Issuu

Heatwave Plan

Version: V3

Ratified by: FiC

Date ratified: 03/07/2024

Job Title of author:

Reviewed by Committee or Expert Group

1. Introduction

This plan provides the framework for coordinating Provides response to a Heatwave or a period of severe weather. It is not a standalone document and supplements the organisation’s existing Major Incident and Business Continuity Plans by providing additional information and guidance specific to mitigating, minimising and responding to the effects and disruptions of a heatwave. In line with national guidance the plan is:

• Constructed to deal with a wide range of scenarios;

• Based on an integrated, multi-sector approach;

• Built on effective service and business continuity arrangements;e

• Responsive to local challenges and needs; and

• Supported by strong local, regional and national leadership measures.

The procedures within this plan are for use within the existing framework for command, control and coordination as detailed in the Provide Major Incident Plan. The activation of procedures from within this plan may or may not put the organisation at either Major Incident ‘STANDBY’ or ‘DECLARED’ status, with the final decision being made by the by the Provide Incident Director. When activated this plan contains procedures that allow the organisation to:

• Receive, and agree appropriate actions arising from, Heat-Health Watch notifications

• Comply with any external reporting requirements and generate local situation reports as required

• Reduce impact of the heatwave (including reducing the likelihood of excess deaths)

• Identify service users that are ‘high risk’ who might be at increased vulnerability during a heatwave

• Ensure that critical services are maintained

• Cope with localised disruptions to services

• Provide timely, authoritative and up-to-date information for staff; and

• Return to normal working after a Heatwave as rapidly and efficiently as possible

This plan like all Provide’s emergency plans will be updated as new guidance is made available and following recommendations from internal (or external) incidents and exercises.

2. Purpose

The aim of this plan is to ensure that Provide can respond to severe weather disruptions to its business in a way that ensures that statutory obligations are met and supports its overall vision and mission.

The objectives of this plan are to ensure:

1. Provide is compliant with its legal and regulatory obligations

2. Critical and essential activities and services are identified, protected and ensure their continuity

3. Stakeholder requirements are understood and can be delivered

4. Staff, service users and the public are properly communicated with

5. Staff receive adequate support and advice in the event of a heatwave.

3. Definitions

The following terms and definitions are included within this document

Term Definition

Business continuity

Business Continuity Incident

Critical Incident

Civil Contingencies Act 2004

Civil Contingencies

Secretariat (CCS)

Capability of the organisation to continue to delivery of products or services at acceptable predefined levels following a disruptive incident

A business continuity incident is an event or occurrence that disrupts an organisation’s normal service delivery, below acceptable predefined levels, where special arrangements are required to be implanted until services can return to an acceptable level.

A critical incident is any localised incident where the level of disruption results in the organisation temporarily or permanently losing its ability to deliver critical services, patients may have been harmed or the environment is not safe requiring special measures and support from other agencies, to restore normal operating functions

The Civil Contingencies Act 2004 (CCA) delivers a single framework for the protection of civil protection in the UK.

The Act divides responder organisations into two categories; Category One and Category Two depending on the extent of their involvement in civil protection work

The Civil Contingencies Secretariat (CCS), or Cabinet Office, is to ensure the United Kingdom's resilience against disruptive challenge, and to do this by working with others to anticipate, assess, prevent, prepare, respond and recover.

Invocation Act of declaring that the business continuity arrangements need to be put into effect in order to continue delivery of key products or services

Major Incident

4. Duties

4.1

Chief Executive

A major incident is any occurrence that presents serious threat to the health of the community or causes such numbers or types of casualties, as to require special arrangements to be implemented.

The Chief Executive has the overall responsibility for emergency preparedness, resilience and response (EPRR) and is accountable to the Board for ensuring that systems are in place to facilitate an effective incident response including the continuity of critical/essential services.

4.2 Accountable Emergency Officer (AEO)

The Chief Executive Officer (CEO) Provide Health is the nominated Accountable Emergency Officer (AEO) who is responsible for ensuring the full implementation of the organisation’s emergency preparedness resilience and response arrangements (on behalf of the Provide Group Chief Executive). The AEO may be called upon to help in the response of any incident that result in the corporate (this) plan being invoked.

4.3

Emergency Preparedness Resilience & Response Manager

The Emergency Preparedness Resilience & Response (EPRR) Manager is responsible for assisting the AEO in implementing the emergency preparedness resilience and response arrangements and where available may be asked to provide advice during the incident response

4.4

All staff

All staff have a role to play in business continuity in raising alerts, assisting service leads/managers in keeping the service running as normal as possible, and being flexible in their working arrangements.

4.5

Heads of Service/Service Leads

Heads of Service/Service leads keep their business-as-usual role in a business disruption including those resulting from a severe weather incident and are responsible forthe coordination ofthe team and functions for which they are usually responsible. All Heads of Service/service leads need to be aware of their team’s essential and critical activities

4.6 Divisional Leads (Operational/Bronze)

The role of the Divisional Leads is to ensure Business Continuity arrangements are implemented within the services. In working hours, they or their nominated deputy are also the first point of contact to manage any incident or disruption that requires extra resources in any of the named teams or functions. Out of hours, this function will be delegated to the most appropriate staff member on duty.

