Health Service Focus

Emergency preparation

John Ibbotson, general project manager for training & exercises at the Health Protection Agency, spoke to NHE about helping prepare the NHS for every eventuality.

When exercising plans and responses to emergencies, the most important element is to make the test as realistic as possible. There will be no extra resources, high-tech technology or space to think in the middle of a crisis, so controlling these factors allows ordinary plans to be tested in the most extraordinary of circumstances.

The Health Protection Agency (HPA) runs several such exercises each year to develop and test emergency response and planning for organisations, including NHS bodies. Their individual risk registers highlight possible scenarios that would benefit from practising the plans they have in place. Exercises range from small desktop discussions to huge field exercises that simulate an incident with mass casualties.

General project manager for training and exercises at the HPA, John Ibbotson, explained why this is so vital for organisations within the NHS.

He told NHE that expertise throughout the HPA is drawn upon to develop exercises for the NHS. In the past, each SHA area was provided with a bespoke element of training and an exercise once a year, but Ibbotson acknowledged: “We’re in a period of transition where the national annual requirements are changing to a degree.”

Not in isolation

These exercises are developed and implemented with input from individual trusts and staff who will help tailor the exercises to ensure the detailed scenarios reflect the realities of their communities and risk registers.

Ibbotson explained: “The exercises themselves aren’t planned in isolation or on a whim; they’re based on the national risk assessment and prioritised by the DH, and we work quite closely with the DH and the NHS, making sure their priorities are being met.”

These individual risk registers are reviewed throughout the year to highlight specific risks or responses that need improvement or testing.

Ibbotson said: “For the participants in the exercises, it’s actually a scenario based on real risk assessments that they recognise and they have plans for. The topics themselves are largely developed from the ground up, involving local planners in the design, as opposed to top down.”

Exercise design depends on the aim and objectives set and can vary from a desktop, which involves roundtable discussion to rehearse lines of communication, to a command post exercise, which is driven using the real communications people would operate with in a real situation.

The numbers of people involved in each also vary depending on the scope, design and complexity of the exercise. The smallest held last year was Exercise Vespa, with 45 people, and the largest series of exercises involved 628 people. The average desktop exercise ranges between 100-150 NHS participants.

Personal Protective Equipment (PPE) is also tested for effectiveness, particularly by large field exercises where the emergency services are operating with different types of PPE. An example Ibbotson gave was Exercise Milo, which simulated a chemical spill, to test the efficiency and effectiveness of decontamination techniques.

Rehearsing the risks

Although there are always new and emerging potential risks to the health service, the HPA exercises mostly test existing plans. Ibbotson said: “We provide the framework in which operators can rehearse in a safe environment.”

Running such exercises allows trusts to evaluate whether their emergency response systems are adequate in as realistic a situation as possible.

“We set up the exercise to allow them to do that and they can rehearse their plans in a safe environment ahead of any real event,” Ibbotson explained.

The most important factor of emergency planning is training, Ibbotson said, and systematic review of those plans to ensure the relevant people are familiar with the necessary action. Over 3,500 health professionals in the NHS were trained by the HPA last year.

Another type of training is Emergo, a Swedish system that rehearses mass casualties coming into a hospital in a simulated environment. This involves ‘building’ the hospital on whiteboards, displaying all the assets, facilities and beds, while different teams manage the command and control structure for the hospital.

Ibbotson explained: “We put individual casualties with a specific set of symptoms into the system; the teams determine how they’re going to deal with it, how long things are going to happen for and what elements of their facilities would be engaged with those patients. Then they’re able to prioritise and work out the sort of things they need to do to deal with mass casualties.”

It is important to practice such emergencies, as although mass casualties seldom occur, they present a huge challenge to the system.

Emergency planning might be thought to use high-tech, top of the range new equipment, but it is actually about keeping all factors ‘normal’, so the exercise is as realistic as possible. Existing communication systems and practices are used so an authentic response to emergency can be tested.

Simulating social media

However, the HPA does have some technological tricks up its sleeve. “One of the areas which sets the team apart is our ability to simulate external media,” Ibbotson said, as he described the website WNN, created to simulate Sky News and CNN. The agency also has its own version of Twitter – called Twister – and provides Facebook through another online platform called OurPage.

The presence of such social media allows staff to practice communication with the external world during an emergency; something that takes place in real-time, with an opportunity for both “patients” and staff to broadcast their message.

Exercise control staff and professional journalists provide real media pressure around the incident and how it is being handled. As well as making the situation more realistic, this also offers another element of evaluation for those participating.

In Exercise Pamina, a number of people from the various headquarters gave face-to-face interviews to the camera, as they would be required to in real life.

Ibbotson said: “We edited that footage during the exercise and during the feedback session gave complete interviews back to the individuals to have a look and assess themselves on how they performed.

“We’re not really testing the people, we’re testing the plans. A training and exercise needs analysis for all those involved in emergency planning resilience and response in the NHS will provide the evidence base, and it’s mapped against the national occupational standards, in terms of what is actually required over the next few years.”

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