Service Specification for NHS Ambulance Services Hazardous Area

24 Pages·2012·1.24 MB·English

by  Terry Todd

National Ambulance
Resilience Unit
NARU
Service Specification for
NHS Ambulance Services
Hazardous Area Response Teams
April 2012
National Ambulance
Resilience Unit
NARU
Service Specification for NHS Ambulance Services Hazardous Area Response Teams
This document supersedes the Draft Department of Health Guidance for Ambulance
Hazardous Area Response Teams: ‘Managing and Sustaining a HART Capability in
NHS Ambulance Service Trusts – Providing Patient Care Within the Inner Cordon of
Major Incidents and Hazardous Environments (April 2011)’.
It should be referred to in conjunction with the NHS Standard Commissioning
Contract for Ambulance Services. It details the requirements in order to maintain
current HART capability and capacity referred to in the NHS Operating Framework
2012-13.
Responsibility for assuring delivery of DH Policy for Emergency Preparedness,
Resilience and Response in NHS Ambulance Trusts in England is delegated to West
Midlands Ambulance Service NHS Trust, through a Service Level Agreement (SLA),
and these services are provided by the National Ambulance Resilience Unit (NARU).
Within the terms of the SLA are the requirements for delivery of Hazardous Area
Response Teams in each of the ambulance trusts as part of a national capability.
Contents
Section A Foreword 3
Section B Background/ Introduction 4
B.1. Roles and responsibilities 5

Section C Hazardous Area Response Teams (HART) 8
C.1. Purpose 8
C.2. Aims and objectives 8
C.3. Definition and scope 8
1. Requirements 8
2. Location of HART units 9
3. Capabilities 10
4. Types of Incidents Attended 12
C.4. The HART Model 14
1. Introduction 14
2. Recruitment & Selection 14
3. Model Unit 14
4. Deployment 15
5. Training 17
6. Standard Operating Procedures 20
7. Vehicles and Equipment 20
8. HART Estate 21
9. Mutual Aid 23
10. Monitoring and Evaluation 23
11. Outcomes 23
11. Quality Assurance 24
Figures in this This material should be read in conjunction with the NHS Emergency Planning
specification document
Guidance. All material forming that guidance is web based and prepared to be used
are adapted from those
primarily in that format. The web-based versions of the guidance including
kindly provided by
underpinning materials have links to complementary material from other
GWAS HART.
organisations and to examples of the practice of and approach to emergency
planning in the NHS in England.
April 2012 The web version of the guidance is available at www.dh.gov.uk/emergencyplanning 2
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National Ambulance
Resilience Unit
NARU
Service Specification for NHS Ambulance Services Hazardous Area Response Teams
Hazardous Area Response Teams (HART) have been established to enable
ambulance services to save lives in environments where previously, our staff
have been unable to safely operate. The development and implementation of
HART began in 2005 and has been funded and initially managed centrally by the
Department of Health (DH). This was to ensure the concept was set up to a
standard model across each of the ambulance trusts involved. A key factor is
that HART is a national capability and there is therefore a requirement for these
teams to be able to provide mutual aid support to anywhere within the UK. The
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effectiveness of this relies upon safe systems of working being applied in a r
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consistent way wherever they may be deployed. These arrangements are in place w
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in order to protect staff in all of the responding agencies, as well as the public, r
Foreword o
and will enable us to save the lives of patients that might otherwise be lost. F
Since June 2011, responsibility for delivery of emergency preparedness policy in A
ambulance services in England has been delegated to the National Ambulance
Resilience Unit (NARU), hosted by West Midlands Ambulance Trust (WMAS) through
a Service Level Agreement with DH. This includes completion of the roll-out of
HART units and the ongoing coordination, monitoring and assurance of the national
HART capability.
Throughout the development and establishment of these specialist assets, all
aspects of the concept and the operation of HART have been monitored and
evaluated. This learning process is ongoing in order to build a robust evidence base
for HART activity and requirements in respect of new and emerging threats and
risks to public health.
It is important that this specification is adhered to, by Trusts and Commissioning
Bodies, so that the national HART capability remains resilient and prepared across
the whole of England. The purpose of this specification is to ensure that this model
is delivered consistently and maintained appropriately across the country to provide
assurance in the systems in place and ease for mutual aid in the event of complex
or mass casualty incidents.
Keith Prior MSc MCPara
Director
National Ambulance Resilience Unit
Ratified on the 29th March 2012.
By the WMAS NARU SLA Delivery Programme Board.
