Exercise Enki

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Exercise Enki

• A Pilot and Evaluation of Primary Care Units in
  Major Incident Rest Centres

Jim McManus, MFPH, MEPS,CPsychol Assistant
Director, Health Improvement Jim.mcmanus_at_bdpct.nhs
.uk
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Enki

• Sumerian God of Wisdom and fresh water, God of
  craftiness, champion of war

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Or

• The Goddess referred to in Cuneiform texts of
  Ugarit as Ruler of Chaos and Confusion

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Challenge and Opportunity

• 167,000 people, 175,000 GP registered
• Second and third languages change every two years
• Average income 13k 17k
• Fastest changing borough in England
• 38 of households do not have access to a car or
  van
• The White British population makes up 80.9 of
  the boroughs population
• 19.9 of the boroughs population has a limiting
  long-term illness
• 39.5 of the population aged 16 to 74 has no
  qualifications
• COMAH and other chemical and petrochemical
  productions
• Major transport routes A13, A406 and C2C from
  Essex into London within COMAH risk zones

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The Context

• Industrial past, high rates of neoplasms and
  morbidity associated with industry
• Huge public concern over chemicals industry and
  new industries despite being much smaller in
  concentration than most other areas
• Significant concern over contaminated land
• Significant burden of ill-health

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Objectives

• To exercise and learn from a simulated chemical
  incident
• To learn how the PCT can divert from hospital
• To identify mechanisms for PCT discharge of
  health care needs
• To simulate a multi agency economy of response

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10 Direct ParticipantsPlus observers from Port
of London Authority Met Office, MoD, Highways,
DT,Water Companies, Media, etc, etc.
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Scenario

• Accidental chemical spillage occurring at an
  outdoor gathering (Sunday Market, 10,000 people)
• Upon hitting the ground the barrel split and
  splashed the contaminant over a widearea.
• Around 100 people were in the vicinity of the
  spillage.

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Scenario 2

• Inner Cordon
• Decontamination Suite Fire, LAS
• Cold Zone Welfare, LAS,
• Outer Cordon
• Transport A E
• Transport Rest Centre, Welfare, PCT
• Control Rooms

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4 Operations Sites
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The Rest Centre

• WRVS
• Social Services
• School Meals
• Red Cross
• PCT

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PCT Involvement

• Provide for Community Pharmacy
• Provide GP and Nursing Triage
• Provide Emergency Primary Care, Minor Injuries
  and other input
• Stabilise people
• Ensure issues picked up in primary care afterwards

• Red cross provided trolleys, beds, blankets,
  paramedic
• PCT provided drugs, FP10s, nursing and medical
  skills,

• Small focus team organised the PCT input,
  co-ordinated and delivered on the day including
  out of hours GPs

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Patients

• Scenarios
• Co-morbidities
• Long term conditions leaving aside medication
  (diabetes, CHD, HF, COPD)
• Some late developing chemical reactions
• Pregnant patients
• Child patients
• Real Life Anaphylaxis
• PCT staff administered adrenalin
• Red Cross took to A and E
• Fire Brigade have changed their detergent!

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On the Day

• PCT Major Incident Declared
• Kept a secret from all but Public Health Team
  small co-ordinating team
• Alert and activate community pharmacy
• Alert and activate rest centre protocol
• Designate manager on site
• Prscription runs

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Arrival at Rest Centre 1. WRVS Registration
Nurse Triage Lead Nurse x 1 Nurses x 3 1.
Prioritise M, E/D and O Groups and those with
visible vulnerability or health issues
Health Issue requiring attention Pass to Primary
Care Unit for treatment and care
Major Health Issue or Sudden Crisis e.g. Labour,
acute asthma attack, coronary event,
hypoglycaemic event, contaminated patient slipped
through, urgent medication or significant injury
not dealt with by LAS at Scene
No or minor issues Discharge to WRVS and Red
Cross in Centre Red Cross observe and deliver
first aid/notify nurses if any sudden issue or
deterioration
Pharmacy Major Incident Team needs to activate
Community Pharmacist to supply drugs
Primary Care Unit Lead Nurse x 1, Nurses x
3 Medical Cover x 1 Treats minor injuries and
other conditions prevention of attendance at A
E
Primary Care Unit Priority
Paramedic or Hospital Transfer

• Medication Needed
• (depending on urgency)
• Supplied from pod
• FP10 is issued and driver collects from Community
  Pharmacist
• FP10 issued and patient collects

• Complete Primary Care Unit Treatment and end
  immediate PCT involvement
• Alert nurse if any deterioration or new need
  arises
• Pass into care of Red Cross/WRVS/Paramedic/Hospita
  l
• Letter to GP and Home PCT if needed
• Register of cases completed and kept for Major
  Incident Team and HPA

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Evaluation Process

• Multi-Agency
• Debriefs with volunteers and participants from
  each agency
• Interviews and questionnaires with participants
• Large Evaluation workshop

• Individual Agency
• Debriefs with teams
• Feedback to large workshop

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Lessons Conclusions

• Triage worked well
• Protocol vital forms re-written and protocol
  re-written
• Need a Manager as troubleshooter
• Closer linking to Walk in Centres can save time,
  money and equipment
• Emergency training for staff
• Red cross and PCT synergies
• Grateful for the medicines bag
• Scenarios helpful
• Identified further work to be done

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CCA Review Brilliant Basicsbeing ready for
our own Carlisle, Grayrigg or Buncefield

• Revise Plan
• Mutual Aid Agreement Red Cross
• Revision of On Call Policy and Procedures
• Minimum Training for all on Call Staff
• Communications Cascade to all Staff
• Business Continuity Planning Operation Tulip
• Policy and Protocol on IPPC sites

• Vulnerable Peoples Identification Protocol
• Faith Communities and Vol Sector Projects
• Lead NED, Reports to Board
• Operation Heartsave Defibrillators and First
  Aiders
• Warning Protocols for COMAH flare ups
• Trained Clinicians for Disaster Protocols
• COMAH Site visits

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Witness
Presence Response
The role of the Church in major incidents and
emergency planning
Pan London Seminar 11 June 2007
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Pan London Pilot Seminar

• 3 RC Dioceses, CofE, Methodists,
• Metropolitan Police Counter-Terrorism
• NHS, Local Government
• London Fire Brigade
• London Resilience
• 60 Area Deans and Chaplains

Toolkit currently in design. London Fire Brigade,
Metropolitan Poice, NHS and Several local
Authorities have signed up.
Hindu, Muslim, Sikh and Jewish faiths now
expressing an interest in rolling out in various
areas, but some will need additional support
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Feel free to use our stuff. and let us know how
we can do better

• Primary Care Tools, Brilliant
• Basics Outputs
• Jim.mcmanus_at_bdpct.nhs.uk
• Enki Evaluation
• Report
• Roger.brett_at_lbbd.gov.uk

by Gods grace, we are proved through our deeds
ENDS