Major Incident Plan - GG&C Paediatric Guidelines · 2020-03-23 · been a major incident, but prior to any official major incident alert, the Nurse in Charge Emergency Department

RHC

Major Incident

Plan

DIVISIONAL RESPONSIBILITY Women And Children’s Directorate Risk Management Group

LEAD CLINICIAN Dr Siobhan Sweeney

IMPLEMENTATION DATE Nov 2016

NEXT REVIEW DATE annual

ISSUE NUMBER 4

NUMBER OF PAGES 188

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If and when a Major Incident is declared:

Initial actions in the Emergency Department

1. Don’t panic. Breathe!

2. Pull your senior team together and make a plan

3. Start a log of key decisions and actions

4. If you have a role in the emergency plan follow your action card

5. Clear the Emergency department

6. Plan breaks for your staff and standby other staff to take over

7. Identify a member of staff to call in the additional staff required-telephone numbers

in ED secretaries office in MI folder

8. Establish triage at the ambulance doors

9. Ensure set up of Clinic 3 out-patients

10. Place staff / signage at front entrance of ED to divert patients to Clinic 3

11. The relative waiting area is in the Therapies Hub, divert relatives here if necessary

12. If you have not read the plan do not do so now, follow your action card.

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PAGE NUMBER

1. INTRODUCTION 5

2. DEFINITION 5

3. MAJOR INCIDENT ALERT PROCEDURE 6

4. STAFF NOTIFICATION PROCEDURE 8

5. HOSPITAL COORDINATION TEAM 11

6. KEY ROLES 12

7. ON SITE MEDICAL TEAM 12

8. OUTLINE PROCESS 13

9. TELEPHONE NUMBERS 13

10. MAJOR INCIDENT DEBRIEFING 13

11. REVIEW 14

12. ACTION CARDS 15

13. APPENDICES 118

CONTENTS

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PAGE NUMBER

APPENDIX 1 MAJOR INCIDENT NOTIFICATION FORM 118

APPENDIX 2 SIGNPOSTING 119

APPENDIX 3 LOCATION OF TELEPHONE CONTACT LISTS 121

APPENDIX 4 LIST OF DESIGNATED AREAS AND TELEPHONE 122

NUMBERS

APPENDIX 5 LIST OF EXTERNAL AGENCIES AND TELEPHONE 125

NUMBERS

APPENDIX 6 MAJOR INCIDENT PATIENT REGISTRATION 126

APPENDIX 7 STRATHCLYDE POLICE CASUALTY BUREAU 130 ARRANGEMENTS

APPENDIX 8 CHEMICAL AND RADIOLOGICAL INCIDENTS 131

APPENDIX 9 EMERGENCY VIP PATIENT POLICY 132

APPENDIX 10 POLICE FORMS USED TO HELP IDENTIFY 135

CASUALTIES

APPENDICES

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MAJOR INCIDENT PLAN

1. INTRODUCTION

1.1 The purpose of the Major Incident Plan is to ensure that the hospital is in a position to respond to incidents outside of its normal experience and of such a scale that special arrangements will be required.

1.2 There is an overarching Major Incident Plan for NHS Greater Glasgow and Clyde

(NHSGGC) which sets out the overall health board response, the designation of receiving hospitals for specific major incidents and coordination with other Emergency Services.

1.3 The Royal Hospital for Children’s (RHC) Major Incident Plan will be activated if it is

known or anticipated that a significant number of paediatric casualties have resulted from a particular incident.

1.4 The Major Incident Plan follows an ‘all hazards approach’ with a single plan

intended to cope with all types of major incident. 1.5 The details of the Major Incident Plan should be known to all staff likely to be

involved in the response to a major incident. The plan has been drawn up to make clear the procedures to be followed and actions to be taken by designated members of staff under these circumstances.

1.6 The Director of Women and Children’s Services bears overall corporate

responsibility for major incident planning for this hospital. 1.7 Regular review, updating and testing of the Major Incident Plan will be overseen

through the Women and Children’s Directorate Risk Management Group.

2. DEFINITION

2.1 A major incident is any event whose impact cannot be handled within routine service arrangements. With regard to health service planning, this would involve an event that owing to the number, severity, type or location of live casualties required an extraordinary response by the hospital.

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Blue Light Services

Contact GGC EDs

Ambulance Control Centre

GG&C Contact Centre

Hospital staff

3. MAJOR INCIDENT ALERT PROCEDURE

3.1 “Major Incident – Standby” Notification

The first notification of a potential major incident is likely to come from the Scottish Ambulance

Service. When the ambulance service first suspects that a major incident might have occurred,

the Scottish Ambulance Service Control Centre will identify all the hospitals potentially involved

and alert them directly. This alert is the “Major Incident- Standby”.

The ambulance service will then alert the GGC Contact centre who will activate the Confirmer

call out system for all staff who will be involved in the response within the designated hospitals.

3.2 The first notification of a potential major incident may be received directly by the Emergency Department. In this case, the Nurse in Charge Emergency Department will contact the Senior Nurse on duty for the hospital (Page 8502/ Dect 85770) to inform them of the information received.

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3.3 It is the responsibility of the Senior Nurse on duty for the hospital (Page 8502/ Dect 85770) to confirm the authenticity of any information received with the Scottish Ambulance Service or Police Scotland, contact details to be found in Appendix 5. The Major Incident Notification Form (Appendix 1) should be used to record the essential details.

3.4 If casualties begin arriving in the Emergency Department reporting that there has

been a major incident, but prior to any official major incident alert, the Nurse in Charge Emergency Department will contact the Senior Nurse on duty for the

hospital (Page 8502/ Dect 85770) to inform them of the situation. They should assess whether the hospital Major Incident Plan should be activated in this case.

3.5 Following notification of a confirmed major incident from the Emergency Services, it

is the responsibility of the Senior Nurse on duty for the hospital (Page 8502/ Dect 85770) to confirm to GGC Contact Centre via 2222 call that a major incident has been declared and that the hospital Major Incident Plan is to be activated.

3.6 “Major Incident – Declared” Notification

If the Emergency services judge that the situation is deemed significant, they will revise the

standby message to “Major Incident –Declared”. This message will be sent to all the hospitals

directly and then to the Contact Centre for further dissemination.

The information relayed to the Contact Centre will be a METHANE message which will be

passed on to the Emergency department. (See Action card – Incident Log Sheet.)

M- Major Incident declared/ standby

E- Exact location

T- Type of incident

H- Hazards

A- Access/Egress

N- Number of casualties

E- Emergency Services present/required

The message that is received by pager, phone, text or email will be a series of questions and

options to select. The call lasts approximately 2 minutes. Confirmer will only cease attempting

the other contact methods as long as ALL prompts during the call have been responded to

positively.

3.7 “Major Incident – Stand down” Procedure

If the Emergency services decide that the situation is no longer significant, they will revise the

message to “Major Incident - Stand down” and contact the emergency department red phone.

This information should be communicated with the Hospital Coordinator who has the

responsibility of verifying the information.

3.8 Major Incident –Stand down at the end of a major incident

The Hospital Coordinator will decide on the phasing of the stand down of the hospital major incident response and will communicate with staff accordingly. If GGC Contact Centre Operator receives a stand down call from the Scottish Ambulance Service Emergency Medical Dispatch Centre, or other External Agency, this information

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must be communicated to the Hospital Coordinator in the first instance, as it is the Incident Controller who has responsibility for declaring any stand down of the hospital major incident response. 4. STAFF NOTIFICATION PROCEDURE

4.1 Major Incident Call-In Procedure

The following entities will be called by the “Confirmer” system to notify them of the Major Incident

status. The following entities will be contacted based on the contact information provided on Rota

watch. Any additional staff will need to be contacted by each departments own major incident

call-in list.

RWRole50 343 Managers On Call North East Stobhill and Glasgow Royal Infirmary Senior Manager On Call

RWRole334 501

Medical Consultant Rota Inverclyde Royal Hospital Consultant

RWRole255 369

Medical Consultant Royal Alexandra or Vale Of Leven Consultant

RWRole166 455

Medical Paediatric Consultant On Call Royal Hospital for Children Consultant

RWRole58 115 Medical Receiving Consultants and Senior Staff Glasgow Royal Infirmary Consultant

RWRole64 152 Orthopaedic On Call Glasgow Royal Consultant

RWRole124 158

Orthopaedic On Call Queen Elizabeth University Hospital Consultant

RWRole253 364

Orthopaedic On Call Royal Alexandra Consultant

RWRole122 155

Orthopaedic On Call Royal Hospital for Children Consultant

RWRole341 502

Press Officer Communications Press Officer On Call

RWRole23 38 Public Health Medicine and Port Health Consultant or Specialist Registrar

RWRole23 456 Public Health Medicine and Port Health Office Staff

RWRole155 444

Surgical Consultant Glasgow Royal and Surgical Receiving Coordinator Duty Consultant Surgeon

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RWRole282 446

Surgical Inverclyde Royal Consultant

RWRole138 179

Surgical Receiving and Neonates Consultants and Registrar Royal Hospital for Children Consultant

RWRole197 222

Surgical Receiving Consultant or Registrar Queen Elizabeth University Hospital Consultant

RWRole254 365

Surgical Royal Alexandra Hospital Consultant

RWRole329 491

Telecoms Manager On Call Telecoms Manager

RWRole297 570

Test 1 Director Head

RWRole93 241 A E Consultants On Call Glasgow Royal Infirmary Consultant

RWRole95 269 A E Consultant on Call Queen Elizabeth University Hospital Consultant

RWRole262 423

A E Consultant Royal Alexandra or Inverclyde Royal Consultant

RWRole104 424

A E Consultants On Call Royal Hospital for Children Consultant

RWRole37 64 Acute Executive Director On Call Acute Executive Director

RWRole358 531

Acute Receiving Unit Queen Elizabeth University Hospital Clusters Consultant

RWRole409 581

Anaesthetic senior trainee Queen Elizabeth University Hospital Senior trainee

RWRole49 78 Anaesthetics Glasgow Royal Infirmary Consultant

RWRole407 579

Anaesthetics Cardiac Consultant On Call Royal Hospital for Children Cardiac Consultant

RWRole106 479

Anaesthetics Consultant On Call Royal Hospital for Children Consultant

RWRole408 580

Anaesthetics General Consultant On Call Royal Hospital for Children General Consultant

RWRole284 449

Anaesthetics Inverclyde Royal Consultant

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RWRole360 536

Anaesthetics Queen Elizabeth University Hospital Consultant

RWRole247 353

Anaesthetics Royal Alexandra Consultant

RWRole251 572

Blood Transfusion Queen Elizabeth University Hospital Bio Medical Scientist

RWRole250 408

Corporate Management Team City Wide Corporate Director

RWRole250 571

Corporate Management Team City Wide Response Medical Director

RWRole143 187

Department of Medicine for the Elderly Glasgow Royal Infirmary Stobhill and Lightburn Consultant

RWRole374 546

Facilities Senior Manager On Call Senior Manager

RWRole389 559

Major Incident I T 1 General I T

RWRole390 560


RWRole391 561


RWRole392 562


RWRole357 525

Manager On Call Queen Elizabeth University Hospital Manager on call

RWRole270 425

Managers Clyde Royal Alexandra or Inverclyde Royal or Vale of Leven Duty Manager

4.2 Confirmer Test Calls

Major Incident Test calls are held every month to ensure that the communication system works.

The Emergency “Red” phone in the ED will also be included in the test calls but is not part of the

confirmer system.

4.3 Secondary ED call out

An updated list of contact numbers for individuals the ED department will contact following

declaration of a major incident is kept in the ED secretaries’ office in the ED department. An

appropriate member of staff will be allocated the call out role following declaration of an MI.

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5. HOSPITAL COORDINATION TEAM

5.1 The hospital major incident response will be controlled by the Hospital Coordination Team.

5.2 The Hospital Coordinator is in overall charge. This role Monday to Friday 9-5 will be

filled the manager in RHSC holding page number 8084. Out of hours this role will be filled by the NHSGGC West Sector General Manager on call. In the unlikely event they are un-available the NHSGGC Executive Director on call will be contacted. The Senior Nurse on duty for the hospital (Page 8502/ DECT 85770) will, if necessary, assume this role until their arrival.

5.3 The Emergency Department Consultant has responsibility for organising the reception phase of the major incident. This role will be filled by the Emergency Department Consultant on call. The senior Emergency Department Specialty Trainee will, if necessary, assume this role until their arrival.

5.4 The Senior Nurse has responsibility for coordinating the nursing response within the hospital. This role will be filled by the Senior Nurse on duty for the hospital (Page 8502/ Dect 85770).

5.5 The Site Facilities Manager has responsibility for coordinating the hospital support and non-clinical services’ response.

5.6 The Hospital Coordination Team will be based in the Seminar room in the

Emergency Department. In a mixed adult and paediatric incident there will be a central control room in QEUH based in the meeting room on level 2 at the main atrium. Clear lines of communication must be established between RHC and QEUH, and the managers will have a role to play in both the adult and the paediatric response.

Emergency Department Consultant

Senior Nurse (8502) 85770

Site Facilities Manager

Hospital Co-ordinator

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6. KEY ROLES

6.1 The duties and responsibilities of specific staff during a major incident are set out on

individual action cards. 6.2 Members of staff fulfilling certain key roles may change according to the nature of

the major incident - surgical/trauma versus medical type incidents. 6.3 All staff that are likely to play a key role in the hospital major incident response will

have an action card. 6.4 Each action card tells an individual what their role will be and how they should achieve it.

6.5 Once informed that the hospital Major Incident Plan has been activated, staff should

proceed to the staff reporting area in the HAN base and adjacent seminar room on the second floor to collect their action cards.

7. ON SITE MEDICAL TEAM

7.1 There is currently no role for RHC in the provision of on-site support at the scene of

a major incident in the form of a Medical Incident Officer or Site Medical Team. 7.2 The Medical Incident Officer and Site Medical Team will be provided by EMRS. 7.3 If additional specialist paediatric skills are required on-site, these will be requested by

the on-site Medical Incident Officer. RHC will respond as appropriate, through the pre-existing structure of the PICU Transport Service and this will include the capability to provide a Site Surgical Team.

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8. OUTLINE PROCESS

8.1 Following activation of the hospital Major Incident Plan, the Senior Nurse on duty for

the hospital will establish the Major Incident Control Room in the Seminar room in

the Emergency Department. 8.2 Other members of the Hospital Coordination Team will proceed to the Major Incident

Control Room in the Seminar room in the Emergency Department.