Date for Review: 1st January 2013
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National Ambulance
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NARU
Service Specification for NHS Ambulance Services Hazardous Area Response Teams
Background
The NHS needs the capability to respond to unconventional incidents. The UK faces a
serious and sustained threat from international terrorism, the level and source of
which is continually monitored and adjusted as required by the Joint Terrorism
Analysis Centre (JTAC). The DH is supporting the PREPARE and PROTECT strands of
the Government’s Counter-Terrorism Strategy (CONTEST 2) by providing health policy
input and coordinating NHS emergency planning to respond to terrorism. DH has
committed to implementing certain aspects of this strategy, including deliverables
around improving the response of the emergency services to incidents involving
Chemical, Biological, Radiological, Nuclear and Enhanced Conventional Weapons
(CBRNE) materials. The HART capability plays a leading role in this response and as
a result, HART is specifically referred to in CONTEST 2 , and the UK Strategy for
Countering the CBRNE terrorism threat. In addition, the Coalition Government
published the National Security Strategy in October 2010. HART provides clinical
response to priority risks identified at Tiers 1, 2 and 3 within this strategy.
The HART capability also forms a major element of the health response within the n
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Home Office National Capabilities Programme to increase UK resilience. In addition ti
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incidents which HART are trained and expected to respond to remain as ‘High Impact’ u
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on the Cabinet Office National Risk Register. Such incidents might include industrial o
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accidents with a HAZMAT component such as the Buncefield explosion; and natural nt
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disasters or incidents that require an Urban Search And Rescue (USAR) response, /
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such as building or trench collapses, or Inland Water Operations (IWO) such as in n
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and around flooding, lakes or waterways; or other incidents that arise in areas of o
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difficult access, such as working at height, in confined spaces or underground.
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The primary aim of HART in all such incidents is to be able to reach patients as quickly B
as possible (by being able to safely enter hazardous environments) to perform
immediate triage, provide life-saving treatment and improve health outcomes for all B
casualties.
There is a continual effort in HART to improve and increase levels of capability in
responding to all types of hazardous incident, whether instigated deliberately as acts
of terrorism, or accidentally or by course of nature, to ensure lives are saved and
health outcomes for casualties are greatly improved.
Throughout the development and introduction of HART great emphasis has been
placed on the importance of building close working relationships with colleagues in
the other emergency services and specialist rescue agencies and this includes
regular exercising and training together and sharing lessons learned. It is essential
that this continues and all policies and procedures are regularly tested in this way.
Throughout this underpinning document, the term ‘emergency’ is used as within the
spirit of the Civil Contingencies Act 2004, i.e. to describe an event or situation that
threatens serious damage to human welfare in a place in the UK or to the
environment of a place in the UK, or war or terrorism, which threatens serious
damage to the security of the UK. To constitute an emergency this event or situation
must require the implementation of special arrangements by one or more Category
One responders.
This specification is built on best practice and shared knowledge, while also
acknowledging that in certain extreme circumstances restrictions or limitations of
April 2012 normal standards of care will be inevitable. It is intended to provide a platform for 4
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National Ambulance
Resilience Unit
NARU
Service Specification for NHS Ambulance Services Hazardous Area Response Teams
all NHS organisations to undertake major incident and emergency planning in
respect to HART resources and to provide information on associated activities that
may also be required. In the context of this Specification, the terms NHS organisation
and NHS Trust includes NHS Foundation Trusts.
HART is referenced in the NHS Operating Framework 2012/13 paragraph 2.45 stating
that Primary Care Trusts (PCTs) must ensure that they maintain the current capability
and capacity of the existing HARTs in Ambulance Trusts. This service specification
should be referred to by Ambulance Trusts and Commissioning bodies during the
commissioning process to ensure this requirement is met.
NARU will undertake audits of ambulance trusts using an assurance framework
based on this service specification.
