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Guideline

Department of Health, NSW73 Miller Street North Sydney NSW 2060

Locked Mail Bag 961 North Sydney NSW 2059Telephone (02) 9391 9000 Fax (02) 9391 9101

http://www.health.nsw.gov.au/policies/

spacespace

HEALTHPLAN - Medical Services Supporting Planspace

Document Number GL2010_011

Publication date 26-Aug-2010

Functional Sub group Corporate Administration - GovernanceClinical/ Patient Services - Critical careClinical/ Patient Services - Incident managementPopulation Health - Disaster management

Summary This plan is the NSW Health Medical Services Supporting Plan for theNSW Health Services Functional Area Disaster Plan (NSWHEALTHPLAN) developed pursuant to the State Emergency and RescueManagement Act 1989 (as amended). This plan outlines the agreed rolesand functions for the medical services component of NSW Health beingone of the five major contributing health service components thatconstitutes a whole of health response incorporating an all hazardsapproach.

Author Branch Counter Disaster Unit

Branch contact Coral Choi 9320 7627

Applies to Area Health Services/Chief Executive Governed Statutory HealthCorporation, Board Governed Statutory Health Corporations, AffiliatedHealth Organisations - Non Declared, Affiliated Health Organisations -Declared, Public Health System Support Division, NSW AmbulanceService, NSW Dept of Health, Public Health Units, Public Hospitals

Audience Chief Executives, AHS Functional Area Co-ordinator, DisasterCo-ordinators, all staff

Distributed to Public Health System, NSW Ambulance Service, NSW Department ofHealth, Private Hospitals and Day Procedure Centres

Review date 26-Aug-2015

Policy Manual Patient Matters

File No.

Status Active

Director-General

GUIDELINE SUMMARY

GL2010_011 Issue date: August 2010 Page 1 of 1

MEDICAL SERVICES SUPPORTING PLAN

PURPOSE

The attached plan is the NSW Health Medical Services Supporting Plan to the NSW Health Services Functional Area Disaster Plan (NSW HEALTHPLAN) developed pursuant to the State Emergency and Rescue Management Act 1989 (as amended).

This plan identifies the emergency management arrangements necessary for the coordination of medical services at State level when HEALTHPLAN is activated.

The arrangements in this plan will also provide guidance for the preparation of the AHS medical services component of the Area HEALTHPLAN.

KEY PRINCIPLES

The plan outlines the agreed roles and functions for the medical services component of NSW Health being one of the five major contributing health service components that constitutes a whole of health response incorporating an all hazards approach.

The plan identifies recommended actions under four phases: Prevention, Preparation, Response and Recovery. Actions under the Prevention and Preparation phases are recommended to be carried out on a continual basis. Actions under the Response and Recovery phases are recommended to be carried out once the Medical Services Supporting Plan has been activated by the State Health Services Functional Area Coordinator (HSFAC).

The primary role for medical services in the response phase will be to manage multiple casualties and potential casualties using central coordination to ensure the provision of definitive care as rapidly as possible.

USE OF THE GUIDELINE

Responsibilities of key parties are detailed in Part Two of the Medical Services Supporting Plan. The plan should be communicated to those with roles and responsibilities under this plan and the HEALTHPLAN.

REVISION HISTORY

Version Approved by Amendment notes

August 2010 (GL2010_011)

Director-General New guideline issuing the Medical Services Support Plan

ASSOCIATED DOCUMENTS

1. NSW Health Medical Services Supporting Plan to HEALTHPLAN

NSW HEALTH MEDICAL SERVICES

SUPPORTING PLAN TO

NSW HEALTHPLAN

August 2010

Medical Services Supporting Plan

Page ii

TABLE OF CONTENTS

AUTHORISATION vi DEFINITIONS viii TABLE OF ACRONYMS xvii PART ONE – INTRODUCTION 1

GENERAL .......................................................................................................... 1

Authority 1 Structure 1 Scope 2 Legislation 2 Related Plans 3 AIM 3

CONCEPT OF OPERATIONS ............................................................................ 3

GENERAL PRINCIPLES .................................................................................... 6

SPECIAL CONSIDERATIONS FOR MEDICAL SERVICES RESPONSE PLANNING ................................................................................................. 7

Time Delay to Resuscitation 7 Time Delay to Surgery 7 Vulnerable Populations Assessment 7 Mass Gatherings and Major Events 8 Remote Area Planning 8 Detainees in custodial / correctional / detention centres 8

PART TWO – ROLES AND RESPONSIBILITIES 9

APPOINTMENTS ............................................................................................... 9

State Medical Controller 9 Area Health Service Medical Controller 9 Health Commander 10 Medical Commander 10 Health Response Team Leader 11 Health Triage Officer 11

ORGANISATIONS ............................................................................................ 11

Medical Services 11

NSW HEALTH RELATED SERVICES ............................................................. 12

NSW Health Counter Disaster Unit 12 NSW Health Pharmaceutical Services Branch 13 Ambulance Service of NSW Aero-Medical & Retrieval Services (AMRS) (formerly referred to as MRU) 13 NETS (NSW Neonatal and Paediatric Emergency Transport Service) 14


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NSW Health Departments of Forensic Medicine 14 The NSW Institute of Trauma and Injury Management (ITIM) 15 Statewide Services Development Branch (SSDB) 15 Intensive Care Coordination and Monitoring Unit (ICCMU) 16 NSW Severe Burn Injury Service 16 NSW Health Support Service (HSS) 16

AREA HEALTH SERVICES ............................................................................. 16

Area Health Service Resource Management 17 Health Care Facility Plans for Internal Emergencies 19 Business Continuity Planning (formerly Critical Operations Standing Operating Procedures) 20 Health Care Facility Plans for External Emergencies 20 External Plans for External Emergencies 20 Justice Health Area Health Service 21

SUPPORTING AND PARTICIPATING ORGANISATIONS ............................. 21

Australian Red Cross Blood Service 21 Royal Flying Doctor Service 22 St John Ambulance Australia (NSW) 22 Other Organisations 22 Private Hospitals 22

General ............................................................................................................ 24

NOTIFICATION ................................................................................................ 24

Pre-hospital 24 Hospital 24 Activation of Medical Services Plan 25 Incident Escalation 26 Key Appointments in Medical Services Supporting Plan 26 The Incident Management Team (IMT) at the Site 27 Operation Centres 27

COORDINATION .............................................................................................. 28

Authority 28 Boundaries 28

COMMUNICATION ........................................................................................... 28

PART FOUR – FIELD TRIAGE AND MANAGEMENT OF CASUALTIES 30

General ............................................................................................................ 30

Aims of Triage ................................................................................................. 30

Triage Priorities ............................................................................................... 30

Triage Labelling .............................................................................................. 31

Triage and Evacuation Map ........................................................................... 31


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Triage Sieve ..................................................................................................... 31

Triage Sort ....................................................................................................... 32

Treatment ........................................................................................................ 34

Transport Triage ............................................................................................. 34

Default Operations Strategy (Metropolitan Mass Casualty Management System) ................................................................................................... 35

Deceased Victims ........................................................................................... 35

Documentation ................................................................................................ 36

PART FIVE – HEALTH RESPONSE TEAM EQUIPMENT 37

Health Response Team Uniform .................................................................... 37

Health Response Team Kits (Medical) .......................................................... 38

PART SIX - ADMINISTRATION AND TRAINING 39

ADMINISTRATION ........................................................................................... 39

General 39 Planning 39 Financial Responsibilities – Expenditure and Recovery of Funds 39 Workers Compensation 39 Logistics Support 39 Review, Testing and Evaluating 40

TRAINING ........................................................................................................ 40

General 40 Health Response Team Training 40 Skills Training 41 Skills Acquisition and Maintenance 41 Evaluation of Training 41 Exercises 42 Exercise Reports 42 Operational Debriefs and Reports 42

ANNEX A – ACTION CARDS 43 ANNEX B - INCIDENT ESCALATION 51 ANNEX C – NSW HEALTH INCIDENT MANAGEMENT STRUCTURE UNDER HEALTHPLAN ACTIVATION 53 ANNEX D - TRIAGE and EVACUATION MAP 54


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ANNEX E - TRIAGE SIEVE PROCESS 55 ANNEX F – FIRST CASUALTY ESTIMATE 56 ANNEX G – MEDICAL RECORD (FIELD / EVENT) 57 ANNEX H – ARRIVALS AND MOVEMENT REGISTER – DISASTER PATIENTS 61 ANNEX I - HEALTH PERSONNEL FORM 62 ANNEX J – PRE-DEPLOYMENT REGISTRATION FORM 63 ANNEX K – HEALTH RESPONSE TEAM MEDICAL EQUIPMENT KIT AND UNIFORM LOCATIONS 64


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AUTHORISATION The New South Wales Health Medical Services Plan has been prepared as a supporting plan to the New South Wales Health Services Functional Area Disaster Plan (HEALTHPLAN) to coordinate medical resources in the event of health emergencies.


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AMENDMENT LIST Proposals for amendment or addition to the contents of the NSW Health Medical Services Supporting Plan to NSW HEALTHPLAN are to be forwarded to:

State Medical Controller NSW Health Counter Disaster Unit Ambulance Service of NSW State Headquarters Locked Bag 105 ROZELLE NSW 2039

Amendments promulgated are to be certified in the under mentioned amendment sheet when entered.

VERSION DATE COMMENTS

0.1 to 0.9 February 2009 Draft for AHSs consultation and comments

1.0 October 2009 Endorsed by State Medical Controller

1.5 Feb 2010 Endorsed by Chief Health Officer

1.5 May Tabled at the HSFAC meeting

1.5 June Tabled at the SEAB meeting

1.6 July Incorporated endorsed Disaster Patient Record form

1.6 August Endorsed by DG and published through Policy Distribution System


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DEFINITIONS NOTE: The definitions used in this plan are sourced from the NSW State Emergency and Rescue Management Act 1989, (as amended), the NSW State Disaster Plan (Displan), NSW HEALTHPLAN and various Functional Area Supporting Plans. Where possible, the reference source is identified as part of the definition e.g., the State Emergency and Rescue Management Act (1989), as amended, is identified as SERM Act. All Hazards Approach The application of one set of control, coordination and communication

policies and procedures in a universal manner to emergency situations of varying type thereby promoting consistency of emergency management at all levels.

Area Health Services Area Health Services are the administrative units of NSW Health and are

defined by geographical boundaries. An Area Health Service is responsible for the administration of NSW Health’s policies and responsibilities within those geographical boundaries.

Area Health Services Functional Area Coordinator (Area HSFAC) An appointed position at Area Health Service level that has the delegated

authority of the Area Chief Executive to coordinate and commit Area resources for the response to and recover from an emergency. The Area HSFAC will be the initial point of contact within an Area Health Service for an emergency and notify the State HSFAC of any emergency that may require State level co-ordination or support under HEALTHPLAN.

Area Health Service Disaster Control Centre In this plan means a centre established specifically to provide centralised

coordination of Area Health Service resources and responses to an emergency

Area Medical Controller This position assumes control and coordination of Area medical resources

following activation of the Area HEALTHPLAN. The Area HSFAC is responsible for the appointment of this position.

Casualty A person who is injured or killed in an emergency Casualty Clearing Station Established at the emergency site when casualties who require definitive

care are unable to be transported immediately or the magnitude of casualties dictates the establishment of a treatment area. Health Response Team personnel will operate from this area under the direction of the Medical Commander to provide clinical management of casualties.


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Chief Executive The appointed position that leads the governance and management of the Area Health Service responsible for the effective exercise of the Area’s statutory powers, authorities, duties and functions consistent with NSW Government policy.

Chief Health Officer

The most senior registered medical practitioner within NSW Health, responsible to the Director-General of Health.

Combat Agency The agency identified in Displan as the agency primarily responsible for

responding to a particular emergency. (Source: SERM Act as amended). Command The authority to command is established in legislation or by agreement

with an agency / organisation. Command relates to agencies / organisations only and operates vertically within an agency / organisation.

Control The overall direction of the activities, agencies or individuals concerned

(Source: SERM Act). Control operates horizontally across all agencies / organisations, functions and individuals. Situations are controlled.