8.3 All members of staff who are designated in the hospital Major Incident Plan should

proceed to the staff reporting area in the HAN base and adjacent seminar room on the second floor to collect their action card.

8.4 Staff members attending the hospital who do not have a designated action card, but

may have a role to play in a major incident should attend the HAN base and

adjacent seminar room on the second floor to give their name and designation to the senior nurse co-ordinating the staff reporting area, and remain in the seminar room to be called upon when required.

8.5 If extra staff are required during a major incident, in addition those specified on the

action cards, they will be contacted.

9. TELEPHONE NUMBERS

9.1 It is essential that GGC Contact Centre is provided with up to date telephone contact details. This is achieved by ensuring that Rotawatch is accurately populated. Individual departments must maintain accurate and regularly updated telephone contact details for members of staff, so all necessary personnel can be contacted in the event of a major incident.

9.2 Telephone contact details for certain designated staff are held at the Contact Centre. More specific departmental telephone contact lists are held in various locations around the hospital as set out in Appendix 3. 9.3 Telephone numbers for key areas within the hospital that will play a designated role in a major incident are set out in Appendix 4. 9.4 Telephone numbers for relevant External Agencies are set out in Appendix 5.

10. MAJOR INCIDENT DEBRIEFING 10.1 Staff debriefing is essential following a major incident. Operational and psychological issues should be addressed. 10.2 The Hospital Coordinator will be responsible for ensuring a debriefing meeting is convened during the week following a major incident.

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10.3 The Hospital Coordination Team will have responsibility for identifying those members of staff significantly involved in the major incident response and who should therefore attend. In addition to medical and nursing staff, hospital support services, medical records and the Contact Centre should also be represented. 10.4 The Hospital Coordinator will prepare a formal report based on the debriefing, which will be presented to the Director of Women and Children’s Services and copied to the Civil Contingencies Planning Unit at NHSGGC. 10.5 All other staff involved should have the opportunity for a major incident debriefing, organised through their head of department. 10.6 There should be a formal and impartial audit carried out of the clinical care delivered to patients during the major incident and of the wider hospital response. This should be completed within a month of the incident. This will help identify any significant failures or successes and facilitate dissemination of lessons learned to a wider audience.

11. REVIEW 11.1 The Major Incident Plan will be subject to regular review and revised/updated as necessary through the Women and Children’s Directorate Risk Management Group.

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ACTION CARD

NUMBER

ACTION CARD TITLE

1 HOSPITAL COORDINATOR

2 SENIOR NURSE ON DUTY PAGE 8502

3, 3A-B EMERGENCY DEPARTMENT CONSULTANTS

4 NURSE IN CHARGE EMERGENCY DEPARTMENT

5 SITE FACILITIES MANAGER

6, 6A-E SENIOR EMERGENCY MEDICINE SPECIALTY TRAINEES

7,7A-E EMERGENCY MEDICINE PAEDAITRIC AND GP STS

8,8A-H EMERGENCY DEPARTMENT NURSES

9,9A-E EMERGENCY DEPARTMENT HEALTH CARE ASSISTANTS

10,10A-C ANAESTHETISTS, TRAINEE AND CONSULTANTS

11, 11A PICU, TRAINEE AND CONSULTANTS

12 NURSE IN CHARGE PICU

13, 13A-D CONSULTANT SURGEON ON CALL, SURGICAL TRAINEES

14, 14A ORTHOPAEDIC CONSULTANT ON CALL, ORTHO TRAINEE

15, 15 A-C CONSULTANT PAEDIATRICIAN, PAEDIATRIC TRAINEES

16 SENIOR NURSE 2A, holding page 8399

16A SENIOR NURSE 1E, holding page 8345

MAJOR INCIDENT ACTION CARDS

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ACTION CARD

NUMBER

ACTION CARD TITLE

17 SENIOR NURSE THEATRES

18 EMERGENCY DEPARTMENT RECEPTIONIST ON DUTY

18A MEDICAL RECORDS MANAGER

18B-D MEDICAL RECORDS STAFF

19 GENERAL SERVICES SUPERVISOR

20 POLICE LIAISON OFFICER

21 HOSPITAL ENQUIRIES OFFICER

21A HOSPITAL ENQUIRIES OFFICER ASSISTANT

22, 22A RELATIVE COORDINATORS

23, 23A PRESS OFFICER

24 HAEMATOLOGY AND BLOOD TRANSFUSION

25 BIOCHEMISTRY

26, 26A RADIOGRAPHER ON CALL , SENIOR RADIOGRAPHER

27 CONSULTANT RADIOLOGIST ON CALL

28 PHARMACIST ON CALL

28A PHARMACY MANAGER

29 DUTY SOCIAL WORKER

30,30A-C HOSPITAL CHAPLAINS

31 MORTUARY TECHNICIAN

32, 32 A-C PORTERS

Decontamination

Action cards

RCH and QEUH

1-10

DECONTAMINATION ACTION CARDS

Only use in the event of a decontamination incident. When a major

incident is declared involving a decontamination incident these

cards will be allocated to ED nursing and medical staff IN ADDITION

to their Major Incident Action cards above

MAJOR INCIDENT ACTION CARDS

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MAJOR INCIDENT ACTION CARD 1

The Hospital Co-ordinator is in overall charge of the RHC hospital response to the

major incident.

Between 9-5, Monday to Friday the RHC manager holding page 8084 should be

contacted. Out of hours this role will be taken by the NHSGGC South Sector

General Manager on call. In the unlikely event they are un-available the NHSGGC

Executive Director on call will be contacted.

The Senior Nurse on duty (8502/ DECT 85770) for the hospital will act as Hospital

Coordinator until he/she arrives on site.

The Contact Centre Operator must be kept up to date on who is Hospital Coordinator.

1. Proceed to the Major Incident Control Room, which is located in the Seminar

room in the Emergency Department. Access the Incident Information Sheet (appendix 1) and contact the Scottish Ambulance Service Emergency Medical Dispatch Centre to obtain and clarify information as to the nature, site and severity of the major incident. Telephone numbers to be found on appendix 5.

2. Confirm/allocate the following roles as soon as possible. There may be a significant delay out of hours:

a) Police Liaison Officer (working hrs- Site Manager)

b) Press Officer (contact no. appendix 5)

c) Press Officer Assistant (working hrs- Play Staff member)

d) Relative Coordinators x 2 (working hrs - Family Information and Play Staff)

e) Hospital Enquiries Officer and Assistant (Main entrance receptionist and day surgery receptionist within hrs)

f) Loggist / minute taker (working hours to be allocated by admin manager)

3. You have no role to play in direct clinical patient care.

4. Take an overall view of the hospital response to the major incident and liaise with the

other members of the Hospital Coordination Team, namely:

(a) The Emergency Department Consultant, who is in charge of the initial clinical response.

(b) The Senior Nurse (8502/ DECT 85770), who is responsible for the preparation of clinical areas and nursing provision.

(c) The Site Facilities Manager, who is responsible for ensuring the provision of support services.

Hospital Co-ordinator

CONTINUED ON REVERSE

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5. Liaise with 8502/ DECT 85770 page holder and page holding nurses from 1E and 2A to form an overarching view of activity in the hospital. Determine the number of vacant beds, intensive care beds and free ventilators. Update the Hospital Coordinator regularly.

6. Task medical staff with the discharge of any appropriate patients to maximise available bed spaces, with regular updates to the Hospital Coordinator as beds become available.

7. Terminate theatre and outpatients clinics as appropriate. Liaise with the surgeon and cardiac anaesthetist co-ordinating theatres

8. Authorise additional medical resources as required

9. Oversee dealings with relatives and the media. This will include working with the Press Officer to coordinate any VIP visits to the hospital.

10. Decide on the phasing of the stand down of the hospital major incident response and communicate with the Contact Centre Operator and staff accordingly.

11. Convene a debriefing meeting during the week following a major incident, liaising as necessary with the Women and Children’s Directorate Management Team. With the help of the other members of the Hospital Coordination Team, identify those staff who were significantly involved and who should therefore be invited attend. In addition to medical and nursing staff, hospital support services, medical records and the Contact Centre should be represented.

12. Ensure the preparation of a report based on the debriefing meeting which should include:

(a) A chronology of the major incident. (b) A summary of the hospital response to the incident . (c) Detail of any significant successes or failures in the hospital response.

(d) An action plan outlining a timescale for further review and any necessary revision of the hospital Major Incident Plan.

13. The report should be presented to the Director of Women and Children’s Services and copied to the Civil Contingencies Planning Unit at NHSGGC.

14. Ensure that all other staff involved in the hospital major incident response have the opportunity for a debriefing, organised through their head of department.

15. Coordinate a formal and impartial audit of the clinical care delivered to patients during the major incident and of the wider hospital response. This should be completed within a month of the incident.

16. Events, decisions and actions should be recorded on a Dictaphone in the absence of a Loggist.

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Role – Coordinate nursing part of the hospital major incident response

It is the responsibility of the Senior Nurse on duty for the hospital (page 8502) to

confirm to the Contact Centre via 2222 call that a major incident has been declared

and that the hospital Major Incident Plan is to be activated.

The Senior Nurse on duty for the hospital (page 8502/ Dect 85770) will assume the

role of Hospital Coordinator until he / she arrives on site - follow Major Incident

Action Card .

1. Help establish the Major Incident Control Room in the Seminar Room in the

Emergency Department.

2. Ensure preparation and adequate nurse staffing of key clinical areas is in hand:

(a) Emergency Department (b) Clinic 3 Out-Patients Department (c) PICU/Theatres

3. Liaise with the page holding Senior Nurses on Ward 1E (page 8345) and 2A

(page 8399). With their assistance, alert all wards. In the process, establish bed status and the number of trained nurses and other ward staff who could be made available to assist elsewhere with the major incident response without jeopardising ward patient care.

4. If assuming the Senior Nurse role in the Hospital Coordination Team continue to

follow Major Incident Action Card 3, if assuming a temporary Hospital Coordinator

role follow Major Incident Action Card 2 and assign the senior nurse role in the

hospital coordination team to a senior member of the nursing staff on shift.

6. Request the nursing staff on all wards, in conjunction with medical staff, to identify any patients who could be discharged to maximise available bed spaces. Collate this information as it becomes available and share with the Hospital Coordinator.

7. Nominate two ‘runners’ to assist the Hospital Coordination Team.

8. Deploy additional available ward nurses and other staff as appropriate/necessary to the Emergency Department, Clinic 3 Out Patients Department, the Relatives Waiting Area (Therapies Hub) and the Patient Reunion/Discharge Area (Outpatient Clinic 5).


SENIOR NURSE ON DUTY PAGE 8502/ Dect 85770

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9. Arrange contact of additional off duty nursing staff as required. Do not go through

the Contact Centre operators - call directly using departmental/ward telephone call out lists.

10. After stand down of the hospital major incident response, ensure that all nursing staff involved participate in the debriefing process.

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Roles – 1. Coordinate clinical response in reception areas

2. Triage Doctor

In the absence of the Emergency Department Consultant, the Senior Emergency

Medicine Specialty Trainee will assume this role until the arrival on site of the

Emergency Department Consultant on call.

1. Ensure that the Major Incident Control Room has been established in the Seminar

Room, in the Emergency Department. In a mixed adult and paediatric MI the

overarching control room is in QEUH. Ensure clear lines of communication

have been established with this area.

2. Coordinate the process of clearing the Emergency Department of existing patients as follows:

(a) Transfer those patients waiting for admission, or requiring a period of

observation, to the wards. (b) Transfer those patients who have been triaged as triage category 3 or above, or who are still to be triaged, to Clinic 3 Out-Patients Department. (c) Send those patients waiting, who have been triaged as non-urgent, home with advice to contact their GP/NHS 24.

3. Work with the Nurse in Charge Emergency Department to ensure the preparation and equipping of all clinical areas for the reception of casualties.

4. Designate an appropriate number of Casualty Treatment Teams, each consisting of two doctors and one nurse. Allocate each Casualty Treatment Team to a specific treatment area.

5. Use the Senior Emergency Medicine Specialty Trainee to call in extra Emergency

Department medical staff as deemed necessary. Do not go through Contact

Centre operators - call directly using your departmental telephone contact list, located in the Major incident contact folder in the ED secretaries’ office.

6. Working together with the Triage Nurse, prepare to triage casualties as they arrive at the ambulance entrance. The availability/presence of a second Emergency

Department Consultant would allow delegation of the Triage Doctor role - Major

Incident Action Card 4A.

7. Coordinate and maintain an overview of all activity in the reception areas in conjunction with the Nurse in Charge Emergency Department. Liaise with radiology, theatres and PICU on a frequent basis.

EMERGENCY DEPARTMENT CONSULTANT 1


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8. There should be regular contact with the Hospital Coordinator to allow accurate and timely clinical progress reports for relatives in the Relatives Waiting Area. Make use of the allocated ‘runners’ to aid this communication process.

9. Once stand down of the hospital major incident response has been declared, ensure the offer of an immediate debrief for all Emergency Department staff before they leave the hospital.

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MAJOR INCIDENT ACTION CARD 3A

Role – Triage Doctor

1. Working together with the Triage Nurse, prepare to triage casualties as they arrive at the ambulance entrance.

2. Assess each patient on arrival and triage major incident casualties as follows:

CATEGORY – IMMEDIATE

Casualties requiring immediate life saving treatment.

CATEGORY – URGENT

Casualties requiring urgent surgical or other treatment intervention.

CATEGORY – DELAYED

Casualties requiring non-urgent treatment.

CATEGORY – DEAD

Casualties who are dead.

CATEGORY – EXPECTANT

Consider making use of this category for those casualties who cannot survive

treatment, or where the degree of intervention required is such that, in the context of a major incident, their treatment would severely compromise the provision of treatment for others.

3. Remain at the ambulance entrance and do not treat patients.


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MAJOR INCIDENT ACTION CARD 3B

Role – Assist coordinating clinical response in reception areas

1. Assist the Emergency Department Consultant on call in the coordination of all activity in the reception areas and in liaison with the Hospital Coordinator and other parts of the hospital.


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Role – Coordinate nursing response in the Emergency Department

The first notification of a major incident may be received directly by the Emergency

Department. In this case, the Nurse in Charge Emergency Department will contact

the Senior Nurse on duty for the hospital (Page 8502/ Dect 85770) to inform them of

the information received.

If casualties begin arriving in the Emergency Department reporting that there has

been a major incident, but prior to any official major incident alert, the Nurse in

Charge Emergency Department will contact the Senior Nurse on duty for the hospital

(Page 8502) to inform them of the situation. They should assess whether the hospital

Major Incident Plan should be activated in this case.