B.1. Roles and Responsibilities
n
In addition to the general roles and responsibilities set out for the DH, the HPA and o
i
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for NHS organisations in the NHS Emergency Planning Guidance (2005), the c
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following roles and responsibilities are specific to the development and deployment d
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of HART teams : r
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Department of Health d
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to continue to liaise across Government departments to ensure the DH u
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contributes appropriately towards national objectives, for example, in relation r
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to the National Security Strategy, National Capability Programme, CONTEST-2 k
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(Counter-Terrorism strategy) and the Home Office Model Response B
Programme (MR), in the provision of healthcare
to ensure central functions in respect of national training, procurement,
B
policy, procedures, research and development and quality assurance are
provided by the National Ambulance Resilience Unit to ensure the national
capability is maintained, via a service delivery contract with the host
ambulance trust
NHS Ambulance Trusts, including Foundation Trusts
to adhere to the specification within this document to ensure HART capabilities
are managed and maintained in a consistent manner
to participate within the HART governance structure of working groups,
contributing to the ongoing monitoring and development of the capability
to ensure sufficient funding is allocated to cover depreciation costs associated
with HART assets and that these are replaced in line with national
specifications within agreed replacement schedules
Commissioning Bodies
are to ensure that a HART capability will be commissioned to this specification
in accordance with the requirements within the NHS Standard Contract for
Ambulance Services and the NHS Operating Framework
where any additional requirements are identified by the ambulance trusts in
support of this specification, these will be considered after taking advice in
conjunction with the NARU
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National Ambulance
Resilience Unit
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Service Specification for NHS Ambulance Services Hazardous Area Response Teams
Strategic Health Authorities
SHAs are accountable for ensuring that effective arrangements are in place for
the provision and maintenance of HART teams in line with this specification
SHAs will seek assurance from NARU in respect of compliance of Trusts with
this specification.
NHS Acute Trusts including NHS Foundation Trusts
Acute trusts will need to liaise closely with ambulance trusts to ensure
they maintain an appropriate level of awareness and understanding of HART
capabilities such that the care pathway for patients between ambulance
trusts and acute trusts operates safely and seamlessly.
Relevant departments and personnel within acute trusts will need to
participate in training exercises and emergency planning in conjunction
with HART adhering to the Emergency Preparedness Guidelines.
Not For Profit, Non-Government Organisations, registered charities and the
voluntary sector
n
Local Authorities and other rescue organisations (statutory and non- o
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statutory) that fall within this category will need to maintain a level of c
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awareness and understanding of HART capabilities and how they contribute d
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to emergency plans which may include undertaking joint exercising and r
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training. I
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Specialist rescue agencies will need to liaise and work closely with HART d
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in the development of relevant Standard Operation Procedures, to ensure u
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coordinated service delivery to patients r
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National Ambulance
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Service Specification for NHS Ambulance Services Hazardous Area Response Teams
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National Ambulance
Resilience Unit
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Service Specification for NHS Ambulance Services Hazardous Area Response Teams
Hazardous Area Response Teams (HART)
C.1. Purpose
The primary purpose of a HART response is to provide life-saving clinical
intervention, if necessary within the ‘inner cordon’, at a range of emergency
incidents involving hazardous materials and/or environments.
C.2. Aims and Objectives
Key aims of HART are to:
have teams of highly trained NHS ambulance personnel who can respond
rapidly into an incident involving hazardous materials and/or environments,
or in areas where there is difficult access and egress, in order to save life
and improve health outcomes for all casualties
provide early intelligence to the wider health communities, assist in the
rescue operation if required and have the ability to provide rapid medical
assistance to other first responder personnel should the need arise
The programme has established HART as a national1 model delivered by NHS
ambulance trusts in order to support any mutual aid requirements in the event of
mass casualty incidents or multiple, concurrent large-scale incidents. To this end
the development of the selection processes, training courses, standard operating
procedures, clinical protocols and vehicle and equipment specifications are being
taken forward on a national basis. This will ensure that HART personnel will be
able to safely operate anywhere in the country, alongside colleagues from other
HART teams and the other emergency services.
C.3. Definition and scope
C.3.1. Requirements
e
s
1Whilst this policy n
and programme has Responding within the inner cordon of a scene, particularly at a major, hazardous o
p
been instigated and incident, requires different working practices, equipment and systems of work to s
e
led by the DH in a conventional ambulance response where usually single responders or two person R
England, close liaison a
crews are deployed. HART provides a team-based response that needs a high level e
with the devolved rT)
administrations and of multi-agency cooperation and understanding. HART personnel need a range of AR
Crown Dependencies Personal Protective Equipment (PPE) and clinical equipment suitable for use in us HA
has been maintained. these conditions, and the skills and knowledge necessary to operate safely within o(
ds
Scotland, Wales and these environments. Specific behavioural competencies and personal attributes arm
Ninotrrothdeurcnin Igre vlaarniadt aiornes that promote confidence and resilience for working within teams and in very HazTea
difficult circumstances are required to ensure safety and optimal performance, so
of these capabilities to
allow ready provision the recruitment and selection processes are tailored to ensure this happens.
C
of mutual aid across
borders it is therefore Because HART needs to have a 24/7, 365 day capability, each participating
important that the
ambulance trust is effectively deploying 42 WTE (or more if the trust has multiple
same or similar model
HART units) appropriately qualified and experienced ambulance personnel, in
and specifications be
addition to those performing conventional frontline duties. Trusts therefore have
adhered to.
had to backfill these roles to cover this move, in order to maintain performance for
conventional responses. DH funding has been provided to support this.