4.7 Director/Manager on-call (Tactical/Silver)

The role of the Director/manager on-call (Tactical/Silver if a major/critical incident has been declared) is to coordinate the business continuity measures across the organisation.

4.8 Director on-call/Strategic (Gold) commander

The Director on-call ( or Strategic (Gold) Commander if a major/critical incident has been declared) sets the strategic direction for the organisations response and provides final oversight and approval for the logs, authorises external situation reports, mutual aid arrangements and communications

5. Consultation and Communication

This plan has been reviewed by the Health & Safety Forum and ratified by the Finance and Investment Committee (FIC).

6. Monitoring

NHS England EPRR Annual Assurance Process

All NHS organisations and providers of NHS funded care are held to account by NHS England for having effective EPRR processes and systems in place. An annual assurance process is used by NHS England to seek assurance that organisations are prepared to respond to an emergency and have the resilience in place to continue to provide safe patient care during a major incident or business continuity event. The indicators are set against the EPRR core standards, and an action plan is agreed against any standard that is assessed as requiring improvement. Progress against the action plan is monitored through the Accountable Emergency officer (AEO) and Senior Leadership Team (SLT)

Business continuity or major/critical incidents will be monitored by the EPRR manager through SLT and any lessons identified will be considered for changes to EPRR practice.

7. Heatwave

information / risk factors / regional and national planning

7.1 Planning information

Increasing temperatures in excess of approximately 25ºC are associated with excess summer deaths, with higher temperatures being associated with greater numbers of excess deaths (as seen in a heatwave); at 27ºC or over, those with impaired sweating mechanisms find it especially difficult to keep their body cool.

When the ambient temperature is higher than skin temperature, the only effective heat-loss mechanism is sweating. Therefore, any factor that reduces the effectiveness of sweating such as dehydration, lack of breeze, tight-fitting clothes or certain medications can cause the body to overheat. Additionally, thermoregulation, which is controlled by the hypothalamus, can be impaired in the elderly and the chronically ill, and potentially in those taking certain medications, rendering the body more vulnerable to overheating.

However, the main causes of illness and death during a heatwave are respiratory and cardiovascular diseases. Part of this rise in mortality may be attributable to air pollution, which makes respiratory symptoms worse. The other main contributor is the effect of heat on the cardiovascular system as in order to keep cool, large quantities of extra blood is circulated to the skin. This can cause strain on the heart, which for elderly people and those with chronic health problems can be enough to precipitate a cardiac event, for example heart failure. Additionally, death rates increase in particular for those with renal disease. A peak in homicide and suicide rates during previous heatwaves in the UK has also been observed.

7.1.1

Sweating and dehydration can also affect electrolyte balance. For people on medications that control electrolyte balance or cardiac function, this can also be a risk. Medicines that affect the ability to sweat, thermoregulation or electrolyte imbalance can make a person more vulnerable to the effects of heat. Such medicines include anticholinergics, vasoconstrictors, antihistamines, drugs that reduce renal function, diuretics, psychoactive drugs and antihypertensives. Ozone and PM10s also increase the level of cardiovascular-related deaths.

Effects of heat on health

The main effects of heat on health are seen in those with existing respiratory or cardiac conditions. However, heat can cause its own specific illnesses including –

Heat Cramps: caused by dehydration and loss of electrolytes, often following exercise.

Heat Exhaustion: occurs as a result of water or sodium depletion, with non-specific features of malaise, vomiting and circulatory collapse. Symptoms include flushed and sweaty appearance, mild cognitive dysfunction with mild confusion and organ dysfunction including decreased urine output and low blood pressure after sitting down or standing up. Left untreated, heat exhaustion may evolve into heatstroke.

Heat Stroke: can become a point of no return whereby the body’s thermoregulation mechanism fails. Heatstroke falls into two categories. Classic heatstroke occurs due to passive exposure to extreme heat; exertional heatstroke occurs as a result of strenuous physical exercise. Symptoms include confusion; disorientation; convulsions; unconsciousness; hot dry skin, hypotension and hyperventilation. It can result in cell death, organ failure, brain damage or death

7.1.2 Heat and excess death

The excess deaths and illness related to a heatwave occur in part due to our inability to adapt and cool ourselves sufficiently. Therefore, relatively more deaths occur in the first days of a heatwave, as happened in 2006 during the first hot period in June (which did not officially reach heatwave status). This emphasises the importance of being well prepared for the first hot period of the season and at the very beginning of a heatwave. High temperatures are also linked to poor air quality with high levels of ozone which are formed more rapidly in strong sunlight; small particles (PM10s) also increase in concentration during hot, still air conditions. Both are associated with respiratory and cardiovascular mortality. Additionally, there may be increases in sulphur dioxide emissions from power stations (due to an increase in energy use for air-conditioning), which in turn worsens the symptoms of asthma.