1. Set up the Major Incident Patient Board on the wall of the resus corridor between the ambulance doors and Majors in the Emergency Department.

2. Alert the Out-Patients Department. Out of hours, ensure you allocate the task of opening up the Out-Patients Department.

3. Work with the Emergency Department Consultant to coordinate the process of clearing the Emergency Department of existing patients as follows:

(a) Transfer those patients waiting for admission, or requiring a period of observation, to the wards. (b) Transfer those patients who have been triaged as triage category 3 or above, or who are still to be triaged, to Clinic 3 Out-Patients Department. (c) Send those patients waiting, who have been triaged as non-urgent, home with advice to contact their GP/NHS 24.

4. Allocate appropriate/sufficient nursing staff to accompany those patients transferred round to Clinic 3 Out-Patients Department.

5. Work with the Emergency Department Consultant to ensure the preparation and equipping of all clinical areas for the reception of casualties.

6. Allocate a Triage Nurse, who will work with the Emergency Department Consultant to triage casualties as they arrive at the ambulance entrance.

7. Assist the Emergency Department Consultant to designate an appropriate number of Casualty Treatment Teams, each consisting of two doctors and one nurse. Allocate each Casualty Treatment Team to a specific treatment area.


NURSE IN CHARGE – EMERGENCY DEPARTMENT

26

8. Organise the call in of extra Emergency Department nursing staff as deemed necessary. Do not go through the Contact Centre operator - call directly using your departmental telephone contact list located in the Major incident contact folder in the ED secretaries’ office.

9. Coordinate and maintain an overview of all activity in the reception area in conjunction with the Emergency Department Consultant.

10. Ensure re-supply of clinical areas as necessary.

11. Once stand down of the hospital major incident response has been declared, ensure the offer of an immediate debrief for all Emergency Department staff before they leave the hospital.

12. In a Major Incident involving hazardous materials requiring activation of the

decontamination plan, the Nurse in Charge will allocate the role of Decontamination Supervisor, This person will the distribute the relevant action cards to the decontamination team. See Decontamination Action Cards 1-10. Laminated decontamination action cards can be found in the Decontamination Unit storage area.

27


Role – Coordinate the support services part of the hospital major incident response

1. Proceed to the Major Incident Control Room in the Seminar Room in the

Emergency Department.

2. Call on the following to assist in the non-clinical part of the hospital major incident response:-

Deputy Site Manager – Desk 69622, Dect 82066 mob 07813524730

Decontamination service (CSSD) - 42800 / 0141 232 2800

Assistant CSSD manager for escalation weekdays - 07960 959020

Assistant CSSD manager for escalation weekends - 07960 959041

Catering Lead- Desk 59619, Dect 82231, mob 07984005639

Facilities Duty Manager-82101

Do not go through the contact centre operator - call directly using the appropriate departmental telephone contact lists.

3. Ensure that the hospital site is locked down as directed and secure, to avoid any access to ALL clinical areas by non hospital staff.

4. Coordinate the involvement of, and liaise regularly with, all the hospital support services.

5. Ensure demands for clinical sterile and non-sterile supplies are met and organise Linen, Domestic and Catering services as necessary.

6. Liaise with Police Scotland and Parking Services to establish traffic flows and adequate access to parking for staff and parents/relatives. As per Action Card 20

7. Assist the Hospital Coordinator as required.

SITE FACILITIES MANAGER

28


Roles – 1. Assist the Emergency Department Consultant on call

2. Casualty treatment

In the absence of an Emergency Department Consultant, the Senior Emergency

Medicine Specialty Trainee will assume their role until the arrival on site of the

Emergency Department Consultant on call – follow Major Incident Action Card 4.

1. Call in extra Emergency Department medical staff, as directed by the Emergency Department Consultant on call. The Contact Centre operator- call directly using your departmental telephone contact list.

2. Assist the Emergency Department Consultant in the formation of Casualty Treatment Teams, each consisting of two doctors and one nurse.

3. Take the lead role in Casualty Treatment Team 1 allocated to the Resuscitation

Room, Bay 1.

4. Check that your treatment area is fully prepared and ready to receive a patient.

5. Summarise patient condition, treatment and management plan on Emergency Department card.

6. Once the patient is ready to leave the Emergency Department and an escort team is available, ensure a verbal handover of important treatment/events and that all patient documentation/property is on the trolley with the patient.

7. Prepare for the next patient.

SENIOR EMERGENCY MEDICINE SPECIALTY TRAINEE

29


Role – Casualty treatment



Room, Bay 2.





EMERGENCY MEDICINE SPECIALTY TRAINEE 2

30




2. Take the lead role in Casualty Treatment Team 5 allocated to Majors area, bays 1-4, where urgent category patients are being assessed.



5. Once the patient is ready to leave the Emergency Department and an escort team is available, ensure a verbal handover of important treatment/events and all patient documentation/property is on the trolley with the patient.


7. When Bays 1-4 are full, bays 5-12, and the Minors area will be used to assess urgent category patients.


31

MAJOR INCIDENT ACTION CARD 6C



2. Take the lead role in Casualty Treatment Team 6 allocated to Majors area, bays 1-4, where urgent category patients are being assessed.





9. When Bays 1-4 are full, bays 5-12, and the Minors area will be used to assess urgent category patients.


32

MAJOR INCIDENT ACTION CARD 6D


1. Go to the Clinical Decisions Unit.

2. Organise the treatment of the non-urgent patients triaged to this area.


33

MAJOR INCIDENT ACTION CARD 6E



2. Organise the treatment of the non-urgent patients triaged to this area.


34




2. Join Casualty Treatment Team 1 allocated to the Resuscitation Room, Bay 1.

EMERGENCY DEPARTMENT PAEDIATRIC SPECIALTY TRAINEE 1

35






36






37






38




2. Join Casualty Treatment Team 5 allocated to Majors area, Bays 1-4, where urgent category patients are being assessed.


39




2. Join Casualty Treatment Team 6 allocated to Majors area, bays 1-4, where urgent category patients are being assessed.

3. When Majors bays 1-4 are full, bays 5-12, and the Minors area will be used to assess urgent category patients.


40


Role – Triage Nurse assisting Triage Doctor

1. Collect Major Incident Packs and triage labels from the Major Incident Trolley.

2. Working together with the Triage Doctor, prepare to triage casualties as they

arrive at the ambulance entrance.

3. On the arrival of each patient, affix an identification band and issue the corresponding Emergency Department card and numbered bag. These bags will be used as evidence by the police, and every item removed from a patient needs to be placed into the bag identified as belonging to a patient, and remaining with them.

4. On the instructions of the Triage Doctor, affix a colour coded triage label as follows:

IMMEDIATE – RED

URGENT – YELLOW

DELAYED – GREEN

DEAD – WHITE

(EXPECTANT – BLUE)

5. Allocate patients to the appropriate reception area according to their triage status as follows:

IMMEDIATE – RED RESUSCITATION ROOM THEN MAJORS 1-4

URGENT – YELLOW MAJORS 5-12 AND MINORS 1-6

DELAYED – GREEN CLINICAL DECISIONS UNIT

DEAD – WHITE MORTUARY

(EXPECTANT – BLUE CDU IF REQUIRED)

6. With the help of the Emergency Department receptionist, ensure that number/location details for each patient are recorded on the white board at the ambulance entrance.

7. Remain at the ambulance entrance and do not treat patients.

EMERGENCY DEPARTMENT NURSE 1

41



1. Assist the Nurse in Charge Emergency Department in the formation of Casualty Treatment Teams, each consisting of two doctors and one nurse.

2. You are allocated to Casualty Treatment Team 1 in the Resuscitation Room, Bay 1.


4. On the arrival of each patient, record vital signs and check that an identification band has been attached.

5. Place any of the patient’s clothing/property that is removed into the numbered plastic bag.

6. Assist medical staff with patient management and treatment as necessary.

7. Once the patient is ready to leave the Emergency Department, inform the Senior

Nurse page holder on Ward 1E (page number 8345) based in the Training

Room in ED, of their intended destination e.g. Radiology/Theatres/PICU/Wards. They will book a bed space, arrange medical/nurse escorts as required and a porter.

8. Once the escort team is available, ensure a verbal handover of important treatment/events and that all patient documentation/property is on the trolley with the patient.

9. Update Major Incident Patient Board and prepare for the next patient.


42















43











Room in ED, of their intended destination, e.g. Radiology/Theatres/PICU/Wards. They will book a bed space, arrange medical/nurse escorts as required and a porter.




44















45




2. You are allocated to Casualty Treatment Team 5 in Majors area, bays 1-4, where urgent category patients are being assessed.










10. When Majors bays 1-4 are full, bays 5-12, and the Minors area will be used to assess urgent category patients.


46

MAJOR INCIDENT ACTION CARD 8F



2. You are allocated to Casualty Treatment Team 6 in Majors Area, bays 1-4, where urgent category patients are being assessed.










10. When Majors bays 1-4 are full, bays 5-12, and the Minors area will be used to assess urgent category patients. .


47

MAJOR INCIDENT ACTION CARD 8G


1. You are allocated to the Clinical Decisions Unit where non-urgent patients are being assessed.

2. Check that your treatment area is fully prepared and ready to receive patients.






Room in ED, if they require admission to the wards. They will book a bed space, arrange a nurse escort and porter.

7. Once the escort team is available, ensure a verbal handover of important treatment/events and that all patient documentation/property is with the patient.

8. If a patient is ready for discharge home, ensure all documentation is completed and that discharge arrangements have been confirmed with an appropriate relative. Discharge can take place either directly from the Emergency Department, or via the Patient Reunion/Discharge Area in the Family Information and Support centre, Main Atrium. Check accurate contact details have been recorded for all patients discharged to ensure subsequent community follow up.

9. Update Major Incident Patient Board.


48

MAJOR INCIDENT ACTION CARD 8H

Role – Continue Emergency Department service for non-major incident patients

1. You are allocated to Clinic 3 Out-Patients Department, where non-major incident Emergency Department patients have been transferred/will continue to attend.

2. Take the Major Incident Airway, Circulation and Dressing trolleys to Clinic 3 in the Out-Patients Department.

3. Take Major Incident Drug box from Resus cupboard.

4. Check that the area is fully prepared and ready to receive patients.

5. Assist medical staff with patient assessment and treatment as necessary.


49


Role – Assist with casualty treatment

1. You are allocated to the Resuscitation Room.

2. Assist the Casualty Treatment Teams in this area as required.

EMERGENCY DEPARTMENT HEALTH CARE ASSISTANT 1

50



1. You are allocated to Majors Area, bays 1-4, where urgent category patients are being assessed.

2. Assist the Casualty Treatment Teams in this area as required.


51




2. Assist with casualty treatment in this area as required.

HEALTH CARE ASSISTANT EMERGENCY DEPARTMENT 3

52




2. Assist with casualty treatment in this area as required.


53


Role- Emergency Department service for non-major incident patients

1. You are allocated to Clinic 3 Out-Patients Department, where non-major incident Emergency Department patients have been transferred/will continue to attend.

2. Help take the Major Incident Airway, Circulation and Dressing trolleys and envelope marked “Clinic 3” from the Major Incident Trolley round to Clinic 3, Out-Patients Department.

3. Check that the area is fully prepared and ready to receive patients.

4. Assist medical staff with patient assessment and treatment as necessary.


54



1. Go to Emergency Department.


Room, Bay 3.





SENIOR ANAESTHETIC SPECIALTY TRAINEE ON CALL

55


Role – Casualty treatment supervision

1. Go to Emergency Department Resuscitation Room.

2. Work together with the Emergency Department/PICU Consultants on call to:

(a) Assist Casualty Treatment Teams with resuscitation and stabilisation of patients. (b) Coordinate transfer of patients to radiology, PICU, theatres and elsewhere. (c) Organise anaesthetic support for patient transfers as required.

3. Decide on additional anaesthetic staff likely to be required in the Emergency Department and arrange for telephone call in. Do not call the Contact Centre operator- call directly using your departmental telephone contact list.

CONSULTANT ANAESTHETIST ON CALL

56


Role – Coordinate anaesthetic response in theatres

1. Go to theatres.

2. Decide on additional anaesthetic staff likely to be required in theatres and arrange for telephone call in. Do not call the Contact Centre operator- call directly using your departmental telephone contact list.

3. Coordinate anaesthetic care of patients in theatres. This will involve close liaison with the Surgical Triage Officer based in the Emergency Department (Consultant Surgeon on call), the Senior Surgeon coordinating surgical care in theatres and Nurse in Charge theatres.

CONSULTANT CARDIAC ANAESTHETIST ON CALL

57


Role – Assist with the anaesthetic management of casualties

In the absence of the senior anaesthetic specialty trainee on call, you should assume that

role until their arrival on site – follow major incident action card 11.

When/if senior trainee in hospital, you should follow junior anaesthetic trainee role:

1. Go to Theatres.

2. Check that theatres are fully prepared and ready to receive patients

3. Assist Consultant Cardiac Anaesthetist on call with anaesthetic management of casualties.

JUNIOR ANAESTHETIC SPECIALTY TRAINEE ON CALL

58



1. Go to Emergency Department.


Room, Bay 4.





SENIOR PICU SPECIALTY TRAINEE ON CALL

59


Role – Casualty treatment supervision

1. Liaise with Nurse in Charge PICU to identify any patients who could be moved out of PICU/HDU and address staffing issues to maximise available PICU/HDU bed spaces.

2. Decide on additional PICU medical staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator- call directly using your departmental telephone contact list.

3. Go to Emergency Department Resuscitation Room.

4. Work together with the Emergency Department Consultant/Consultant

Anaesthetist on call to:

(a) Assist Casualty Treatment Teams with resuscitation and stabilisation of patients.

(b) Coordinate transfer of patients to radiology, PICU, theatres and elsewhere.

5. Be available to discuss possible requests for specialist paediatric skills needed nearer to/at the site of the major incident. RHC will respond as appropriate, through the pre-existing structure of the PICU transport service and this will include the capability to provide a Site Surgical Team.

6. Liaise with PICU RHSC Edinburgh.

PICU CONSULTANT ON CALL

60


Role – Preparation of PICU to receive casualties

1. Liaise with the PICU Consultant on call to identify any patients who could be moved out of PICU/HDU and address staffing issues to maximise available PICU/HDU bed spaces.

