The Northern Care Alliance NHS Group has taken a radical and pioneering approach to emergency planning. The group is believed to be the first NHS Trust to develop its own, dedicated Emergency Planning, Resilience and Response Unit, which brings everything together in one place - specially trained staff and facilities - to deal with day-to-day incidents as well as major emergencies.
Formed in 2017 by the amalgamation of Salford Royal NHS Foundation Trust and The Pennine Acute Hospitals NHS Trust, the Northern Care Alliance NHS Group serves a population of over one million people in the Greater Manchester area through five local hospitals, one major trauma unit (MTU), one Trauma Unit (TU), a range of community services and some 17,500 staff.
The Emergency Planning, Resilience and Response Unit is headed up by Allan Cordwell, an emergency planning expert who has spent 17 years as an A&E nurse within the NHS and served with the Army Reserves in Iraq. He is assisted by two Band 7 Emergency Planning Officers and one Emergency Planning Support Officer. The unit took five years to develop and has been operational for just under two years. It facilitates a professional and dynamic approach to emergency planning.
On a daily basis this emergency team responds to any incident that threatens to result in loss of service. This might include IT issues, such as cyber attacks, dealing with incidents involving hazardous materials, small fires and supporting the regional infectious diseases unit in Manchester. It also links with the Trust’s internal operations, providing tactical support and assistance to staff across the Care Organisations if local operational pressures escalate, for instance, perhaps as a result of industrial action or disruption through severe weather.
Of course, every hospital has to meet challenges of this nature, but the difference here is that the learning can be reviewed and shared. Without the Emergency Planning, Resilience and Response Unit daily operational problems would be handled locally. This unit, however, means the Trust can learn from every incident and the response team is able to design and deliver recommended training for staff. This knowledge is disseminated across all sites, so the process of reporting on an event is meaningful and constructive and not just an administrative task.
The model developed at NCA means every site has two control rooms - a forward operations bronze room for daily tasks including running the bed managers and patient flow, and a silver incident control room for when escalation is required. These rooms are permanent facilities and are inter-changeable so no time is wasted in the event of an emergency in establishing and equipping a control room. “I would strongly recommend you identify a room, use it for hot desking, managers on call or a secondary meeting room, but have those assets set up and ready to go in a permanent state of readiness,” Allan says.
The control room should be equipped with an emergency secondary power supply as well as hard copies of everything in case power fails, including site maps, generic continuity plans and action cards.
Emergency response is not just a clinical function, it’s not just a question of doctors and nurses treating patients, it is far wider than that. Allan expresses his frustration that this is not more widely recognised. “I always recommend to my colleagues in emergency response that they should stay close to the Estates and Facilities teams because we need them, without them nothing is going to function. E&F staff are pivotal in responding to any kind of incident in providing support.”
When Pulse caught up with Allan in summer he was busy devising a continuity plan for heat and water shortages. The fires on the moors outside Manchester were also raging but he wasn’t as worried about that at the time as the impact of the heatwave. BC plans were implemented to mitigate the impact of the heat which included simple but effective measures such as closing curtains and switching lighting down to make the environment more comfortable for patients, staff and visitors.
Case study
In May 2017 the Emergency Planning, Resilience and Response Unit was a relatively new initiative and it was to be tested in a way that no-one could possibly have predicted. That it was in place and able to respond promptly and efficiently was undoubtedly a major bonus on the night that Salman Abedi, an Islamist terrorist, detonated a bomb at Manchester Arena following an Ariana Grande concert.
Allan Cordwell received the alarm - almost simultaneously across his mobile phone, home phone and bleeper. In less than 15 minutes after the detonation of the bomb the response at Northern Care Alliance was underway.
Although Salford Royal Hospital is the major trauma unit for the Trust, Allan elected to run the initial response from a control room at North Manchester General Hospital. Thanks to the Trust’s policy, the control room was ready for immediate occupancy: “Literally, at the flick of a button, the control room was open.” The importance of this was evident, as the first patients began to arrive in taxis just 20 minutes after the bomb had exploded.
The proximity of North Manchester General Hospital to the Arena meant it was the first to receive patients - both self-presenters and those that needed life-saving interventions. This is logical, but as the hospital isn’t the major trauma unit, many of the staff on duty had no experience of dealing with the nature of the injuries they were faced with.
The emergency response team used radiation monitors to scan casualties as they were brought in - if the bomb had been a so-called ‘dirty’ bomb, patients could also be contaminated with radiation.
Confusion was rife whilst the Trust and teams of clinical and EFM staff cared for the incoming wounded with multiple triages set up under the growing scrutiny of the media. Genuine intelligence and false information was received and acted on - including a second bomb threat on the North Manchester hospital site. Ambulance services were struggling to cope and patients were transported to hospital by bus, which broke down. Patients were carried to hospital by ambulance, bus, taxi and in the back of police cars.
This was a devastating attack, but the chilling reality is that it could have been much worse had the bomber gained access to the Arena exit points.
Recommendations
* Rotate all clinical staff in emergency departments into trauma units for three months every five years so when a facility that is not designated as a trauma unit has to deal with one staff are prepared and can get to work saving lives
* Expect the unexpected - no amount of planning can prepare you for what may happen in a real life situation
* Carry out military style medical training with civilian teams in all Acute hospitals
* Train staff to be dynamic and fluid - say what you see, look at your intelligence, make a decision, log it and move on - even if the decision is wrong the log will provide documentary evidence that at the time it was the right action to take based on the information available
* Be aware of your staff and the impact the trauma response is having on them
* Train, train some more and train again.
