EMERGENCY PLANNING ANNUAL REPORT EMERGENCY PLANNING NHS SHETLAND ANNUAL REPORT

EMERGENCY PLANNING NHS SHETLAND ANNUAL REPORT 2009-10

Contents: Page no. Introduction 2 Local Inter-agency arrangements 3 National and regional emergency planning 3 Local Planning 4 Incidents 6 Training 6 Exercises 7 Partner Exercises 8 Risk Management 8 Audit and Self-assessment 8 Acknowledgements 9 1

Introduction This is the fourth Emergency Planning Annual Report written for NHS Shetland. It reports on emergency planning activity in Shetland for the year 2009 2010. Reporting also happens locally across agencies and to the local service via the Shetland Emergency Planning Forum. Emergency planning for health services is part of the core public health responsibilities carried out by the public health department and led by the Director of Public Health, supported by the Emergency Planning and Resilience Service: the Emergency Planning & Resilience Manager and his service, jointly appointed between NHS Shetland and Shetland Islands Council. However, it is the responsibility of all staff and managers within the service to be prepared for emergencies, and therefore to plan, train and exercise their preparedness appropriately. This Annual Report describes the activities undertaken in the last year to support and deliver the function of emergency planning for NHS Shetland. The local service works within the guidance issued by the Highlands and Islands Strategic Co-ordinating Group (HISCG) which has underpinned our local and regional preparedness, and which helpfully summarises the context of our local emergency planning. The Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2005 create responsibilities on a number of organisations in the event of an emergency. Under the 2004 Act an emergency is defined as an event or situation which threatens serious damage to human welfare in a place in the United Kingdom, the environment of a place in the UK, or war or terrorism which threatens serious damage to the security of the UK: An event or situation threatens damage to human welfare only if it involves, causes or may cause: loss of human life human illness or injury homelessness damage to property disruption of a supply of money, food, water, energy or fuel disruption of a system of communication disruption of facilities for transport, or disruption of services relating to health. An event or situation threatens damage to the environment only if it involves, causes or may cause: contamination of land, water or air with biological, chemical or radioactive matter, or disruption or destruction of plant life or animal life. 2

Each statutory emergency service and other agencies have a responsibility to serve and protect the public. In practice, in Shetland the local emergency plans prepare us for situations, which call on responses beyond the usual capacity of our organisations. NHS Shetland is a Category One responder (organizations that provide vital services in an emergency), along with local authorities, police, fire service, ambulance, coastguard, environment protection and weather services. Local Inter-agency arrangements The emergency services and other relevant partners come together within Shetland in formal inter-agency groups that take collaborative responsibility for the preparing and testing of local plans. Shetland Emergency Planning Forum: this is an inter-agency meeting held annually to update stakeholders in local emergency planning activity. The meeting held in October 2009 covered items on: Influenza A (H1N1) preparedness Update on Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2005 Risk assessment and the Community Risk Register Business continuity and emergency planning The role of the Secretary of State s Representative (SOSREP) for Maritime Salvage and Intervention Exercises undertaken and planned Severe weather contacts / contact numbers to be used in an emergency. Shetland Emergency Planning Forum Executive meets regularly throughout the year, and in 2009-10 has dealt with a range of topics including: A process for developing local guidance on Care for People in response to national guidance in the form of a multi-agency specific plan administered by the Education & Social Care Department of the SIC Improving Civil Contingencies the Audit Scotland report Review and update of plans and procedures Planning the Annual Seminar Community Risk Register Training and exercising Business continuity planning Recovery Guidance Emergency Helicopter Landing Site Forward planning for the Tall Ships event in 2011. National and regional emergency planning Shetland participates in the Highlands and Islands Strategic Co-ordinating Group (Regional Emergencies Strategic Coordinating Group). This group acts at the strategic level to co-ordinate and support the response to any 3

emergency within any part of the Highlands and Islands area. It describes the initial response of all the responding agencies for an all hazards approach to deal with an emergency at the strategic level of command, when the Strategic Co-ordinating Group is initiated. It is a structure that outlines the roles and responsibilities of the emergency services and other agencies, and from which Shetland s Emergency Planning Forum prepared its Multi-Agency Initial Response Plan (MAIRP). In addition, NHS Shetland has specific surge capacity arrangements in place across the north of Scotland via the North of Scotland Public Health Network, between the functions of Public Health, laboratory services and hospital services. These are designed to ensure co-operation and collaboration between Shetland and the other northern NHS Boards in emergency situations where local demands outstrip local capacity. National Scottish arrangements for the management of emergencies are set out in Preparing Scotland; Scottish Guidance on Preparing for Emergencies 2007; the Scottish Resilience Civil Contingencies Circular 5/2008; STAC Guidance: Providing Public Health, Environmental, Scientific and Technical Advice to Emergency Co-ordinating Groups in Scotland; and Responding to Emergencies in Scotland. Local Planning The Shetland Emergency Planning Forum s mission statement is to provide the communities of the Shetland Islands with fully integrated, cohesive, efficient, and quality civil contingencies planning, management and response services. Local plans for dealing with major emergencies in Shetland are set out in: Shetland s Emergency Planning Forum s Multi-Agency Initial Response Plan; Shetland Islands Council s Emergency Plan; NHS Shetland s Major Emergency Procedures; Shetland Public Health Incident / Outbreak Plan (currently in draft form, used operationally and to be finalised summer 2010) and Shetland Hospital Outbreak Plan; In addition, specific plans are in place to deal with specific hazards including: Shetland s Contingency Plan for Pandemic Influenza; Plan for the Investigation and Control of Foodborne Disease Outbreaks; 4