2. Decide on additional PICU nursing staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

3. Be aware of potential requests for specialist paediatric skills needed nearer to/at the site of the major incident. RHC will respond as appropriate, through the pre-existing structure of the PICU transport service and this will include the capability to provide a Site surgical Team.

4. Liaise with PICU RHSC Edinburgh as required.

NURSE IN CHARGE – PICU

61


Role – Surgical Triage Officer – oversees the surgical response to the major

incident

1. Go to the Emergency Department.

2. Coordinate the surgical management of casualties.

3. Ensure that the right patients reach radiology and/or theatres at the right time with the right surgeon available – liaise with the Senior Surgeon Theatres.

4. Decide on additional surgical staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator- call directly using your departmental telephone contact list.

CONSULTANT SURGEON ON CALL 1

62


Role – Senior Surgeon Theatres

1. Ensure appropriate delegation of the task of liaising with the Surgical Wards to identify any patients who could be discharged to maximise available bed spaces.

2. Go to theatres.

3. Check with the Surgical Triage Officer (Consultant Surgeon on call) based in the Emergency Department on the additional surgical staff likely to be required in theatres and help arrange their telephone call in. Do not call the Contact Centre operator- call directly using your departmental telephone contact list.

4. Coordinate the surgical care of patients in theatres. This will involve close liaison with the Surgical Triage Officer, Consultant Cardiac Anaesthetist (coordinating anaesthetic care in theatres) and Nurse in Charge theatres.

CONSULTANT SURGEON ON CALL 2

63


Role – Assist with the surgical management of casualties

In the absence of the Consultant Surgeon on call, the Senior Surgical Specialty

Trainee on call will assume their role until the arrival on site of the Consultant

Surgeon on call – follow Major Incident Action Card 13.

1. Proceed to the surgical wards and identify any surgical patients who could be discharged to maximise available bed space.

2. Advise Contact centre to direct all GP receiving calls to extension 84112 to be dealt with by medical staff based in Clinic 3 in the Out Patients Department.

3. Call in additional surgical staff as directed by the Consultant Surgeons on call. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.


5. Assist the Consultant Surgeon on call with the surgical management of casualties.

SENIOR SURGICAL SPECIALTY TRAINEE ON CALL

64


Role – If present to assist with the surgical management of casualties


2. Help to organise the treatment of non-urgent patients triaged to this area.

BASIC SURGICAL TRAINEE

65


Role – Assist with the surgical management of patients

1. Go to Clinic 3 Out-Patients Department.

2. Help to organise the surgical treatment of existing/new non-major incident Emergency Department patients.

SURGICAL FY 1

66


Role – Coordinate the management of musculo-skeletal injuries


2. Coordinate the orthopaedic management of casualties.

3. Ensure that the right patients reach radiology and/or theatres at the right time with the right orthopaedic surgeon available.

4. Decide on additional orthopaedic staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

ORTHOPAEDIC CONSULTANT ON CALL

67


Role – Assist with the management of musculo-skeletal injuries

In the absence of the Orthopaedic Consultant on call, the Orthopaedic Specialty

Trainee on call will assume their role until the arrival on site of the Orthopaedic

Consultant on call – follow Major Incident Action Card 13.

1. Proceed to the Acute Receiving Floor and identify any orthopaedic patients who could be discharged to maximise available bed space.

2. Advise Contact centre to direct all GP receiving calls to extension 84112 to be dealt with by medical staff based in Clinic 3 in the Out Patients Department.

3. Call in additional orthopaedic staff as directed by the Orthopaedic Consultant on call. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

4. Go to theatres.

5. Coordinate the orthopaedic care of patients in theatres. This will involve close liaison with the Orthopaedic Consultant on call, Consultant Cardiac Anaesthetist (coordinating anaesthetic care in theatres), Senior Surgeon Theatres and Nurse in Charge theatres.

ORTHOPAEDIC SPECIALTY TRAINEE ON CALL

68


Role – Medical Triage Officer – oversees the medical response to the major

incident i.e. the treatment of non-surgical casualties

1. Go to the Emergency Department and contact the Hospital Coordinator.

2. If the major incident is not a surgical/trauma incident but a medical incident, help coordinate the medical management of casualties in the Emergency Department.

3. If the major incident is a surgical/trauma incident, liaise with the Clinical Decisions

Unit and the Acute Receiving Floor to identify any patients who could be discharged to maximise available bed spaces.

4. Decide on additional paediatric medical staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

5. Continue to liaise with the Hospital Coordinator and the Emergency Department Consultant. Consultant

CONSULTANT PAEDIATRICIAN ON CALL

69


Role – To assist with the medical management of patients

In the absence of the Consultant Paediatrician on call, the Senior Medical Paediatric

Specialty Trainee on call will assume their role until the arrival on site of the

Consultant Paediatrician on call – follow Major Incident Action Card 15.

1. Go to Clinic 3, Out-Patients Department.

2. Coordinate the medical treatment of existing/new non-major incident Emergency Department patients.

3. Subsequently make yourself available to the Clinic 3 to assist in the treatment of non-urgent patients triaged to this area.

SENIOR MEDICAL PAEDIATRIC SPECIALTY TRAINEE ON CALL

70



1. Provide a medical ward presence to assist the Consultant Paediatrician on call and the Senior Nurse Wards in identifying any medical patients who could be discharged to maximise available bed space.

2. Call in additional paediatric medical staff as directed by the Consultant Paediatrician on call. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

3. Advise Contact centre to direct all GP receiving calls to extension 84112 to be dealt with by medical staff based in Clinic 3 in the Out Patients Department. .

4. Subsequently make yourself available to the Clinical Decisions Unit to assist in the treatment of non-urgent patients triaged to this area.

JUNIOR MEDICAL PAEDIATRIC SPECIALTY TRAINEE ON CALL

71



1. Go to Clinic 3, Out-Patients Department.

2. Organise the medical treatment of existing/new non-major incident Emergency Department patients.

JUNIOR MEDICAL PAEDIATRIC SPECIALTY TRAINEE ON CALL

72


Role – Senior Nurse Medical Wards – To prepare ward facilities for the reception of

patients from the major incident

1. Go to the Major Incident Control Room in the Seminar Room in ED and contact

the Senior Nurse on duty for the hospital (Page 8502/ DECT 85770).

2. Working from the Training Room in ED, assist the Senior Nurse on duty (Page 8502) in the task of alerting all wards.

3. In the process, establish bed status and the number of trained nurses and other ward staff who could be made available to assist elsewhere with the major incident response, without jeopardising ward patient care.


5. Deploy additional available ward nurses and other staff as appropriate/necessary to the Emergency Department, Clinic 3 Out Patients Department, the Relatives Waiting Area (Therapies Hub) and the Patient Discharge/Reunion Area (Outpatient Clinic 5).

6. Allocate a member of nursing staff to the HAN base to record on an “Action

Card Pick Up” list who has arrived to fulfil action card roles. Ensure this member of staff picks up a walkie talkie, and keeps a register of additional staff arriving, and where staff have been allocated too. The two page holding senior nurses need to be kept up to date with this information. Be aware of ongoing hospital staffing requirements. Any staff arriving that do not have an action card, and do not immediately need to be deployed should have their name and designation recorded and asked to wait in the Discharge lounge (Area 3D). As the

need arises relevant staff can be deployed from this area. Close contact must be

maintained with this staff member.

7. Arrange contact of additional off duty nursing staff as required. Do not call the Contact Centre operator - call directly using the appropriate departmental telephone contact lists.

8. Allocate Volunteer Coordinator.

9. Liaise with Duty Social Worker and Hospital Chaplin.

SENIOR NURSE holding page 8399 on 2A

73


Role – Senior Nurse Surgical Wards – Help prepare ward facilities for the reception

of patients from the major incident and coordinate their safe transfer from

the Emergency Department

1. Go to the Major Incident Control Room and contact the Senior Nurse on duty for

the hospital (Page 8502/ DECT 85770).

2. Working from the Training Room in ED, assist the senior nurse on duty (page 8502/ DECT 85770) in the task of alerting all wards.

3. Go to the HAN base AND ALLOCATE ANOTHER MEMBER OF STAFF to record on

an “Action Card Pick Up” list who has arrived to fulfil action card roles. Ensure they pick up a walkie talkie, and keep a register of additional staff arriving, and where staff have been allocated too. The two page holding senior nurses need to be kept up to date with this information. Be aware of ongoing hospital staffing requirements. Any staff arriving that do not have an action card, and do not immediately need to be deployed should have their name and designation recorded and asked to wait in the Discharge lounge (Area 3D). As the need arises relevant staff can be deployed from

this area. Close contact must be maintained with this staff member.

4. Return to the Training room in ED to assist with bed booking and allocation.

5. In the process, establish bed status and the number of trained nurses and other ward staff who could be made available to assist elsewhere with the major incident response without jeopardising ward patient care.


7. All bed requests for patients being admitted will be channelled through you. During working hours the bed manager (8521) will assist in this role. Organise porters for patient transfers to Radiology/Theatres/PICU/Wards and, in conjunction with the Consultant Anaesthetist on call, arrange medical/nurse escort teams as required.

SENIOR NURSE holding page 8345 on Ward 1E

74


Role – To prepare theatre suite for the reception of patients from the major incident

requiring surgical intervention

1. Work together with the Surgical Triage Officer (Consultant Surgeon in the

Emergency Department), the Consultant Cardiac Anaesthetist (coordinating

anaesthetic care in theatres) and the Senior Surgeon Theatres to coordinate the surgical care of patients in theatres.

2. Allocate a member of nursing staff to contact theatre staff from major incident contact list starting from the most senior staff, anaesthetic team and scrub, floor staff

3. Ensure that the set up of adequate theatre space for emergency cases is underway. To facilitate this preparation, on receiving warning of major incident relating to RHC:

- gain an estimate of casualties and the range of specialties required if known, from the

major incident control room - set up theatres based on estimated number of patients - as staff arrive ensure staff reporting base aware, and that if they have a specific major

incident action card this has been collected, and the designated role fulfilled - check in and allocate to theatre - If staff arrive that are not required in theatre direct them to the staff reporting area, then

the staff holding area at the HAN base to be called upon when and where they are required

Anaesthetic Nurses - prepare fluid warmer - prepare level 1 infuser - set up invasive monitoring - ensure ventilator checks are performed - increase environmental temperature in theatres - ensure adequate stock of blood sampling bottles

Scrub/floor Nurses - gather surgical instruments required for range of specialties - locate specialist equipment

SENIOR NURSE THEATRES page 8092

75


Role – To provide accurate and reliable administrative support to the reception area

during a major incident

1. Identify the pre numbered MI packs in the filing cabinet at reception

2. Note the time of arrival of the first major incident casualty.

3. Assist the triage team in the issue of one Major Incident Pack per patient as each patient arrives, ensuring careful adherence to the number sequence.

4. See Major Incident Patient Registration process – Appendix 6.

5. Record the number/location details for each patient on the white board at the ambulance entrance, as directed by the Triage Nurse.

6. Stay in position at the Ambulance Entrance until notified of major incident stand down.

EMERGENCY DEPARTMENT RECEPTIONIST ON DUTY

76


Responsibilities

The Health Records Department are responsible for providing:

A Health Records Documentation Team to register and process patients attending the ED Department following a Major Incident.

Senior Health Records Information Officer to assist in the control room. To keep and maintain an Incident Register

Initial Actions

The ED clerical staff should inform a senior Health Records Officer that an Incident has occurred.

This officer will act as the Incident Officer within the Department ensuring adequate staffing levels are provided during the Incident. Health Records Manager should be notified immediately.

The Health Records Incident Officer should set up a clerical incident desk within ED Reception ensuring that the pre-numbered Major Incident packs are available prior to the arrival of the casualties

The Health Records Incident Officer should allocate clerical staff to receive the casualties at the appropriate entrance.

Clerical staff should transfer patients currently in ED who are not being discharged to Area 3 of the Out Patient department, and provide a member of staff to register patients attending Area 3 if possible.

Upon arrival of the patients the ED clerical staff should:

Register the casualties on to the Hospital Administration system using the unique patient identifier number included in the documentation pack provided for each casualty.

After Registration provide the clinical staff with the Major Incident Documentation pack.

Provide a copy of the patients Registration document to the Police Bureau which is based near the Hospital Control Room.

Update and maintain the Major Incident Register as the Incident progresses

Liaise with the Hospital Coordinator.

Stand down

MEDICAL RECORDS PERSONNEL

77

Update the Major Incident Register with all discharge locations ensuring that all patient identifiers have been merged or created.

78


HEALTH RECORDS SENIOR

Responsibilities

To facilitate the provision of accurate and reliable administrative support during a major incident.

Initial Actions

1. Review available medical records staff resources and ensure all key roles are filled.

2. Decide on additional medical records staff likely to be required and arrange for telephone call in. Do not contact operator – call directly using departmental phone.

3. Liaise with incident controller as necessary.

79


Role – To provide accurate and reliable administrative support to the reception area

during a major incident

1. Move around the Emergency Department to obtain accurate patient identification details where possible and at the convenience of medical and nursing staff.

2. Update major incident casualty list as information is collected.

MEDICAL RECORDS STAFF 3

80


Role – To coordinate portering services with reference to action cards 32, 32 A-C.

Ensure that one porter is tasked with locking down and securing hospital

entrances/exits as required.

1. Delegate the following tasks as a priority:

(a) Collection of the major incident emergency signs from the Major Incident Store cupboard in the Emergency Department and ensure that these are displayed as detailed in Appendix 2.

(b) Out-of-hours, open the Out-Patients Department, open up the Therapies Hub

and Outpatient Clinic 5. Contact Security staff for assistance

2. Base yourself in the Training Room in the ED, to liaise with Senior Nurses from 2A (8399) and Ward 1E (8345)

3. Send a porter to the main hospital road entrance to direct:

(a) Major incident patients round to the Emergency Department ambulance entrance. Standby ambulance patients not involved in the Major Incident should also enter via the ED ambulance entrance. All other emergency patients not involved in the major incident should be directed to to Clinic 3 Out-Patients Department.

(b) Relatives to the Relatives Waiting Area, in the Adult OPD in a mixed MI, or the Therapies Hub in an incident affecting purely children, clarify with the MI Coordination team if unsure.

(c) Media/press representatives- discuss with on call press office re appropriate

location. (d) Staff Volunteers – discuss with Hospital Coordinator.

4. Decide on additional portering staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

5. Maximise the number of wheelchairs and trolleys available in the trolley bay at the Emergency Department ambulance entrance.

