vaccination(National guidance proposesin GP surgeries – back upvia “Mass vaccination” infacilities already identified byLA).Monitor ordering of vaccines andimmunisation across NHS SouthCentral SHA and within NHSorganisations to assess effectiveness ofdelivery to priority groups. Redistributeresources as required.Utilise HPA and SHA Healthinformatics, to calculate numbers ofpeople in priority groups by locality.Utilise daily sitrep reporting of numbersDPH/EPMVersion 3.1 Page 104 of 144

of immunisations for priority groupsEstablish percentage of priority groupsimmunised in each localityAddress any needs in areas with lowimmunisation ratesImplementation of measuresaimed at a gradual andsustainable return towardsnormality, includingmanagement of the backlogof treatment.Progressive reinstatement of targets,taking into account local capability andadvice and policy direction from theRecovery and Support Unit of theDepartment of HealthExecDirectorsSupply chain may be weakleading to acute shortages inSouth Central which cannotbe overcome by redeployingresources within the SHAboundary.Contact neighbouring PCTs withsupport of SHA to call uponMemorandum of Understanding forMutual Aid.SHA to liaise with DH to address anyacute shortages in South Central ofitems from national NHS suppliers.ExecDirectorlead for EPSHAMany NHS staff will haveexperienced bereavementduring a time of extremework pressure. They willrequire support to achievean effective return to normalworking.Monitor all directorates to ensure theyare implementing their staff supportplans effectively. Redeploy resourcesas required.OH/HRAs facilities which have beenused for people withinfluenza are returned totheir normal use, there is therisk of infection, if cleaning isnot undertakenIn conjunction with HPA monitor newcases of infection (influenza andsecondary infections), to identify anyfacilities which may have suboptimalinfection control procedures in place.Liaise with local staff to address this ifEstates/InfectionControlLeadVersion 3.1 Page 105 of 144

appropriately.required.Significant impact onfinancial position of parts ofthe NHSTrusts will suffer the loss ofelective surgical income atnational tariff which would bereplaced with emergencyadmissions which under thecurrent regime might onlyattract 50% of national tariff.Play a role in smoothing the financialimpact of a Flu Pandemic and assesswhat steps can be taken after the costand income consequences are known.ExecDirectorsPCT’s may well benefit fromthe impact to Trusts but willhave compensatingpressures from higher spendin prescribing and pressurefrom GP’s on the impactincreasing levels of patientspresenting with Flu will haveon their relative QoF positionand subsequent income.Impact on Annual Healthassessments by HealthCareCommission.The Clinical Standards and QualityLeads within the PCT will need toreview the impact of the flu pandemicon the trust and take this intoconsideration in relation to theStandards placed on Trusts. Seekclarification from SHA. The SHA will notwant to see any compromise in relationto clinical standards e.g. Patient Safety,Healthcare Acquired Infections, Privacyand Dignity.Head ofQualityVersion 3.1 Page 106 of 144

LRF areas will have ongoingRecovery Working GroupsMonitor appropriate PCT input into theLRF working groups.Provide input into regional recoveryworking groupExecdirector forEPMaintaining business continuityPCT actions Activity LeadImplement recovery plans inpartnership with otheragencies to return systemsand services to normality assoon as possible.Review all aspects of the response andregroup in light of the first waveexperience.ExecdirectorsAssess clinical and nonclinicalstaff available toreturn to workMay need phasing in of services toallow staff return. Recruitment of staffmay be curtailed by pandemicoutcomes.HR/OHAssessment, evaluation andrevision of contingencyarrangements in light oflessons learnt.Collate and disseminate lessons learnt.Oversee incorporation into businesscontinuity and pandemic plans inpreparedness for subsequent waves ofpandemic.ExecdirectorsCommunicationsPCT actions Activity LeadReview communicationsstrategy and materials, andamend as appropriate inanticipation of futurepandemic waves.Collate and disseminate lessons learnt.Oversee incorporation into pandemiccommunications plans in preparednessfor subsequent waves of pandemicCommsleadManaging public and otherexpectations accordingly.Coordinate communications activityacross PortsmouthCommsleadVersion 3.1 Page 107 of 144

14 Annex - Vulnerable People14.1 ResponsibilitiesThe Civil Contingencies Act 2004 placed the duty upon category 1 responders tohave regard for the needs of vulnerable people.14.2 CollaborationIdentifying, planning and providing for the needs of vulnerable people will involve alarge number of partners and the pulling together of a large amount of complicated,and changing information. To ensure the needs of vulnerable people are met duringa major incident NHS Portsmouth will provide the tactical collaboration for the healthinput to a multi-agency setting, this will be met using the following strategy:• Coordinate with health providers across the City to ensure the identification ofvulnerable people• Coordinate with health providers to ensure the strategy set for themanagement of vulnerable people, by the strategic coordinating group, isimplemented• NHS Portsmouth will provide the health link with other non-health agenciessuch as the local authority, voluntary group and the police to ensure the multiagencytactical coordination14.3 Identifying vulnerable peopleIt may be necessary to identify and warn vulnerable people whose circumstancesplace them at particular risk during a major incident. Whilst everyone caught up in amajor incident could be classed as vulnerable, planning and response arrangementswill focus on those who are assessed as not being self-reliant and may need externalassistance to become safe.It is not easy to define in advance and for planning purposes who are the vulnerablepeople to whom special considerations should be given in plans. Those who arevulnerable will vary depending on the nature of the emergency. The following twotables give an overview of the potentially vulnerable groups, the organisations whohave close links and the potential support required in a major incident.Version 3.1 Page 108 of 144

