Health Emergency Preparedness and Response

Chloe Sellwood, Andy Wapling, Chloe Sellwood, Andy Wapling

• Publisher: CAB International
• Year: 2016
• Print ISBN: 9781780644554
• eBook ISBN: 9781786390431
• Topic: Medicine
• Subtopic: Health Care Delivery

Intensely practical and down to earth, this text covers the breadth of health emergency preparedness, resilience and response topics in the context of inter-disciplinary and whole society responses to a range of threats. It includes public, private and third sector roles in preparation for and in response to natural and man-made events, such as: major incident planning; infectious disease epidemics and pandemics; natural disasters; terrorist threats; and business and service continuity management. The book builds upon the basics of risk assessment and writing an emergency plan, and then covers inter-agency working, command and control, communication, personal impact and business continuity as well as training, exercises and post-incident follow up. Detailing the full emergency preparedness and civil protection planning cycle, the book is illustrated throughout with real-life examples and case studies from global experts in the field for countries with both advanced and developing healthcare systems. This practical handbook covering the essential aspects of major incident and disaster management is ideal for undergraduate and master's students in emergency management and public health, as well as for practitioners in emergency preparedness and civil protection. It will be valuable to all health practitioners from ambulance, hospital, primary and community care, mental health and public health backgrounds.

1 Introduction: Why Do We Need to Prepare?

C. SELLWOOD ¹ AND A. WAPLING ²

¹National Lead Pandemic Influenza, NHS England, London, UK

²Regional Head of Emergency Preparedness, Resilience and Response, NHS England (South), UK

Key Questions

• What is the key underpinning legislation for emergency preparedness, resilience and response (EPRR) in the UK?

• What are the main categories of major incidents and emergencies?

• Who benefits from EPRR processes being embedded in health organizations?

• What could be the repercussions of health organizations not undertaking or engaging in emergency preparedness activity?

• What is the Sendai Framework and why is it relevant to health emergency preparedness?

1.1 Introduction

Incidents and emergencies, by their nature, can occur at any time and in any place. Man-made, accidental or naturally occurring, these can pose significant threats to the health of the population. From earthquakes to terrorism there is a responsibility for communities to have arrangements in place to preserve life, prevent deterioration and promote recovery.

Some of the first questions to consider with regard to emergency preparedness, resilience and response (EPRR) in the health sector is ‘why do we need to plan?’ and ‘why can’t we just use existing systems and processes?’ This book attempts to answer these questions through the subsequent chapters.

Preparing for unique, rare or extreme events results in many benefits to those affected by the emergency, to the responders and to the effective running of organizations. It is important that the response to any major incident is through a structured and coordinated framework within which responders can operate safely and effectively. This is most effective when it reflects existing systems as new processes at the time of an incident response could result in unnecessary suffering and potentially lives being lost. Staff would also face unnecessary stress and resources could be wasted as people and organizations try to respond in an uncoordinated or haphazard manner. This chapter discusses some of the benefits of planning, as well as why we prepare for emergencies.

1.2 Legislative Setting

The UK Civil Contingencies Act (2004) defines an emergency as:

an event or situation which threatens serious damage to human welfare in a place in the UK, the environment of a place in the UK, or war or terrorism which threatens serious damage to the security of the UK.

The Cabinet Office National Risk Register currently identifies a number of threats and hazards to the UK, as illustrated in Fig. 1.1.

Fig. 1.1. Hazards and threats to the UK as identified in the Cabinet Office National Risk Register 2015: (a) risks of terrorist and other malicious attacks (CBR, chemical/biological/radiation); (b) other risks. (Reproduced with permission from www.gov.uk/government/uploads/system/uploads/attachment_data/file/419549/20150331_2015-NRR-WA_Final.pdf under the Open Government Licence (www.nationalarchives.gov.uk/doc/open-government-licence/version/3/).)

The terminology used to describe such events is varied and includes ‘emergencies’, ‘major incidents’ and ‘civil emergency’, among others. Equally, they can range in size and impact from something affecting a village or town (such as localized flooding), to something affecting a discrete population (such as a major transport incident or release of a chemical), to something affecting whole countries or even the world (such as an outbreak of an infectious disease like Ebola or pandemic influenza).

Rightfully health organizations are involved in planning for and responding to more and more scenarios – both health-specific events as well as the health impacts of other emergencies. These include big-bang events such as explosions, cloud-on-the-horizon events such as the plume from a volcanic eruption, and rising-tide events such as pandemics (Table 1.1).

Table 1.1. Types of major incidents and emergencies.