April 2012 8
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National Ambulance
Resilience Unit
NARU
Service Specification for NHS Ambulance Services Hazardous Area Response Teams
Each HART will have specific and specialised vehicles and equipment to enable the
teams to deploy effectively and safely. There is a requirement therefore, for the
provision of suitable facilities to accommodate them. There are specific
recommendations for accommodation that include statutory measures for
equipment storage, cleaning and maintenance, security measures to protect
assets, and an appropriate environment to support ongoing training and staff
welfare.
Because of the nature of the work, a high level of inter-agency awareness and
cooperation is essential. There is therefore a need for regular multi-agency training
and exercising both locally and nationally.
The HART programme initially concentrated on introducing specific capabilities
within the service: Incident Response Unit (CBRNE/HAZMAT incidents), Urban
Search & Rescue and Inland Water Operations. The range of capabilities has since
expanded to cover response to certain firearms incidents. Decisions to expand or
change the range of capabilities within HART will be assessed by NARU and will
be risk and evidence based in response to changing threats and risks. Introduction
of additional capability will necessarily depend on resources and capacity available.
C.3.2. Location of HART Units
The original programme that began in 2005 sought to establish twelve HARTs
across England. These were to be located in line with the Home Office Model
Response Programme which looks at emergency services response to a CBRNE
type attack in the UK. Three additional teams have been added to the original
objective in 2011/12.
There are 15 HARTs based strategically to enable a 45 minute response to high risk
locations identified within the Home Office Model Response Programme. These
are located in the following Ambulance Trusts (unless otherwise specified each
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Trust currently has one HART): s
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East Midlands s
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East of England – (two teams) R
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Great Western e
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London – (two teams) AR
North East s A
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North West – (two teams) o(
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South Central arm
South East Coast – (two teams) azea
South West HT
West Midlands
C
Yorkshire
Further HARTs may be required in response to the emerging evidence base, the
National Risk Register, increasing threats to national security, and reviews of the
Home Office Model Response.
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National Ambulance
Resilience Unit
NARU
Service Specification for NHS Ambulance Services Hazardous Area Response Teams
C.3.3. Capabilities
Incident Response Unit Capability (IRU)
IRU capability forms the basis for improved response in the event of potential or
actual contamination or presence of hazardous substances or environments,
including in the ‘Hot Zone’ or Inner Cordon. This means that ambulance personnel
can assess, triage and treat casualties quicker than they previously could, by
accessing them earlier. All HART personnel are trained and equipped to provide
IRU capabilities.
Beyond the conventional or CBRNE decontamination ambulance response within
the ‘warm zone’, the IRU capability can work on scene and within the inner
cordon to:
a
Undertake scene risk assessment making use of specialist knowledge
gained in training and liaising with other experts on scene and
online/remotely
a
Work alongside FRS personnel to deploy forward into the inner cordon
or hot zone of an incident to provide emergency medical assistance
a
Facilitate rescue, in conjunction with FRS, of mass casualties at a hazardous
materials incident
a
Operate in varying levels of PPE, based on dynamic risk assessment,
including Gas Tight Chemical Protection Suit (GTCPS) and use of Extended
or Single Duration Breathing Apparatus (E/SDBA)
a
Identify indicators which may determine any materials involved/present
at an incident
a
Undertake rapid clinical reconnaissance to determine:
a
Scale of incident
a
Commencement of (Toxic) Triage
a
Number & distribution of live casualties
a
Clinical toxidromes using clinical diagnostic algorithms in conjunction,
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if possible, with any available scientific data, for example from FRS Detection, s
n
Identification and Monitoring (DIM) teams o
a p
Clinical resources required within the inner cordon to save life s
a e
Provide basic life saving treatment measures, (targeted principally at P1 R
and P2 patients who are clinically at most risk): a
a e)
aToxic Triage (Hot Zone) ArRT
Rescue (evacuate) – using any possible means s A
a uH
Catastrophic haemorrhage control (tourniquets/compression dressings) o(
a ds
aNerve Agent Antidotes (via combo-pens) arm
Inter-Osseous access za
a ae
Assist ventilation via Bag, Valve Mask (BVM) + CBRNE filter HT
a
Oxygen (multiple delivery system where necessary)
a
Provide rapid feedback to ambulance and other Incident Commanders C
regarding scene assessment, clinical resources required and potential
wider health requirements
a
Provide clinical details on rescued patients for effective handover in
warm zone to CBRNE decontamination teams
a
Provide clinical backup and support for colleagues and personnel
working within the inner cordon / hot zone
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