Coordination The bringing together of agencies and individuals to ensure effective

emergency and rescue management but does not include the control of agencies, organisations and individuals by direction. (Source: SERM Act).

Cross Border Health Committee In situations where health services have a shared border the

establishment of cross border health committees will facilitate the effective sharing of resources and specialist expertise thereby reducing any unnecessary duplication of those resources.

Debrief A meeting held during or at the end of an operation with the purpose of

assessing the conduct or results of an operation. Delegate A person nominated to act as the representative of an officially appointed

position holder, having the same powers and authority to commit the resources of the official appointee.

Director-General of Health The Director General, NSW Health.


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Disaster An occurrence, whether or not due to natural causes, that seriously

disrupts the functions of a community. A disaster will generate a large number of casualties and overwhelm the capacity of immediately available resources to manage the situation.

Displan The New South Wales State Disaster Plan is also known as Displan. The

purpose of Displan is to ensure the coordinated response to emergencies by all agencies having responsibilities and functions in emergencies (Source: Displan).

Emergency Means an emergency due to the actual or imminent occurrence (such as

fire, flood, storm, earthquake, explosion, accident, epidemic or warlike action) which:

(a) endangers or threatens to endanger, the safety or health of persons

or animals in the State; or (b) destroys or damages, or threatens to destroy or damage, any

property in the State, being an emergency which requires a significant and coordinated response.

For the purposes of the definition of emergency, property in the State

includes any part of the environment of the State. Accordingly, a reference in the Act to:

(a) threats or danger to property includes a reference to threats or danger to the environment, and

(b) the protection of property includes a reference to the protection of the environment. (Source: SERM Act).

Emergency Management District The State is divided into emergency management districts as determined

by the Minister for Emergency Services. Emergency Risk Management The concept of emergency risk management has been adopted and used

in Australia since 1995 when Standards Australia and Standards New Zealand published AS/NZS 4360 Risk Management and its subsequent revision (AS/NZS 4360:2004). This standard was developed ‘with the objectives of providing a generic framework for identification, analysis, assessment, treatment and monitoring of risk’. This standard provides a generic guide to assist Emergency Management Committees develop and review emergency management arrangements by focussing on the causes of risk, rather than on emergencies that may result from risk.

Emergency Services Organisation Means The Police Service, NSW Fire Brigades, Rural Fire Service,

Ambulance Service, State Emergency Service, Volunteer Rescue


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Association or any other agency which manages or controls an accredited rescue unit (Source: SERM Act).

Functional Area A category of services involved in the preparations for an emergency,

including the following: a. Agriculture and Animal Services; b. Communication Services; c. Energy and Utility Supply Services; d. Engineering Services; e. Environmental Services; f. Health Services; g. Public Information Services;

h. Transport Services; and i. Disaster Recovery Human Services. Functional Area Coordinator The nominated coordinator of a Functional Area, tasked to coordinate the

provision of Functional Area support and resources for emergency response and initial recovery operations, who by agreement of Participating and Supporting Organisations within the Functional Area, has the authority to commit the resources of those organisations.

Health Commander

The commander appointed by the State HSFAC to coordinate and control all health operations at the incident site. The Ambulance Commander operates as Health Commander unless the State HSFAC determines otherwise.

Health Communications The Director, Media and Communications Branch of the NSW Health is responsible for coordinating responses to media inquiries with a well-organised strategy to manage the communications aspects of major health emergencies.

Health Emergency

An emergency due to actual or imminent occurrence, which endangers or threatens to endanger the safety and health of persons in the state of NSW, and requires a significant and coordinated whole-of-health response. This particularly applies to human infectious disease emergencies from whatever cause.

Health Incident A localised event, either accidental or deliberate, which may result in

death or injury, which requires a normal response from an agency, or agencies from one or more of the components of NSW Health.


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Health Response Teams

Medical, Nursing and other health professionals selected for a response to an emergency at the emergency site, a receiving hospital or emergency medical facility. The composition of the team will be determined by the relevant State Controller and will only respond at the request of the relevant State Controller in consultation with the State HSFAC.

Health Services Any medical, hospital, ambulance, allied health, community health or

environmental health service or any other service relating to the maintenance or improvement of the health, or restoration to health, of persons or the prevention of disease in or injury to persons (Health Administration Act, 1982 No 135).

Health Services Disaster Control Centre (HSDCC)

Is the state level Health services operations centre and is manned when HEALTHPLAN is activated. The HSDCC incorporates all elements of the strategic level management of an emergency and can include the State Ambulance Emergency Operation Centre (EOC).

Incident A localised event, either accidental or deliberate, which may result in

death, injury or damage to property, and which requires a normal response from an agency or agencies

Major Incident An incident involving, or having the potential to involve a large number of

casualties which can be adequately managed by the available resources but which requires a significant and coordinated response involving those resources.

Mass Gatherings

Mass gathering have been defined by the World Health Organisation (WHO) as “events attended by a sufficient number of people to strain the planning and response resources of a community, state or nation”.

Mass Casualty Incident An occurrence that threatens to overwhelm the resources of hospitals

and health care systems and is likely to impose a sustained demand for health services rather than the short demand associated with incidents.

Medical Equipment Kit A standardised set of equipment maintained and managed by each Area

Health Service in readiness for deployment when requested by the State HSFAC to support Health Response Team(s) in an emergency.


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Medical Retrieval Medical Retrieval is the transfer of patients with critical illness or injury

whose condition warrants either stabilisation prior to transport or management during transport by an escorting doctor.

Medical Services In this plan encompasses all Area Health Services, public hospitals and

associated community health services within NSW. The willingness of private hospitals to participate in a whole of Health emergency response is recognised as being the responsibility of each AHS to negotiate at area level.

Memorandum of Understanding A non- legally binding document exchanged between two consenting

agencies / organisations that identifies terms including the purpose, boundaries, roles and responsibilities of the consenting agencies / organisations and the life of the document.

NSW Health NSW Health is the combat agency for health emergencies within NSW.

Five major contributing health service components constitute the whole of health response incorporating an all-hazards approach. They are:

a. Medical Services; b. Ambulance Services; c. Mental Health Services; d. Public Health Services; and e. Health Communications. Participating Organisations Statutory authorities, volunteer organisations and other agencies who

have given formal notice that they are willing to participate in the event of an emergency in NSW.

Personal Protective Equipment (PPE) PPE provides protection to the body of the wearer in an emergency

response. In addition to providing protection, PPE must also be durable and comfortable. It must also visually distinguish the wearer at the emergency scene by identifying position (if appropriate) and agency / organisation.

State of Emergency A state of emergency declared by the Premier under Section 33 (1) of the

State Emergency and Rescue Management Act (1989), as amended. NOTE: Other New South Wales legislation also provides for a declaration

of an "emergency" which has different meanings and different authorities within that specific legislation – that is: Essential Services Act, 1988: Dam Safety Act, 1978: and Rural Fires Act, 1997 (as amended).


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State Emergency Management Committee (SEMC) The committee constituted under the State Emergency and Rescue

Management Act, 1989 (as amended), as the principal committee established under this Act for the purposes of emergency management throughout the State, and, in particular, is responsible for emergency planning at State level.

State Emergency Operations Controller (SEOCON) The person appointed by the Governor, on the recommendation of the

Minister, responsible, in the event of an emergency, which affects more than one District, for controlling the allocation of resources in response to the emergency. The appointee establishes and controls the State Emergency Operations Centre (SEOC) (Source: SERM Act).

State Emergency and Rescue Management Act (1989, amended) (SERM Act)

The Act relating to the management of State level emergencies and rescues.

State Health Services Functional Area Coordinator (State HSFAC)

Is a senior officer appointed by the SEMC in accordance with Minister’s direction, who has the responsibility for the control and co-ordination of the Health Functional Services Area response as detailed in HEALTHPLAN. The State HSFAC is contactable 24 hours through the Ambulance Service of NSW.

Subplans

A plan prepared by an agency/organisation of functional area, which describes the management arrangements and support required for dealing with a specific hazard or emergency. A subplan is made under HEALTHPLAN when a specialised response is required for a particular hazard or emergency.

Supporting Organisations Organisations that have indicated a willingness to participate and provide

specialist support resources to an emergency. Supporting Plans

A plan prepared by an agency / organisation or functional area, which describes the support to be provided to the controlling or coordinating authority during emergency operations. It is an action plan which describes how the agency / organisation or functional area is to be coordinated in order to fulfil the roles and responsibilities allocated eg. AMPLAN, which is a supporting plan to HEALTHPLAN.


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Situation Report (SITREP) A brief sequenced report which outlines the relevant details of the effects

of the event, the needs generated, and the responses undertaken and planned.

Staging Area A pre-arranged, strategically placed area where ambulance and other

health personnel, equipment and vehicles can be held in readiness to respond to a major incident or emergency.

Standing Operating Guidelines The internal response guidelines which document operational and

administrative procedures to be used during activation of this plan Surge Capacity During a health emergency, hospitals will have to convert quickly from

their current care capacity to surge capacity— the maximum patient load a hospital or medical system can handle. Surge Capacity is managed through a re-prioritisation of health care needs to provide essential services to mass casualties eg. cancellation of elective surgery, diversion of patients with minor complaints or early discharge of hospitalised patients.

Tactics The tasking of personnel and resources to implement the incident

strategies. Incident control tactics are accomplished in accordance with appropriate agency procedures and safety directives.

Trauma Bypass A system of trauma management that is particularly applicable to

metropolitan areas where some hospitals are bypassed in accordance with defined protocol for patients with severe trauma to be preferentially transported to a major trauma centre.

Triage The process by which casualties are sorted prioritised and distributed

according to their first aid, resuscitation, emergency transportation and definitive care needs.

Triage Area An area generally established at the entrance to the Casualty Clearing

Station specifically for triage of casualties by the Health Triage Officer as they are brought to the area from the field.

Triage Labels A form of patient medical documentation usually in the form of labels

which can be attached to the patient and which clearly identifies the individual’s priority for treatment and transport, and on which basic details of assessment and treatment are recorded


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Urban Search and Rescue (USAR)

An integrated multi-agency response which is beyond the capability of normal rescue arrangements to locate, provide initial medical care and remove entrapped persons from damaged structures and other environments in a safe and expeditious manner. The organisation of these responses is detailed under the Major Structural Collapse sub-plan to Displan.

Whole of Health

HEALTHPLAN provides for five major contributing health service components (see NSW Health), which constitutes the whole-of-health response incorporating an all-hazards approach and outlines their agreed roles and functions.


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TABLE OF ACRONYMS AHS Area Health Services AMRS Aero-medical and Medical Retrieval Service AMRU Aero-medical Retrieval Unit AOC Aero-medical Operations Centre ASNSW Ambulance Service of NSW CBR Chemical Biological Radiological CDU NSW Health Counter Disaster Unit COSOPs Critical Operations Standard Operating Procedures DISPLAN NSW State Disaster Plan DHS (CS) Department of Human Services (Community Services) DVI Disaster Victim Identification EOC Emergency Operations Centre HEMC Health Emergency Management Committee HSDCC Health Services Disaster Control Centre HSFAC Health Services Functional Area Coordinator IAP Incident Action Plan ICCMU Intensive Care Coordination and Monitoring Unit ICU Intensive Care Unit ICS Incident Control System IMT Incident Management Team ITIM Institute of Trauma and Injury Management NETS NSW Neonatal and Paediatric Emergency Transport

Service PPE Personal Protective Equipment SEOC State Emergency Operations Centre SEMC State Emergency Management Committee SEOCON State Emergency Operations Controller SSDB Statewide Services Development Branch USAR Urban Search and Rescue


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PART ONE – INTRODUCTION GENERAL

Authority 101 This plan is the NSW Health Medical Services Supporting Plan to the

NSW Health Services Functional Area Disaster Plan (NSW HEALTHPLAN) developed pursuant to the State Emergency and Rescue Management Act 1989 (as amended).

Structure 102 NSW State Disaster Plan (Displan) identifies NSW Health Services

Functional Area role as that of coordination and control of the mobilisation of all health responses to emergencies within NSW.

103 NSW HEALTHPLAN identifies the primary role for the medical services

component of NSW Health as that of coordinating a medical services plan for the prevention, preparation, emergency response and subsequent recovery from the impacts of an emergency.

104 Incident Control System (ICS)

With the activation of this plan the Incident Control System (ICS) will be utilised. ICS involves four broad functional areas:

a. Control: This function has the overall responsibility for the management of the incident, which includes managing all the people involved and liaison with the relevant authorities. The control function approves and takes responsibility for a plan to deal with the incident.

b. Operations: This function deals with the incident. It determines the

effect of strategies and contributes feedback to the development of an action plan. NSW Medical Services Supporting Plan outlines the medical services’ component of the Operations Unit under the ICS Incident Management Team and the key position holder is the State Medical Controller as the Operations Unit Leader when this plan is activated.

c. Planning: This function gathers and analyses all the relevant

information about the incident, and predicts future development and plans a response.

d. Logistics: This function supplies all the resources needed to respond

to the incident. It maintains all the facilities and services that are part of the operation.


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The type and scale of the incident does not affect the principles of the ICS. In a very large event such as a mass casualty incident, there will be multiple layers to the response structure e.g., national, state, and regional, but the functions of control, operations, planning, and logistics will operate for all of these layers.

105 The paramount position holder concerning health emergency operations is the State Health Services Functional Area Coordinator (State HSFAC).

106 The paramount position holder concerning medical services emergency

operations is the State Medical Controller. 107 This plan outlines the agreed roles and functions for the medical services

component of NSW Health being one of the five major contributing health service components that constitutes a whole of health response incorporating an all hazards approach.

Scope 108 This plan encompasses all public hospitals and community health

services within NSW. It also makes provision for the role of private hospitals in a whole of Health coordinated response when HEALTHPLAN is activated.

109 The NSW Health Medical Services Supporting Plan will not be activated

in isolation of HEALTHPLAN activation. 110 This plan identifies the emergency management arrangements

necessary for the coordination of medical services at State level when HEALTHPLAN is activated.

111 The arrangements in this plan will also provide guidance for the

preparation of the AHS medical services component of the Area HEALTHPLAN.

112 The NSW Health Medical Services plan relies heavily upon the

Ambulance Service of NSW as the initial emergency service responder, the major communications provider, and as the principal transport organisation for the NSW Health.

Legislation 113 Legislative Acts and their respective Regulations pertinent to all agencies

having responsibilities under this plan remain applicable whilst this plan is activated.


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Related Plans 114 The following plans should be read in conjunction with this plan:

a. NSW State Disaster Plan (Displan);

b. NSW HEALTHPLAN;

c. Ambulance Service NSW State Major Incident / Disaster Plan (AMPLAN);

d. Public Health Services Supporting Plan / Standing Operating

Guidelines;

e. NSW Health Influenza Pandemic Action Plan;

f. Mental Health Services Supporting Plan

g. Health Communications Supporting Plan

AIM 115 The aim of this plan is to identify the emergency management

arrangements necessary at State level for the coordination of the medical services component of a whole of Health response including the supplementation of resources when HEALTHPLAN has been activated.

CONCEPT OF OPERATIONS 116 Prevention Phase. Prevention (mitigation) measures are designed to

avoid (or reduce) the consequences of emergencies on the community. The medical services component of NSW Health will achieve this through:

a. conducting emergency risk management at the state, area and local

level; b. the NSW Health Emergency Management Committee (HEMC)

which is the principal committee that provides advice to the Director General of NSW Health in exercising his or her functions and responsibilities in relation to emergency planning and response.

c. the establishment of cross border health committees;

d. the identification of prevention or mitigation options; and

e. the development and implementation of prevention plans at the

state, area and local level.


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117 Preparation Phase. This phase addresses the preparation and

planning arrangements for the medical services component of NSW Health with the main focus on establishing a framework for the mobilisation of resources and management structures to support an emergency. This will be achieved through:

a. establishing strong organisational and networks between the health

services, the emergency services, functional areas and the community;

b. the maintenance and management by AHS of medical disaster

response equipment including clear mechanisms for its deployment;

c. the maintenance and management by AHS of equipment and PPE for a CBR incident;

d. the establishment and maintenance of memorandums of agreement

between AHS, private hospitals (including psychiatric and geriatric) in relation to resource management at area level;

e. the establishment and maintenance of memorandums of agreement

between AHS and other jurisdictions that share a cross-border response to an emergency;

f. the monitoring of key performance indicators by the CDU in regards

to the development and maintenance of AHS emergency preparedness

g. reviewing and testing of the NSW Health Medical Services plan by

the State Medical Controller on the conclusion of an emergency in which this plan was activated, at least every five years or when legislative changes are introduced that affect the conduct of this plan; and

h. AHS provision of emergency management education and training

(in accordance with the minimum competencies as agreed to by the NSW Health Disaster Education Advisory Committee) for personnel responsible for the medical response or management of emergencies. This will include the evaluation and maintenance of that skill set by each AHS.

118 Response Phase. This phase addresses the medical services

response to emergencies in order to minimise the health impacts to individuals and the community during an emergency.

119 The primary role for medical services in the response phase will be to

manage multiple casualties and potential casualties using central coordination to ensure the provision of definitive care as rapidly as possible.


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120 When NSW HEALTHPLAN is activated the State Medical Controller will

immediately deploy to the HSDCC to assume the operations unit leader of the incident management team. This may require that the following key actions be undertaken: a. Health Commander will be nominated by the State HSFAC; b. State Medical Controller will consult with the State Ambulance

Controller to ensure appropriate assessment of the logistics of the deployment of teams and resources;

c. the deployment of Health personnel to the site to provide initial

assessment of the medical services requirements and specialist expertise where required;

d. the appointment of a Medical Commander by the State Medical

Controller;

e. the deployment of Health Response Teams and medical resources to either the emergency site, receiving hospital or emergency medical facility as determined by the State Medical Controller in consultation with Area HSFAC(s);

f. the clinical management of casualties in the Casualty Clearing

Station by Health Response Teams under the direction of the Medical Commander;

g. the appointment of a Health Triage Officer by the Medical

Commander on arrival at the site;

h. determination of hospital bed availability for admission of critically injured casualties by the State Medical Controller through Area HSFAC(s);

i. the distribution of casualties to receiving hospitals in conjunction

with the State Ambulance Controller; and

j. preparation of facilities to receive casualties. 121 Recovery Phase. This phase addresses the process of returning an

affected community to its proper level of functioning after an emergency. This phase will usually commence concurrently with the Response Phase and includes:

a. support to the Recovery Committee or Recovery Coordinator;

b. continued provision of medical services to the community;


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c. the deactivation of Health Response Teams (when appropriate); and

d. debriefings and preparation of reports to inform future prevention,

planning, response and recovery operations. GENERAL PRINCIPLES 122 The following principles apply to this plan:

a. medical services are provided in a timely and flexible manner;

b. control and coordination of an emergency response and initial recovery operations will be conducted at the lowest effective level;

c. management arrangements recognise that the recovery phase may

be a complex, dynamic and protracted process;

d. medical services management arrangements recognise the need for sustainability of response;

e. the provision of medical services in an emergency may involve a

reversal of normal priorities to ensure the greatest good for the greater number;

f. training programmes and exercises support the effective response

of medical service personnel; g. core medical services are maintained throughout the State during a

health emergency; h. the safety of responding personnel is of paramount importance and

each agency having responsibilities under this plan will ensure adequate protection and management is provided to its personnel as obligated under the Occupational Health and Safety Act 2000; and

i. when this plan is implemented, the identified related plans will be

cross referenced as appropriate.


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SPECIAL CONSIDERATIONS FOR MEDICAL SERVICES RESPONSE PLANNING

Time Delay to Resuscitation 123 Mortality from trauma typically occurs in one of three distinguishable

time periods. These are:

a. Seconds to minutes (usually from head or major vessel damage) b. One to two hours (usually from major chest, head or abdominal

injuries, and/or major blood loss); and

c. Days to weeks (usually from brain death, sepsis and organ failure). 124 Accurate diagnosis and resuscitation in the early stages may

significantly reduce the second and third time periods. Time Delay to Surgery

125 Data suggests that the greater the period of time delay to surgery for

casualties requiring surgical intervention, the greater the likelihood of their increased rate of mortality and morbidity. 1

126 These special considerations form the basis for the establishment of

early notification systems, networks of critical care and response mechanisms like the Default Operations Strategy (Refer Part Three of this plan).

Vulnerable Populations Assessment 127 Vulnerable population’s early assessment and interventions will reduce

the likelihood of acute health requirements. These populations include those community based individuals receiving health care at home or through out-reach services such as dialysis, respiratory, mental health, drug and alcohol, and community health services.

128 It is important that AH Services work with relevant emergency risk

management committees regarding disaster risk assessment. 129 Some vulnerable population groups such as aged care facilities, child

care centres and group homes are identified and mapped through Emergency Information Coordination Unit, Department of Lands.

1 Australian Emergency Manuals Series, Part III Emergency Management Practice Volume 1, Manual 2 Disaster Medicine (Second Edition) 1999


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130 This information is provided in an electronically mapping format to District Emergency Management Committee for risk assessment in a major incident or disaster.

Mass Gatherings and Major Events 131 Mass gatherings and major events increase the risk of a mass casualty

incident. Ambulance and Health Services including public health should be actively involved in the planning for such events in an endeavour to reduce the risk of occurrence of, and plan the response to, a mass casualty situations and/or an infectious disease outbreak.

Remote Area Planning 132 Clinical management principles remain the same regardless of

situations, however planning for a remote area emergency will require that key factors of time delay to Resuscitation / Surgery are adequately addressed. Planning should consider the inherent difficulties of accessibility, distance or isolation.

Detainees in custodial / correctional / detention centres 133 Health Services and Departments that provide health and / or security

services in forensic mental health / custodial / correctional / detention centres should ensure appropriate levels of consultation take place with NSW Health Service providers in their planning arrangements to ensure an adequate level of safety for health personnel and their equipment.


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PART TWO – ROLES AND RESPONSIBILITIES APPOINTMENTS Action Cards for each key appointment in this plan are located in Annex A.

State Medical Controller 201 The position holder is responsible, during the time this plan is activated,

to the State HSFAC. The State Medical Controller is responsible for the operational management of the Medical Services component of Health when HEALTHPLAN is activated which includes:

a. the determination of hospital bed availability for admission of

critically injured casualties in consultation with the Area HSFAC(s);

b. the appropriate distribution of casualties to receiving hospitals in conjunction with the State Ambulance Controller to ensure the right patient is sent to the right hospital;

c. effecting all secondary referrals of critically injured casualties by

determining destination hospitals and priorities for secondary transport;

d. maintaining core medical services throughout the State during an

emergency;

e. the provision of technical and clinical management advice on medical issues during the emergency;

f. coordination of pharmaceutical support;

g. coordination of aero-medical support of operations through

delegation to the AMRS; and

h. coordination of the provision of blood supplies through the Australian Red Cross Blood Service.

Area Health Service Medical Controller 202 The position is by appointment by the Area HSFAC, in consultation with

the Chief Executive. 203 The Area Medical Controller will provide support to the Area HSFAC in

relation to the coordination of area medical resources in an emergency.


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Health Commander 204 When NSW HEALTHPLAN is activated, the State HSFAC will appoint a

Health Commander at the site. 205 The Health Commander who will usually be the senior Ambulance

Officer is responsible for:

a. coordination of all health operations on site;

b. participating in the IMT once Site Control has been established;

c. receiving reports from the Medical and Ambulance Commanders (and additional commanders as required); and

d. reporting to the State HSFAC through the HSDCC.

Medical Commander 206 When HEALTHPLAN is activated the position will be appointed by the

State Medical Controller as rapidly as possible to provide an expert assessment of the emergency site in order to determine the medical services requirements.

207 A roster of on-call Medical Commanders will be maintained at State

level and will form part of the Health Commander roster. 208 A medical retrieval presence may already be on scene as part of the

initial ASNSW response (see AMRS). In this instance, when the incident escalates to require HEALTHPLAN activation, the AMRS Medical Officer on scene will assume the Medical Commander role until the position holder appointed by the State Medical Controller arrives.

209 The position is responsible for:

a. liaising with the Ambulance Commander regarding priorities for treatment and transport of casualties;

b. the coordination of medical resources on site; c. the clinical management of casualties in the Casualty Clearing

Station;

d. the appointment of a Health Triage Officer; e. the management of Health Response Team personnel on site; and


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f. ensuring information regarding the clinical management of the site is provided to the Health Commander in Site Control and the State Medical Controller in the HSDCC.

Health Response Team Leader 210 The Health Response Team Leader is appointed by the Area HSFAC

that has provided the Health Response Team. This position reports to the Health Commander regarding the composition and expertise of the team (Refer Annex J for pre-deployment documentation).

Health Triage Officer 211 The Health Triage Officer is appointed by the Medical Commander to

provide secondary triage in the Casualty Clearing Station under the direction of the Medical Commander.

ORGANISATIONS

Medical Services 212 Medical Services are responsible for:

a. co-ordinating medical services response for prevention, preparation, emergency response and subsequent recovery from the impacts of an emergency under HEALTHPLAN;

b. providing definitive care for multiple casualties as rapidly as

possible; c. coordinating medical and non-medical resources; d. maintaining core hospital and medical services throughout the

State during an emergency; e. possible re-allocation of health and medical resources as required

to provide the best management for multiple casualties;

f. deploying key position holders or mobile Health Response Teams; and

g. providing the medical component of a multi-agency task force in the

form of specialist trained medical and health personnel.


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NSW HEALTH RELATED SERVICES 213 The following services / branches of NSW Health will play an essential

role in the activation of the Medical Services supporting plan to NSW HEALTHPLAN.

214 A list of contacts for the purpose of activating the following services /

branches of NSW Health in an emergency will be maintained by the Director, CDU and held in the HSDCC in both electronic and hard copy versions.

NSW Health Counter Disaster Unit 215 The role of the NSW Health Counter Disaster Unit is to ensure NSW

Health is prepared to respond effectively to major health emergencies and disasters through the development of policies and a performance management framework for Area Health Services as well as supporting the health aspects of major events within NSW.

216 The key responsibilities of the Counter Disaster Unit are to:

• develop and implement a strategic planning process for counter disaster preparedness across NSW Health;

• develop and implement plans, policies and procedural guidelines for the conduct of counter disaster response across NSW Health;

• regularly review plans, policies and practice having regard to developments in State and National disaster management policy, developments in disaster medicine and assessed counter disaster preparedness in NSW Health;

• develop and implement a performance management process for the assessment and enhancement of counter disaster preparedness of Area Health Services and other functional units with response requirements under HEALTHPLAN (including testing of response preparedness through simulation);

• develop and maintain an effective counter disaster management network within NSW Health and effective linkages with relevant external agencies;

• develop and implement an education and training strategy for counter disaster preparedness in NSW Health;

• undertake strategic contingency planning and project management for specified major events; and

• provide support and advice to ensure specialised disaster plans, such as human influenza pandemic planning, interact effectively and efficiently with established disaster response systems.


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NSW Health Pharmaceutical Services Branch 217 Pharmaceutical Services Branch has the responsibility to arrange for

the supply and redistribution of medicines within the public hospital system and the wider community for use in emergencies as requested by the State Medical Controller.

218 Chief Pharmacist and Director of the Pharmaceutical Services Branch

will provide liaison to the State Medical Controller as requested during the activation of NSW HEALTHPLAN.

219 When requested by the State Medical Controller, the Director of the

Pharmaceutical Services Branch may utilize the pharmaceutical resources of the AHS in consultation with the Area HSFAC(s).

Ambulance Service of NSW Aero-Medical & Retrieval Services (AMRS) (formerly referred to as MRU) 220 The ASNSW Aero-Medical and Retrieval Services consist of the Aero-

medical Operations Centre (AOC) and the Aero-medical Retrieval Unit (AMRU).

221 The AOC co-located with the AMRU routinely coordinates:

a. fixed wing and the majority of rotary wing activity (ASNSW holds contracts with multiple helicopter operators throughout NSW and the ACT to provide emergency pre-hospital care and inter-hospital retrieval services for the State);

b. road retrieval activity within greater Sydney;

c. requests for medical retrieval to NSW hospitals;

d. the provision of vehicles for NETS; and

e. an intensive care bed finding and critical care clinical advice

service. 222 The AOC and AMRU are operational 24 hours a day, 7 days a week. 223 The AMRS form part of normal ASNSW pre-hospital resources for core

business functions and are ultimately responsible to the State Ambulance Controller following the activation of AMPLAN.

224 When HEALTHPLAN is activated, AMRS resources will become

available for utilisation at the request of the State HSFAC. The tasking of AMRS when HEALTHPLAN is activated will be the responsibility of the State HSFAC in consultation with the State Ambulance Controller through the Director of AMRS.


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225 The Director, AMRS will work in collaboration with the State Medical

Controller to support the operations of the HSDCC including the appropriate distribution of aero-medical patients to receiving hospitals.

226 At the direction of the State Ambulance Controller, aero-medical

resources may also be used to transport Ambulance and / or Health personnel to the site.

NETS (NSW Neonatal and Paediatric Emergency Transport Service) 227 NETS is a statewide service of NSW Health providing an emergency

service for critically ill and injured babies and children who need intensive care, offering clinical advice, coordination and retrieval.

228 The Medical Director of NETS will provide liaison to the Director AMRS

and the State Medical Controller during the activation of HEALTHPLAN particularly related to the distribution of paediatric casualties.

229 NETS is activated through the AMRS.

NSW Health Departments of Forensic Medicine 230 NSW Health Departments of Forensic Medicine provide the following

services to the State Coroner:

a. Disaster Victim Identification (DVI);

b. determination of the cause of death; c. an investigation of the factors which may have caused the

disaster; and d. delivery of bereavement support services.

231 The services of the NSW Health Departments of Forensic Medicine

may also be required on a national basis at the request of the relevant State Coroner.

232 When requested by the Australian Federal government, the NSW

Health Departments of Forensic Medicine will provide assistance as part of an international DVI response.

233 The General Manager, Department of Forensic Medicine, Glebe will be

the central coordination point for activation of the services by the State Public Health Controller.

234 Health issues are to be reported through and coordinated by the State

Public Health Controller during activation of HEALTHPLAN.


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235 When mobilising the services of the Departments of Forensic Medicine regarding HEALTHPLAN activation, the General Manager(s) will ensure consultation is made with their respective Area HSFAC.

The NSW Institute of Trauma and Injury Management (ITIM) 236 The NSW Institute of Trauma and Injury Management is the body

responsible for overseeing, coordinating and supporting the NSW Trauma System in partnership with Area Health Services and relevant clinical groups.

237 The Chief Executive Officer, NSW Institute of Trauma and Injury

Management will provide specialist advice to the State Medical Controller when HEALTHPLAN is activated.

Statewide Services Development Branch (SSDB) 238 The key functions of the State wide Services Development Branch

(SSDB) are to develop, manage and coordinate NSW Health planning and policy in relation to acute health services for which there are state wide implications, particularly in the areas of speciality services.

239 SSDB significantly contributes to the working elements of this plan by

undertaking the following functions:

a. Lead and facilitate development and implementation on state wide programs for Intensive Care Units (ICU) and provide strategic advice in relation to the development of Surge Plans for mass casualty incidents;

b. Lead and facilitate planning and service delivery of state wide

models for Critical Care and Trauma Services by developing and implementing the NSW Trauma Services Plan in collaboration with ITIM; and

c. Performance monitoring in areas where the Branch actively

develops policy including medical retrieval and the oversight of the NSW Severe Burn Injury Service in collaboration with AMRS and NETS.


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Intensive Care Coordination and Monitoring Unit (ICCMU) 240 ICCMU promotes excellence in the standard of care in Intensive Care

Units across NSW through clinical networking, promotion and dissemination of evidence based practice and by providing a forum for the systematic analysis and assessment of information regarding the quality of care in NSW ICUs.

241 To achieve its aims, ICCMU works closely with key stakeholders

including SSDB, Area Health Services, AMRS and the CDU to ensure the NSW Intensive Care System is capable of meeting demand by: a. researching patterns of demand and staffing;

b. providing a central data repository for AHS benchmarking; and

c. other quality assessment activities.

242 When HEALTHPLAN or NSW Health Medical Services Supporting Plan

is activated, liaison officer from ICCMU will provide specialist advice to the State Medical Controller.

NSW Severe Burn Injury Service 243 The NSW Severe Burn Injury Service implements a Burns Model of

Care for NSW across three campuses; Concord Repatriation General Hospital, Royal North Shore Hospital and The Children’s Hospital at Westmead in collaboration with AMRS and NETS.

244 The Directorate, NSW Severe Burn Injury Service will provide liaison to

the State Medical Controller regarding burns consultancy as per NSW Severe Burn Injury Services SOP when NSW HEALTHPLAN is activated.

NSW Health Support Service (HSS) 245 When HEALTHPLAN or NSW Health Medical Services Supporting Plan

is activated, liaison officer from HSS will provide specialist advice to the State Medical Controller on issues relating to support services and activities.

AREA HEALTH SERVICES 246 AHS will prepare Area Medical Services Supporting Plan reflecting the

NSW Health Medical Services Supporting Plan to coordinate the resources within the Area.

247 Area Medical Services Supporting Plan will also recognise the role of

ASNSW as the initial emergency service responder and the principal transport organisation for the NSW Health.


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248 The AHS will be responsible for managing an incident occurring within

its boundaries until circumstances exceed the resource capacity of the Area to effectively manage the response.

249 The Area HSFAC should advise that the State HSFAC of any situation

that has the potential to overwhelm the existing AHSs capability to manage the major incident, resulting in NSW HEALTHPLAN to be activated.

250 Any request for medical services assistance from external agencies

would be actioned by the State HSFAC through the State Medical Controller. The State Medical Controller will liaise with the Area HSFAC(s) for the provision of required medical services.

251 A copy of the Area Medical Services Supporting Plan will be held in

each AHS Disaster Control Centre and in the State HSDCC.

Area Health Service Resource Management 252 AHS will provide personnel for Health Response Teams when

requested by the State Medical Controller in consultation with the Area HSFAC(s).

253 The State Medical Controller will contact the Area HSFACs to request

the provision of Health Response Team/s whose composition will be dependent upon the circumstances of the emergency including (but not limited to):

a. Casualty Clearing Station (External Emergency Response);

A Casualty Clearing Station may be established at an emergency site for the purpose of the immediate clinical management of mass casualties when physical conditions or overwhelming numbers preclude their rapid transport to hospitals for definitive care.

b. Displaced Communities/Evacuation Centres (External Emergency Response); The Department of Human Services (Community Services – DHS - CS) is responsible for coordinating the welfare response to an emergency which includes the establishment of evacuation centres to temporarily house, feed and clothe emergency evacuees. NSW Health will work in close cooperation with DHS-CS to provide emergency medical treatment and professional debriefing and counselling services for evacuees.

c. Mass Gatherings (External Emergency Response);

Mass gathering events such as the City to Surf have the potential to generate mass casualties which justifies a significant pre-emptive presence by NSW Health. The establishment of Medical Centres manned by Health Response Team personnel and the


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strategic assembly of ASNSW resources ensures rapid assessment and timely management of injury and illness in which delayed treatment may lead to complex morbidity and occasionally mortality.

d. Major Trauma Incidents; and

The Ambulance Service of NSW “Protocol 4” states that all metropolitan trauma patients who fit the designated criteria are transported directly to a Major Trauma (Metropolitan) Hospital. The Operations Default Strategy is a mass casualty management system based on this Protocol (Refer to annex three of AMPLAN). The State Medical Controller may deploy Health Response Teams in response to major trauma incidents to support another hospital / institution receiving large numbers of casualties (see also Mass Casualty Incidents).

254 Health Response Team personnel will be deployed at the request of the

relevant State Controller in consultation with the State HSFAC (Note: International deployments will be subjected to request by Australian Government through Emergency Management Australia and approved through State Emergency Operations Centre).

255 Health Response Teams are responsible for providing health care and

support of casualties on site or at a location designated by the State Medical Controller under the direction of the Medical Commander.

Mission “Team” a. Staff deployed in support of rural

or regional hospital Emergency team deployed from one hospital to another

b. Rural retrieval teams Specialised team for retrieval from regional or base hospitals

c. Primary health care team to an evacuation centre

Existing primary care team concept (if location assessed safe secure and not vulnerable)

d. Emergency or trauma team to major incident in localised emergency

General team from that Area or adjacent if trained to work outdoors

e. Support medical, primary care and public health team to an isolated community

Self-sufficient team with all resources to manage team and community for several days

f. Team to be deployed inter-state within Australia

Self-sufficient team with all resources to managed team for several days in another jurisdiction

g. Team to be deployed internationally as authorised part of Australian Government response

Pre-selected staff trained in specialised area of overseas support


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256 AHS will maintain a register of appropriately trained personnel for:

a. Health Response Teams; and b. Incident Management Position Holders.

257 AHS will ensure the skill set for the above personnel is maintained

through the provision of recertification / refresher training. Up to date commander and controller rosters will also be maintained by the AHS to ensure personnel are available at all times for an emergency response.

258 AHS are also responsible for the maintenance and management of

medical disaster response equipment and PPE to ensure these resources remain at all times in good working order. This will be achieved through regular inspection and appropriate mechanisms for:

a. deployment;

b. battery charging and / or replacement;

c. stock rotation; and

d. maintaining standard contents and system of packing.

259 A list of medical equipment for hospital based Health Response Teams

is included in Annex K.

Health Care Facility Plans for Internal Emergencies 260 All AHS are required to develop and maintain internal plans for internal

emergencies in accordance with the Australian Standard (AS4083-1997) “Planning for emergencies – Health care facilities”.

261 These internal plans should provide for the subsequent accommodation

of patients in suitable premises where the facility is capable of managing its own emergency evacuation.

262 Arrangements for alternative accommodation are to include the

provision of medical and nursing care. 263 In the event that an emergency evacuation of a facility is beyond the

capacity of the AHS to manage, then the coordination and operational management of the emergency will move to the State level.


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Business Continuity Planning (formerly Critical Operations Standing Operating Procedures) 264 AHS emergency management arrangements are to include plans to

provide for systems failure within health care facilities identified as critical infrastructure; including the state wide services of Health Support Services.

265 Business Continuity Planning (BCP) detail the procedures to be

followed in times of facility wide resource malfunction and system failure to ensure that critical business functions and services are maintained at acceptable levels at all times across the facility.

266 These BCP (formerly COSOPs) are to be reviewed and updated bi-

annually.

Health Care Facility Plans for External Emergencies

267 All AHS are required to have internal plans to respond to external emergencies that describe how the surge phase of a major incident will be managed.

268 These internal plans for external emergencies will detail the

arrangements for the reception of large numbers of casualties and will include designated treatment areas, security arrangements and the control of vehicular and pedestrian traffic to facilitate ambulance turnaround.

269 All public hospitals throughout the State are expected to maintain core

functions during an emergency.

External Plans for External Emergencies 270 All AHS are required to have plans detailing how they will provide

resources and personnel to respond to an external emergency when requested by the State HSFAC.

271 Resources requested may include Health Response Teams, State

Incident Management Team position holders and Liaison Officers. 272 Personnel employed by an AHS must consult with their Area HSFAC if

they are to deploy in an emergency response as part of a military or humanitarian effort in order to ensure the effective management of the Area resources (personnel).


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Justice Health Area Health Service 273 Justice Health under agreement with the Department of Corrective

Services and Juvenile Justice provide health services to people who interface with the NSW criminal system.

274 Justice Health is responsible for ensuring that each of the health care

facilities under its control has internal plans to respond to internal emergencies. The Justice Health Area HSFAC co-ordinates both the maintenance of the internal plans and the response to a health emergency within the corrections setting.

275 In the event of a local emergency involving or impacting on a

correctional facility, a Senior Department of Corrective Services or Juvenile Justice representative becomes the Site Commander and liaises with the Justice Health Area HSFAC regarding the health response.

276 In the event that an internal emergency within a correctional facility

escalates to require a whole of government response, the provision of emergency health services to detainees in a custodial setting will be coordinated by the State HSFAC through the Justice Health Area HSFAC under the direction of the SEOCON.

277 In the event of an external emergency requiring resource support from

or for Justice Health, such as mass receptions into custody, this will be co-ordinated under the direction of the SEOCON by the State HSFAC through the Justice Health Area HSFAC.

SUPPORTING AND PARTICIPATING ORGANISATIONS

Australian Red Cross Blood Service 278 Provision to mobilise this service is through the State HSFAC. The

resources of the Australian Red Cross Blood Service will be coordinated centrally by the service including:

a. the provision of blood products to locations designated by the

State Medical Controller or as requested by facilities under existing arrangements; and

b. when appropriate, requests for donors to attend nominated

collection points in order to replenish stocks.


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Royal Flying Doctor Service 279 The Royal Flying Doctor Service of Australia has the capacity to provide

a medical team for deployment to a site outside the normal area of operation.

280 The Royal Flying Doctor Service of Australia (NSW Section) is the usual

aero-medical responder to emergencies within the Broken Hill area. 281 The coordination of these resources is through the Chief Medical Officer

Royal Flying Doctors Service of Australia (Broken Hill) in conjunction with the Director AMRS and the State Medical Controller.

St John Ambulance Australia (NSW) 282 St John Ambulance Australia (NSW) is a supporting organisation to the

Ambulance Service of NSW and NSW Health under NSW DISPLAN. 283 Requests to mobilise this service are made through the State HSFAC to

the Commissioner of St John Ambulance Australia, NSW Branch. Following this request, the method of activation of the service is the responsibility of St John Ambulance Organisation.

284 The St John Ambulance on – site role is coordinated by the Ambulance

Commander.

Other Organisations 285 The following organisations have indicated their willingness to

participate and provide specialist resources to an emergency and requests for assistance would be activated by the State HSFAC through the Area HSFAC(s):

a. Private Hospitals (including private psychiatric facilities); b. General Practitioners; and c. Local Government agencies.

Private Hospitals 286 All Private Hospitals (including private psychiatric hospitals) are

required to have plans to respond to emergencies (AS 4083 – 1997). The plans are required to be in place for internal management of internal emergencies.

287 Any incident occurring within a facility which may lead to evacuation

requires immediate notification to the Area HSFAC.

288 Plans should identify a number of suitable sites for the temporary re-location of patients with evacuation centre as a last resource. However


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the operational needs of an emergency will ultimately determine the exact location for the establishment of an evacuation centre and/or staging area.

289 Facilities are to use their own staff to provide care for temporarily re-

located patients. 290 In the event of an emergency involving large numbers of casualties,

sheltered accommodation and treatment of patients within these private facilities may be requested by the State HSFAC through the Area HSFAC.


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PART THREE – CONTROL and COORDINATION General 301 The control and coordination for emergencies is designed to provide

the most effective mechanism, which is applicable to all situations. The control of the health response for emergencies in NSW is achieved through the provision of key appointments and the establishment of a number of command and control structures.

302 Control and coordination is to be managed using the principles of the

Incident Control System (ICS) NOTIFICATION 303 Notification systems and procedures have been established across the

health system to enhance the transfer of information between each component of an emergency response to ensure the appropriate mobilisation of resources.

Pre-hospital 304 In the pre-hospital setting, notification of a major incident is the

responsibility of the first Ambulance on scene who will establish communication with the Operations Centre by providing a Situation Report following the METHANE method:

M Major incident DECLARED E Exact location T Type of Incident H Hazards (present and potential) A Access to the area N Number of casualties (actual or estimated) and main categories E Emergency services (present or required)

Hospital 305 In the hospital setting, it is the responsibility of each facility to appoint a

Hospital Disaster Controller (available 24 hours a day) who will notify the Area HSFAC should the hospital become involved in a major incident or disaster.

306 The Area HSFAC will ensure that the State HSFAC is kept informed of

any situation that has the potential to overwhelm the existing AHSs capability to manage the major incident, resulting in NSW HEALTHPLAN to be activated.


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307 The State HSFAC is responsible for activating HEALTHPLAN and will notify the State Medical Controller and Area HSFAC(s) of HEALTHPLAN activation.

• nature of the incident;

• likelihood of the hospitals involvement; • numbers of patients likely to be received; • types of injuries; • approximate ages of patients (adults or children); • multi-cultural considerations; and • political considerations.

308 The Area HSFAC is responsible for notifying and relaying the above

information to all hospitals within the AHS that HEALTHPLAN activation has occurred.

309 It is imperative that any hospital notification of arriving patients (other

than that initiated by the Area HSFAC) is communicated through the hospital disaster controller.

Activation of Medical Services Plan 310 The Medical Services plan will not be activated in isolation of

HEALTHPLAN activation. 311 Recognised Stages of Activation (Annex B)

a. ALERT (Be Aware). On receipt of notification of a situation, which could escalate, or which may require the central coordination of resources and support;

b. STANDBY (Assemble). On receipt of information that a major

incident is imminent and may require deployment of personnel and resources which are placed on stand-by, being ready to respond immediately;

c. CALL OUT (Respond). On receipt of information that a major

incident has occurred HEALTHPLAN becomes fully operational and personnel and resources are deployed to combat the incident; and

d. STAND DOWN. State level operations are no longer required


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Incident Escalation 312 Annex B categorises the escalation process in accordance with the

recognised stages of activation identified in HEALTHPLAN.

Key Appointments in Medical Services Supporting Plan

a. State Medical Controller / Deputy State HSFAC. The State Medical Controller is responsible for controlling and coordinating medical services during an emergency when HEALTHPLAN is activated. The Director, Aero Medical Retrieval Services will generally fulfil this role unless otherwise advised.

b. Area Health Service Medical Controller. The Area HSFAC will

appoint an Area Medical Controller to provide support in relation to the coordination of area medical resources for an emergency response.

313 The NSW Health command structure at an emergency site includes:

a. Health Commander. In the event of a major incident requiring a whole of Health response, the State HSFAC will appoint a Health Commander to coordinate all health operations at the emergency site. The appointment of the Health Commander will be dependent upon the incident type and may be a senior officer from any of the five components of NSW Health. When a Site Control is established, the Health Commander will report directly to the Site Controller. The Health Commander will also receive reports from the Medical and Ambulance Commanders (and additional appointed commanders as required). The Health Commander will report to the State HSFAC through the HSDCC.

b. Ambulance Commander. The State Ambulance Controller will

appoint an Ambulance Commander who commands all ASNSW operations at the emergency site. The Ambulance Commander reports directly to the Health Commander and State Ambulance Controller for ambulance operational matters.

c. Medical Commander. The State Medical Controller will appoint a

Medical Commander who commands all medical operations at the emergency site, including public health issues. The Medical Commander reports directly to the Health Commander, and reports to the State Medical Controller for medical operational matters.

d. Additional Commanders. Additional commanders will be

deployed to control various aspects of the health response as required.


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The Incident Management Team (IMT) at the Site 314 The composition of the IMT at the emergency site will be multi-agency. 315 The Health Commander will liaise with the Incident Controller (generally

a senior officer from NSW Police) and form part of the multi-agency IMT.

316 A Site Safety Officer(s) from the Ambulance Service will be appointed

by the Ambulance Commander to ensure the well-being and safety of responding Health personnel at the site.

317 The NSW Health Incident Management Structure under HEALTHPLAN

activation is shown diagrammatically in Annex C. Operation Centres 318 The key operation centres include:

a. Health Services Disaster Control Centre (HSDCC). When HEALTHPLAN is activated the State HSFAC and support staff drawn from across the health system will operate this centre. The State Controllers and their support staff will deploy to the HSDCC as requested.

b. Aero medical Operations Centre. The AOC coordinates tasking

and prioritisation of fixed wing and the majority of rotary wing operations statewide being co-located with the HSDCC and State Ambulance EOC.

c. Area Health Services Disaster Control Centre (Area HSDCC).

An Area HSDCC will be established within the respective AHS to control health operations in support of emergencies within and from the area. The Area HSDCC will report to the respective EOC and to the HSDCC.

d. Health Command Post. The Health Command Post will be

established in Site Control and accommodate the Health Commander.

e. Medical Forward Command Post. A Medical Forward Command

Post will normally be established in the Casualty Clearing Station. The Medical Commander will operate from this location.

f. Ambulance Forward Command Post. An Ambulance Forward

Command Post will normally be established wherever it will be most effective. The Ambulance Commander may operate from this location.


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g. Site Control. Site Control will be established at an emergency site where a multi-agency response is required and will accommodate the multi-agency Incident Management Team.

COORDINATION

Authority 319 The State HSFAC and Area HSFACs have the authority to commit

State or Area Health Service assets respectively when NSW and/or Area HEALTHPLANs are activated.

Boundaries 320 The key boundaries related to this plan are:

a. Area Health Services; b. Ambulance Service Divisions; and c. Emergency Management Districts.

321 Where boundary mismatching occurs it will be necessary for the AHS to

have cross AHS arrangements in place and these must be formalised in the relevant Area HEALTHPLAN.

322 The geographical boundaries of AHS do not always correspond with the

Emergency Management Districts or the Ambulance Service of NSW boundaries. Annex F sets out the relationship between these boundaries for organisation management purposes (resource management).

COMMUNICATION 323 The State HSFAC / Duty State HSFAC is contactable 24 hours on the

HEALTHPLAN activation line through the Ambulance Service of NSW. 324 Each Area HSFAC or delegate will be on-call 24 hours to respond to an

emergency. 325 The landline telephone system will provide the primary mode of

communication between the HSDCC, Area Disaster Control Centre(s), the SEOC and other EOC(s).

326 It will be the responsibility of the Director, CDU to ensure that a list of

emergency contact numbers is maintained for State level operations and is available in electronic and hard copy within the HSDCC.


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327 The Area HSFAC will ensure a list of emergency contact numbers is maintained for the purpose of the Area HEALTHPLAN and is available in electronic and hard copy within the Area Disaster Control Centre.

328 ASNSW will be relied upon as the major communications provider for

Health Services when HEALTHPLAN is activated. 329 Communication between the emergency site and the HSDCC (co-

located with the State Ambulance EOC) will be established through the Government Radio Network (GRN). Alternative (redundancy) communications include:

a. Satellite telephones for use in isolated areas where normal radio

and telephone communications are unavailable;

b. Mobile telephones that permit longer conversations allowing the passing of urgent messages via radio (this system is not always viable where mobile network installations have been damaged as a result of the emergency or the system is overloaded due to multiple users); and

c. Paging systems where alpha-numeric messages can be used for

short ‘information only’ correspondence between senior Health personnel.


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PART FOUR – FIELD TRIAGE AND MANAGEMENT OF CASUALTIES

General 401 Triage is a dynamic, continuous process to assign priorities for the

treatment and transport of mass casualties to ensure the greatest good for the greatest number. The condition of the patient may alter because of a progression of injuries, or due to interventions. The process is repeated frequently during the care of casualties, for example when first seen, in the Treatment Area, and following transport to hospital.

Aims of Triage 402 The principles of triage are applied whenever the number of casualties

exceeds the capacity of immediately available skilled assistance. It aims to deliver the right treatment to the right patient at the right time, and ensures that valuable resources are not diverted nor concentrated on irrecoverable conditions.

Triage Priorities First (Immediate) Priority

Casualties who require immediate life saving procedures

Second Priority (Urgent)

Casualties who require definitive treatment within four to six hours

Third (Delayed) Priority

Less serious cases who do not require treatment within the above times

Dead Category

Deceased persons can be declared dead by an Ambulance Officer or a nurse. However, deceased persons must be certified as dead, by a registered medical practitioner. These are labelled and left undisturbed, in situ, and Police Forensic Services Group notified (note responsibility of the Institute of Forensic Medicine in mass casualty incidents).


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Triage Labelling 403 Labelling is necessary to allow other rescuers to be aware of the results

of the earlier assessments. Labels must be highly visible, standardised and easily attached to a patient.

404 The triage labelling used in Australia is called Smart Triage Tag. The

Smart Tag is an interchangeable triage tag for Red, Yellow and Green category if the category has changed. A separate Black colour tag is used for deceased patient.

TRIAGE LABELS

RED First Priority Immediate YELLOW Second Priority Urgent GREEN Third Priority Delayed (walking) BLACK Dead Left in situ for DVI 405 The labelling system is designed for casualty triage and documentation

in the field and when patients are immediately transported to hospital. Triage labels become part of the patient’s medical records.

Triage and Evacuation Map 406 Site organisation should be structured to enable the process of triage to

be carried out effectively. Triage Sieve will be undertaken where the casualty is found, and Triage Sort is undertaken in the Treatment Area.

See Annex D: Triage and Evacuation Map

Triage Sieve

407 This is the “first look” for rapid assignment of priorities. It is quick and

therefore not perfect, but mistakes made at this stage may be corrected later.

408 Walking Casualties

Are assigned the Third Priority on initial triage, and quickly evacuated from the site. This rapid triage will inevitably result in some patients suffering from major trauma being assigned the least urgent level of triage, but as triage is continuous, mobile process, this will be rapidly corrected at the later Triage Sort.

409 Casualties not walking

Sorted according to airway, breathing and circulation If not breathing despite simple airway manoeuvre, classified as dead (BLACK Label).

410 If breathing, determine respiratory rate. If 10 or less, or 30 or more, assigned First (Immediate) Priority. If between 11 and 29, assess circulation.


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411 Assessment is by capillary refill time (CRT) in nail bed. If greater than 2

seconds, assign First (Immediate) Priority (Red Label). This may be affected by ambient temperature, and will be reduced in cold conditions. Therefore, test own capillary refill time as “control”.

412 If capillary refill time is impracticable, may need to use pulse rate of 120

per minute as circulatory sieve, but note the time taken for this assessment, 15 seconds compared to 7 seconds for capillary refill (5 seconds to press, 2 seconds to read).

See Annex E: Triage Sieve Process

Triage Sort 413 Re-triage occurs in the Triage area of the Casualty Clearing Station. 414 Triage Revised Trauma Score (TRTS) is used in mass casualty

situations as anatomical assessment is impracticable because of its time consuming nature, and the level of expertise required to effect this assessment.

415 Triage Sorting is a mixed approach consisting of physiological score,

such as TRTS, supplemented by relevant anatomical information. 416 Triage Revised Trauma Score is based on three parameters

Parameter Coded Value Respiratory Rate 0 – 4 Systolic Blood Pressure 0 – 4 Glasgow Coma Scale 0 – 4


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TRIAGE REVISED TRAUMA SCORING SYSTEM

Physiological Variable Measured Value Score Respiratory Rate

10 – 29 29+ 6 – 9 1 – 5 0

4 3 2 1 0

Systolic Blood Pressure

90+ 76 – 89 50 – 75 1 – 49 0

4 3 2 1 0

Glasgow Coma Scale

13 – 15 9 – 12 6 – 8 4 – 5 3

4 3 2 1 0

TRIAGE REVISED TRAUMA SCORE AND TRIAGE PRIORITY

Priority TRTS T1 1 - 10 T2 11 T3 12

DEAD 0


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Treatment 417 The Treatment Area (Casualty Clearing Station) is the area where

casualties are provided with treatment prior to transport to a hospital. This area should be divided into three sections corresponding to the triage label colours; red, yellow and green. Health Response Teams will work in this area under the direction of the Health/Medical Commander. In general, Health Response Teams will remain in the designated Treatment Area.

418 Hospitals will be notified of their likelihood of receiving casualties from a

major incident or disaster. They will, wherever possible, be informed of the likely numbers to expect. The matching of patients to hospitals will be undertaken with the assistance of the State Medical Controller and State HSFAC.

419 In any major incident or disaster situation, large numbers of casualties

will ‘self present’ to hospitals, and not necessarily be transported by ambulance. There will be no control over the numbers who self-present, and arrangements will be necessary for all hospitals to be able to receive large numbers of disaster victims through their emergency departments.

Transport Triage 420 Following resuscitation, stabilisation and preparation for transport,

patients in the Treatment Area (Casualty Clearing Station) are assessed by a clinician prior to despatch to hospital.

421 When ready for transport, the top of the triage label is removed, and

retained, to indicate to the Ambulance Loading Officer that the patient is to be transported to hospital. The top of the tag is retained as a checking system on the number of patients treated, and their identification.

422 The Ambulance Loading Officer will consult with the Medical

Commander, or assigned clinician, to determine the priorities for patient transport. For example, a closed head injury will require less treatment on site, but more urgent transport than a spinal injury requiring careful stabilisation on – site.

423 Resource management may require that in some instances, patients

with minor injuries are transported ahead of those more seriously injured, given the need for decongestion at the scene. Some sitting patient may accompany stretcher patients in an ambulance in order to maximise the carrying capacity of the ambulance.

424 All minor (green labels) require close observation in case of

deterioration. However transported, whether by ambulance vehicle, bus, or other conveyance, all patients must be accompanied by a


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responsible escort. Ideally, this will be a medical, nursing or ambulance escort, but depending on available resources, and the nature of the injuries, the responsibility may be delegated to another service provider, e.g. St John Ambulance.

Default Operations Strategy (Metropolitan Mass Casualty Management System) 425 A default operations strategy will provide a standard response

mechanism for an emergency involving mass casualties to ensure the rapid removal and even distribution of critically injured patients from the emergency site to the closest trauma centres (Metropolitan) where definitive care can be provided within an appropriate time frame.

426 The default operations strategy provides a framework for the automatic

transportation of up to ten critically injured (RED) patients from the site to dedicated trauma centres through the implementation of Ambulance circuits (Carousel System) to ensure that no individual hospital is inundated with emergency casualties.

427 The principle of the Default Operations Strategy is based on

consequence management that provides the Ambulance Commander with pre-delegated authority to implement the Ambulance Carousel System.

428 Road ambulances will transport casualties to trauma centres close to

the site and rotary wing will be utilised for those to be sent further a field.

a. Once RED patients have been distributed, the YELLOW patients

will be transported to trauma centres coordinated by the State Medical Controller.

b. The GREEN (Walking Wounded) will be transported by bus to

District Hospitals or a Casualty Holding Area away from the site in groups of up to 30 at a time for treatment (as appropriate) under the coordination of the State Medical Controller.

c. Paediatric casualties (RED/YELLOW) should be preferentially

transported to Children’s Hospitals. 429 The State Medical Controller will delegate decisions on the

transportation of aero medical casualties to the Director, AMRS. Deceased Victims 430 Deceased victims are certified as dead, by a registered medical

practitioner, who signs a BLACK label to that effect. This is attached to the victim, who is left in situ, and the Police are notified. Where


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possible, the certification on the BLACK label is done in the presence of the Police Forensic Services Group (FSG).

431 The Police Forensic Services Group is responsible for the management

of all the deceased disaster victims. It is important that no bodies be moved unless impeding access to living casualties, when the body may be moved with as little disturbance as possible and the Police FSG informed.

432 In a mass fatality situation, the Director of the Institute of Forensic

Medicine will be notified, and the Institute will assist the FSG in the discharge of its responsibilities. This may require a forensic medical team to attend the scene. They will work under the direction of the Police Commander, but in consultation with the Health Commander.

433 Persons who die in the casualty triage or treatment area are tagged

with a Black label, which is signed by a registered medical practitioner certifying that the person has died. Existing labels are left intact and the body then transferred to the field morgue and the police notified.

Documentation 434 There are two categories of documentation, the labelling system and

forms. The labelling system is mainly intended for casualty triage in the field, and when patients are immediately transported to hospital. Triage labels become part of the patient’s medical record.

435 First Casualty Estimate Table (Annex F) provides an effective tool to

count the number of patient triaged in the filed areas. 436 Medical Record – Field / Event (Annex G) is used when patients are

managed in an evacuation centre or a designated location. 437 Arrival and Movement Register – Disaster Patient (Annex H) is used to

provide a tracking of patients’ movement in field treatment areas or evacuation centre.

438 A Health Personnel Form (Annex I) is used by the Health Response

Team Leader in recording the names, designations, seniority and experience of all Health Response Team members at the site.

439 A Pre-Deployment Registration Form (Annex J) is completed by Health

Response Team members prior to departing to the disaster site.


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PART FIVE – HEALTH RESPONSE TEAM EQUIPMENT Annex K provides a list of NSW Health facilities that maintain Health Response Team Kits. Health Response Team Uniform 501 Health Response Team/s (HRT) may be mobilised to provide a range of

health and medical support to a major incident or disaster site under the direction of the State HSFAC.

502 As HRTs represent NSW Health, their uniform not only provides comfort and safety to the members but clearly identifies each team member to other emergency management organisations at the site.

503 NSW Health Disaster Preparedness Protocol for HRT Uniform has been

developed to provide standard guidelines and procedures for Area Health Services and Public Hospitals on the HRT uniform and its maintenance.

504 A complete HRT Uniform (Attire) includes:

a. Safety Helmet;

b. Broad brimmed Hat;

c. High Visibility Garments (Jacket and Trousers);

d. Inner Clothes (T-Shirt);

e. Safety Vest (Tabard);

f. Safety Boots; and

g. Wet Weather Gear

505 Under the Disaster Preparedness Service Agreement, the Area Health Services are responsible for disaster preparedness and planning. The HRT uniform falls within this responsibility.

506 The NSW Health Counter Disaster Unit will be responsible for the

development and update of this protocol.

507 This protocol is to be reviewed every 3 years or if any request is made to

NSW Health Counter Disaster Unit following an incident or disaster operation, or when a change occurs to a relevant standard.


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Health Response Team Kits (Medical) 508 NSW Health Disaster Preparedness Protocol for the HRT Medical

Equipment Kit has been developed to provide standard guidelines and procedures for the Area Health Services and Public Hospitals in relation to the equipment, maintenance and standard.

509 The purpose of this protocol is to establish a standard procedure for the

management of the Medical Equipment Kit, to ensure the Medical Equipment Kit’s content meets the requirement of the Health Response Team in a medical response to a mass casualty situation resulting from an incident or disaster.

510 The Medical Equipment Kit is specifically designed for the Health

Response Team to be able to provide Advanced Life Support to compliment and support the Ambulance response to a mass casualty situation in New South Wales.

511 The protocol is developed to support the Medical Services Plan as a

supporting policy. 512 For medical equipment requirement in a Medical Response Deployment

overseas and other jurisdictions refer to the commonwealth equipment caches and guidelines.

513 One standard and functional set of Medical Equipment Kit (details see

Annexure H) consist of:

a. 2 set of Critical Care Pack; b. 2 set of Basic Support and Dressing Bag;

c. 2 Re-supply and Paediatric Bags – One blue and 1 red; and

d. 6 set of Comfort Pack for a team of 6 members.

514 The content of one standard and functional set of Medical Equipment Kit

is established to provide critical care support for up to 4 critical “Red Colour” patients.

515 This protocol is to be reviewed every 3 years or if any request is made to

NSW Health Counter Disaster Unit following an incident or disaster operation.


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PART SIX - ADMINISTRATION AND TRAINING ADMINISTRATION

General 601 Responsibility for the administration of Area Health Service Functional

Area Plans including Area Medical Services Supporting Plan rests with the Area Chief Executives and is reflected in their performance agreement.

602 Area Health Services are to develop specific plans reflecting the NSW

Health Medical Services Supporting Plan arrangements.

Planning 603 Preparation and planning for NSW Health Services will be based on

AHS administrative boundaries. 604 Separate plans will be developed by each AHS utilising the format

identified in NSW Medical Services Supporting Plan.

Financial Responsibilities – Expenditure and Recovery of Funds 605 Area Health Services (AHS) financial responsibilities are detailed in

HEALTHPLAN sections 403 to 406. Workers Compensation 606 When participating in emergency response or recovery operations

under the direction of Agency Controllers or Functional Area Coordinators the provisions of the Workers Compensation Act, 1987 (as amended) apply to employees of the Crown. (Displan)

Logistics Support 607 Whenever possible, normal procedures for the acquisition of health

service goods and services are to be utilised. Should assistance be required it should be requested through the State Medical Controller.

608 Should the State HSFAC require assistance in acquiring health service

and non-health service goods and services, they will be requested through the SEOCON.


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Review, Testing and Evaluating 609 This plan is to be reviewed and / or updated by the State Medical

Controller: a. on the conclusion of an emergency in which this plan was activated; b. on the introduction of any major structural, organisational or

legislative changes which could affect the conduct of this plan; or c. at least every five years.

610 Supporting plans are to be reviewed every five years or more frequently

at the direction of the Functional Area Coordinator. TRAINING

General 611 Training is essential to ensure a coordinated response in the event of

plan activation, and is to be tailored for each component of the plan in accordance with the minimum competencies as defined by the NSW Health Emergency Management Committee (HEMC) and agreed to by the NSW Health Disaster Clinical Advisory Committee

612 Formal training is the responsibility of each AHS to ensure adequate

numbers of trained personnel, from a variety of occupation including nursing, medical, mental and public heath. Personnel requiring training should include acute, emergency, medical, community health, administrative and security services.

613 A central register of trained personnel will be maintained by each AHS

and the NSW Health CDU will maintain a key state position holders’ register.

Health Response Team Training 614 Health Response Team personnel require a variety of clinical

judgement skills, together with familiarity with the arrangements and plans in place for a health emergency response.

615 Training must equip Health Response Team personnel with the ability

to integrate medical principals with the limitations that the emergency imposes. The aim of Health Response Team training is to provide the participants with the knowledge and skills that will permit the greatest good for the greater number.

616 It is essential that personnel in a Health Response Team identified for

an emergency response are physically and psychologically prepared for


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emergency activities in addition to having completed appropriate training.

Skills Training 617 Training is required for those personnel who may be required to perform

specific skills in unusual and difficult circumstances in the pre-hospital / emergency environment including (but not limited to):

a. Command, Control, Coordination and Communications;

b. Triage;

c. Equipment and PPE;

d. Safety and Disaster Site Management;

e. Emergency Services Roles and Responsibilities;

f. Treatment and Transport;

g. Documentation;

h. Mental Health Aspects of Disasters; and

i. Public Health Aspects of Disasters.

Skills Acquisition and Maintenance 618 Skills must be continually practiced to maintain proficiency and should

be linked wherever possible to skills performed in day to day practice. Evaluation of Training 619 The total effect of training should be evaluated for both its effectiveness

and efficiency as indicated below:

a. Efficiency: Training is efficient when a satisfactory number and proportion of trainees meet the requirements of the training objectives for the least cost;

b. Effectiveness: Training is effective when it prepares the

trainees to perform the desired standard. 620 The NSW Health Disaster Education Advisory Group is responsible for

providing a State-based training framework to ensure uniformity of training across the Area Health Services.

621 Training packages developed by individual AHS require review by the

NSW Health Disaster Education Advisory Group and endorsement by


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the NSW Health Disaster Advisory Group to ensure conformity with the State-based training framework.

Exercises 622 Training exercises are a method of evaluating emergency management

plans and arrangements and should be conducted regularly to reinforce and test existing arrangements.

623 Exercise objectives will need to be realistic and consistent with the

training objectives to be tested and should address the following three components:

a. performance required from exercise participants; b. conditions under which this performance will be tested; and

c. performance standards to be achieved.

Exercise Reports 624 A written Exercise Report will be provided to the State HSFAC within

State HSFAC Committee reporting period (quarterly) identifying any discrepancies between optimal and actual performance to assist in the establishment of priorities for improvement to emergency management plans and arrangements.

Operational Debriefs and Reports 625 The State HSFAC will conduct a debrief of Health Service personnel

present in the State HSDCC before closing the centre and diverting in-coming telephone calls to the HEALTHPLAN 24 hour activation line.

626 The State HSFAC will conduct a whole of Health operational debrief

within fourteen days of the stand down order and submit a written report to the NSW Health Disaster Planning Advisory Committee and Chief Health Officer.

627 The State Medical Controller will contribute to the operational debrief

and submit a written report to the State HSFAC following the stand down order.


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ANNEX A – ACTION CARDS 01 State Medical Controller ̀ 43 02 Health Commander 45 03 Medical Commander 46 04 Health Triage Officer 48 05 Health Response Team Leader 49 06 Health Response Team(s) 50


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ACTION CARD – 01 STATE MEDICAL CONTROLLER The primary role of the State Medical Controller is to coordinate the medical services when NSW HEALTHPLAN is activated working with the Area HSFACs and the State Ambulance Controller to determine the appropriate treatment and transport of casualties. The State Medical Controller will: � Proceed to the HSDCC when notified of HEALTHPLAN activation by the

State HSFAC; � On arrival at HSDCC:

a. Meet with State HSFAC to formalise role delineation between Medical Control and HSFAC functions;

b. Meet with Ambulance Controller and obtain briefing; and

c. Liaise with Director, AMRS to formally delegate responsibilities for the coordination of aero-medical support of operations

� Ensure Area HSFACs are notified of NSW HEALTHPLAN activation and communicate:

a. number of casualties AHS may expect to receive;

b. types of injuries and age group of casualties (adults or children); and

c. hospitals to which casualties may be dispatched.

� Appoint a Medical Commander from the rostered list of on-call personnel to provide an expert assessment of the site to determine the requirements for medical services;

� Request transport for Medical personnel to attend the site through the

State Ambulance Controller; � Determine the need for Health Response Teams; � Coordinate the provision of Health Response Teams through the Area

HSFACs if it is determined that such resources are required;


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� Confer with the State Ambulance Controller on distribution of casualties to

receiving hospitals; � Assume responsibility for all secondary referrals of casualties, and

determine destination hospitals and priorities of secondary transport; � Coordinate through the Director, Aero medical Retrieval Services for

secondary transports; � Maintain communications with Area HSFACs to determine on-going

admitting capacity of hospitals; � Ensure relief of the Medical Commander and Health Response Teams is

provided for including the conduct of debriefings at the end of each shift; � Liaise with IMT functions within the HSDCC to ensure planning, logistics

and operations functions are in place for medical elements; � Hand over to relieving Duty HSFAC at the direction of State HSFAC; and � Submit a written report to the State HSFAC subsequent to Stand Down

order


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ACTION CARD – 02 HEALTH COMMANDER The Health Commander will be appointed by the State HSFAC to coordinate all Health resources on site on activation of NSW HEALTHPLAN. RADIO CALL SIGN: HEALTH COMMANDER PRIORITY: PROTECTIVE CLOTHING MUST BE WORN i.e. SAFETY HELMET AND REFLECTIVE VEST. ENSURE YOU ARE PROPERLY IDENTIFIED. DO NOT BECOME INVOLVED WITH THE DIRECT TREATMENT OF CASUALTIES. The Health Commander will: � Proceed to emergency site at the direction of the State HSFAC; � Advise the State HSFAC of arrival; � Obtain a situation report and make a reconnaissance of the site before

assuming the role of Health Commander; � Assume command of all Health operations on site; � Establish and maintain close liaison with the Ambulance, Medical, Mental

or Public Health Commander who will report to the Health Commander on all Health activities on site;

� Ensure Health site management structure is in place (see Annex C) � Form part of the multi-agency Incident Management Team once

established in Site Control; � Provide reports as appropriate to the State HSFAC through the HSDCC;


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ACTION CARD – 03 MEDICAL COMMANDER The Medical Commander is effectively the ‘Director of Medical Services’ in a ‘hospital’ established on site (Casualty Clearing Station) for the purpose of immediate clinical management of casualties when physical conditions or overwhelming numbers preclude their rapid transport to hospitals for definitive care.

RADIO CALL SIGN: MEDICAL COMMANDER PRIORITY: PROTECTIVE CLOTHING MUST BE WORN i.e. SAFETY HELMET AND REFLECTIVE VEST. ENSURE YOU ARE PROPERLY IDENTIFIED. DO NOT BECOME INVOLVED WITH THE DIRECT TREATMENT OF CASUALTIES.

The Medical Commander will: � Proceed to the site in emergency transport (as provided for by the

Ambulance Service on the authority of the State Ambulance Controller) to take command of the Casualty Clearing Station and coordinate all medical resources at the site;

� Make contact with Ambulance Commander on arrival at site and maintain

close liaison throughout the duration of the incident to ensure full cooperation between Ambulance and Health Response Team personnel;

� Provide regular reports to the Health Commander on site and the State

Medical Controller in the HSDCC on the status of the situation and the need for Health Response Teams and/or other medical resources;

� Command and allocate tasks (ensuring adequate resources are available)

to incoming Health Response Teams; � Appoint or confirm the appointment of the Health Triage Officer; � Ensure the welfare and safety of the Health Response Team personnel is

taken care of, including relief, sustenance and debriefing; and � Provide the clinical input to any debrief.


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ACTION CARD – 04 HEALTH TRIAGE OFFICER The Medical Commander, in liaison with the Ambulance Commander will appoint the Health Triage Officer(s). Responsible to the Medical Commander, the position holder does not become involved in direct patient care (with the exception of opening airways and direct pressure for haemorrhage control) PRIORITY: PROTECTIVE CLOTHING MUST BE WORN i.e. SAFETY HELMET, REFLECTIVE VEST AND DISPOSABLE GLOVES. ENSURE YOU ARE PROPERLY IDENTIFIED. The Health Triage Officer will: � Establish the Triage Point adjacent to the Casualty Clearing Station. � Conduct the triage sort and prioritise patients taking into account the

physiological variable and anatomical injury, directing patients to the appropriate treatment sector.

� Clinical status will be classified by the appropriate Triage Label: RED Serious, life threatening injuries. Patients require resuscitation and

should not be left unattended and are accorded first priority transport to hospital. Red labelled patients must not be left unattended.

YELLOW Non-ambulatory patients whose condition is not immediately life

threatening, but requires clinical stabilisation before transport to hospital

GREEN Ambulatory patients, the ‘walking wounded’. Signifies less serious

injuries. Treatment and transport can be delayed. BLACK Deceased victims are to be certified deceased by a Registered

Medical Practitioner and initially left in the field for the Police DVI Teams. Bodies are labelled and must be left in-situ for DVI unless the body is obstructing access to living casualties.


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ACTION CARD – 05 HEALTH RESPONSE TEAM LEADER The Health Response Team Leader is appointed by the Area HSFAC and as with all other team members is responsible to the Medical Commander on site. RADIO CALL SIGN: WILL BE ALLOCATED

PRIOR TO DEPLOYMENT PRIORITY: PROTECTIVE CLOTHING MUST BE WORN i.e. SAFETY HELMET AND REFLECTIVE VEST. ENSURE YOU ARE PROPERLY IDENTIFIED. Health Response Team Leader will: � On arrival at the site, report to the Medical Commander in the Medical

Forward Command Post with a list of team personnel and their qualifications and experience;

� Receive a briefing and allocation of tasks from the Medical Commander; � Escort team members to the assigned Casualty Clearing Station to

undertake task allocation; � Ensure that all team members are correctly attired and have reasonable

breaks and relief, as necessary, through liaison with the Medical Commander;

� Undertake an initial debrief at the site when the team is stood down by the

Medical Commander; and � Arrange debriefing for the team prior to dispersal and notify/arrange for all

team personnel to attend a post incident clinical debrief.


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ACTION CARD – 06 HEALTH RESPONSE TEAM(S) Health Response Team(s) may be deployed to the emergency site at the request of the State Medical Controller through the Area HSFAC. Team members are responsible when on site, to the Medical Commander. PRIORITY: PROTECTIVE CLOTHING MUST BE WORN i.e. SAFETY HELMET, REFLECTIVE VEST AND DISPOSABLE GLOVES. ENSURE YOU ARE PROPERLY IDENTIFIED. Health Response Teams will: � Provide treatment of mass casualties at the emergency site prior to their

evacuation to hospitals for definitive care Composition Teams may be discrete, individual, hospital-based or composite AHS teams depending on the nature of the incident and the specialist requirements. A pool of personnel (especially from within Anaesthetics, Surgical, Critical Care and Trauma Disciplines) will be identified by each AHS to undertake Health Response Team training. NB: Each AHS must have the capability to supply a minimum of 2 teams (comprising, at the least, of 2 doctors and 4 nurses) when requested to do so by the State HSFAC through the State Medical Controller for a State coordinated emergency response.


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ANNEX B - INCIDENT ESCALATION ALERT STATUS (Level 1) – BE AWARE This activation level is based on:

• Threat and risk assessment • On receipt of information on a situation, which could escalate, or which

may require the coordination of resources and support. ACTION: State HSFAC will:

• Monitor the situation for the purpose of determining whether HEALTHPLAN requires activation to a higher level

Area HSFAC will:

• Continue to keep the State HSFAC informed of any situation occurring within the area as early notification is necessary to allow for the rapid coordination of health resources should the situation escalate

STANDBY STATUS (Level 2) - ASSEMBLE This activation level is based on:

• Receipt of information that an incident has occurred and that it has the potential to escalate to a major incident/disaster;

• A fire in a hospital or nursing home; • An incident that involves hazardous materials; • An incident which has the potential to kill or injure 8 or more people; • An incident that may attract political implications; • An incident that may attract wide-spread media or TV interest; • An incident that is likely to be of a protracted nature; and • Also based on threat and risk assessment

ACTION: State HSFAC will:

• Continue to monitor situation; and • Make arrangements to prepare the HSDCC to an appropriate level for

operation. Area HSFAC will:

• Prepare for an activation of the Area HEALTHPLAN in response to an activation of NSW HEALTHPLAN and the Default Operations Strategy.


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CALLOUT STATUS (Level 3) - RESPOND This activation level is based on:

• Receipt of information that a major incident/disaster has occurred and there is a requirement for deployment of personnel and resources for a State coordinated response.

ACTION:

• NSW HEALTHPLAN activated and the Default Operations Strategy invoked.

STAND DOWN Stand down will occur when State level operations are no longer required as determined by the State HSFAC in consultation with the State Medical Controller.


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ANNEX C – NSW HEALTH INCIDENT MANAGEMENT STRUCTURE UNDER HEALTHPLAN ACTIVATION


Page 54

ANNEX D - TRIAGE and EVACUATION MAP

AMBULANCE LOADING

POINT 2. Urgent (Yellow)

2. Urgent (Yellow)

2. Dead (Black)


Page 55

ANNEX E - TRIAGE SIEVE PROCESS

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Page 56

ANNEX F – FIRST CASUALTY ESTIMATE

Priority 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1516 17 18 19 20 21 22 23 24 25 26 27 28 29 3031 32 33 34 35 36 37 38 39 40 41 42 43 44 4546 47 48 49 50 51 52 53 54 55 56 57 58 59 6061 62 63 64 65 66 67 68 69 70 71 72 73 74 7576 77 78 79 80 81 82 83 84 85 86 87 88 89 9091 92 93 94 95 96 97 98 99 100 101 102 103 104 105106 107 108 109 110 111 112 113 114 115 116 117 118 119 120121 122 123 124 125 126 127 128 129 130 131 132 133 134 135

Priority 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1516 17 18 19 20 21 22 23 24 25 26 27 28 29 3031 32 33 34 35 36 37 38 39 40 41 42 43 44 4546 47 48 49 50 51 52 53 54 55 56 57 58 59 6061 62 63 64 65 66 67 68 69 70 71 72 73 74 7576 77 78 79 80 81 82 83 84 85 86 87 88 89 9091 92 93 94 95 96 97 98 99 100 101 102 103 104 105106 107 108 109 110 111 112 113 114 115 116 117 118 119 120121 122 123 124 125 126 127 128 129 130 131 132 133 134 135

Priority 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1516 17 18 19 20 21 22 23 24 25 26 27 28 29 3031 32 33 34 35 36 37 38 39 40 41 42 43 44 4546 47 48 49 50 51 52 53 54 55 56 57 58 59 6061 62 63 64 65 66 67 68 69 70 71 72 73 74 7576 77 78 79 80 81 82 83 84 85 86 87 88 89 9091 92 93 94 95 96 97 98 99 100 101 102 103 104 105106 107 108 109 110 111 112 113 114 115 116 117 118 119 120121 122 123 124 125 126 127 128 129 130 131 132 133 134 135

Dead 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1516 17 18 19 20 21 22 23 24 25 26 27 28 29 3031 32 33 34 35 36 37 38 39 40 41 42 43 44 4546 47 48 49 50 51 52 53 54 55 56 57 58 59 6061 62 63 64 65 66 67 68 69 70 71 72 73 74 7576 77 78 79 80 81 82 83 84 85 86 87 88 89 9091 92 93 94 95 96 97 98 99 100 101 102 103 104 105106 107 108 109 110 111 112 113 114 115 116 117 118 119 120121 122 123 124 125 126 127 128 129 130 131 132 133 134 135

Number Cross the next number in each row as you find a new patient

(RED - Immediate)

Triage Priority

(GREEN - Delayed)

(BLACK)

(YELLOW – Urgent)


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ANNEX G – MEDICAL RECORD (FIELD / EVENT)


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Page 59


Page 60


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ANNEX H – ARRIVALS AND MOVEMENT REGISTER – DISASTER PATIENTS


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ANNEX I - HEALTH PERSONNEL FORM DATE: ________________________

HOSPITAL OR AHS TEAM

DISPATCHED ON-SITE STOOD DOWN

RETURNED

TEAM NAMES

ANY INDIVIDUAL ARRANGEMENTS

1.

2.

3.

4.

5.

6.

Other members

TRAVEL DETAILS


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ANNEX J – PRE-DEPLOYMENT REGISTRATION FORM

SURNAME GIVEN NAME(S)

PREFERRED NAME

DATE OF BIRTH

RESIDENTIAL ADDRESS

TELEPHONE

MOBILE No.

FACSIMILE

EMAIL ADDRESS

OCCUPATION / SPECIALTY

REGISTRATION NUMBER

EMPLOYER DETAILS

COMPANY

ADDRESS

TELEPHONE

FACSIMILE

PASSPORT CURRENT (Y/N) [Please circle] YES NO

PASSPORT No.

EXPIRY DATE:

VACCINATIONS

CURRENT (Y/N) [Please circle] YES NO

RECOMMENDED Vaccination List Please Circle Administered

Routine Childhood Immunisations (esp. Measles)

YES NO Date

Adult Diptheria-Tetanus YES NO Date

Hepatitis A YES NO Date

Hepatitis B YES NO Date

Typhoid YES NO Date

LIST ANY ADDITIONAL

CURRENT VACCINATIONS

Date:

Date:

Date:

PRE-EXISTING MEDICAL CONDITIONS (List – eg. Allergies)

NEXT OF KIN

Emergency Contact

NAME

ADDRESS

TELEPHONE

MOBILE No.

EMAIL ADDRESS

Signature: ________________________ Date: ________________________

ANNEX K – HEALTH RESPONSE TEAM MEDICAL EQUIPMENT KIT AND UNIFORM LOCATIONS

Health Response Team Medical Equipment Kits and Uniform are located at the following NSW Health Facilities:

NSW HEALTH FACILITIES WITH HEALTH RESPONSE KITS (Medical) Area Health Service Facility Sydney South West AHS Liverpool

Royal Prince Alfred Bankstown Fairfield Campbelltown Bowral Concord

Sydney West AHS Westmead Nepean Auburn Blacktown

Northern Sydney Central Coast AHS Royal North Shore Gosford Mona Vale Hornsby

South Eastern Sydney Illawarra AHS St George St Vincents Prince Of Wales Wollongong Shoalhaven Shell Harbour

Hunter New England AHS John Hunter Calvary Mater Maitland Muswellbrook Tamworth Taree Armidale Moree

Greater Western Dubbo Broken Hill Orange Bathurst

North Coast AHS Port Macquarie Tweed Heads Coffs Harbour Lismore

Greater Southern AHS Wagga Wagga Albury Goulburn Griffith Deniliquin Cooma Bega

AHSs are required to annually audit on equipment for use in a major incident or disaster. The NSW Health Counter Disaster Unit will undertake random audits of NSW Health facilities to ensure that the above equipment and PPE for a health response is maintained in good working order and is ready at all times for deployment. Audits will address the following:

• Storage Arrangements; • Arrangements for Accountability of Equipment and PPE

Maintenance and Testing; • Training of Staff in site response and Disaster Management; • Plans for Mass Casualty Event Patient Management; • Plans for the Receipt of Mass Casualty Trauma Surge Incidents at

the Health Facility; and • Functionality of Area Disaster Control Centres.

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