Type	Example
Big bang	An explosion or major transport incident
Cloud on the horizon	A significant chemical or nuclear release developing elsewhere and needing preparatory action
Rising tide	Epidemic or pandemic of infectious disease, or a capacity/staffing crisis (e.g. industrial action)
Headline news	Public or media alarm about an actual or impending situation (e.g. the MMR (measles, mumps, rubella) vaccine issues)
Internal incidents	Utility or equipment failure, fire, hospital-acquired infections, violent crime
CBRN(e)	Deliberate (criminal intent) release of chemical, biological, radioactive or nuclear materials or explosive device
HAZMAT	Incident involving hazardous materials (typically non-malicious)
Mass casualties/fatalities	Incident resulting in significant numbers of casualties or fatalities that would potentially overwhelm the capacity of a single organization to cope

The Civil Contingencies Act (2004) places statutory duties on many organizations in the UK to prepare for and respond to major incidents and emergencies. This was passed into law following a number of major incidents in the UK and overseas. The incidents ranged in size, location and cause, but all affected people and communities. Many of the reviews of these incidents identified common areas for improvement such as better joint working between responding organizations, better capabilities and equipment, and better communication processes.

1.3 Health Service and Systems Preparedness

To paraphrase one of the authors of a later chapter in this book: there are no health emergencies; all emergencies have health aspects. It is increasingly important that health organizations across the breadth of providers and commissioners, in public, private and voluntary sectors, undertake and engage in EPRR activities.

Many organizations in the UK have a legal or statutory obligation to prepare for and respond to major incidents. In addition, it is good practice for all primary, secondary and tertiary health care providers to undertake business continuity management (BCM) processes and to engage with their local communities and partner organizations to ensure they can continue to deliver services during a disruption, or respond to the external challenges of a major incident.

Guidance in the UK for the NHS on EPRR has been led by NHS England since 2013. An overarching framework and annual assurance process, with periodic specialist subject deep-dive assessments, is helping to ensure that EPRR activity is embedded within organizations and accorded due attention and status (https://www.england.nhs.uk/ourwork/eprr/gf/).

In many incident scenarios, health organizations can face a double challenge of both responding to the incident (e.g. treating increased numbers of patients with broken hips or hypothermia during extended periods of severe cold weather) as well as facing the complication of reduced staffing (e.g. due to transport disruption caused by heavy snowfall).

Additionally, health care settings themselves can become the scene of a major incident – such as a fire or flood – which means that the responders themselves equally become entangled in the incident as ‘victims’. In 2008/09 London experienced five hospital fires across the capital that required the evacuation of part or all of the building.

These events proved that with good teamwork, leadership and planning, a safe and successful evacuation of a health care facility is achievable. London’s experiences during 2008/09 demonstrate the critical importance of being prepared for all emergencies.

1.4 Planning in Partnership

We live in an increasingly complex and intertwined society. It is rare that a single, individual organization will be able to respond effectively in isolation to a major incident. There is increasing scrutiny by the public and politicians through instant 24/7 media access. The benefits of getting preparedness and response right are clearly that lives are saved and normality is restored promptly. However, if we get it wrong, reputations can be ruined, trust lost and the financial consequences can be severe.

For some organizations the greatest risk could be the loss of reputation or confidence, which is just as important for health care organizations as it is for finance and retail businesses. For the health service, this could be the risk of failure to provide emergency and life-saving services. EPRR and business continuity processes (Chapter 10, this volume) will help to identify reputational risks ...

Table of contents

• Cover
• Half Title
• Dedication
• Title Page
• Copyright
• Contents
• Contributors
• About the Editors
• Preface
• 1 Introduction: Why Do We Need to Prepare?
• 2 The Planning Process
• 3 Risk Assessment
• 4 Writing an Emergency Plan
• 5 Emergency Planning and Response: Working in Partnership
• 6 Interprofessional Working: Understanding Some Emotional Barriers and Unconscious Processes That Might Influence Practice in Group and Team Work
• 7 Command, Control and Communication
• 8 Communications During a Health Emergency
• 9 Psychosocial and Mental Health Care Before, During and After Emergencies, Disasters and Major Incidents
• 10 Business Continuity
• 11 Training and Exercising for Emergency Preparedness, Resilience and Response
• 12 Post-incident Follow-up
• 13 Mass Casualty Incidents
• 14 Preparedness and Response to Pandemics and Other Infectious Disease Emergencies
• 15 CBRN Incidents
• 16 A Military Case Study
• 17 From Pandemics to Earthquakes: Health and Emergencies in Canterbury, New Zealand
• Index
• Back Cover