Shetland Islands Council Integrated Contingency Plan for the Investigation and Control of Environmental Health Incidents; Scottish Waterborne Hazard Plan; Shetland Blue/Green Algae Monitoring and Action Plan; Public Health Plan for cryptosporidium in public drinking water supplies; Procedures for the management of Legionnaire s Disease; Viral Haemorrhagic Fever; prevention and control of TB; Meningococcal Disease. Shetland Islands Council Control of Major Accident Hazards (COMAH) Plans for specific local sites including Sullom Voe Oil Terminal, and local airports; Shetland Islands Council Pipeline Safety Plan (Brent, Ninian and Clair Pipelines); CBRN (Chemical, Biological, Radiological and Nuclear) Joint Initial Response Plan (Highlands & Islands Emergencies Co-ordinating Group); and various supporting guidance including: Managing Incidents presenting actual or potential risks to the public health (Guidance on the roles and responsibilities of Incident Control Teams); NHS in Scotland Manual of Guidance; responding to Emergencies. During 2009/10 the Director of Public Health also produced a Shetland Joint Health Protection Plan in line with the requirements of the Public Health etc (Scotland) Act 2008, which provides an overview of health protection (communicable disease and environmental health) priorities, provision and preparedness for the NHS Board area (prepared in consultation with Shetland Islands Council). During 2009 / 10 further progress was made in developing and updating the Board s Business Continuity Plans (BCPs), with all service areas (priority and non-priority, clinical and non-clinical ) now having a BCP in place and updating plans to a standard template that prompts responses to the major potential impacts against timescales for recovery. Work was completed to provide a replacement Emergency Helicopter Landing Site in Lerwick. With the redevelopment of the Clickimin running track for the Island Games in 2005 the Emergency Helicopter Landing Site was lost to the community of Shetland. The Shetland Emergency Planning Forum (SEPF) undertook to locate a new emergency landing site close to the Gilbert Bain Hospital. Following a feasibility study on possible sites in and around Lerwick, only one site was deemed suitable that of the overspill car park at the Clickimin Leisure Centre. In November 2008 Shetland Recreational Trust who 5

owns the land agreed in principle to this proposal, the business case was agreed at the NHS Shetland Board in September 2009, and the finished Site was officially opened in May 2010. Incidents Influenza A H1N1v: In April 2009 a new strain of Influenza A (known as Swine Flu) subsequently identified as H1N1 started circulating internationally, and was formally identified as a pandemic in June 2009, circulating worldwide with cases across the UK including Shetland. A local multi-agency response was initiated with the formation of a Pandemic Influenza Control Team (PICT) under the Chairmanship of the DPH. This team co-ordinated responses across the NHS and other services throughout the summer and autumn of 2009, through the phases of containment and treatment, with considerable and detailed contingency planning. An increasing trend of Influenza illness peaked in July 2009 with a smaller second wave through September after which the incidence reduced. There were 68 deaths in Scotland attributed to H1N1, none occurring in Shetland. From October 2009, a vaccination programme was rolled out in Shetland as well as across Scotland, and good uptake was achieved locally. Though the response involved significant effort from all parts of the service, and required the activation of business continuity plans particularly for the public health team, at no time were normal clinical services to patients disrupted in Shetland. The PICT was stood down in January 2010, though national surveillance continues, and H1N1 vaccination is now included in the national seasonal flu vaccination programme. Telephone system failure: an incident occurred in June 2010 when a cut in the microwave link to the Scottish mainland (in Orkney) caused a failure of telephone communication for a number of hours covering the whole of Shetland (and Orkney). Business continuity plans were called into action, and liaison with the other emergency services was put in place via the police service. Sumburgh airport was closed to commercial traffic but arrangements were made for emergency air ambulance traffic if necessary. Alternative internal arrangements for in-hospital communication were also made since the on-call pager system was affected, and there were no adverse outcomes for patient care. Training A training programme is in place, which provides relevant training both within NHS Shetland and in conjunction with partner agencies. Training in 2009 / 10 has included: The annual Emergency Planning Seminar in April 2009 Back to the Future, used lessons learnt from experience to inform future planning. It covered an example of military aid to the civil community, a disaster management researcher focussing on community recovery and care of survivors, lessons 6