7.1.3 Heat and urban areas

During a heatwave it is likely to be hotter in cities than in surrounding rural areas, especially at night. Temperatures typically rise from the outer edges of the city and peak in the centre. This phenomenon is referred to as the ‘Urban Heat Island’ and its impact can be significant. In London during the August 2003 heatwave, the maximum temperature difference between urban and rural locations reached 9ºC on occasions.

It should be noted that the effects of a heatwave could be quite vastly different across the organisation dependant on how urban the facility is, and this will need to be monitored.

7.2 Risk factors

7.2.1 People at risk

In a moderate heatwave it is mainly the high-risk groups listed below who are affected. However, during an extreme heatwave normally fit and healthy people can also be affected. High-risk groups include:

Community: Over 65, underlying health conditions, pregnant women, living on own and isolated, severe physical or mental illness; urban areas, south-facing top flat; alcohol and/or drug dependency, homeless, babies and young children, multiple medication, people who are physically active and spend a lot of time outside and people who work in jobs that require manual labour or extensive time outside.

Care home or hospital: over 65, frail, underlying health conditions, pregnant women, severe physical or mental illness; multiple medications; babies and young children (hospitals)

7.2.2

Heat and Respiratory Illness

The heat can affect anyone, but some people run a greater risk of serious harm. Many people who are at higher risk of ill health due to heat are also at higher risk of severe illness from respiratory related illness.

Clinical vulnerabilities that have been linked with worse outcomes from respiratory illness that are also risks for heat related harms are:

• high blood pressure

• chronic obstructive pulmonary disease

• heart and lung conditions (cardiovascular disease)

• conditions that affect the flow of blood in the brain (cerebrovascular disease)

• kidney disease

7.2.3 Medications

Some medications increase the risk of poor health outcomes during hot weather. The medications list below is not exhaustive but should be reviewed to assess the risk and benefits of any changes.

• diuretics, especially loop diuretics, which can lead to dehydration and electrolyte abnormalities.

• medications that interfere with cardiovascular responses such as antihypertensives and antianginal drugs.

• medications that interfere with sweating, such as anticholinergics or beta blockers

• medications that cause diarrhoea or vomiting, such as colchicine, antibiotics and opiates, which can lead to dehydration.

• medications that can impair renal function, such as certain antimicrobials, immunosuppressants, non-steroidal anti-inflammatories, anti-ulcer agents and chemotherapies.

• agents with levels affected by dehydration, such as lithium, digoxin, antiepileptics.

• drugs that alter states of alertness, such as hypnotics, anxiolytics and analgesics

• medications that can interfere with central nervous system thermoregulation, such as neuroleptics and serotoninergic agonists.

• drugs that increase the basal metabolic rate such as thyroxine

7.2.4

Medication Storage

Most medicines are stored at room temperature, also known as “ambient” temperature. This may be expressed on packaging in different ways e.g. “between 15ºC and 25ºC” or “below 30ºC.

If it is foreseeable that there will be temperature excursions in hot weather, steps can be taken proactively to minimise their impact. Staff should monitor stock turnover closely; keep stock levels to the minimum and ensure stock is strictly rotated:

• For high stock turnover areas, this means that the medicines will only be exposed to high temperatures for a brief time before being used.

• For low stock turnover areas, this means that the minimum quantity of medicines will be affected by the excursion.

A system of manually reducing the expiry date on medicines that are frequently exposed to temperatures a few degrees above their required storage temperature may also be used. Please see Appendix E for the process to follow.

7.3

Preventative Measures

The key way of preventing heat-related illness and death is by ensuring people keep themselves cool; the best ways they can achieve this are by –

• Keeping out of the sun between 11am and 15:00

• Wearing sunscreen, hats and loose-fitting cotton clothing

• Avoiding extreme physical exertion

• Drinking plenty of cold drinks and avoiding excess alcohol, caffeine and hot drinks

• Monitoring their daily fluid intake, particularly if they have several carers or are not always able to drink unaided

• Eating cold foods, particularly salads and fruit with high water content.

• Taking cool showers or at least an overall body wash

• Sprinkling their clothes with water regularly and splashing cool water on their face and the back of their neck. A damp cloth on the back of the neck helps temperature regulation

• Ensuring they stay cool at home

• In hospital move the most vulnerable patients to the coolest rooms (ideally less than 26˚)

• Keeping windows exposed to the sun closed during the day and only opening windows at night when the temperature has dropped (please note that security risks will need to be assessed when leaving windows open at night)

• Turning off non-essential lights and electrical equipment.

Provide extra care:

• Keep in regular contact throughout the heatwave, and try to arrange for someone to visit or contact at least once a day

• Keep giving advice on what to do to help keep cool

• During extended periods of raised temperatures ensure that persons over the age of 65 are advised to increase their fluid intake to reduce the risk of blood-stream infections caused by Gram-negative bacteria

UKHSA have produced heatwave guidance that includes leaflets and posters and specific resources for heat risk. These can be accessed via their website https://www.gov.uk/government/publications/heatwave-plan-for-england.