The table below identifies potentially vulnerable groups that should be considered forplanning purposes and the organisation most likely to target that particular group.Potentially VulnerableIndividual/GroupChildrenOlder PeopleMobility impairedMental/cognitive functionimpairedSensory impairedIndividuals supported byhealth or local authoritiesTemporarily orpermanently illIndividuals cared for byrelativesHomelessPregnant womenMinority language speakersTouristsTravelling communityExamples and NotesWhere children are concerned, whilst atschool the school authorities have dutyof care responsibilities. Certain schoolsmay require more attention than others.Certain sections of the elderlycommunity including those of ill healthrequiring regular medication and/ormedical support equipmentThe “oldest-old” (aged 80 or over) aremore likely to be widowed women,which may impact upon planningFor example: wheel chair users; leginjuries (e.g. on crutches);bedridden/non movers; slow movers.For example: developmental disabilities;clinical psychiatric needs; learningdisabilities.For example: blind or reduced sight;deaf; speech and other communicationimpaired.Potentially a large group encompassingnot only those that need regular medialattention (e.g. dialysis, oxygen or acontinuous supply of drugs), but thosewith chronic illnesses that may beexacerbated or destabilised either as aresult of the evacuation or becauseprescription drugs were left behind.Target through the followingorganisations/agenciesLEA schools through LocalAuthorities and non-LEAschools through theirgoverning body or proprietor.Crèches/playgroups/nurseriesResidential Care HomesHelp the AgedAdult Social CareNursing HomesResidential Care HomesCharitiesHealth service providersLocal Health AuthoritiesCharities e.g. the DeafCouncilLocal groupsSocial servicesGP surgeriesGP surgeriesOther health providers (public,private or charitable hospitalsetc.)Community nursesGP surgeriesCarers groupsShelters, soup kitchensGP surgeriesCommunity GroupsJob centre plusTransport and travelcompaniesHoteliersLA traveller servicesPolice liaison officerVersion 3.1 Page 109 of 144

The table below provides an overview of the potential vulnerability and the potentialsupport needs during an incidentMobility ImpairedSensory ImpairmentMental/Cognitive ImpairmentPotential Nature ofvulnerabilityInability to walk / Inabilityto walk more than shortdistances.Inability to walk withoutassistance / mobility aid.Inability to walk / inability tomove from bed. Paralysis.Inability to move quickly.Inability to see / partialability to see.Inability to hear / partialability to hear.Difficulty communicatingthrough speech.Severe chronic condition -impairment in physical,cognitive, speech orlanguage, or self-careareas.Conditions which canaffect moods, perceptionsof reality, behaviour, etc.Can sometimes becontrolled with medication.Have average or aboveintelligence, but have aprocessing deficit, e.g. incommunication, language,memory, etc.Support needed in nonemergencysituationAccessible housing / transport.Access to education &employment. Home care/daycare/residential care.Accessible housing / transport.Access to education &employment. Home care / daycare / residential care.Home or residential care.Equipment/aids for everydayliving. Rehabilitation.Equipment or home alterations.Accessible transport. Mobility aids- e.g. walking stick. Meals onwheels.Sight aids. Mobility aids, e.g. whitesticks. Equipment (e.g. for talkingbooks). Training in use of Braille.Information in accessible formats.Service animal.Hearing aids. Equipment (e.g.textphones). Training inspeech/sign language/lip reading.Communication aids. Speechtherapy. Access to education.Home or residential care. Accessto education, housing,employment, etc.Mental health support services:psychiatrists, GPs, CPNs,volunteer groups, etc. Appropriatemedication. Access to education,housing, employment, etc.Assistance with reading, writing,oral, maths, and organisation andplanning skills, as well asfinancial, personal and medicalneeds. Access to education.Support needed in emergencysituationAssistance if wheelchair isimpeded & mobility is required.Accessible services. Replacementmobility aids.Assistance if mobility is required,particularly if speed important.Accessible services. Medicalassistance. Replacement mobilityaids if needed.Accessible services inc. transportfrom home. Medical assistance.Vital equipment - e.g. specialistbeds.Assistance if mobility is requiredand speed important. Accessibleservices. Medical assistance.Accessible information. Assistancein following routes/moving downstairs. Transport. Provision forservice animals.Warnings/informationcommunicated in accessibleformats. Sign language interpretersin reception centres.Workers need to be patient. Couldcommunicate through writing ifspeech is too difficult.Info / directions repeated in astraightforward manner. Workersneed to be understanding.Extra sensitivity / understandingfrom workers. Reassurance &support. Emergency prescriptionmedication. Mental health supportservices. Hospitalisation.May need support in rememberingor responding toinstructions/directions. Often notan obvious disability, and may notask for help, so difficult to identify.May need help with registering,filling out claim forms, etc.Version 3.1 Page 110 of 144

Other Vulnerable GroupsMotor skills & cognitivelevels are lower, plusincreased vulnerabilitymedically.Motor skills & cognitivelevels might be lower, plusincreased vulnerabilitymedically.Affected by conditionssuch as heart disease,arthritis, Alzheimer’s, etc.Old age.Affected by chronic ortemporary illnesses thatrequire medication, withoutwhich life could beseriously affected /threatened.Affected by chronic ortemporary illnesses thatrequire treatment viamedical supportequipment, without whichlife could be seriouslyaffected / threatened.Inability to understand,speak or write in theEnglish language.Appropriate care from parents,childminders, or other carers.Appropriate care from parents,teachers, childminders, or othercarers. Education.Equipment or home alterations.Accessible transport. Mobility aids- e.g. walking stick. Meals onwheels.Access to a GP, chemists.Regular medication. Makingpeople aware of the condition andtreatment (e.g. diabetic mightneed to teach family how to giveinsulin injection).Medical equipment and theknowledge to use it. Access to aGP, medical treatment. Homecare / residential care.Accessible information. Help withtranslations. Access to education.Adult (CRB checked) to takecharge. Assistance for carer. Safetransport. Child facilities.Entertainment. Emotional support.Adult (CRB checked) to takecharge. Assistance for carer. Safetransport. Child facilities.Entertainment. Emotional support.Assistance if mobility is requiredand speed important. Accessibleservices. Medical assistance.Workers to remind people to bringmedication. Assistance if mobilityimpeded (e.g. respiratorycondition). Medical attention/treatment. Provision of emergencyprescription medication.Assistance in handling / movingequipment. As little separationfrom equipment as possible.Replacement equipment available.Accessible information - e.g.translations. Workers should keepcommunications as simple aspossible.The identification of people with a health vulnerability either known or unknown to theNHS will be carried out by the providing health organisation and coordinated by NHSPortsmouth at a tactical level. The Health organisations will work closely withpartners across the city to ensure as far as possible vulnerable people are identifiedand their needs are catered for.Each Health organisation that provide services for the residents of Portsmouth willneed to ensure lists of vulnerable people are kept up to date and accurate.14.4 Further guidanceIdentifying people who are vulnerable in a crisis:http://www.cabinetoffice.gov.uk/media/161195/vulnerable_guidance.pdfVersion 3.1 Page 111 of 144

