All acute hospitals in the Republic of Ireland have developed Hospital Major Emergency Plans (HMEP). While most share common characteristics, there are many variations in emphasis, layout and terminology. Evidently, this leads to inconsistency and possible confusion particularly among healthcare staff that rotate between institutions and among other emergency services. In addition, there may also be unintentional lack of alignment with national directives.
Individual hospitals are well versed in handling incidents and emergencies with multiple casualties with long established procedures. More patients will be dealt with, probably faster and with fewer resources than usual, but it is possible to maintain the usual levels of service.
However, a Major Emergency is defined as being ‘beyond the normal capabilities’ and the response to which ‘requires the activation of specific additional procedures’ and may also require the ‘mobilisation of additional resources’. Arrangements for a major emergency should grow from the 'normal' range of emergencies. While coordination of response at 'normal' emergencies is implicitly in place, the Hospital Major Emergency Plan lays down explicit arrangements.
A clear distinction needs to be understood in relation to a ‘Significant Incident’ or a ‘Surge’ which can be managed by utilising long established local hospital procedures versus the formal declaration of a Major Emergency. However, there is no reason why some of the arrangements for coordination of a major emergency cannot be used for a ‘Significant Incident’.
The national inter-agency document ‘A Framework for Major Emergency Management’ defines a Major Emergency as: ‘any event which, usually with little or no warning, causes or threatens death or injury, serious disruption of essential services or damage to property, the environment or infrastructure beyond the normal capabilities of the principal emergency services in the area in which the event occurs, and requires the activation of specific additional procedures and the mobilisation of additional resources to ensure an effective, coordinated response.’
The Framework for Major Emergency Management describes the roles of the three Principal Response Agencies (PRA) – An Garda Síochána, the Health Service Executive and the Local Authority and details the high level coordination between them for planning and response to major emergencies. It also describes the management of casualties at the site of a Major Emergency.
This Guide for Hospital Emergency Planning offers a standard national guidance and accompanying plan template for hospitals and can be seen as part of an overall Health Service Executive standard and guidance in the context of the Framework.
This ‘all hazards’ guide forms a basis for response common to all potential causes of a major emergency (e.g. transport, mass gathering, severe weather, infectious disease, etc.). It places special emphasis on the management of casualties from a Major Emergency at receiving hospitals and the measures required by hospitals to respond effectively.
The content of existing Hospital Major Emergency Plans can be transposed to the template in many cases. The guidance and template should also aid development and revision of plans. The template plan is set at a high level – it should be populated with local detail.
The Hospital Major Emergency Plan facilitates management of the hospital during a major emergency, but does not obviate the need for individual departmental plans. Identification of personnel to fill designated roles, designation of key areas, special directories and appendices of local affiliated plans and areas of risk all need local completion. It is the overall approach to major emergency management and the design and format of plans which needs to be uniform. The detail will vary between hospitals.
The creation of Hospital Groups now allows for arrangements by which individual plans can be adapted such that individual hospital plans can be interoperable with the plans of other hospitals, the HSE region, the National Ambulance Service and those of our partner Principal Response Agencies. At the very outset of an emergency, an unequal load will fall on the ‘nearest’ hospital but the very existence of hospital groups now provides a means by which the impact can be spread over a number of health care facilities.
This Template Plan is underpinned by a number of principles:
- Compatible with HSE Aims & Policy and aligned with national directives
- Not in conflict with related plans particularly that of the National Ambulance Service Major Emergency Plan
- Facilitates an in-built audit process which allows the potential effectiveness of the plan to be demonstrated
- Capability to develop an e-plan
- Not in conflict with the national Framework for Major Emergency Management