For advice staff. patients and carers can also be directed to https://www.nhs.uk/summerhealth and http://www.sunsmart.com.au/

7.4 Staff advice

During hot weather to help staff remain cool they should consider the following actions;

• Drink plenty of water

• If possible, restrict the length of time that they are exposed to hot conditions and avoid sources of heat and direct sunlight, particularly during the hottest time of the day; 11.00 –15.00

• Dress appropriately, removing layers where possible (as far as possible, whilst complying with dress code, health and safety and infection control requirements of the job); managers are encouraged to be flexible with dress code as long as patient care and safety are not compromised,

• Open windows where possible and shade them by closing curtains or blinds to reduce the heating effects of the sun

• In areas where there is poor air circulation, it may be beneficial to use a fan or air conditioning unit (ACU)

TO NOTE: Portable fans and air conditioning units are an important consideration in maintaining a comfortable environment for service users, staff, and visitors.  However, Portable fans have been linked to cross infection in health and social care facilities. Dust and debris can accumulate on the surface of fans particularly on the internal blades which provides a reservoir for microorganisms and increases the risk of transmission. Therefore, any device for air cooling must be carefully considered and have been subject to a risk assessment approach

Please refer to the Provide Standard Operating Procedure (SOP) for use of Portable fans and ACU’s for further detail.

For staff wearing PPE for prolonged periods;

• Take a drink before donning PPE

• Remove your mask when you can and take regular short breaks, even ten minutes will help

find a quiet spot or social distance in an office

• Frequently apply lip balm and face moisturiser – include your ears

• Beware of sore or red patches on the bridge of your nose or strap contact points behind the ears – loosen the mask or protect your skin with a plaster

• ‘Buddy up’ – ask your colleague or teammate how they are managing the mask and remind them of these tips

For staff working in offices there is no maximum temperature. For areas that are experiencing hot conditions a thermometer should be provided in suitable locations. Each service will need to procure a thermometer ideally with a digital display. Staff should monitor the temperature on a temperature log (see appendix F) and if required seek further advice from Estates and/or the Health and Safety Manager. Incidents involving ill-health effects i.e. nausea, sickness, dizziness, lack of concentration to staff patients or visitors for which heat is thought to be a contributory factor should be recorded on Datix with the temperature log attached

7.5 Regional and national planning

Planning for a heatwave is conducted at a national, regional and local level alongside severe weather now combined in an ‘Adverse Weather Plan for England’ that sets out the responsibilities at a national, regional and local level for alerting people once a heatwave has been forecast, and for advising them on what to do during a heatwave

The core elements of the plan are:

• The ‘Heat-Health Watch’ system that operates from 1 June to 30 September;

• The ‘trigger levels’ and response requirements from all agencies;

• Detailed role of UKHSA, NHS England, Integrated care Boards (ICB), Met Office, Hospitals, NHS Trusts, NHS Providers, Commissioners, Health & Social Care Services and care, residential and nursing homes;

• How the media will provide advice.

The UKHSA Adverse Weather Health Plan and the supporting guides can be found online from the following sources:

https://www.gov.uk/government/publications/heatwave-plan-for-england: http://www.metoffice.gov.uk/weather/uk/heathealth/

8. Heatwave notification procedures

8.1

Heat-Health Watch System

A Heat-Health Watch alert system will operate in England from 1 June to 30 September each year which is in line with other weather warning systems in operation within England and during this period, the Met Office may forecast heatwaves, as defined by forecasts of day and night-time temperatures and their duration.

The Heat-Health Watch system comprises three main alerts (yellow, amber or red) outlined in Table 1 and described in further detail below The alerts will be given a colour (based on the combination of the impact the weather conditions could have, and the likelihood of those impacts being realised).

• A Green Alert is general summer preparedness. No alert will be issued as the conditions are likely to have minimal impact and health but allows the organisation to be ready and plan to escalate the response as required.

• Yellow and Amber Alerts cover a range of potential impacts (including impacts on specific vulnerable groups (for example people sleeping rough) through to wider impacts on the general population) as well as the likelihood (low to high) of those impacts occurring. This

information should aid the organisation in making decisions about the appropriate level of response during the alert period.

• A Red Alert would indicate significant risk to life for even the healthy population. A red warning would be issued in conjunction with and aligned to a red National Severe Weather Warning Service (NSWWS) Extreme Heat warning and is a judgement at national level made as a result of a cross-Government assessment of the weather conditions and occurs when the impacts of heat extend beyond the health sector.

8.2 Met Office National Severe Weather Warning Service (NSWWS)

The Met Office also issues weather warnings through the National Severe Weather Warning Service (NSWWS) for severe weather that has potential for impact to the UK and uses a colour coded matrix system to convey the likelihood of impact and severity. A NSWWS warning alerts the public and emergency responders of a severe weather warning that has a likelihood of low, medium and high impact across various sectors causing widespread disruption such as damage to property, infrastructure and power lines, travel delays and cancellations, loss of water supplies and in the most severe cases, danger to life.