15 Annex - Data Sharing15.1 Guidance and protocolThe Hampshire and Isle of Wight Local Resilience Forum information sharingprotocol describes the agreed method in H&IOW to share information in anemergency.The key principle and guidance for sharing data are outlined in the Cabinet Officeguidance “Data Protection and Sharing: Guidance for Emergency Planners andResponders”. This guidance should be used by the executive team when makingdecisions on sharing information; the guidance can be accessed via the followinglink- http://www.cabinetoffice.gov.uk/media/132709/dataprotection.pdf15.2 Key principlesThe key principles for data sharing outlined in the cabinet office guidance are:• Data protection legislation does not prohibit the collection, and sharing ofpersonal data – it provides a framework where personal data can be used withconfidence that individuals’ privacy rights are respected.• Emergency responders’ starting point should be to consider the risks and thepotential harm that may arise if they do not share information.• Emergency responders should balance the potential damage to the individual(and where appropriate the public interest of keeping the information confidential)against the public interest in sharing the information.• In emergencies, the public interest consideration will generally be more significantthan during day-to-day business.• Always check whether the objective can still be achieved by passing lesspersonal data.• Category 1 and 2 responders should be robust in asserting their power to sharepersonal data lawfully in emergency planning, response and recovery situations.• The consent of the data subject is not always a necessary pre-condition to lawfuldata sharing.• You should seek advice where you are in doubt – though prepare on the basisthat you will need to make a decision without formal advice during an emergency.Version 3.1 Page 112 of 144

The way in which emergency planners and responders may use the personal datathat they hold is governed by the 8 data protection principles; these require thatinformation is:• Processed fairly and lawfully and in accordance with a legitimising condition• Processed for specified and not incompatible purposes;• Adequate, relevant and not excessive;• Accurate and up-to-date;• Not kept longer than necessary;• Processed in accordance with individuals’ rights;• Kept secure; and• Not transferred to countries outside the European Economic Area withoutadequate protection.15.3 Recoding decisionsIt is vital that all decisions concerning information sharing are documented. Thefollowing information about the decision process should be documented in a formallogbook:oooRecord of the information to be sharedClear evaluation of the information to be shared against the key principlesThe option chosen and clear reasoning for the decision15.4 Additional adviceThe Corporate Information Governance team is available to support and provideadvice.15.5 Flowchart of key principles for information sharingExecutives involved in decision making around sharing information should use thefollowing flow chart as an aid memoir (this flow chart is taken directly from the cabinetoffice guidance referenced above and the chapter references in it refer directly to thatguidance).Version 3.1 Page 113 of 144

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16 Annex - Supporting Information16.1 Plan review and auditThe plan will be reviewed on a 2 yearly basis as a minimum against the Departmentof Health PCT Major Incident Planning Audit and Assessment Tool. This plan willalso be reviewed after each exercise or actual incident if recommended in the postexercise or incident debrief.Major incident telephone call in-lists and the contents of the emergency planningcupboard will be reviewed every 6 months. The Emergency Control Room will betested every 3 months. The Director on call bag will be reviewed every month.16.2 Consultation and disseminationThe consultation strategy will follow the following 2 stages:• Internal consultation - final draft of the plan will go for consultation for a period of1 month to internal NHS Portsmouth Directors and other internal stakeholders• External consultation – the revised plan post internal consultation will beforwarded to LRF multi-agency partners for a consultation period of 1 month.The final completed version of the major incident plan will be reviewed and acceptedat the Executive Management Committee. When accepted the plan will be posted onthe internal intranet and the external NHS Portsmouth website and disseminated tothe agencies identified on the distribution list in section 16.9 via an email link to thewebsite.16.3 TrainingRequirementsNHS Portsmouth are required to ensure mechanisms are in place to identify, selectand train staff to participate in a major incident which ensures those staff:• understand the role they are to fulfil in the event of an incident• have the necessary competencies to fulfil that role• have received training to fulfil these competencies, and, as a minimum standard,all NHS staff include in their induction training an introduction to the role of theirorganisation in major incident planning and responseVersion 3.1 Page 115 of 144

Training, testing and exercising should take place within the context of:• A training needs analysis that reflects normal good training practice• The definition of different training needs along a spectrum from generalawareness to specific training for staff with key roles• Providing a framework that states clearly who is accountable for ensuring trainingand exercising takes place, the respective frequency for each element, is basedon an annual plan for the process and is supported by appropriate documentationand record keeping and allows for post exercise reporting and debriefingTraining programmeThe training programme for NHS Portsmouth staff is based on a training needsanalysis undertaken by the EPLO; from this a programme of training is outlinedbelow. This is a minimum requirement and there is scope in the training programmeto provide additional training as deemed necessary if the need arises. A training needanalysis will be conducted yearly and the training programme reviewed accordingly.Type of training Staff Group Frequency LeadStrategic Leadership Executive Directors Yearly EPLOControl room operations Control room staff 2 yearly EPLOLoggist training Loggists 2 yearly EPLORefresher loggist training Loggists and Directors Yearly EPLONetley health cell trainingExecutive Directorsand support staff2 yearly NHSHampshireInduction training for all staffAll new NHSPortsmouth staffMonthlyLearning andDevelopmentMedia spokesperson Executive Team 2 yearly EPLOMedia and comms workingin an emergencyMedia team 2 yearly EPLODirector on call training Director on call Yearly EPLOSwitchboard call taking inan emergencyReception staff Yearly EstatesVersion 3.1 Page 116 of 144