6. Ensure that all available General Services Staff report to the HaN base to await allocation of further tasks.

7. Liaise with Hospital Coordinator as necessary.

GENERAL SERVICES SUPERVISOR

81


Role – To liaise with Police Scotland Casualty Bureau Documentation Team

1. Ensure the establishment of the Police Control Room in the Adult Emergency

Department.

2. Identify yourself to the Senior Police Officer on site.

3. Assist the police as required and with reference to the information set out in Appendix 7 of the Major Incident Plan.

POLICE LIAISON OFFICER

82


Role – To provide appropriate information and directions to hospital visitors during a

major incident

1. The Hospital Major Incident Enquiry Desk will be located at the front desk in the

main hospital entrance.

2. The Enquiry Desk will act as a focus point for anyone who attends the hospital in person asking about casualties from the major incident.

3. Relatives up to the Relatives Waiting Area, in adult OPD in a mixed incident, and in the Therapies Hub in a paediatric incident. Liaise with on call press officer re press personnel, and Hospital Coordinator re volunteers.

4. You should be as satisfied as possible as to the identity of visitors and only admit bona fide enquirers through to clinical and relative waiting areas. Some form of escort should be provided if possible.

5. The Enquiry Desk will be updated as regularly as possible with relevant patient information via runners.

7. People attending the Enquiry Desk asking about individuals on whom you have no information should be advised to contact the Police Scotland Casualty Bureau.

8. Any staff reporting to the Enquiry Desk should be directed to the HaN room to register and await further instructions, non registered and unknown volunteers should be thanked for their offer of help but advised that they cannot assist.

HOSPITAL ENQUIRIES OFFICER

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Role – To staff the Day Surgery Unit reception desk

1. The Therapies Hub and Outpatients Clinic 5 will be used as the Relatives Waiting Area and the Patient Reunion/Discharge Area respectively.

2. Base yourself at the reception desk at the ground floor entrance to monitor access to these areas. You should be as satisfied as possible as to the identity of visitors and only admit bona fide enquirers through to the relative waiting areas.

3. Provide assistance to the Relative Coordinators as required.

HOSPITAL ENQUIRIES OFFICER ASSISTANT

84


Role – To look after the relatives of casualties and provide as accurate and up-to-

date information as possible

1. The Relatives’ Waiting Area is located in the Adult Out Patient Department in a

mixed incident, or the Therapies Hub in a paediatric incident.

2. An accurate record of attending relatives’ details should be established.

3. You should endeavour to keep relatives as fully informed as possible with regard to patients’ conditions and progress. The Relatives’ Waiting Area will be updated regularly with relevant patient information via runners.

4. As a general rule, parents and their children should be re-united as soon as is practicably possible.

5. Ensure availability of basic refreshments.

6. Patient reunions with relatives and subsequent discharge should be organised to take place in Outpatients Clinic Area 5.

RELATIVE COORDINATOR 1

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Role – To coordinate patient reunions with relatives and subsequent discharge

4. The Patient Reunion Area is adjacent to the Relatives’ Waiting Area and is

located in the Adult Out Patient Department in a mixed incident, or the Therapies

Hub in a paediatric incident. .

2. Check accurate contact details have been recorded for all patients discharged from the Reunion/Discharge Area to ensure subsequent community follow up.

3. Ensure availability of basic refreshments.

4. Assist with arrangements for patient transport home as required.

RELATIVE COORDINATOR 2

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Role – To manage media handling of the major incident

This role will be filled by the NHSGGC Press Officer on call, contactable through the

Communications Department, NHSGGC HQ at JB Russell House.

In their absence, it is the responsibility of the Hospital Coordinator to nominate an

alternative. The following is guidance until the arrival of the NHSGGC Press Officer.

1. The Press Officer will be based in the Training Room adjacent to the Seminar

Room in the Emergency Department.

2. Media representatives arriving on site will be directed to the Aroma Coffee shop to await instruction upon arrival of the NHSGGC Press Officer.

3. It should be made clear that under no circumstances should children be spoken to or photographed without the express consent of their parent or guardian.

4. Update media representatives on site on a regular basis and field any media phone calls.

5. Liaise with the Hospital Coordinator with regard to the content of any official press release and the organisation of any press conferences or interviews. Consider requests for access by press photographers and television cameras to clinical areas. Similarly, work together with the Hospital Coordinator to coordinate VIP visits to the hospital.

PRESS OFFICER

87


Role – To assist the Press Officer with media representatives

1. The Press Officer Assistant will be based in the Training Room adjacent to the

Seminar Room in the Emergency Department.

2. Assist the Press Officer in providing regular updates to the media representatives on site.

3. Try to ensure that media representatives remain in the Aroma Coffee shop, or an alternative location as per the direction of the NHSGGC Press Officer, unless being escorted for approved access elsewhere in the hospital.

PRESS OFFICER ASSISTANT

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Responsible Officer: Duty MLSO

Role – To manage haematology major incident response

1. Contact Consultant Haematologist on call and Senior Chief MLSO. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

2. Contact Hospital Coordinator to ascertain the anticipated number and type of casualties.

3. Contact the Regional Blood Transfusion Centre and arrange additional supplies of blood products.

4. Ensure that adequate staff are available to coordinate the receipt of specimens and dissemination of results and blood products.

5. Liaise regularly with Emergency Department, operating theatres and PICU.

HAEMATOLOGY AND BLOOD TRANSFUSION

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Biochemistry

RESPONSIBILITIES

Responsible for the preparation and provision of biochemistry

laboratory services.

Mobilisation of additional staff as required.

ACTIONS

1. If during core hours the reporting Biochemist who receives notification of a major incident will inform the Technical Services Manager (TSM) or Laboratory Sector Manager (LSM) that a major incident has occurred.

2. If outside core hours the Consultant Biochemist On-Call who receives notification of a major incident will inform one of the Biomedical Scientists working on shift that a major incident has occurred.

3. If the nature of the incident is such that a significant increase in urgent Biochemistry analysis is expected the TSM/LSM or Consultant Biochemist On-Call will inform the BMS staff working in core Biochemistry.

4. BMS staff will take steps to clear outstanding work. 5. BMS staff will ensure the Architect and blood gas analysers are ready to

receive samples.

PRIORITIES

Informing the BMS staff working in core Biochemistry

Preparing the analysers to receive samples.

If outside core hours:

1. the on-call consultant biochemist will consider whether the expected

workload requires additional BMS staff to attend the laboratory. If so they

will arrange this by telephoning BMS staff at home.

2. If considered necessary the Consultant on call will make his/her way to the

department, or if this is not immediately possible, arrange for a reporting

biochemist to attend.

3. The consultant or reporting biochemist will then a) handle telephoned or

paged requests for emergency analyses, and b) telephone results relating to patients

90


Action

Card

Contact Telephone Number: EXT 84202 (once in

hospital)

Paediatric Radiographer

RESPONSIBILITIES

Responsible for co-ordinating and providing specialist

radiological investigations in consultation with clinical staff.

IMMEDIATE ACTIONS

1. Attend x-ray department. Arrange for on-call radiology Consultant to attend.

2. Check on call radiographer has been contacted and cascade has been initiated.

3. Radiology call-out using cascade. 4. Assess resources currently available and further staff required. 5. Arrange for consultant radiologist to attend emergency

department. 6. Respond to requests for radiological referrals. 7. Liaise closely with Senior Emergency Physician on capacity for

radiological investigations.

1. PRIORITIES

Ensure adequate radiology and radiographer staffing.

Liaise regularly with Senior Emergency Physician and Lead Consultant Radiologist

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Role – To initiate preparation for radiology major incident response

1. If not already informed, ensure Superintendent Radiographer is contacted.

2. Decide on additional radiology staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

2. Assess priority of work until arrival of Consultant Radiologist on call.

3. Arrange teams as necessary to cover workload in the Emergency Department and operating theatres in addition to the Radiology Department.

SENIOR RADIOGRAPHER

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Role – To oversee radiology major incident response

1. Go to Radiology Department.

2. Contact Hospital Coordinator in the ED Seminar room to ascertain the anticipated number and type of casualties.

3. Decide on additional radiology staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator - call directly using your departmental telephone contact list.

4. Assess and control priority of work. Liaise regularly with the Emergency Department Consultant and Surgical Triage Officer (Consultant Surgeon on call based in the Emergency Department) to inform this process.

5. Ensure ‘hot reporting’ of imaging as appropriate.

CONSULTANT RADIOLOGIST ON CALL

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Role – To manage pharmacy major incident response

1. Contact the Pharmacy Manager**. Do not call the Contact Centre operator- call directly using your departmental telephone contact list. (Contact List in On-Call Bag and copy at front of Major Incident Plan )

2. Go to Pharmacy.

3. Arrange for supplies of drugs and IV fluids as required by the Emergency Department, operating theatres and PICU/wards.

4. Dispense medicines as required for Emergency Department patients/In-patients being discharged from hospital. ** Pharmacy Managers:- Lead Clinical Pharmacist – Stephen Bowhay Sector Chief Technician – Joanne Barton

PHARMACIST ON CALL

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Role – To manage pharmacy major incident response

1. Go to Pharmacy.

2. Contact Hospital Coordinator to assess likely demand for pharmacy services.

3. Decide on additional pharmacy staff likely to be required and arrange for telephone call in. Do not call the Contact Centre operator- call directly using your departmental telephone contact list. (Contact List can be found in On-Call Bag and Front of Major Incident Plan)

4. Arrange for supplies of drugs and IV fluids as required by the Emergency Department, operating theatres and PICU/wards.

4. Dispense medicines as required for Emergency Department patients/In-patients being discharged from hospital.

** Pharmacy Managers:-

Lead Clinical Pharmacist – Stephen Bowhay

Sector Chief Technician – Joanne Barton

PHARMACY MANAGER

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Role – To manage social work major incident response

1. Organise a social work team to attend the hospital. Do not call the Contact Centre operator- call directly using your departmental telephone contact list.

2. Social Work Team Leader to liaise with Senior Nurse page holders from 2A

(8399) and Ward 1E (8345) to discuss social work support required for casualties and their families.

3. Contact Family Support Service to enlist their assistance.

4. Contact Department of Child and Family Psychiatry and Bereavement Service as appropriate.

5. Liaise with hospital chaplaincy service to ensure support tasks are allocated appropriately.

DUTY SOCIAL WORKER

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ROLE

The Healthcare Chaplaincy Service provides and facilitates spiritual care to patients,

families and staff. Spiritual care may or may not include religious care.

The resources of the service, spiritual care facilities and of faith / belief community

representatives will be made available.

1. Healthcare Chaplain will assess needs and contact other Chaplains and faith

representatives as required, as per Chaplaincy Service internal protocol. 2. Liaise with Emergency Department Relatives Coordinator in Therapies Hub (Ground

Floor Atrium.)

3. The RHC Sanctuary (Ground floor) will be staffed for use by relatives and staff.

4. The service will ensure adequate cover to respond to requests for spiritual care services elsewhere on Hospital site.

5. The service will be available to provide staff support, before and after stand down, where

appropriate.

6. Chaplaincy Service will ensure on-going Chaplaincy cover is available to provide follow-up support for patients and relatives transferred to wards.

HEALTHCARE CHAPLAINCY

SERVICE

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Role – To provide mortuary services as required

1. Contact Consultant Pathologist on call. Do not call the Contact Centre operator- call directly using your departmental telephone contact list.

2. Contact Hospital Coordinator to discuss any anticipated need for a temporary mortuary facility.

3. Open hospital mortuary and prepare to receive bodies of any fatalities. 4. Contact second mortuary technician. Do not call the Contact Centre operator- again call directly using your departmental telephone contact list.

5. Maintain a register of dead patients according to details available, which may only be a numbered major incident identification band.

6. Second mortuary technician to alert other laboratory staff as required.

MORTUARY TECHNICIAN

98


Role - Enact lockdown of hospital and non essential buildings in accordance with

standard procedures or as directed by Site Facilities Manager/Major Incident

Control

1. Lock down and secure hospital entrances/exits – this involves the same security

measures that are currently in place for the post 10pm and weekend shutdown.

2. Report to the Training Room in the ED, where the General Services Manager is based for further instructions

PORTER 1

99


Role - To display external major incident signs at main roads and provide directions to

persons arriving at hospital

1. Collect “Major Incident In Progress ” and “All Press enquiries to Main Entrance” signs from

the Major Incident cupboard in the Emergency Department and display at main traffic entrance to hospital

2. Remain at main traffic entrance and direct traffic / pedestrians as follows:

a) Major incident patients to ED ambulance entrances b) All other emergency patients to Outpatients Department – Clinic 3

c) Relatives of Major Incident patients to Relatives Waiting Area in the Therapies Hub

in a paediatric incident, and the Adult Out Patient Department in a mixed MI

d) Media / Press representatives to Aroma Coffee Shop

e) Staff Volunteers to the HaN base on the second floor

PORTER 2

100


Role: To display external major incident signs ED Department and provide directions to

persons arriving at hospital

1. Collect “Major Incident In Progress ” and “All Press enquiries to Main Entrance” signs from

he Major Incident cupboard in the Emergency Department and display at Emergency Department Entrance

2 Collect “Major Incident in Progress Ambulances Only Diversion for all other traffic” sign

and display at Govan Road entrances and Hardgate Road entrance 3. Remain at Emergency Department entrance and direct traffic / pedestrians as follows:

a) Major incident patients to ED ambulance entrances b) All other emergency patients to Outpatients Department – Clinic 3

c) Relatives of Major Incident patients to Relatives Waiting Area in the Therapies Hub

in a paediatric incident, and the Adult Out Patient Department in a mixed MI

d) Media / Press representatives to Aroma Coffee Shop

e) Staff Volunteers to the HaN base on the second floor

PORTER 3

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Role: To display internal major incident signage as per guidance and Appendix 2 and

open OPD, Day Surgery, Physiotherapy Gym and Major Incident Hub as required 1. On instruction ensure that relevant Major Incident signage is displayed correctly at the

following locations:

a) Seminar Room Emergency Department - on door “Major Incident Control Room” b) Training Room in Emergency Department- on door “Senior Nurse /Press Officer” c) HAN base and adjacent Seminar Room, 2

nd floor - on door “Staff Reporting Base”

2. Report to Training Room in the Emergency Department for further instructions

PORTER 4

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QEUH AND RHC Decontamination Plan Action Card 1 – Senior Nurse Emergency Department Responsibilities:

1. Identify Decontamination Lead in conjunction with Senior Emergency Physician 2. Identify, if possible, the nature of the contamination. 3. Continue with Co-ordination of the Emergency Department

Actions:

1. Inform security

2. Start and Maintain a log of incident/ decisions taken

3. Clear clinical areas as needed, e.g. by sending patients directly to wards.

4. Ensure contaminated casualties are kept out of the ED. If prior warning of a contamination incident is obtained, a member of staff should be allocated to meet the ambulance and ensure patients are not taken directly to ED.