Within any alert that is issued, the combination of impact and likelihood undertaken by UKHSA and the Met Office will be displayed within a risk matrix as illustrated in Appendix A

Table 1

Green Alert Summer Preparedness

No alert will be issued as the conditions are likely to have minimal impact and health. However, during periods where the risk is minimal it is important that organisations ensure that they have plans in place and are prepared to respond should an alert (yellow, amber or red) be issued

Yellow Alert Response

Yellow alerts may be issued during periods of heat in which it would be unlikely to impact most people, however those who are particularly vulnerable (for example the elderly with multiple health conditions and on multiple medications) are likely to struggle to cope, and where action is required within the health and social care sector specifically. A yellow alert may also be issued if the confidence in the weather forecast is low, but there could be more significant impacts if the worstcase scenario is realised. In this situation the alert may be upgraded as the confidence in both the weather forecast and the likelihood of observing those impacts improves

Amber Alert Enhanced Response

An amber alert would represent a situation in which the expected impacts are likely to be felt across the whole health service, with potential for the whole population to be at risk and where other sectors apart from health may also start to observe impacts, indicating that a coordinated response is required. In addition, in some circumstances a NSWWS warning may be issued in conjunction with and aligned to the WHA. This situation would indicate that significant impacts are expected across multiple sectors.

Red Alert Major Incident – Emergency response

A red alert would indicate significant risk to life for even the healthy population. A red health alert would likely be issued in conjunction with a similar appropriate red NSWWS warning, noting that the NSWWS warning also focusses on infrastructure impacts and may have slightly different coverage. Several impacts would be expected across all sectors with a coordinated response essential

As levels are based on a risk and likelihood, there may be jumps between levels. Following Alert level Amber, it is considered best practice to wait until temperatures cool to Alert level Yellow before stopping Alert Amber actions.

8.3 Receiving Heat-health watch Alerts and Activating the Plan

From 1 June to 30 September, the Met Office sends out a Heat-Health Watch alert, which advises as to the current level to the Chief Executive or nominated deputy of every NHS England Region, Health Trusts, local authority and social care organisation in England, and to Health Board CEs and local authority Directors of Social Services in Wales.

Provide is also directly set up to receive Met office alerts; they are sent by email to the Emergency Preparedness Resilience and Response (EPRR) Manager and the generic email address PROVIDE.ep@nhs.net

In the event of receiving an alert from any of the agencies, the EPRR Manager/ Director On-call will assess the alert / warning to determine whether further action is required. Initial further actions may consist of:

• A follow-up call with the issuing agency

• A follow-up email either from the issuing agency or local authority

• Telephone discussion with senior management to agree further actions/monitoring

• Dissemination of alert to staff advising them to carry out the Heat-Health Watch Response Actions as detailed in Section 9

9. HEATWAVE RESPONSE ACTIONS

The Provide Emergency Preparedness Resilience and Response (EPRR) Manager will develop and review the Heatwave Plan on an annual basis ensuring it is fit for purpose and adheres to national guidance. The EPRR Manager will ensure that the actions in this heatwave plan are brought to the attention of relevant staff so that they are aware of all the guidance on minimising and coping with extreme heat related health risks

1 Work with commissioners and partners to develop longer term plans to prepare for heatwaves

2 Work with partners and staff to raise awareness of the impacts of severe heat and on risk reduction awareness.

3 Review business continuity plans ensuring where appropriate they cover a heatwave event (storage of medicines, computer resilience, etc.)

Manager

Yellow alerts may be issued during periods of heat which would be unlikely to impact most people but could impact those who are particularly vulnerable. NHS England, ICBs and/or commissioners will inform health organisations and the Met Office will broadcast public weather warnings.

Community Team Actions

Action

1 Identify individuals who are at risk from extreme heat (see section 7.2 – (these people are likely to be already receiving care) using the table in Appendix A)

2 Identify any changes to individual care plans for those in high risk groups, which might be necessary in the event of a Heatwave

3 Work with the families and informal carers of at-risk individuals to ensure awareness of the dangers of heat and how to keep cool. Where individual households are identified as being at particular risk from hot weather, making a request to Environmental Health to do an assessment using the Housing Health & Safety Rating System (HHRS).

4 Provide advice and support on self-care and heatwave resilience for those at risk. Advise clients or patients on how to keep their own homes cool, using the Beat the heat: keep cool at home checklist Additionally see Appendix B for key public health messages

5 Review surge capacity and the need for, and availability of, staff support in the event of a Heatwave, especially if it lasts for more than a few days.

Owner/Responder

Team Managers/Senior Staff

Team managers/AD’s

Inpatient/Outpatient Area Actions

1 Install indoor thermometers in each room that vulnerable individuals spend substantial time in and, during a Heatwave

2 Create or identify cool rooms (or areas) for high risk groups (see section 7.2). For individuals who cannot be moved to cool areas, or for whom a move might be too disorienting, take actions to cool them down (for example, liquids, cool wipes) and enhance surveillance

3 Where there is the additional risk of psychiatric medications affecting thermoregulation and sweating, teams need to ensure that Heatwave considerations are pre-included within an individuals’ Care Programme Approach.