16.4 ExercisesAs a minimum requirement, NHS Portsmouth is required to undertake aoooA ‘live’ exercise every three yearsA ‘table top’ exercise every yearA test of communications cascades every six monthsExercise programmeThe programme below outlines the generic exercise programme which includesinternally organised exercises and the participation in multi-agency exercises.Exercise Purpose Frequency LeadInternal communicationMeet requirements ofEvery 6EPLONHS EP GuidancemonthsExternal communication Multi-agency led test As required LRFControl room set-upEnsure set-up ofYearlyEPLOcontrol room is testedControl room functioningEnsure functioning ofcontrol room is tested2 Yearly EPLOTable top exerciseMeet requirements ofYearlyEPLONHS EP GuidancePORTSAFE multi-agencyTest strategic, tacticalEvery 3Portsmouthexerciseand operationalyearsCity Councilaspects of the planOther LRF organised tableTest multi-agencyAs requiredLRFtop and live exercisesplansmembersOther DH, SHA, other PCTled exercisesTest inter-health plans As required NHSRecords of all exercises and tests will be kept by the EPLO. Following a MajorIncident exercise or incident NHS Portsmouth’s ability to comply with each element ofVersion 3.1 Page 117 of 144

the plan will be analysed and evaluated and response arrangements amended toreflect lessons learnt if necessary.The training and exercises identified above will ensure that staff performing roles in amajor incident know what their role and responsibilities are.16.5 Supporting documentationThis Major Incident plan was compiled with reference to the following guidelines• Cabinet Office: Emergency Preparedness• Cabinet Office: Emergency Response and Recovery• DH: NHS Emergency Planning Guidance• DH: Strategic Command arrangement for the NHS during a Major Incident• The Civil Contingencies Act 2004• Cabinet Office: Data Protection and Sharing - Guidance for EmergencyPlanners and Responders• Cabinet Office: Identifying people who are vulnerable in a crisis - Guidancefor Emergency Planners and Responders16.6 Useful websitesUK Resilience: www.cabinetoffice.gov.uk/ukresilienceDepartment of Health: www.dh.gov.ukHealth Protection Agency: www.hpa.org.ukEmergency Planning Society: www.the-eps.orgHampshire LRF: www.hiow-localresilienceforum.org.ukEuropean Centre for Disease Prevention and Control: http://www.ecdc.europa.eu/16.7 NHS Portsmouth supporting plansSerious untoward incident reportingA major incident is classed (for reporting purposes) as a Serious Untoward Incidentand must be reported immediately to the Strategic Health Authority as perinstructions in the latest guidance Serious Untoward Incident Guidance issued by theSouth Central Strategic Health Authority.Version 3.1 Page 118 of 144

Pandemic influenza planNHS Portsmouth has a specific plan for managing in the event of a pandemicoutbreak. The plan deals with specific issues relating to pandemic influenza andspecific measures for preparing, responding and recovering from a pandemicoutbreak. Although it is a separate plan it is based on the principles outlined in thismajor incident plan and both plans should be utilised when responding to a pandemicoutbreak.Heatwave planNHS Portsmouth Heatwave plan outlines the responsibilities of the commissioningand community healthcare providers and actions to take at each level of theheatwave alert. These actions are summarised in the heatwave action card above.Disruption to road fuel supplyNHS Portsmouth has a specific plan for managing in the event of a disruption to roadfuel supply and this will be used in conjunction with the major incident plan to preparefor, respond to and recover from a disruption to road fuel supply incident.Security and fire safetyNHS Portsmouth has internal security and fire safety plans which will compliment themajor incident plan to ensure the security and safety of staff and facilities during amajor incident or internal incident.Lock down policyThis document outlines the Trusts policy on lock down. The implementation of a lockdown will be to ensure the safety of facilities and staff if deemed the necessarycourse of action by the executive team in response to a major incident or internalincident.16.8 Multi-agency complementary plansThe multi-agency plans which compliment this plan include:• NHS Hampshire Major Incident Plan• LRF Media Plan• LRF Strategic Response FrameworkVersion 3.1 Page 119 of 144

• LRF Scientific and Technical Advice Cell Plan• LRF Pandemic Influenza Framework• LRF Telecommunications Plan• Hampshire and Isle of Wight CBRN Memorandum of Understanding• South Central Ambulance Service NHS Trust Major Incident plan• Solent Healthcare Major Incident Plan• Hampshire Community Healthcare Major Incident Plan• NHS Southampton City Major Incident Plan• NHS Isle of Wight Major Incident Plan• Hampshire Police Major Incident Plan• Hampshire Fire & Rescue Major Incident Plan• Hampshire County Council Emergency plan• Portsmouth City Council Emergency Response Plan and Urgent Support Plan16.9 Distribution listSectorStrategic Health AuthoritiesHealth Protection AgencyPrimary Care TrustsOrganisation NameNHS South CentralHampshire & Isle of Wight Health Protection UnitNHS HampshireNHS PortsmouthNHS Southampton CityNHS Isle of WightNHS TrustsPortsmouth Hospitals NHS TrustHampshire Partnership NHS TrustSouthampton University Hospitals TrustVersion 3.1 Page 120 of 144

Hampshire Partnership NHS Foundation TrustHampshire Community HealthcareSolent HealthcareIndependent providersAmbulance ServicesIndependent Sector Treatment CentreSouth Central Ambulance Service NHS TrustIsle of Wight Ambulance ServiceNHS DirectEmergency ServicesNHS Direct Hampshire & Isle of WightHampshire ConstabularyHampshire Fire & Rescue ServiceLocal authoritiesPortsmouth City Council (including Port Health Authority)Hampshire County Council Emergency Planning UnitOther Agencies or BodiesEnvironment AgencyLocal Medical CommitteeLocal Pharmaceutical CommitteeVersion 3.1 Page 121 of 144

16.10 Glossary of termsAcute Trust - NHS Service Providers, Ambulance, Hospitals & Mental HealthBronze - Operational command of frontline staffCBRN - Chemical, Biological, Radiological &NuclearCCA - Civil Contingencies ActCOMAH - Control of Major Accident HazardsCommunity Hospital - Hospital managed by PCT for treating patients locallyDPH - Director of Public HealthEmergency Control Room - PCT Control room for Major IncidentsExecutive Incident Team - Team of Executive and senior Managers who coordinatethe PCT responseGold - Strategic command of the incidentLocality - Operational area of the PCTHIOW Health Protection Unit - The Local division of the HPAHealth Visitor - Registered nurse with special training in the assessment of healthneeds of families especially preschool childrenHealth Gold - Coordination of the NHS response across HampshireHCHC - Hampshire Community Health CareHEPA - Health Emergency Planning Advisor for Hampshire & IOWHealth Protection Agency (HPA) - Government organisation dedicated to protectingpeople’s health, divisions include:• Radiation division• Chemical, Hazards & Poisons division• Local & Regional Services• Centre for Infection• Emergency preparedness divisionHIOW - Hampshire and the Isle of WightHPU - Health Protection Unit (local office for HPA)Version 3.1 Page 122 of 144

Incident log - Record of all actions Dated, Timed and SignedIntermediate Care Team - Provides support to enable patients to be cared for in theirown homeLead Officer - First Senior manager contactedLead PCT - PCT with responsibility for lead emergency planning.LRF - Local Resilience ForumMedia liaison Officer - Member of control team responsible for media contactMilitary Aid to the Civil - Types of military assistance to the civil Authority (MACA)authorities and include:• Military Aid to the Civil Communities (MACC) – assistance in anemergency• Military Aid to the Civil Ministries (MACM) – e.g. assistance in the event ofindustrial action;• Military Aid to the Civil Powers (MACP) – assistance to the PoliceNHS Direct - NHS telephone Help Line 24 HoursOOH - Out of HoursReceiving hospital - A & E Hospital designated to receive casualties from a majorincidentRest Centre - Local authority organised centre for evacuees from an incidentSilver - Tactical control of the incident, manages the operational responseSTAC - Scientific & Technical Advisory Cell (formally HAT & JHAC)Strategic Coordinating Group (SCG) - Multi-agency group of executives leading theresponse in HampshireStrategic Health Authority - South Central SHA based at Newbury performancemanages the NHS Trusts in Hampshire & Isle of Wight and Thames ValleyVersion 3.1 Page 123 of 144

17 Annex – H&IOW NHS Memorandum of UnderstandingThis Memorandum of Understanding determines the emergency planning andresponse mechanism for Hampshire and the Isle of Wight health economy.Hampshire PCT acts as the lead PCT for emergency planning on behalf of NHSSouth Central SHA within Hampshire and Isle of Wight and this incorporates thefollowing Trusts:NHS PortsmouthNHS Southampton CityIsle of Wight NHSBasingstoke & North Hampshire Foundation TrustPortsmouth Hospitals NHS TrustSouthampton University Hospital NHS TrustWinchester & Eastleigh Healthcare NHS TrustHampshire Partnership NHS TrustSouth Central Ambulance ServiceIsle of Wight Ambulance ServicePart 1 - Emergency Preparedness requirementsCivil Contingencies Act 2004Under the Civil Contingencies Act 2004 NHS Trusts are designated Category 1responders and that places the following legal duties on them;1. To cooperate2. To share information3. To carry out risk assessments4. To make emergency plans5. To have business continuity plans-6. To warn and inform the publicVersion 3.1 Page 124 of 144

NHS Emergency Planning Guidance 2005The guidance requires NHS organisations to reflect in arrangements for emergencypreparedness the following:• The requirements of the Civil Contingencies Act 2004• The Chief Executive Officer will be responsible for ensuring that theirorganisation has a major incident plan in place that will be built on theprinciples of risk assessment, cooperation with partners, emergency planning,communicating with the public and information sharing. The plan will link intothe organisation’s arrangements for business continuity.• The CEO will ensure that the Board receives regular reports regardingemergency preparedness; including reports on exercises, training, and testingundertaken by the organisation and that adequate resources are madeavailable to allow the discharge of these responsibilities. As a minimumrequirement, NHS organisations will be required to undertake a live exerciseevery three years; a table top exercise every year and a test ofcommunications cascades every six months. To support these arrangementsit is suggested that an Executive Director be designated to take responsibilityfor emergency preparedness on behalf of the organisation. It is consideredgood practice for NHS organisations designate an adequately resourcedofficer to support the executive in the discharge of their duties for emergencypreparedness.Standards for Better Health Core 24Healthcare organisations protect the public by having a planned, prepared and wherepossible practised response to incidents and emergency situations which could affectthe provision of normal services.Part 2 – Emergency PlanningThe Lead PCT will undertake to:• Send a Chief Executive or nominated director to attend the Local ResilienceForum (LRF) Executive• Send an Emergency Planning Manager to attend the LRF Working Group• Provide an emergency planner or alternative appropriate person to attend theappropriate LRF Sub groups• Lead a LRF health emergency planning groupVersion 3.1 Page 125 of 144

• Ensure that the local health economy plans fit with each other and those ofpartner organisations• Ensure that there are clear protocols to lead the coordination of the healtheconomy response• Coordinate arrangements for LRF emergency planning exercises includingdebrief and feedback from those exercises• Attend emergency planning meetings at the sites requiring statutory plans• Lead in the production of pan health economy plans• Work with the SHA to identify standards expected of all NHS organisations.• Ensure lessons learnt from exercises and major incidents are identified andappropriate action taken across the LRF area.• Be owners of the training and exercise calendar for their area• Ensure local action plans arising from exercises and major incidents areimplemented in a timely way. If actions remain outstanding the Lead PCT willinform the SHA.• Work with NHSOs to develop an action plans as required by the SHA toachieve the required standard. These will draw on resources from within theNHSO, the Thames Valley or Hampshire and Isle of Wight Health EmergencyPlanning Group and HPA as required. The action plan will include timescalesand lead names for achieving actions.• To cascade information directly to all NHSOs through their nominatedemergency planning lead / manager or pandemic influenza lead / manager.The lead PCTs will be owners of the e-mail distribution lists and responsiblefor keeping these up to date.PCTs will undertake to:• Chair the Joint Health Emergency Planning Group (JHEPG) in their local area• Attend local emergency planning meetings associated with their local risks• Plan with the appropriate Local Authority• Share reports of communications exercises, tabletops and live exercises withthe Lead PCT• Produce an annual review of emergency preparednessVersion 3.1 Page 126 of 144

• Support the Lead PCT in the performance management of NHS TrustsAll NHS Organisations will undertake to:• Attend the LRF Health Emergency Planning group quarterly• Attend the appropriate local JHEPG• Attend LRF exercises as requested• Share reports of communications exercises, tabletops and live exercises withthe Lead PCT• Produce an annual review of emergency preparedness• Inform the Lead PCT of training events and exercises they are planning, toinform the training and exercise calendar. This will include communicationscascades, tabletop and live exercises.• Share action plans arising from exercises and major incidents with the LeadPCT. The Local PCT will also notify the Lead PCT when all action plans froma particular incident have been fully implemented to the satisfaction of allorganisations concerned.Ambulance Services will undertake to• Attend the LRF Health Emergency Planning group quarterly• Attend the appropriate local JHEPG• Attend LRF exercises as requested• Share reports of communications exercises, tabletops and live exercises withthe Lead PCT• Produce an annual review of emergency preparedness• Inform the Lead PCT of training events and exercises they are planning, toinform the training and exercise calendar. This will include communicationscascades, tabletop and live exercises.• Share action plans arising from exercises and major incidents with the LeadPCT. The Local PCT will also notify the Lead PCT when all action plans froma particular incident have been fully implemented to the satisfaction of allorganisations concerned.• The SHA will performance manage the Ambulance ServicesVersion 3.1 Page 127 of 144

Part 3 Emergency Response3.1 Levels of health responseThere are three broad levels of NHS response to a major emergency in Hampshire orthe Isle of Wight and the following table describes these:Emergencycommand led byLevelCriteria for establishment of Major EmergencyControl Centre (MECC)Individual PCT 1 Established by the PCT affected in the event of anymajor emergency declaredLead PCT 2 Established if:• the emergency is too large or complex to handlesolely by one PCT, and/or• the emergency is major or widespread andaffects more than one PCT• the lead PCT is asked by SHA or another agencyto establish a command and control centreStrategicAuthorityHealth3 Established if:• the emergency is too large or complex to handlesolely by PCTs working together, and/or:• the emergency is exceptionally major orwidespread and affects more PCTs than in oneLRF area• the SHA is asked by Department of Health oranother agency to take strategic control of theNHS response to an emergency• the emergency occurs outside Hampshire andthe Isle of Wight and where county-wide coordinationin support of the emergency isrequiredVersion 3.1 Page 128 of 144

3.2 Strategic Coordinating Centre (Gold)• Hampshire PCT will send an executive director to the multi-agency strategiccoordinating group at the strategic coordination centre at Netley or nominatedalternative.• This executive will represent the Hampshire and Isle of Wight health economywith the authority to commit NHS resources on behalf of Trusts andPCTs as part of the multi-agency response.• Ideally this will be after discussion with organisations but there may becircumstances where a strategic decision needs to be made in response torapidly changing events.• If an incident specifically involves one of the unitary PCTs then a director fromthe affected PCT would be required to form part of the Health ManagementTeam (HMT) at Netley.• If an incident is protracted over several days directors from the affected PCTsand or other PCTs may be called on to assist with the provision of the NHSexecutive response3.3 Scientific and Technical Advisory Cell (STAC)• The STAC will be established and staffed by the public health personnel of allthe HIOW PCTs.• The Lead PCT will produce a STAC response plan.• During office hours the chair of the STAC will be agreed between the Directorof the affected PCT and the Consultant in Health Protection from the HealthProtection Unit,• Out of Hours the on call staff on the Public Health and CommunicableDisease rotas will agree the chair.• If an incident is protracted over several days public health directors from allHIOW PCTs may be called on to assist with the provision of the STAC3.4 NHS Coordination• The coordination of the HIOW health economy will be undertaken byHampshire PCT via a separate cell at the PCT Emergency Control Centre inEastleigh.Version 3.1 Page 129 of 144

• This cell will liaise with South Central Strategic Health Authority andHampshire and the Isle of Wight Health Protection Unit on behalf of the HIOWhealth economy.• Hampshire PCT, through the NHS Coordination Team, will deal directly withthe unitary PCT control centres and the acute Trust control centres to provideupdates to the NHS Executive Lead at Gold.3.5 NHS Trust Emergency Control Centres (NHS Silvers)• Each Trust will operate its own organisational emergency control centre asidentified in their Major Incident Plan.• This centre will be responsible for managing the Trust’s response.• It will be responsible for contacting the NHS Coordination cell at HampshirePCT with regular situation reports.3.6 Mutual AidNHS organisations unaffected by an incident may be required to provide mutual aidto assist the response in other parts of Hampshire and the Isle of Wight.This will be coordinated by the Lead PCT within the LRF area and by South CentralSHA if the request is to or from a neighbouring area.South Central SHA – BerkshireSouth West SHA – Dorset and WiltshireSouth East Coast SHA – Surrey and SussexReferencesDH Emergency Planning guidance 2005DH Strategic Command arrangements for the NHS in a Major incidentCivil Contingencies Act 2004NHS South Central SHA Operational Framework……………………………………Chief Executive NHS PCT/Trust……………………………………Chief Executive Lead PCTJuly 2008 July 2008Version 3.1 Page 130 of 144

18 Annex - Opening the Emergency Control RoomThis action card outlines the steps to take to open the Emergency Control Room.1. Arrive at the designated emergency control roomThe main control room is located at St James Hospital, Trust HeadquartersCommittee room. Access to the office is by swipe card only; if you do not have thenecessary access then the security team at main reception can arrange this.2. Call in staffa. Obtain the volunteer list (contained in the director on call emergency folder foundin the emergency planning cupboard); a key for the major incident cupboard isobtained from the Emergency Planning Liaison Officer (EPLO), BusinessExecutive team or the Director on call.b. Ensure the Director has told you which type of Emergency Control Room (ECR)to open either a small scale or full scale room. Call in staff as indicated in thetables below for either a full or small scale ECR.c. For information: The Director on call will take on the role of the Incident Director.Call in additional staff such as IT support, a member of the public healthintelligence teams if the Director requires.Small scale ECR staff includes:Role Write volunteers name here: DescriptionIncident director loggistSelect people with loggist skillsSecretarial SupportCall taker 2Info Runner & Call takerPublic Health LeadRoom and InformationmanagerMedia ManagerIf it is during normal working hoursallocate the staff normally working inoffice 6 to this role alternatively contactpeople on the volunteer listCall if requested by Incident DirectorThis will normally be taken on by theemergency planning teamRequest staff from the media teamVersion 3.1 Page 131 of 144

Full scale ECR staff includes:RoleWrite volunteersname here:DescriptionIncident director loggistSelect people with loggist skillsSecretarial SupportCall taker 2Info Runner & Call takerCall taker 3 (if required)Public Health LeadRoom and Information managerProvider Lead (SolentHealthcare)Primary Care LeadIf it is during normal working hours allocatethe staff normally working in office 6 to thisrole alternatively contact people on thevolunteer listProvide local public health adviceThis will normally be taken on by theemergency planning teamContact the Solent HC Director on call orDuty Manager EastHead of Primary Care or deputyLocal authority / Social ServicesLead (if required)Contact the City Council Contact OfficerMedia Manager (Manager)Media Manager (Monitor)Request staff from the media teamVersion 3.1 Page 132 of 144

3. Physically set-up the emergency control roomWith the assistance of other members of staff set up the room by following theactions below:No Action Notes1 Obtain the emergency cupboard key3 Keys are available, one is held in the Director oncall bag, one is held by business executive teamand one by the EPLO2Obtain the following from the cupboard• BT phones• Internal phones• Laptops• Stands with role names• Major incident folder (which has rolecards, diagram of the room, phonenumbers, email and usernames)• Pens and other stationery• Logbooks and message padsIf there is not enough equipment in the cupboard tosupport all the roles – ask the business executiveteam for further items – or borrow (with permission)from surrounding offices3Rearrange the conference room tables asshown on the layout diagram. Leave theremaining tables in a square in the middle ofthe roomUse the appropriate room diagram (full scale orsmall scale) below. In hours ask estates to helpwith moving tables etc4 Put role name stands and copies of the rolecard on the appropriate desks5Set-up the correct phones to the assignedtable as per the diagram.• The phone numbers for the internal lines(MITEL phones) are designated to the phone –so please ensure the right phone is given to thedesignated role as indicated on the diagram.• The phone numbers for the BT lines aredesignated to the socket so it doesn’t matterVersion 3.1 Page 133 of 144

which of the BT phones is used.6 Set-up any of the laptops contained in thecupboard.Begin with the secretary and the information andcontrol room manager.7 Attach Incident Co-ordination Centre signs toentrance doors of rooms to be used8 With the support of the EPLO distribute themajor incident IT accounts to the secretarialsupport, incoming call taker, informationrunner, media manager, media monitor andother roles with IT facilities as required.Account details are available in the EmergencyControl Room folder held by the incident director orin the major incident cupboardThe passwords for the IT accounts are keptsecurely and are available from the Incident Director Emergency Planning Liaison Officer4. Check the telephones, faxes and email accountsOnce the room is set up check the contact details for the room are in accordancewith the Emergency Control Room set-up details. With the support of the informationrunner ring each phone line, check the generic major incident email address and faxnumber to make sure they are correct and operational before proceeding to point 5.5. Inform others the room is open, share contact details and other initialactions5.1 Ensure the secretary is carrying out the initial actions on their role card whichinclude:• Logging onto the Emergency Control Room group mail box and monitoringemails• Ascertaining from the incident director if they should contact the PCT’sChairman/Directors/Managers, if so they should begin calling them to informof the incident• Contact the business executive team to inform of the major incident andconsider the need to rearrange meetings scheduled in the room.5.2 Direct the Information runner (this is detailed on their action card) to ring each ofthe organisations listed below concerning the following points:Version 3.1 Page 134 of 144

a. let them know our Emergency Control Room is set-upb. ask if they would like our Emergency Control Room contact details, if soeither give them over the phone, or arrange for them to be faxed oremailedc. check the contact details we have for them are correct, if not request them(either over the phone, via email or fax)d. during the call ascertain if they require any action from us or they wish topass any information to us. Pass all key information to the informationmanagerCall the following organisations first:• NHS Hampshire Control Room• Portsmouth Hospitals NHS trust Control Room• South Central Ambulance Services Control Room• Portsmouth City Council Control RoomDepending on the affected area or type of incident contact as appropriate:• Health Protection Agency Control Room• Isle of White NHS PCT Control Room• NHS Southampton City Control RoomVersion 3.1 Page 135 of 144

18.1 Layout of NHS Portsmouth emergency control roomThe Emergency control room is scalable and two possible room layouts are outlined below; called small and large scale:Small scalePrinterPA toCEOOffice1 BT Phone1 ComputerInfo Runner &Call takerWindowSpare1 BT Phone1 Computer1 BT Phone1 ComputerCalltaker 2ControlledEntranceActive boardPC1 PhoneTV (BBC &Sky news)1 Phone1 LaptopPublic HealthLead (if req.)MediaManagerWindowWhite boardloggistLogbookMeeting space for briefingsCommittee RoomCupboards1 Phone1 LaptopRoom & InfoMgr1 PhoneWindowDoor locked1 LaptopSecretaryIncidentDirector1 Phone1 LaptopWhite boardWhite boardOptimal location for Satellite Phone connectionVersion 3.1 Page 136 of 144

Large scaleControlledEntranceWhite boardWhite boardDoor lockedPrinterPA toCEOOffice1 BT Phone1 ComputerInfo Runner &Call taker(call taker 3 ifreq)Window1 BT Phone1 Computer1 BT Phone1 ComputerCalltaker 2Active boardPC1 PhoneTV (BBC &Sky news)Primary Carelead1 Phone1 Laptop1 PhoneMediaManager x2Window1 LaptopPublic HealthLeadloggistMeeting spacefor briefingsCupboardsLogbookCommittee RoomSolent HClead1 PhoneWindow1 LaptopRoom & InfoMgr 1 Phone1 Laptop1 Phone1 LaptopSecretaryIncidentDirectorLA/SSleadWhite boardWhite boardOptimal location for Satellite Phone connection18.2 Role cardsEach role identified has an associated role card. They are accessible via the network drive T and located in the emergency planning cupboard.Version 3.1 Page 137 of 144