5. If contaminated patients are in the ED, follow action card 3. Continue with duties as below.

6. Nominate the next most senior or appropriately trained member of staff to act as Decontamination Lead. If you are the most appropriately trained person on duty, hand the Nurse In-charge role over and manage the Hazmat/CBRN incident yourself. Ensure Radiation Protection Advisor contacted in a radiation incident.

7. Allocate staff for decontamination team (at least initially). If insufficient staff available – call in decontamination trained staff from call-in sheets.

8. Inform Switchboard to place hospital on Major Incident Stand By (Hazmat/CBRN).

9. Call duty manager and ED consultant.

10. Continue to liaise with Decontamination Lead and the Hospital Control Team (if a Major Incident has been declared).

11. Continue with management of the Emergency Department. If Major Incident Not Declared:

1. Monitor staff resources and allocate someone to call in additional staff as required. If Major Incident Declared:

1. Follow your action card in the Major Incident Plan.

Priorities:

1. Allocate staff for decontamination 2. Control entry into the emergency department

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QEUH AND RHC Decontamination Plan

Action Card 2 – Senior Emergency Physician Responsibilities:

1. Identify Decontamination Lead. 2. Continue with Co-ordination of the Emergency Department.

Initial Actions:

1. Start and maintain a log of activity/ decisions taken

2. Obtain a radio from staff area RCH ED to facilitate communication with the decontamination team.

3. Ensure contaminated casualties are kept out of the ED.

4. If contaminated patients are in the ED follow action card for this. Continue with duties as below.

5. Together with nurse in-charge, allocate staff for decontamination team (one or more medical staff may be needed for this depending on clinical condition of incoming contaminated patients).

6. Consider closing the Emergency Department, i.e. by phoning the ambulance service, and informing other local Emergency Departments.

7. Ensure hospital management are informed and are providing assistance.

8. Allocate medical staff duties, e.g. prepare for resuscitation cases.

9. Ensure on call public health consultant is contacted to inform them of incident and ,if necessary, to ask their assistance in: a. accessing information on treatment b. advice on symptoms

10. Ensure that a Radiation Protection Advisor is contacted in a radiation incident, via switch. A back-up list of contact numbers is held in the Radiation Box in the decontamination unit storage area.

Priorities:

1. Allocate staff for decontamination 2. Prepare emergency department for resuscitation cases

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Action Card 3 – Contaminated patients inside the Emergency

Department

The ED must be closed in this eventuality. Senior Staff on duty should ensure the following is carried out:

1. Move the contaminated casualties outside the ED (or, if appropriate keep isolated from other

persons in the ED): if a patient is a resuscitation case, balance the risks to the patient of being moved outside versus safety of

staff and others within the ED,

move the contaminated patients to an area away from the entrance of ED, down wind and away from others,

stay away and up wind from these casualties,

once staff are in PPE, they should approach the casualties to provide triage, decontamination, and treatment.

In a radiation incident contamination level can be ascertained using the Geiger counter stored in the decontamination preparation room.

2. Cross Contamination: identify any staff or others who may have become contaminated as a result of exposure or contact with the

contaminated casualties,

move those who are at high risk of this outside ED, treat them as contaminated casualties,

those less likely to be cross contaminated should have clothing changed (discarded clothes sealed in a bag), hands washed etc. If in doubt, move them outside as above.

3. Isolate the area affected: move all staff and patients outside the area,

cordon off the area, using chairs, tape, and trolleys,

place “do not enter” signs on cordon,

keep all persons out of cordoned off area until declared safe by the appropriate authority, e.g. public health, radiation protection advisor.

4. Ventilate: (This applies to airborne contaminants, such as vapours and dusts.) open doors and windows to allow ventilation, taking care not to spread contaminant further into the building

by taking account of wind direction and closing internal doors as appropriate.

5. Reduce Spread: close off all but one access route from ED into the hospital (e.g. lock doors),

establish a cleaning station on the remaining access route, providing at the station: o a cordon using chairs, trolleys, and signs, o position a member of staff at the station, e.g. domestic supervisor or deputy, o clean patient trolleys to enable any patients coming from ED to be moved onto a clean trolley, then

return the ED trolley back to ED, o plastic theatre overshoes, gloves and apron for staff to change into each time they pass the station,

in either direction, o garbage bags. o reduce movement of personnel through this point to a minimum, o domestic staff: repeatedly clean the corridor floors on the hospital side of the station, using usual

mop and bucket and on the ED side of the station using separate equipment.

6. Lockdown of other areas immediately adjacent.

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Action Card 4 – Decontamination Lead Officer Locate yourself in the clean side of the area close to the decontamination module. There is no need to wear PPE.

Responsibilities:

1. Assume command of the decontamination response (responsible for overall management including recovery).

2. Liaise with Senior Emergency Physician and Senior Nurse Emergency Department

Initial Actions: 1. Direct facilities to undertake lockdown as an initial precautionary measure.

It will be necessary to control the movement of public, patients & staff to ensure the “Clean and “dirty” areas are clearly separated and to prevent contaminated patients entering the hospital (setting up barriers/cordons & directing traffic).

2. If sufficient warning of inbound contaminated patients is received set up a reception point outside

of the hospital building in order to prevent cross contamination. Contaminated patients should then be directed to a suitable triage location and holding area. Patients known to be contaminated by radiation should remain in the ambulance until they are brought one by one to the decontamination facility entrance, located between the entrances to the paediatric and adult ED.

3. Communicate with decontamination team, senior ED physician and ED senior nurse via radio

(available from staff area RCH ED). Source Dect phone also.

4. Assess the situation to determine the type of contaminant and method of decontamination required.

5. Seek expert advice and support in risk assessment and decision-making. Where possible, the

following information should be obtained:

Number of casualties?

What are the signs and symptoms?

Type of contaminant?

Is it necessary to maintain Lockdown? If so is it the Emergency Department only or the entire hospital site?

Is it likely that decontamination will be required?

If so, what is the best method of decontamination?

What level of PPE is likely to be required?

Wind direction?

Number of trained operators available?

Number of suits available?

106

Information relating to the incident can be obtained from:

Patients,

SAS or NHS staff at the scene of incident,

Local Police.

REFER TO EXPERT ADVICE CONTACT LIST

Specialist information can be obtained from:

Fire & Rescue Service,

SAS,

Public Health Department,

Health Protection Scotland,

Radiation Protection Advisor,

Health Protection Agency,

National Poisons Information Service

6. Nominate members of decontamination team (or teams if first strike and clinical decontamination

teams are required). If insufficient staff available – call in decontamination trained staff from call-in sheets.

7. Arrange for the decontamination facility to be made operational. 8. Ensure Decontamination Team wear the correct PPE. 9. As waste water storage capacity is limited contact Scottish Water and advise of potential need to

run to drain 10. Maintain effective communications (detail a member of staff as a runner if necessary) with:

Hospital Control Room Emergency Department, Queen Elizabeth University Hospital +/- Royal Children’s Hospital if paediatric cases involved.

11. Log all messages and actions taken (detail a member of staff as a scribe if available to assist with

this). 12. Ensure decontaminated persons are clean. Radiation levels should be checked with a monitor at

the point of exit from the dirty to the clean area to ensure no contamination of the ED department.

13. When monitoring and decontamination is compete all members of the team must be monitored, remove their protective clothing and decontaminated if necessary.

14. Ensure decontamination area is cleared of any waste and valuables and equipment which should

be handled and stored appropriately. In radiation incidents waste disposal will be coordinated by the RPA.

15. Post incident, organise a hot debrief for members of the decontamination team and other staff

involved in the incident. 16. Ensure Media/communications is handled appropriately 17. Ensure security is in place.

107

Priorities:

1. Take command of whole decontamination process 2. Maintain effective communication with emergency department, hospital control room and external

agencies e.g. SAS, F&R

108


Action Card 5 – Decontamination Entry Control Officer Responsibilities:

1. Management of decontamination team, 2. Ensure the safety of all members of the decontamination team, 3. Management of the decontamination process (positioned in the Clean Zone), 4. Quality Assurance of patients exiting decontamination.

Initial Actions:

1. Don theatre ‘blues/greens.’ 2. Go to the toilet. 3. Have a soft drink. 4. Remove all jewellery. 5. Gather equipment:

permanent marker pen,

decontamination team monitoring board

Patient Decontamination body map forms

‘tuff cut’ scissors. 6. Consider if a separate team is required to set up the Clinical Decontamination equipment if

another is involved in improvised/ interim decontamination. 7. Ensure ‘safety team’ are in relevant PPE and ready to enter the Decontamination area should they

be required 8. Number all staff as they enter the dirty zone and log the time on the board. 9. Scribe, or allocate a member of staff in clean area to scribe, upon the body map areas of

contamination identified by the triage officer for each patient. Use TJ trakcare numbers to identify patients for the duration of the decontamination incident.

10. Monitor all personnel for signs of exhaustion, problems etc. 11. After maximum of one hour, arrange relief of personnel on the dirty side and assist out of suits.

Log time on the board. 12. Ensure suits are bagged and tagged for decontamination. 13. Log all information from decontamination team board onto hard copy and give to Lead Nurse,

Emergency Department. 14. Monitor the Health & Safety of all Staff within the dirty side. 15. Maintain effective communications with the Triage Officer, Decontamination Operators, and

Decontamination Team Leader. Ensure staff in PPE use hands free radios, stored in Paediatric ED staff area, with staff in the clean area on hand held devices.

Priorities:

1. Ensure safety of decontamination teams 2. Keep decontamination team monitoring board up to date 3. Liaise regularly with Triage Officer, Decontamination Operators and Decontamination Team

Leader

109


Action Card 6 – Triage Officer Responsibilities:

1. Triage of contaminated patients using triage sieve. 2. To be the 1st member of the decontamination team into the dirty zone, 3. To start decontamination of casualties prior to formal decontamination in unit.

Action:

1. Don theatre ‘blues/greens.’ 2. Go to the toilet. 3. Have a soft drink. 4. Remove all jewellery. 5. Don appropriate PPE and enter dirty zone. 6. Gather equipment:

2 x buckets per person, 1 filled with tepid/warm, 1 filled with tepid/warm water and 20ml of detergent,

“Tuff cut” scissors,

Property bags,

Disrobe packs,

Marker pen,

Sponges.

Radiation monitor and patient decontamination forms in a radiation incident 7. Reassure casualties waiting for decontamination. (Issue instructions such as remove outer

garments and rinse using buckets and sponges to assist in decontamination process). 8. Assess each of the casualties/self presenters to decide which, if any, require decontamination –

see algorithm 9. Triage patients using triage sieve for order of decontamination. 10. Carry out patient decontamination/treatments prior to formal decontamination in decontamination

unit. 11. Inform decontamination team of order of priority. 12. Assist decontamination team in appropriate treatments and decontamination of patients. 13. Monitor the Health & Safety of all Staff within the dirty zone. 14. Liaise with Decontamination Entry Control Officer and Decontamination Lead Officer. Use hands

free radios, stored in Paediatric ED staff area. 15. When monitoring and decontamination of patients is complete all members of the team must be

monitored, remove their protective clothing and be decontaminated if necessary. This will occur within the dirty area, with a final check with a radiation monitor prior to entry into the clean area.

Priorities:

1. Gather equipment required for use at triage 2. Use algorithm to determine need for decontamination 3. Use triage sieve to organise order of decontamination

110

111


Action Card 7 – Staff member decontaminating patient Responsibilities:

1. Decontamination of casualties, 2. Manage and control contaminated casualties.

Action:

1. Don theatre ‘blues/greens.’ 2. Go to the toilet. 3. Have a soft drink. 4. Remove all jewellery. 5. Gather equipment:

2 x buckets per person, 1 filled with tepid/warm water, 1 filled with tepid/warm water and 20ml of detergent,

“Tuff cut” scissors,

Disrobe packs,

Property bags,

Marker pen,

Sponges. 6. If time allows, deploy the decontamination unit. If time does not allow, prepare the area for use

with buckets of water with 20ml detergent and sponges. (This responsibility may lie with a separate MDU team)

7. Don appropriate PPE. 8. Use hand free radio to communicate with decontamination team. Radios are stored in the staff

area of the RCH ED. 9. Decontaminate patients in order that 1

st Out/Triage Officer states.

10. Instruct ambulatory patients to follow instructions for Ambulatory Rinse-Wipe-Rinse. Do not advise rinsing in a radiation contamination incident.

11. Decontaminate using the Rinse-Wipe-Rinse method, except in a radiation contamination incident where risk of splashes must be minimised, see specific instructions later on this card.

12. Communicate with Decontamination Entry Control Officer and follow their instructions. 13. Hand over decontaminated patients to clean team.

Priorites:

1. If time allows deploy decontamination unit 2. Gather all equipment required 3. Decontaminate using rinse-wipe-rinse method, except in radiation incidents, see subsequent

instructions.

112

RINSE-WIPE-RINSE PROCEDURE

(N.B. Showering should be avoided in radiation contamination to avoid spread.)

Equipment per person

For effective application of the RINSE-WIPE-RINSE method of skin decontamination, the following is required:

(i) Water, preferably warm/tepid. (ii) A bucket or other container (5 to 10 litre capacity) or a shower head with clean, preferably

warm/tepid, running water. (iii) A second bucket (5 to 10 litre capacity) for use with a water (preferably warm/tepid) and

detergent mix. (iv) Detergent. (v) A sponge or soft brush.

Procedure

1. If walking casualties can self decontaminate then this is the best approach to take. Hospital personnel should supervise and assist as required.

The recommended procedure for applying the RINSE-WIPE-RINSE method is as follows:

(i) Make up a water/detergent solution of 0.5% detergent in warm/tepid water (5ml of detergent per litre of water or about three squirts of liquid detergent into a bucket of water).

(ii) Having removed the contaminated person's clothes, RINSE the affected areas with clean

water (no detergent) using showerheads or buckets. RINSE from the highest point downward, ensuring that any sponge or brush used does not come into contact with the casualty or their clothing.

(iii) The RINSE should be applied to contaminated areas of skin only, to avoid spread to uncontaminated areas.

(iv) Using the water/detergent mix detailed in point (i), WIPE the affected areas of skin with a wet sponge or soft brush.

(v) RINSE the decontaminated casualty with clean warm/tepid water (no detergent) to remove the detergent and any residual chemicals.

(vi) Dry the skin with a clean towel. (vii) This process should not take more than three to five minutes for an individual walking

casualty. Repeat the RINSE-WIPE-RINSE procedure only if skin contamination remains obvious. (Persistent chemical warfare agents are poorly soluble in water and might require extended or repeated application.)

Additional notes

2. It might not always be possible to guarantee that a casualty will be totally decontaminated at the end of this procedure. Remain cautious and observe for ill effects in the decontaminated person and in unprotected staff.

3. The rinse water itself will be contaminated, and therefore hazardous, and a source of further contamination spread.

4. Brushes and sponges used in this process will also be contaminated and should not be used on a new patient.

5. On average, stretcher casualty decontamination can take between 10 to 12 minutes to complete.

6. The risk from hypothermia should be considered when any form of decontamination is carried out.

7. The use of contamination/dose rate monitor may assist in determining if the decontamination of radio active material has been successful. Dry wipe may also be effective for radiation contamination.

113

Decontamination Techniques in Radiation Contamination

1. Any wounds that are not contaminated should first be protected with a waterproof dressing. 2. Contamination in wounds should be dealt with first. Following this any contamination in the nose, eyes, mouth or ears should be addressed before general decontamination of the skin is undertaken.

3. Materials used in decontamination must be collected in polythene bags for disposal as radioactive waste.

Skin: Contaminated skin should be swabbed with absorbent pads dampened with mild soap and warm water. Gauze pads or small sponges may be suitable. Even a soft nail brush may be tried but damage to the outer horny layer of the skin must be avoided. The cleaning process should work from the edge of the contaminated area towards the centre. The area should be dried using disposable tissues and then monitored for residual contamination.

Contaminated finger nails should be cut away as much as possible. Radioactive material lodged under or beside the nail may be removed by applying calamine lotion, which should be allowed to dry and then carefully brushed off. This procedure should be performed with the hand inside a plastic bag to avoid dispersing the powder into the atmosphere.

If use of soap and water does not reduce contamination to an acceptable level, the skin may be swabbed with a solution of 1% Cetrimide and rinsed with water.

A chelating agent (such as EDTA soap) may be used if advised by the Radiation Protection Adviser.

A further measure that may be adopted is the application of 4% potassium permanganate solution. After a few minutes, when this is dry, the dark brown stains should be removed with 5% sodium bisulphite solution. This method should not be used on delicate skin such as the face as potassium permanganate is corrosive.

Eyes: The eyes should be irrigated with sterile saline or water. Rolling back the eyelid will assist the irrigation procedures. This should only be carried out by a trained nurse or doctor. Contaminated washings should not be allowed to run into the nose, mouth or any wound.

Mouth: If oral contamination is suspected, dentures should first be removed. The person should be told not to swallow and asked to wash their mouth thoroughly with repeated mouthwashes. The subjects should then be asked to brush their teeth, brushing away from the gums and carefully spitting out the water. Dentures should be scrubbed with a soft brush until free from contamination.

Nose: If the nasal system is contaminated, the subjects should be asked to blow their nose into a disposable tissue, which should be collected for monitoring. If repeated nose blowing does not reduce the contamination to an acceptable level, nasal irrigation with saline or sterile water should be carried out under medical supervision. The head must be tilted forwards so that the bridge of the nasal septum is almost vertical in order that the contaminated liquid flows out of the nostril. The irrigation tube should be positioned just inside the nostril and the subject should be in a sitting position with a waterproof cover and absorbent material over their front and lap.

114

Ears: The opening of the ear may be cleaned with cotton swabs but caution must be exercised. If contamination has entered the ear, then trained nursing or medical staff should syringe the ears using water at body temperature.

Hair: Do not shower the person if the scalp is contaminated. The person should be positioned with their head laid back over a sink and the hair washed carefully with shampoo. Care should be taken to ensure that contamination is not spread to other parts of the body especially the nose, mouth, ears and eyes. It may be necessary to wrap or cover some parts if spread of contamination cannot be avoided by other methods. The head should be dried with a clean towel and monitored to assess the level of residual contamination. If further decontamination is required, the hair may be treated with Cetrimide solution. If this still fails to remove the contamination then the hair should be trimmed, but the head must not be shaved. The clippings should be collected for assay and subsequent safe disposal.

Wounds: The skin surrounding the wound should be cleaned carefully. The wound may be encouraged to bleed moderately and irrigated with sterile water to disperse the contamination, but this must not be spread to other parts of the body. The area should be dried by wiping away the liquid from the edge of the wound. Debridement of the wound may also assist the decontamination process. When the skin surrounding the wound has been decontaminated, the area should be sealed with a waterproof dressing.

If fragments of radioactive metal have penetrated the wound, a wound probe may be required to assist in localisation of radioactive fragments. These should be removed with forceps, but may require surgical intervention. All fragments should be collected in plastic bags and retained for assessment.

Following each decontamination attempt radiation levels must be rechecked and recorded upon Patient Decontamination body map form. It may be necessary to communicate the relevant information to a scribe with the form, via the hands free radio.

When monitoring and decontamination is complete all members of the team must be monitored, remove their protective clothing and decontaminated if necessary.

All staff in PPE should undergo this process in the dirty area and have a final radiation level check prior to exiting into the clean area.

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Action Card 8 – Decontamination Team Members Responsibilities:

1. Decontamination of casualties, 2. Manage and control contaminated casualties.

Immediate Actions:

1. Don theatre ‘blues/greens.’

2. Go to the toilet.

3. Have a soft drink.

4. Remove all jewellery.

5. Don appropriate PPE. If respirator required, do not zip up and switch on respirator until ready to enter contaminated area or deal with potentially contaminated patients.

6. Use hand free radio from RCH ED staff area to communicate with decontamination team members.

7. Provide reassurance that decontamination will start as soon as possible for those waiting.

8. Prepare decontamination area and equipment.

9. Follow instructions of decontamination team leader.

Priorities:

1. Follow instructions from decontamination team leader.

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Action Card 9 – Decontamination Dresser

Responsibilities: 1. If required assist clean casualties in the re-robe area. 2. To assist staff in PRPS suits (who have self decontaminated) to remove protective clothing.

Immediate Actions:

1. Don theatre ‘blues/greens.’ 2. Go to the toilet. 3. Have a soft drink. 4. Remove all jewellery. 5. Don intermediate PPE. 6. Report to decontamination lead. 7. Ensure that there are sufficient re-robe kits for the numbers of decontaminated people coming

through the unit. 8. If more re-robe kits are required inform the decontamination lead.

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Action Card 10 – Emergency Department Receptionist Responsibilities:

To notify Nurse in Charge of arrival at Emergency department if you are made aware of casualties that are potentially contaminated.

Assign TJ numbers to casualties brought in via ambulance direct to the decontamination facility, to be used for the duration of the decontamination incident.

Immediate Actions:

1. Tell potentially contaminated patient to avoid contact with other patients and remain where they are awaiting instruction.

2. Alert Nurse in Charge Emergency Department immediately.

3. Inform security.

4. Along with Nurse in Charge Emergency Department inform all persons in waiting room to vacate the area via ED front door and remain in ED drop off area for further instruction.

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MAJOR INCIDENT NOTIFICATION SHEET

1. TIME/DATE

2. NAME/ADDRESS OF INFORMANT

3. LOCATION OF INCIDENT

4. STATUS OF INCIDENT (POSSIBLE/CONFIRMED)

5. TIME OF INCIDENT

6. NATURE OF INCIDENT

7. POTENTIAL EXTENT OF PAEDIATRIC CASUALTIES

8. NOTES

APPENDIX 1 – MAJOR INCIDENT NOTIFICATION FORM

119

Location Sign

EMERGENCY DEPARTMENT

‘Major Incident only All other casualties please report to Out Patients Department’


‘All press enquiries to Main Entrance’

MAIN ENTRANCE TO HOSPITAL SITE

‘Major Incident in Progress Temporary Accident and Emergency Area for all other Paediatric Casualties in Out Patients Department’

MAIN ENTRANCE TO HOSPITAL SITE

‘All press enquiries to Main Entrance’

EMERGENCY DEPARTMENT – MAIN

CORRIDOR ENTRY

‘No Entry’

RADIOLOGY DEPARTMENT – MAIN

CORRIDOR ENTRY

‘No Entry’

ON CORNER APPROACHING ED

ENTRANCES

‘Major Incident in Progress Ambulances Only Diversion for all other traffic’

APPENDIX 2 - SIGNPOSTING

120

Location Sign

Seminar Room, Emergency

Department

‘Incident Control Room’

Police Base

Adult Emergency Department

‘Police Control Room’

Training Room in Emergency

Department

‘General Services Supervisor / Senior Nurses/Press Officer

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LOCATION OF TELEPHONE CONTACT LISTS

CONTACT LIST LOCATION 1. Contact Centre Contact Centre Hillington 2. Emergency Department Emergency Department Nurses’ Station 3. PICU PICU 4. Surgical/Orthopaedics/ENT Major Incident Box in Major Incident Store ED 5. Anaesthetics Major Incident Box in Major Incident Store ED 6. Theatres Theatre Manager’s Office 7. Medical Major Incident Box in Major Incident Store ED 8. Radiology Via Rotawatch

9. Site / Facilities See Action Card 6 10. Nursing Staff In SCN Office in each ward 11. Medical Records Medical Records Office / ED Reception 12. Haematology Haematology Laboratory Office 13. Biochemistry via Rotawatch 14. Pharmacy via Rotawatch

For medical/surgical ward nursing staff, telephone contact lists are held / maintained

locally on individual wards.

It is the responsibility of Clinical Directors/Managers to ensure that up-to-date

departmental telephone contact lists are maintained.

It is the responsibility of Clinical Directors/Managers to ensure that up-to-date

departmental telephone contact lists are provided to the Contact Centre Team

Leaders.

APPENDIX 3

122

DESIGNATED AREA TELEPHONE NUMBERS AND MANAGEMENT NUMBERS

1. Major Incident Control Room Seminar Room, Emergency Department 84601

2. Police Control Room Police Base Adult Emergency Department 80399

3. Staff Reporting Area Han Base and adjacent Seminar Room 84469 2

nd Floor

4. Senior Nurses Wards 1C Ambulatory Care 84400 / 84401 1D PICU 84710 / 84711 / 84713

1E Cardiology 84437 / 84438 / 84439 2A Oncology / Haematology 84450 / 84451

2B Oncology / Haematology 84475 / 84476 2C Acute Receiving 84490 / 84491 / 84492 3A 84500 / 84501 / 84502

3B 84510 / 84511 / 84512 3C 84520 / 84521 / 84522 4 Psychiatry 84539

5. Emergency Department ED Minors Staff Base 84050 / 84051 ED Majors Staff Base 84055 / 84056 / 85057 ED Resuscitation Area 84042

6. Clinical Decisions Unit Staff Base 84670 / 84671 / 84672

7. Radiology 84234

8. Non Major Incident / Existing Emergency Department Patients Clinic 3 Out-Patients Department 84112

Relatives Waiting Area Therapies Hub in a paediatric incident 84650 / 84651 Adult Out Patient Department in a mixed Major Incident

Patient Reunion /Discharge Area Outpatient Clinic Area 5 84059

9. Hospital Enquiry Desk Hospital Main Entrance 84000 / 62844 Main Entrance Adult Hospital 82381

APPENDIX 4

123

10. Theatre Areas Theatre Coordinator Page 8539 / ext 84381 Theatre Recovery 84397 Theatre 1 84376 / 84377 Theatre 2 84371 / 84372 Theatre 3 84368 / 84369 Theatre 4 84364 / 84363 Theatre 5 84361 / 84362 Theatre 6 (Emergency Theatre) 84358 / 84360 Theatre 7 84355 Theatre 8 84348 / 84346 Theatre 9 84349 / 84350 Cath Lab 84283 Interventional Radiology 84284

11. Mortuary 59357

12. Children’s Management Team Bed manager Anne Douglas 84575 Lead Nurse Maureen Taylor 85742 / 07957724841 Lead Nurse Elaine Johnston 85832 Lead Nurse Melanie Hutton 85743 Lead Nurse Patricia Friel 85831 / 07855109423 Service Manager Lynne Robertson 85741 / 07534919300 Service Manager Heather Dawes 84716 / 07770812781 General Manager Jamie Redfern 07818423402 Clinical Director Phil Davies 86683 / 07855101244 Clinical Director Christine Gallacher 07855104625 Clinical Director Pam Cupples 84317 / 07855109191 Clinical Director Morag Campbell 07870513679 Chief of Medicine Alan Mathers 07984003699 Director Kevin Hill 07747790014

13. Facilities Management Facilities Duty Manager 7am-7pm 82101 Catering Services Manager 7am-7pm 82084 Domestic Services Department 24 hrs 82103 / 82007 / 82008 / 82009 Portering Department 24 hrs 82097 Estates Department page 7047 Emergency Duty Manager ( on call) 07816997955 FM General Manager Billy Hunter 59615 Site Manager Ronnie Clinton 59613 Site Manager Frank McGuire 59616 ( RCH) Deputy Site Manager Sharon Johnstone 59614 Deputy Site Manager Majorie McCulloch 59614 Deputy Site Manager Sheenagh Leighton 59622 (RCH) Professional Lead Portering Jim Magee 59648 Professional Lead Catering Jeanette Wilson 59643 / 82007 Professional Lead Domestic Pat Coyne 59643 / 82007 Duty Manager Tam Rae 82098 Duty Manager Barbara Speight 82098

124

Duty Manager John Donaldson 82219 Duty Manager John Heron 82102 Duty Manager Adam Wright 82216

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LIST OF EXTERNAL AGENCIES AND TELEPHONE NUMBERS

1. Police Scotland Headquarters 999 French Street, Dalmornock

2. Scottish Ambulance Service Emergency 0141 810 6311

Medical Dispatch Centre West Caledonia House, Cardonald Park, Glasgow

3. Strathclyde Fire and Rescue Service 01505 331661

Control Room South Thornhill, Johnstone

4. Social Work Department (Office hours) Ext: 80057/80058 Page: 8154

(Out of Hours Service) 0141 305 6706

5. NHS Greater Glasgow and Clyde Press Officer 0141 201 4429 (Office hours/Out of Hours will automatically connect to Duty Officer)

6. Regional Blood Transfusion Centre 0141 357 7802 Gartnavel General Hospital

7. Designated Major Incident Hospitals NHSGGC –

HOSPITAL

CONTROL ROOM


Glasgow Royal Infirmary

0141 211 4961/2/3 0141 211 4344

Southern General Hospital

0141 201 1478 0141 201 1456

Royal Alexandra Hospital Paisley

0141 314 6933 0141 314 6698/6774

Inverclyde Hospital

01475 504378 01475 504166

APPENDIX 5

126

Accident & Emergency Reception Registration Process Action Card

Should a Major Incident take place, Health Records Accident & Emergency seniors should ensure Health Records processes for data recording are implemented. MI Patient Identifiers are as follows on Trakcare:

All Major Incident patients are recorded with a unique TJ number and with the following same details: o Surname: Major Incident – One (Through to Fifty) o Forename: Your site short code (i.e. VIC/SGH/IRH/RAH/ etc.) o DOB: 01/01/1901

Prior to Major Incidents Health Records Senior Staff should ensure the major incident cupboard is always fully stocked with 80 MI patient packs and packs now have all the up-to-date Major Incident patient identifiers. These should be in numerical order 1- 80 Day of Major Incident Ensure a Health Records Major Incident basket is in place at reception. This basket will hold the completed MI Patient Form. This form is for Health Records use only and should not be removed from reception during the MI. Registration All patients who present during the Major Incident should be given the MI TJ number irrespective if they are identified or not. If a patient is identified (i.e. able to provide details) please update the TJ number with as many “real” patient details possible. Retain “major Incident” name as an alias. PLEASE ALWAYS RECORD THE GENDER EVEN IF THAT IS THE ONLY INFORMATION YOU HAVE.