4 Identify any patients who are receiving medications: as listed in section 7.2 and assess risk.

5 Monitor medication storage areas, see appendix E to ensure steps are taken to minimise impact of high temperatures

6 Assess refrigeration capacity to ensure sufficient cold water and ice are available to reduce risks from dehydration

7 Ensure discharge planning takes home temperatures and support into account

Manager/Matrons/Senior Staff

Managers/Matrons/Senior Staff

9.3 Heat-health watch – Amber Alert (Enhanced Response)

ALERT & READINESS – AMBER ALERT (ENHANCED RESPONSE) ACTIONS

NHS England, ICB’s and/or commissioners will inform the health system of the Amber Alert (Heat-Health alert will also be sent) and the Met Office will broadcast public warning messages via television and radio broadcasts and on http://www.metoffice.gov.uk/weather/uk/heathealth/ Community Team Actions

Action

1 Ensure individuals who are at risk from extreme heat (see section 2.2 - these people are likely to be already receiving care) have been identified using the table in Appendix C as part of the Alert Level Yellow actions

2 Arrange where appropriate any changes to individual care plans for those in high-risk groups and consider including initiating daily visits/phone calls by formal or informal carers to check on people living on their own. Ensure that staff are aware of risk and protective factors.

3 Distributing heatwave guidance to high-risk groups and their carers.

Advise social care or informal carers to contact the GP if there are concerns about an individual’s health.

Owner/Responder

Team Managers/Senior Staff

Inpatient/Outpatient Area Actions

1 Ensure cool rooms are consistently at or below 26oC as this is the temperature threshold at which many vulnerable patients find it difficult to cool themselves naturally if sweating is impaired due to old age, sickness or medication. Identify any naturally cooler rooms that vulnerable patients can be moved to if necessary. Identify particularly vulnerable patients who may be prioritised for time in a cool room. Seek early medical help if an individual starts to become unwell.

2 Check that indoor thermometers are in place and recording sheets printed (in Appendix D) to measure temperature four times a day in patient areas

Identify particularly vulnerable individuals (those with chronic/severe illness, on multiple medications, or who are bed bound) for prioritisation in cool rooms.

4 Monitor and minimise temperatures in all patient areas and take action if the temperature is a significant risk to patient safety, as high risk patients may suffer undue health effects including worsening cardiovascular or respiratory symptoms at temperatures exceeding 26ºC

Team Manager/ Matrons/Senior Staff

Team Managers/ Matrons/Senior Staff

Team Managers/ Matrons/ Senior Staff

5 Continue to monitor medication storage areas, see appendix E to ensure steps are taken to minimise impact of high temperatures

6 Reduce internal temperatures by turning off unnecessary lights and electrical equipment also consider moving visiting hours to mornings and evenings to reduce afternoon heat from increased numbers of people.

7 Make the most of cooling the building at night with cross ventilation (fire doors must never be wedged openunder any circumstance). Additionally, high night time temperatures in particular have been found to be associated with higher mortality rates. Due to the potential increased risk of cross infection that may be induced by cross ventilation, ensure increased vigilance of other routine infection control measures

8 Implement appropriate protective factors, including regular supplies and assistance with cold drinks and water rich foods such as fruits, yoghurt and salad.

9 Ensure that discharge planning takes into account the temperature of accommodation and level of daily care during the Heatwave period

Team Managers/Matrons/Senior Staff

All Staff

Team Managers/ Matrons/ Senior Staff

Team Managers/ Matrons/Senior Staff

9.4 Heat-health watch – Red Alert (Emergency Response)

EMERGENCY – RED ALERT (EMERGENCY RESPONSE) ACTIONS

Central government will declare a Red Alert Level Emergency Response in the event of severe or prolonged heatwave affecting sectors other than health and if requiring coordinated multi-agency response.

This is reached when a heatwave is so severe and/or prolonged that its effects extend outside health and social care, such as power or water shortages, and/or where the integrity of health and social care systems is threatened. At this level, illness and death may occur among the fit and healthy, and not just in high-risk groups and will require a multi-sector response at national and regional levels. A Red Alert is not triggered automatically by a greater than four-day period of severe hot weather.

If a Red Alert Heatwave is declared, it is likely that the organisation may find it necessary to declare a major/critical incident. In this event all Yellow Alert responsibilities will continue to apply and will be used alongside any other major incident response procedures required

10. Heatwave major incident response procedures

10.1

Determining the response

Depending on the type, severity and lead-in time of the Heatwave, the response may be treated as a major incident (especially at Red Alert) when the organisation would invoke the arrangements in the Provide Major Incident Plan (MIP). This should only be invoked if the Heatwave meets the criteria for a Provide major incident. The following anticipated risks must also be considered when determining the response to a Heatwave:

• Transport Infrastructure

• Power supplies

• Environmental pollution

• Wildfires

Water

• Children’s sector • Crops

10.2 Maintaining business continuity

In the event of invocation of the Heatwave Plan, it may be necessary depending on the severity and impact of the Heatwave to invoke business continuity arrangements. For this, Provide has developed Business Continuity Plans that identify the critical activities within each part of the organisation and the resources needed to sustain these activities. The Business Continuity Plans will assist the Provide Incident Director and Tactical (Silver) Command, if in place, in making decisions about allocation of resources during a major incident.