learnt from the opening of Terminal 5 at Heathrow, experience of an IT based system of business continuity management in the private sector, and reporting from a project which is part of the Northern Periphery Programme on the cooperation for safety in sparsely populated areas Co-Safe aiming to increase preparedness in remote areas and to develop emergency medical care in extreme conditions. Extensive update training both for the public health team and for NHS staff (and partner agency staff) on the wide range of issues relating to the H1N1 Pandemic, from policy and strategic planning to business continuity testing, to infection control measures, the use of protective personal equipment (including the introduction of face mask testing and fitting), and the delivery of the associated vaccination programme. Training with individual departments within the NHS as part of the support for the development of Business Continuity Plans. Individual Continuing Professional Development (CPD) by members of the Public Health team on aspects of emergency planning including Pandemic Flu and waterborne hazards. In addition, local exercising of plans always includes a de-brief in which specific training issues are identified and actioned within the service. Exercises Bonxie 2 Sumburgh Airport 9 th February 2010: the second phase of a three year modulated exercise tested resources, practice, and the evaluation of existing procedures in a live scenario based on an aircraft crash on Sumburgh airfield. The exercise tested the health service response through ambulance participation, and co-ordination and decision making between the on-site response and the Gilbert Bain Hospital Medical Controller, and other responding services. De-brief was useful and learning from the exercise has been incorporated into the current revision of the NHS Major Emergency Procedures. Responses to the identified weaknesses (in communication and back-up resources in the event of delayed response by the on-call out of hours GP) will be re-tested in the third phase exercise next year. A multi-agency Influenza H1N1 table-top exercise was run for the full Emergency Planning Forum in August 2009 to allow participants to examine resources, plans and existing procedures in relation to Influenza A (H1N1)v. 63 participants from 19 partner organisations attended, included press and local voluntary organisations, and a number of learning and action points were taken back by individual participants and subsequently by the Emergency Planning Forum Executive. 7

Partner exercises A number of exercises were also undertaken by the local Emergency Planning partnership which did not have direct NHS involvement, but which tested aspects of partner agencies emergency preparedness: Access Tingwall Airport 26 th May 2009 Cloudburst Air BP 21 st July 2009 Plover Scatsta Airport 18 th August 2009. Because of the small scale and isolated context of Shetland services, it also continues to be important for local agencies to use national exercises and reports to inform local plans. Risk Management One of the responsibilities outlined in the Civil Contingencies Act 2004 for category 1 and 2 responders is to assess local risks and use this to inform emergency planning, and this is done via Shetland s Community Risk Register which identifies local emergency planning risks, along with remedial actions. The Community Risk Register is updated annually or whenever an incident occurs, to ensure the risks contained therein are correctly assessed. This correlates with the risks identified within Shetland NHS Board s Corporate Risk Register (which has been regularly updated through 2009/10 with respect to emergency planning risks), and the process for risk management within the Board. The Public Health Department Risk Register has also been updated in 2009/10, with more detailed risks (and their management) recorded in relation to the public health team s role in emergency planning. A specific risk in relation to the H1N1 pandemic was raised during 2009 and has been updated throughout the year to reflect the local situation and response (see section on Incidents on page 6 for more detail). Audit and self-assessment The Board s public health team contributed to the Shetland response to an NHS Scotland Quality Improvement Scotland (QIS) assessment on Clinical Governance and Risk Management which had a focus on Emergency Planning as one of the themes, and early feedback has been positive in relation this theme. Audit Scotland published it s Civil Contingencies Report in August 2009, and the local Emergency Planning Forum Executive has considered its response to the recommendations to include in forward planning of local arrangements. 8

The Board s Internal Audit programme included an audit of the Board s Infection Control arrangements against the national QIS standards on Healthcare Associated Infection (HAI). This was considered of particular relevance given the risks relating to HAI and the importance of infection control in prevention not only of individual cases of healthcare associated infection but in outbreak control. The audit included a review of relevant plans, policies and procedures, and the outcome was largely positive. However, five recommendations were made, one of which was considered to be a priority one recommendation: that the Public Health Outbreak Plan was in draft format and needed to be finalised. This has been picked up as a management action and is in the 10/11 work programme with a target completion date of August 2010. Acknowledgements Thanks for help in the preparation of this Annual Report go to Dr Susan Laidlaw, Consultant in Public Health Medicine, and John Taylor and Ingrid Gall, colleagues in the Emergency Planning & Resilience Service of Shetland Islands Council. Dr Sarah Taylor Director of Public Health 2 nd July 2010 9