APPENDIX 6

127

On changing the surname & Forename you will be asked

Please select OK The Major Incident surname/forename now become the alias names

On updating all new details please print new patient labels and place these in the pack removing labels referring to patient name “major incident” Patients who are unknown i.e. where no patient details are provided will continue to be known as Major Incident – one, two, three etc. Major Incident Patient Form

Ensure the form has a patient label especially if you update with new details

Complete as many details as possible before the patient is moved to another location Process patient details accordingly on Trak ED Reg and Move; please ensure to record “MAJOR INCIDENT” in the reason for attendance this will allow us to quickly identify MI patients using the ED Enquiry screen – if possible record the true CHI number in the reason for attendance (time allowing)

Once patient is recorded on Trak place the patient form in the Health Records MI basket

128

ED Card Once the ED card is returned to the front desk staff should “marry” the card with the patient form in preparation for merging the TJ number with the patients “true” details Merging patient major incident TJ Merging the TJ numbers with the patients true CHI should only take place when the MI is stood down and the responsible clinician states that the patient is not in a crucial stage of treatment this will ensure there is no confusion over patient’s details during the MI or when the TJ is already in use by labs/blood transfusion or radiology. Following the merge of the TJ number with the true CHI Health Records staff should ensure any physical records created using the TJ number are merged accordingly. Health Records staff should also inform relevant colleagues that a patient merge has taken place in order that they can update their relevant systems. On merging the TJ number with the true CHI following stand down please DELETE the alias forename and surname relating to patient name major incident.

To delete an alias click on the Alias hyper link in the patient demographic page now click the edit icon at “given name” and click delete repeat for surname

Major Incident Patient Form Once patient details have been merged please retain this form in a “Health Records MI folder” for future reference if required - DO NOT FILE IT WITH THE ED CARD Post Major Incident ED Supervisors should replenish the MI cupboard and create a further batch of Major Incident Patients for their own site thus ensuring we always have 50 major incident patients recorded on Trak

129

Major Incident Patient Form V2

Health Records use only

DO NOT REMOVE THIS FORM FROM RECEPTION

ED Staff should ensure a Major Incident patient label is placed on this form if it has not been already. This TJ number will be the patient identifier throughout the MI. If you have the patient’s “real” details please update this TJ

Number with as much detail available to you. If you are updating the name please retain the major incident name

as an alias. The alias will be removed following stand down of the MI – If you update patient details please re print a patient label set and place in the pack removing the labels with the details relating to the name “major Incident”

PATIENT LABEL

Please complete this box before

the patient is moved to another

location

Patient location i.e. Resus/Waiting

Room/X-Ray

Please complete this box

before the patient is moved

to another location

Gender

M/F/Unknown

3. Patient details – once identified -

Surname ; First Name : Date of Birth : Address :

Next of Kin Details Surname : First Name : Relationship : Contact Number :

Date of Major Incident: …………………………………………………. ED Episode Number: ………………………………………………..... Hospital : …………………………………………………………….

Please keep this form at the front desk in the Health Records Major Incident Tray. Staff should “marry” the

form with the ED card and update/merge accordingly.

CHI –

130

STRATHCLYDE POLICE – CASUALTY BUREAU

POLICE CASUALTY BUREAU DOCUMENTATION TEAM INTERFACE

WITH DESIGNATED RECEIVING HOSPITALS

WITHIN STRATHCLYDE REGION

1. Police on arrival will report to the Hospital Coordinator.

2. The Hospital Coordinator will ensure the agreed facilities for the Police are available and will appoint a member of hospital staff to liaise with the Police.

3. Casualty information will be accessed via medical records staff or other staff identified by the Hospital Police Liaison Officer.

4. Opportunities to interview casualties will be on the authority of clinical staff and with the agreement of the Hospital Coordinator.

5. Casualties availability for interview will be considered:

(a) Prior to discharge after treatment

(b) After admission to a hospital ward

(c) Prior to transfer to another hospital

Information on casualties in theatre/PICU will be available from medical records staff or other staff identified by Hospital Police Liaison Officer.

6. Police will arrange for additional security at the hospital if required.

Note: The Police Documentation Teams attending have a responsibility to bring with them:

(a) Relevant casualty forms (b) Fax Machine

APPENDIX 7

131

CHEMICAL AND RADIOLOGICAL INCIDENTS

1. The Royal Hospital for Sick Children’s Major Incident Plan follows an ‘all hazards approach’ with a single plan intended to cope with all types of major incident.

2. If a major incident involving a chemical or radiological agent occurs, the hospital response should be in line with the full and detailed guidelines set out in the relevant sections of the NHSGGC Area Major Incident Plan.

3. Similar detailed advice exists within the NHSGGC Area Major Incident Plan for incidents involving the deliberate release of chemical, biological, radiological or nuclear (CBRN) agents.

4. The main difference in the hospital response to a major incident involving a chemical or radiological agent will be in regard of the decontamination of casualties.

5. RHC is a designated receiving hospital for chemical and radiological incidents involving paediatric casualties. There is a decontamination facility plus appropriate protective clothing held in the hospital for this purpose.

6. Decontamination procedures, including prior to transportation to hospital, continue to be developed. However, RHC has to maintain an adequate on-site decontamination capability.

7. The decontamination unit is situated between the Paediatric and Adult Emergency Department Entrances. Decontamination suits are situated in the decontamination store area of the decontamination unit.

8. Emergency Department medical and nursing staff in appropriate protective clothing will manage the decontamination and flow of casualties through the decontamination chamber as necessary.

9. If a radiological agent is involved, there will be a further amendment to patient flow within the Emergency Department for radiation monitoring purposes, as outlined in the RHC specific Appendix of the NHSGGC Emergency Response Plan for Major Radiation Incidents.

APPENDIX 8

132

Background Patients/parents with high public and media profiles or security risks may attend the Royal Hospital for Children Glasgow. This plan advises hospital staff regarding the management of such patients with the aims of optimising privacy, safety and security and facilitating effective co-operation with the police and the media. Where possible the plan attempts to minimise disruption to the normal working of the hospital. In the event of terrorism this plan may form the basis of response but will be augmented following discussions with Police Scotland.

Application Patients/parents with high or potentially high security risk Patients/parents with high public and media profile May be used as a basis for responding to incidents involving terrorism

Implementation The plan can be implemented by the Emergency Department Consultant on call, Emergency Department Nurse in Charge or the Duty Manager (8502 page holder/ Dect 85770). The plan can be implemented on the arrival of the patient or if the hospital receives prior notification of the imminent arrival of a high profile patient from the emergency services or other sources. The plan is implemented by telephoning switchboard and requesting that the “High profile patient telephone list” be activated.

Switchboard: High profile patient telephone list When requested to do so by the Emergency Department Consultant on call, Emergency Department Nurse in Charge or the Duty Manager (8502 page holder/ Dect 85770), the switchboard should telephone the following people and convey the following message: “The hospital’s high profile patient plan has been activated, please report to RHC Emergency Department.” Emergency Department Nurse in Charge

Emergency Department Consultant on call

Senior Nurse 8502 page holder/ Dect 85770

On Call Manager for South of Scotland

Switchboard supervisor

Facilities Supervisor

Emergency High Profile Patient/Parent Plan Royal Hospital for Children Glasgow

December 2015

APPENDIX 9

133

Press officer on duty for NHSGGC.

Emergency Department Nurse in Charge Designate appropriate area for patient assessment and management: resuscitation room if required or ED treatment room or cubicle.

Brief Emergency Department staff on situation. Advise on:

Information received

Need for discretion

Minimal staff contact with patient – allocate two dedicated nurses to deal with patient.

Potential or actual need to close department

Area where patient will be managed in the department

Potential risks

Ask for two porters to station themselves at either end of the corridor in the Emergency Department and limit entry to those with appropriate identification until relieved by the police. Principles of management should be to limit patient/parent movement and staff contacts in the hospital. The patient should be assessed and treated in the Emergency Department and reviewed from other specialities as required in the Emergency Department.

Emergency Department Consultant You will lead on patient assessment and management. Principles of management should be to limit patient movement and staff contacts in the hospital by bringing relevant specialists to the patient in the Emergency Department. Use near patient investigations and consultant assessments where possible.

Designated hospital areas

Emergency department Resuscitation room, or ED treatment room or cubicle

Admission bed As appropriate for clinical presentation

Hospital control room Major Incident Hub – ED Seminar Room

Media Seek the advice of on call manager/duty press officer

Department closure

The reception of a high profile patient may constitute a Level 2 emergency or Level 3 incident:

Level 2 Major Emergency - A major emergency is defined as a situation, either arising or threatened, which requires the special mobilisation and/or redeployment of staff or other resources with consequent interruption to routine activities. Major emergencies are any events which may cause significant disruption in the delivery of health care to patients.

134

Level 3 Major Incident - This is a widely accepted term used by the emergency services to describe any emergency that requires (and triggers) the implementation of special arrangements by one or more of the emergency services, the NHS or the local authority. For the NHS, Major incidents are events involving the reception of significant numbers of casualties or limited numbers of casualties whose injuries place special demands on the NHS. If the Emergency Department or other areas of the hospital require closure please use the

Business Continuity Plan.

Media

Seek the advice of on call manager/duty press officer

Site manger folder This is held in the major incident box situated within the major incident control room. Relevant documents contained: site and building plans, all door access codes, hospital master keys, high profile patient policy.

Distribution of high profile patient plan Emergency Department consultants and senior nurses Site manager folder Switchboard On call senior managers Clinical service mangers Lead nurses Medical Director Head of Nursing Civil Contingencies Planning Unit, NHS GG&C Media services Other staff members as patient journey dictates Copy also kept with Major Incident Plan in Major Incident Hub

135

Police Forms used to help identify casualties Holmes Ref.:

Misper Casualty Survivor / Evacuee

Personal Details:

Last name/family name: First name(s):

Build: Fat Medium Slim Stocky Thin

Eyes Blue Green Hazel Unknown Grey Pink

Brown

Complexion: Fair Fresh Ruddy Spotted Tanned Freckled

Pale Sallow Swarthy Wrinkled

Glasses: Glasses No glasses Contact

lenses

Glasses use: Constant Driving Reading

Nationality: Religion:

Head hair: Afro

Bald

Beehive

Bushy

Collar length

Cropped

Curly

Dirty

Dreadlocks

Dyed

Greasy

Greying

Mohican

Permed

Plaited

Ponytail

Rasta

Receding

Shaven

Short

Shoulder length

Skinhead

Straight

Streaked

Teddy

Thinning

Untidy

Very long

Wavy

Wig

Colour: Auburn

Black

Blonde

Blue

Brown

Dark Brown

Light Brown

Fair

Ginger

Green

Grey

Mousy

Multi

Orange

Pink

Purple

Red

Sandy

White

Yellow

Facial hair: Bushy

Clean shaven

Curly

Dirty

Dyed

Full beard

Goatee

Greasy

Greying

Hairy

Handlebar

Long sideburns

Moustache

Plucked

Streaked

Stubble

Very long

Waxed

Distinguishing features::

Type: Lacking, Mark, Peculiarity,

Pierced, Scar, Tattoo

Feature: Ear,

Eye, Arm, Leg

Position: Left,

Right, Both Full Description

Jewellery:

Clothing:

Personal effects:

Person completing form: Date & time:

Last name/family name: ID No.:

APPENDIX 10

136

CASUALTY Holmes Ref.:

Location where form completed: Inv. Grading:

Identified casualty Unidentified casualty Previous survivor

Hospital Ref.: Reception Centre Ref.:

Personal Details:

Last name/family name: Gender: Male Female Unknown

First name(s): Other name:

Date of Birth: / / Or Age from: Age to:

Nationality:

Ethnic appearance:

White – North European White – South European Chinese, Japanese or any other South East Asian

Arabic or North African Black Asian Unknown

Address:

Type Address Postcode

Home

Telephone number(s):

Mobile tel. number(s):

E-mail address(s):

Location at time of incident:

Identification method:

Brief description

of injuries:

Body condition: Dead Serious Slight Detained in hospital: Yes No

Next of Kin Details:

Last name/family name: First name(s): Relationship:

Informed: Unknown Informed To be informed Not to be informed

Involved: Unknown Yes No

Address:

Type Address Postcode

Home

Telephone number(s):

Mobile tel. number(s):

E-mail address(s):

Information Sharing Statement:

This data may be disclosed to the government and/or their partner agencies and/or emergency services in order to protect your

vital interests and/or the vital interests of others for the purpose of emergency response and the recovery process in accordance

with the Data Protection Act 1998.

Additional Information:

Descriptive form:

Person completing form: Date & time:

Last name/family name: ID No.:

137

Documents

Major Incident Plan - GG&C Paediatric Guidelines · 2020-03-23 · been a major incident, but prior to any official major incident alert, the Nurse in Charge Emergency Department