10.3 Record-keeping

During a Heatwave records must be kept of all actions taken in relation to the response to the incident as they would any other major incident. This can be aided by the use of loggists, who will record all the decisions made by the Incident Director and Incident Controllers in the dedicated Log Book. This also includes any filled in Room Temperature Recording Charts in Appendix D

11. Command, control and co-ordination arrangements

11.1 Heatwave Command and Control

The response to Heatwave will be localised at levels Green to Amber and coordinated though the Senior Leadership Team and business as usual arrangements. At Red Alert Level if the Heatwave becomes a ‘DECLARED’ major incident then the usual procedures as contained in the Provide Major Incident Plan will apply alongside all dedicated Heatwave response arrangements as detailed in section 9 of this plan.

The alert levels will act as triggers for initiating internal organisational response arrangements. NHS England will request assurance from organisations as to the impact and mitigation in place during periods of sustained heatwave response at any alerting level.

NHS England East and MSE ICB

NHS England East region with support from the Mid & South Essex Integrated Care Board (MSE ICB) will act as the lead agency for their respective areas, in working with multi-agency partners through the Local Resilience Forum. Provide may be asked to provide assurance that the change in alert level has been circulated, received, and supply information and/or undertake actions as requested. Sitreps may also be required.

12. Communications

12.1

Pre-Heatwave Communications

Before the Health-Heat Watch period in May/June the EPRR Manager along with the Communications team will ensure that staff are aware of the importance of Heatwave planning and of the actions as detailed below.

GENERAL AWARENESS STRATEGY (GREEN ALERT)

• Heatwave Plan advertised through May & June in weekly update & on the intranet.

• All managers reminded of the Green Alert Level Heatwave actions and responsibilities by ADs

YELLOW ALERT - COMMUNICATIONS

• All managers reminded of the Yellow Heatwave actions and responsibilities by the EPRR Manager.

12.2 Communications during a Heatwave

In the event of a Heatwave the Provide Communications team will ensure that staff are aware of Heatwave procedures and receive heat watch health alerts. The Provide Website, Intranet, email system and social media will also be used to provide information to staff and services users.

AMBER & RED ALERTS COMMUNICATIONS

• All areas receive a Heat-Health Watch alert confirming Alert Level Amber

• All managers reminded of the Amber Alert Heatwave actions and responsibilities by the EPRR Manager through an all-staff email.

• If a Major Incident is declared, then all major incident communications procedures as documented in the Provide Major Incident Plan will apply.

13.1 Debrief

A debrief should be held after every Red Alert Level Heatwave response The key aspects of the Provide debrief process are as follows (the full process can be found in the Provide organisational Major Incident Plan);

• It should be held within 4 weeks of the incident

• It should include key players within the organisation who were involved in the response to the incident

• It should address organisational issues, not personal or psychological issues

• It should look for both strengths and weaknesses and ideas for future learning

• It should provide an opportunity to thank staff and provide positive feedback

• It may be facilitated by a range of people within the organisation.

If a multiagency debrief is convened, the key aspects in addition to those above are as follows:

• It should be held within 6 weeks of the incident

• It may be facilitated by a partner agency.

The debrief will help to inform:

• The Provide post Incident report

• Lessons identified from the incident

• An action plan for Senior Leadership Team

13.2 Post-Incident Recovery

The EPRR manager will be responsible for collating and storing all the records, logs and reports associated with the incident. At the same time, the Senior Leadership Team will meet to consider the implications of how the debrief and plan should be reconsidered in light of the lessons identified.

The Provide debrief report, collated by the EPRR Manager, signed off by the Board and a copy sent to NHS England will as a minimum summarise the sequence of events, describe the actions of staff, provide an accurate timeline and report on any lessons identified and associated actions to mitigate any highlighted risks.

After a Heatwave, an assessment should be carried out to review the disruption to Provide functions caused by the incident this should include:

• Effects on staffing (e.g. loss of staff through injury or sickness, impact of overtime worked by staff during the incident on staffing levels)

• Support needs of staff affected by the incident (including trauma support)

• Disruption caused to patient care

• Disruption caused to other Provide functions

• Damage inflicted to Provide property or property the organisation shares

• Financial losses

• Future provision of services in the short/medium and long-term.

Appendix A – UKHSA Risk Matrix

Appendix B – Key public health messages

Appendix C – Patients at risk

Compiling lists of patients ‘at risk’

This section contains the procedure that can be used to produce lists of service users deemed to be at increased risk during Heatwaves. These could include those who are in the following high-risk groups:

Care home or hospital: over 65, frail, underlying health conditions, pregnant women, severe physical or mental illness; multiple medications; babies and young children (hospitals)

‘At risk’ list

It is the responsibility of the Provide clinical teams to identify patients in their locality who will be at increasedrisk during a heatwave. In a Yellow Alert Heatwave the listed individuals or their carers may also need receive advice and information on how to stay cool in warm weather. During an Amber or Red Heatwave the listed individuals will additionally need either a home visit or a telephone call to check on their well-being. Careful co-ordination will be required between health and social care teams to ensure that the appropriate organisations are aware of individuals at risk and is therefore in a position to discharge their responsibilities accordingly. Where possible health and social care teams should where possible share information to pass on any concerned about an individuals wellbeing in a Heatwave.