19 Annex - National Reserve Stocks19.1 Department of Health guidanceGuidance is given by the Department of Health for accessing reserve stocks; this canbe found at www.dh.gov.uk under the gateway reference number 13611 and a briefsummary is outlined below:A. NHS Acute Trusts and Primary Care Trusts should access the following items bycontacting South Central Ambulance Service Control Room:1. Nerve agent antidote pod to treat 90 people.2. Obidoxime further treatment for nerve agent poisoning.3. Dicobalt edetate pod for treatment of cyanide poisoning in 90 people.4. Botulinum antitoxin.B. NHS Acute Trusts and Primary Care Trusts should access the following itemsthrough the Department of Health Major Incident Coordination Centre 0845 000 5555(callers should clearly give the details of the incident, the number of pods requestedand their contact details):1. Biological pods (oral ciprofloxacin) to treat 100 or 250 adults, or 50 or 100children, for 5 days, with post-exposure prophylaxis for anthrax, plague ortularaemia.2. Further stocks of ciprofloxacin to complete a treatment course, and stocksof doxycyline to change treatment if required.3. Ciprofloxacin intravenous injection for post-exposure treatment.4. Gentamicin intravenous/intramuscular injection for post-exposuretreatment.5. Potassium iodate tablets to block the uptake of radioactive iodine, plusinformation leaflets for the public. (Locally these are accessible fromPortsmouth City Council or Health Protection Unit)6. Prussian blue for the treatment of thallium poisoning.7. Naloxone for the treatment of opioid poisoning.Version 3.1 Page 138 of 144

The decision to request these medical supplies will normally be taken by the localConsultant in Health Protection (CHP), Director of Public Health (DPH), or Consultantin Public Health Medicine, who must inform the Regional Director of Public Health oftheir request.Copies of the guidance documents packed in the biological pods and of patient groupdirections for the countermeasures may be found here:http://www.dh.gov.uk/en/Policyandguidance/Emergencyplanning/DH_406961019.2 Further informationThe reserve stocks of equipment, antidotes and extra drug supplies held by SouthCentral Ambulance Service used to be stored the equipment and drugs in PODsstrategically placed across the county; these are being replaced by mass casualtyvehicles as part of the national HART (Hazardous Area Response Teams)programme.The HART programme is a government initiative which supports ambulancepersonnel working within the inner cordon (Hot Zones) of an incident along with otheremergency services personnel. South Central Ambulance Service has beenallocated two vehicles to cover HIOW and Thames Valley. More information on theHART programme available from www.ambulancehart.org.uk/about_hart/The table below summarises how to access the appropriate reserve stock:Type Use Contact to mobilise1. Reserve StockEquipmentThe equipment can be used for all forms ofrespiratory distress at the scene of an incident,at the receiving hospital or at a field hospitallocation. It is also suppliedwith IV access and atropine for use in thetreatment of nerve agent poisoning in a prehospitalsetting.Ambulance ServiceModestyFor use after decontamination to preventembarrassment and prevent hypothermia.Ambulance ServiceVersion 3.1 Page 139 of 144

Nerve AgentDrugs for the treatment of nerve agentpoisoning in hospital settings.Ambulance ServiceDicobaltedetateDrugs for the treatment of cyanide poisoning.Ambulance ServiceAdult & ChildCiprofloxacinFor the initial prophylactic treatment of patientsexposed to an unknown biological agent.Via HPU or DPH2. Strategic loose stocksPotassiumIodate Tablets(PITs)For the prophylactic treatment of patientsexposed to radioiodine.Via HPU orPortsmouth CityCouncil or RoyalNavy1st 100 doses Vaccination for avian flu. Via HPUOther itemsFor treatment.Via HPU orDepartment of Health3. Centrally held stocksVariousMultiple items available from the Department ofHealth as identified in section 19.1Department of HealthVersion 3.1 Page 140 of 144

20 Annex - Executive Incident Team Template AgendaItem No. Description Lead Person1. Introduction of Attendees, Roles and Responsibilities Chair2. Declaration of Items for Urgent Attention Chair2a. Decision on Items for Urgent Attention ChairBreak out time (if required) to action urgent items asagreed above3. Review and Agree Minutes of Previous Meeting Chair4. Update on Situation (Common Recognised InformationPicture)InformationManager5. Review and Agree Strategic Aim and Objectives Chair6. Review Outstanding Actions Chair7. Update from Teams / Attendees (By exception) Team leads8. (a) Discuss and Agree on Internal strategic DecisionsAll Members(b) Discuss and agree on multi-agency actions(c) Confirmation and Allocation of Actions Required.9. Date and Time of Next Meeting (2 hour gap approximately)ChairClosure of MeetingVersion 3.1 Page 141 of 144

21 Annex - Incident Assessment and Situation ReportReport detailsDateTimeName of person completing formName of people contributingSummary of the current situation:What are the facts about the incident? Use the aide memoir below as a guideC - Number of Casualties, if they requireany primary care treatmentH - Hazards i.e. Chemical plumeA - Access (road closures etc.)L - Location (address of incident, type ofbuilding where appropriate)E - Emergency Services (who should youcontact for more information)T - Type (i.e. chemical / road trafficaccident / outbreak)Other facts:What are the assumptions about the incident?What additional information is required?Version 3.1 Page 142 of 144

Alerting and informingWhat agencies are involved in the incident? Who has been informed (when and by whom ifknown)?Do we need to inform or request actions of other individuals / services / partnerorganisations?RisksWhat are the main risks and consequences of the incident?What are the knock on effects to other services and/or partner organisations?MediaWill the incident attract media interest? What is the current situation with the media? Areactions required?Next situation report due:DateTimeVersion 3.1 Page 143 of 144

Document available fromEmergency Planning Liaison OfficerNHS Portsmouth, Trust Headquarters,St James Hospital, Locksway Road,Portsmouth, Hampshire, PO4 8LDwww.portsmouthcitypct.nhs.ukVersion 3.1 Page 144 of 144