1. 1
Role and responsibilities of the
NHS in emergency response
Dominic Mellon
Specialty Registrar – Public Health

2. 2
Role and responsibilities of the
NHS in emergency response
 NHS command, control and coordination
 The structure of the NHS
 Organisational roles and responsibilities
 NHS role in a chemical, biological, radiological
or nuclear response (HART)
 Hazardous Area Response Teams (HART)
 Scientific and Technical Advice Cell (STAC)
 NHS reorganisation
SUBJECT TO
CHANGE

3. 3
Department of HealthCabinet Office
Civil Contingencies Committee
NHS South West
(Strategic Health Authority)
Regional Coordinating
Group
Primary Care
Trust
AcuteTrusts
SHA
representative
PrimaryCar
Ambulance
Service
Otherhealth
services
Local Health responseLocal Strategic
Coordinating
Centre
(‘Gold’)
Ambulance
Executive
representative
PCT Executive
representative
Operational Level management (Bronze Commanders)
Command and Control

4. 4
Strategic Health Authorities
Role of NHS South West:
 Strategic leadership of the NHS
 Ensuring the local NHS operates effectively
and delivers improved health and healthcare
performance
 Development of NHS organisations and staff
 Delivery assurance, e.g. Civil Contingencies
A compliance

5. 5
Role and Responsibilities
Source: Information about the NHS in the Southwest, NHS Southwest, 2006

6. 6
Role and Responsibilities
Strategic Health Authorities:
 Strategic command and control for widespread
major incidents
 Support coordination of local NHS response
 Coordinate mutual aid/military assistance
 Liaise with the Department of Health
 Assure command of a local response if required
 Asses ongoing situation and identify emerging
issues

7. 7
Primary Care Trusts
Role of Primary Care Trusts:
 14 Primary Care Trusts in the South West
 Primary Care health services:
 General Practitioners;
 Public Health of the local population;
 walk-in centres/ minor injuries units;
 Community hospitals
 Community nurses;

8. 8
Role and Responsibilities
Primary Care Trusts
 Represent the local NHS at Strategic
Coordinating Group
 Coordinate the implementation of the local
NHS response
 Implement arrangements for mass
prophylaxis
 Health monitoring and surveillance
 Manage local health media messages

9. 9
Role and Responsibilities
Acute Trusts
 Activate Major Incident Plans when alerted
by the Ambulance Service
 Establish a control room
 Provide a Medical Emergency Response
incident Team to the scene
 Lockdown hospital
 Decontaminate patients

10. 10
Ambulance Service Trust
Ambulance Service Trusts:
 Two ambulance services in the South West
 Great Western Ambulance Service NHS Trust
(GWAS)
 South Western Ambulance Services NHS Trust
(SWAST)
 The saving of life
 …by instigate a triage process when required
 …by treat casualties
 …by transport casualties to hospital

11. 11
Role and Responsibilities
Ambulance Service Trusts
 To instigate a command and control structure
 To protect the health, safety and welfare of all
health service personnel on site
 To co-ordinate the NHS communications on
site and to alert the main 'receiving' hospitals
for the receipt of the injured
 To carry out a health service assessment for
the incident

12. 12
Specialist incident response
 Special Incident Response Teams (SORT) provide
clinical decontamination and support mass
decontamination
 Specialist equipment:
 National capabilities mass casualty equipment
 Multi-patient oxygen delivery
Ambulance service chemical, biological,
radiological and nuclear incident response:

13. 13

14. 14
NHS Zones
IncidentIncident
SiteSite
Hot ZoneHot Zone
MobileMobile
Decon.Decon.
UnitUnit
De-De-
robbingrobbing
areaarea
ModestyModesty
areaarea
Warm ZoneWarm Zone
CasualtyCasualty
ClearingClearing
Amb.Amb.
LoadingLoading
PointPoint
Cold ZoneCold Zone
HospitalsHospitals
InnerInner
CordonCordon
OuterOuter
CordonCordon
Fire & RescueFire & Rescue Ambulance ServiceAmbulance Service
TriageTriage
OfficerOfficer
Decon.Decon.
operatorsoperators
Decon. Officer

15. 15
Hazardous Area Response
Teams
 The Hazardous Area Response Team (HART) is
a new capability to Great Western Ambulance
Service
 Hazardous Area Response Teams are national
assets
 Provides a capability for ambulance services to
save lives in CBRN or hazardous incidents
 Improve the care provided by ambulance
services inside the inner cordon of major
incidents
 Teams of six provide 24 hour cover

16. 16
 HART provides an incident support capability to
extend paramedic care into a range of
challenging situations:
 Complex/protracted incidents
 Urban Search and Rescue
 Incident Response Unit
 Incidents involving hazardous materials
 Working at height
 Inland water operations
 CBRN decontamination
Hazardous Area Response
Teams

17. 17

18. 18
NHS Blood & Transplant
Role of NHS Blood & Transplant
 Hold reserve national stockpile for Major
Emergencies on behalf of Department of Health
 Stockpile includes nerve agent antidotes and
other counter measures
 Activated by ambulance control to NHS Blood &
Transplant
 Only delivered to hospitals with a transfusion lab

19. 19
Scientific and Technical
Advice Cell
 Multi-agency expert group
 Provide advice to Strategic Coordinating
Group (SCG) on health, scientific and
technical matters
 Activated by SCG chair
 Commonly chaired by Director of Public
Health
 Ensures advice is consistence
 Liaison with national specialist advisors

20. 20
Scientific & Technical Advice
Cell
Regional Civil
Contingencies
Committee
Strategic
Coordinating
Group
Tactical
Operational
Regional
STAC
STAC
Scientific Advice
for Government
in Emergencies
Cabinet Office
Briefing Room
(COBR)

21. 21
Scientific and Technical
Advice Cell
 Members of the Scientific and Advice Cell may
include:
 Director of Public Health
 Health Protection Unit
 Environmental Health (Local Authority)
 Utility companies (water/gas/electric)
 Environment Agency
 Met Office
 Health & Safety Executive
 Site Operator
 Port Health

22. 22
NHS reorganisation
 April 2011 – provider services must be
independent from the Primary Care Trust
 March 2012 Abolition of Strategic Health
Authorities
 March 2013 Abolition of Primary Care
Trusts
 Creation of GP consortia
 Creation of Public Health Service
 Abolition of Health Protection Agency
 Implications for resilience?

23. 23
Department of HealthCabinet Office
Civil Contingencies Committee
NHS South West
(Strategic Health Authority)
Regional Coordinating
Group
Primary Care
Trust
AcuteTrusts
SHA
representative
PrimaryCar
Ambulance
Service
Otherhealth
services
Local Health responseLocal Strategic
Coordinating
Centre
(‘Gold’)
Ambulance
Executive
representative
PCT Executive
representative
Operational Level management (Bronze Commanders)
Command and Control

24. 24
NHS reorganisation
Department of
Health
?
X GP consortia
17 Acute
Trusts
2 Ambulance
Service Trusts
6 Mental
Health Trusts
National
Regional
Local
x Primary Care
Provider
Services
NHS Commissioning
Board
(Including Public
Health Service)

25. 25
Questions?
Jody James
Associate Director Regional Resilience
NHS South West
jody.james@southwest.nhs.uk