An example of the type of table to be use for these lists is included below in Word format below. All the data requested, including contact details for the, must be provided to allow the staff to contact the individuals and arrange follow up as required. It will be up community teams to identify those patients who fall into the above at risk groups.

of Spreadsheet: “At risk patients due to be visited – (Team Name)”

Surname

Example

Appendix D – Heatwave Room Temperature Recording Sheet

This chart should be used by all inpatient areas when a Level Two (or above) Health-Heat Watch warning is received. Any room that contains a person (or persons) in a high-risk group for heat related illness should have its temperature monitored 4 times a day If the temperature is found to be over 26°C steps should be taken to bring down the temperature in the room or the individual (or individuals) should be moved to a cool room immediately.

Site Name: __________________________________

Heatwave Room Temperature Chart

Room

Name/Number

Appendix E – Clinic Room Temperature Monitoring

Most medicines are stored at room temperature, also known as “ambient” temperature. This may be expressed on packaging in different ways e.g. “between 15ºC and 25ºC” or “below 30ºC”.

Process:

• Monitor the temperature in the clinical room including treatment rooms using a maximum/minimum thermometer once a day on every working day.

• Room temperature monitoring best if monitored same time each day and the thermometer should be reset after each reading.

• Record the actual, minimum and maximum temperatures on a record log.

• Sign the clinical room temperature record and record that the thermometer has been reset.

• Temperature records must be stored for a minimum of two years.

• If the clinical room temperature is above 25°C first reset thermometer then re-check. If temperature still remains above 25°C for 7 consecutive days then report to Medicines Management Team for an estimate on reduction in shelf life of medicines. Please note Medicines Management Team will need to know the medicines stored to advice appropriately

Actions to be taken if temperatures outside of normal range (15-25°C):

1. Inform your Line Manager.

2. Report to Estates – to determine if ventilation can be improved.

3. Contact Medicines Management to determine if any medicine stocks are heat sensitive.

Optimising Temperature Control

• Air conditioning should be installed, if possible.

• Store medicines away from radiators and warm air ventilation inlets. Direct sunlight may create hot spots, especially in summer. If this is the case, consider moving affected medicines into a shaded location or adding reflective film to the windows.

• Keep windows and doors closed as much as possible. Windows may be opened to aid cooling but only if it is cooler outside and be cautious of security risks

High temperatures and heatwaves

Actions such as those described above are not always possible, or do not give full assurance that the temperature is reliably controlled. If it is foreseeable that there will be temperature excursions in hot weather, steps can be taken pro-actively to minimise their impact.

Monitor stock turnover closely; keep stock levels to the minimum and ensure stock is strictly rotated:

• For high stock turnover areas, this means that the medicines will only be exposed to high temperatures for a brief time before being used.

• For low stock turnover areas, this means that the minimum quantity of medicines will be affected by the excursion.

A system of manually reducing the expiry date on medicines that are frequently exposed to temperatures a few degrees above their required storage temperature may also be used.

Managing Temperature Excursions:

• Take immediate remedial action

Check and rectify obvious causes, e.g. air conditioning switched off, door left open or blinds left open during a heatwave.

Transfer to a more suitable locked storage area if possible. Some medicines (e.g. creams, ointments, suppositories) may be best transferred to a fridge if there is no cool place to store them. Check with Medicines Management Team whether this would be appropriate.

• Gather excursion information

Establish the circumstances

➢ Find out what happened.

➢ Determine how it happened.

➢ How warm the medicines became (maximum temperature reached).

➢ How cold the medicines became (minimum temperature reached).

➢ The total time the storage area was outside its recommended storage temperature range.

• Assess the significance

Most medicines may be stored at temperature up to 25°C, some allow up to 30°C and some medicines have no storage conditions specified by the manufacturer.

− A single, isolated excursion of less than 5°C above the specified maximum storage temperature for less than seven days is unlikely to have an adverse effect on the medicines.

• Confirm if affected medicines can be used

− If temperature still remains above 25°C for seven consecutive days then report to Medicines Management Team. Medicines may still be suitable for use with risk mitigation measures:

➢ The medicine is suitable for use but its remaining shelf-life needs to be shortened.

➢ The medicine is suitable for use but the patient will require additional monitoring.

➢ The medicine is not suitable for use and should be discarded

Appendix F – Heatwave office Temperature Recording Sheet

This chart can be used by staff to record office temperatures. While the law does not specify a maximum temperature, temperatures should normally be at least 16°C in offices and 13°C in workplaces where physical effort is involved. If the temperature is found to be hot actions must be taken to bring down the temperature (see Section 2.3.1). Staff that experience ill health effects i.e. headache, fatigue etc, attributed to the heat should complete a Datix and attach this log.

Service/team: _______________________

Location: