Emergency planning arrangements for the NHS in the UK - a collection of responses from the Board of Science
Board of Science and Education
January 2005
The training of appropriate NHS staff with regard to emergency planning arrangements in the UK is the responsibility of NHS Trusts. Guidance is drawn up by the respective departments of health of each devolved nation.
In addressing the following annual representative meeting motion, ‘that this Meeting demands that all potential front line health care workers be provided with adequate training and information to operate effectively in the event of terrorist, biochemical or nuclear incidents,’ members agreed that letters be sent to relevant organisations to gather information. The following organisations were contacted in order to gather information on emergency planning training provided to NHS staff during their induction:
- Royal Colleges
- Chief Medical Officers
- British Medical Journal
- Health Protection Agency
- Centre for Disease Control and Surveillance (Northern Ireland)
- Scottish Centre for Infection and Environmental Health
(GP specific guidance)
Department of health (England)
Each NHS organisation is responsible as part of its induction and ongoing training for their staff to perform their duties effectively in the event of an emergency. In 2004, £2.6 million was allocated to the Health Protection Agency’s (HPA) chemical, biological, radiological and nuclear (CBRN) training programme. The emphasis of the programme is on front-line staff.
In addition, the Ambulance Service Association has set up a National CBRN Faculty to oversee development of CBRN training courses for ambulance staff. The department of health (DH) is revising the guidance on Planning for major incidents, published in 1998, and will consider this issue as part of that revision.
Scottish executive
Emergency planning unit of the health department
The standard guidance for health emergency planning in Scotland is a Manual of guidance: responding to emergencies(www.show.scot.nhs/emergencyplanning/guidance.htm). Specific guidance that deals with release of chemical or biological agents is available at:www.scotland.gov.uk/library5/health/drbc-00.asp
The Scottish Ambulance Service is carrying out a rolling programme of accredited training in the use of personal protective equipment (PPE) for front-line responders in the event of a chemical or biological incident.
Welsh assembly
Each trust and local health board in Wales has a major incident plan and is expected to provide training and simulated exercises to train staff in major incident procedures. The Welsh Assembly Government has arrangements to monitor this training through its emergency planning advisory group and through the activities of the health emergency planning adviser. Individual trusts are expected to refer to the emergency planning arrangements in induction procedures for those staff likely to be directly involved.
Department of health, social services and public safety (N.Ireland)
The department of health, social services and public safety (DHSSPS) has issued a number of emergency planning guidance circulars which require health and social services boards, trusts and agencies to have effective emergency plans in place to ensure that staff are familiar with emergency plans and receive appropriate training.
- The chief medical officer (CMO) issued Emergency planning functions directions to chief executives on 28 June 2004. It is intended that these directions enhance preparedness, clarify and provide statutory authority for the emergency planning responsibilities of the department, boards, trusts and agencies, enable effective chain of command from operational level to regional level and mirror the requirements in Part 1 of the Civil Contingency Act 2004.
- Draft control assurance standards on emergency planning were circulated for comment in June 2004 and are due to be issued in March 2005.
- CMO chairs the DHSSPS counter measures working group that has recently appointed a training sub-group to develop emergency planning training strategy. Initial research demonstrates that all acute hospitals provide major incident induction training.
- DHSSPS has made high level investment in CBRN preparedness in the provision of PPE and decontamination units for all acute hospitals in Northern Ireland. PPE training courses have been provided for hospital and ambulance staff and a programme of radiation awareness training for hospital staff has recently commenced.
- DHSSPS established the emergency medical assistance and rescue team as a volunteer resource in April 2003.
- Limited emergency planning training has been provided to the family practitioner services. Clinical cards on infectious diseases (HPA) have been adapted for Northern Ireland and will shortly be issued to all GPs.
For further information please refer to our summary of Guidance available to general practitioners on actions to take in the event of a terrorist attack/chemical leak.
Faculty of Public Health of the Royal College of Physicians of the UK was not aware of training provided by the NHS for their staff.
Royal College of Physicians and Surgeons of Glasgow suggests that it may be possible to develop some educational activities within their College education programme to offer more specific training for interested individuals.
Royal College of Anaesthetists highlighted the following publications for further information:
- Department of Health (2004) Handling major incidents: an operational doctrine.
- Department of Health (1998, updated 2004) Planning for major incidents: the NHS guidance.
- Cabinet Office (2003, updated 2004) Dealing with disaster.
Guidance available to GPs on actions to take in the event of a terrorist attack/chemical leak
The majority of the information available is aimed at all healthcare professionals and those responsible for planning strategies to responses. Within these documents, there is information aimed specifically at GPs, or that may be of use to GPs. The exception is the booklet produced by the Royal College of General Practitioners, which is aimed solely at GPs.
Major Incidents and disasters - the role of the GP and the primary health care team, The Royal College of General Practitioners Position Statement www.rcgp.org.uk
This booklet considers the preparedness of GPs and primary health care teams in responding to major incidents, including CBRN. It also looks at the ability to continue providing essential healthcare in the aftermath of an incident. It discusses the implications of a major incident on GPs, and recommends that practices have a service continuity plan in place, outlining how to deal with an emergency and the recovery of normal services. The guidance suggests the implementation of a specific role for a GP with a special interest in emergency planning, and the incorporation of bioterrorism as part of GPs training.
Department of Health (DH)
www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/fs/en
Planning for major incidents: the NHS guidance
This handbook provides NHS guidance on responses to major incidents. It identifies key issues, and covers all health sectors. Guidance for GPs is covered in the section on community health and primary care organisations. It highlights the importance of planning for an emergency, in conjunction with other healthcare providers, in order to be able to mount an immediate and sustained response to a major incident. The importance of effective communication between the various bodies is also emphasised.
The handbook recognises that GPs will be central to healthcare in the community in the aftermath of an incident, and that they should be fully supported in this role. It outlines ways in which this should be achieved. As well as providing healthcare and support in the immediate aftermath, primary care also plays a significant role in long-term care following the incident. It is advised that this should be planned so that it can be absorbed into normal services.
The guidance includes specific information on responses to chemical or radiation incidents. Whilst these are not specifically aimed at GPs, it is suggested that it may be of use to them. It again highlights the necessity to have plans in place, and that these are co-ordinated with other response agencies.
Planning for major incidents: the NHS guidance, the primary care trust (PCT)
This chapter updates guidance on emergency planning in the NHS, specifically dealing with the role of PCTs in the event of an emergency. It discusses the role of PCTs as part of a whole systems approach in dealing with major incidents. It outlines key roles, responsibilities and actions for PCTs, and highlights the need to have specific plans and arrangements in place to deal with emergencies. The importance of planning in conjunction with other agencies, and a clear understanding of the roles of all agencies is noted. Plans should also take into consideration the risks faced by the PCT.
Deliberate release
www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/DeliberateRelease/fs/en
This collection of resources on the DH website provide information about specific substances that could be used in a terrorist attack, including chemical, biological and radioactive materials. Although specifically aimed at Directors of Public Health and Consultants in Communicable Disease Control, it would also be of use to GPs and those planning for such incidents.
More detailed information includes:
Public response to the deliberate release of biological and chemical agents
This guidance complements Planning for major incidents: NHS guidance. It looks at ways of detecting unusual diseases, and whether they could be linked to biological, chemical or radiological causes. It discusses ways of tackling deliberate release of chemical or biological agents, and provides guidance for PCTs in planning for these incidents.
Release of radioactivity into the environment (or food chain), contingency planning and response
This document discusses the roles of agencies in the event of a radiological incident, including PCTs. It highlights the need for plans, and the necessary responses of PCTs, in co-operation with other agencies. It refers to the practical guidance contained in Planning for major incidents.
Health Protection Agency
www.hpa.org.uk/hpa/info/cards.htm
Clinical action cards for healthcare professionals
These cards for GPs and frontline healthcare professionals to aid them in identification of symptoms caused by biological, chemical and radiological agents, with advice on who to contact in the event of patients presenting with these symptoms
Deliberate release - information for health professionals - chemical agents
This provides information on actions required in response to the deliberate release of chemical agents, for use by all healthcare professionals involved. Documents include guidelines for ammonium nitrate, nerve agents, mustard gas, chlorine, hydrogen cyanide, phosgene and ricin.
Deliberate release - biological agents
Information on the response to the deliberate release of biological agents is provided for use by all healthcare professionals. Diseases covered are anthrax, smallpox, botulism, plague, tularaemia and viral haemorrhagic fevers.
Initial investigation and management of outbreaks and incidents of unusual illnesses. With particular reference to events that might be due to chemical, biological or radiological causes, including deliberate releases.
Produced by the HPA and National Radiological Protection Board, this provides guidance to those who may be involved in the initial response to an unusual illness. It provides information on actions to take, and helps healthcare professionals in establishing whether the outbreak is due to natural, accidental or deliberate causes. The publication includes general guidance for all healthcare professionals and specific guidance for GPs.