25 August 2020
Emergency Preparedness, Resilience and Response (EPRR) and reflections on COVID-19

Steve Arrowsmith

When the Medway Innovation Institute gave me the chance to write something on EPRR (Emergency Preparedness, Resilience and Response) I was surprised that anyone would be interested in two pages on the subject (other than me) as, I get that for hospital staff, or even others in the corporate world, it’s not the sexiest of subjects when you compare it to medicine, It doesn’t have the emotional pull that an article on nursing might have and it doesn’t have that roll your sleeves up and get stuck in character that you might get reading an article on our amazing estates teams. It’s something that I know is important and hopefully at the end of this you might to.

With Emergency Preparedness, Resilience and Response, the idea is to look at threats on the horizon that could impact the hospital and have plans, processes and the right people in place and to manage an incident when it occurs whilst continuing with as much day to day patient care as possible. So for instance, we have a plan and command structure for electrical failure, we have back-ups in the form of generators, and each service within our hospital has a business continuity plan to keep our patients safe during an interruption.

Prior to COVID-19 we had a plan in place that addressed Pandemic Flu, this was based on the response to the 2009 pandemic and you will find the same thing in every hospital and NHS provider up and down the country as it’s a requirement under the NHS England EPRR Framework (2015). Around February time, when COVID-19 started to pick up momentum, we looked to the Flu Pandemic plan and with the guidance that was coming out centrally we could tell that the one plan fits all approach wasn’t going to manage this situation.

We called a middle managers meeting (two levels down from Executive level) to engage staff, and the night before the meeting I wrote the bones of a new plan based on the intelligence that was coming out with links to the Public Health England website on  key advice and guides. Low and behold when we had 75 people in the auditorium that morning and I was navigating through the document on screen none of the links worked, and that was the start of what was different with this event; the rapid pace of changing information mixed with the protracted length of the incident.

We immediately set up a command structure which included daily reporting as you would expect from Emergency Planning during an emergency incident, but a few times we as a trust had to pivot away from normal command and control and set up something new that suited this incident. Tiers of command were put in place (Strategic, Tactical and Operational) with specialist groups created to address key areas of the response (staff welfare, infrastructure and ethics) all bespoke for this event.

In the initial stages there was also a need to deal with the rising tide incident creep, where the national news would report on the first cases in York (far away), then Brighton (getting closer), then London (closer still) until the first reported cases of COVID-19 in Medway. All the while, there is a need to make sure our staff were keeping one another calm and that people were being communicated with so no one felt in the dark. We achieved this simply by creating an Internal COVID-19 bulletin which went out to staff daily and staff fed back that this was really welcomed as it was separate from the general trust communication and so didn’t get lost in other organisational noise.

We had some innovative opportunities as a result of COVID-19, for instance the use of Video conferencing has changed the way we do meetings and then spend the time in those meetings to ensure efficiencies are saved and also people are kept safe. We had the onsite charity shop (Medway League of Friends) and restaurant stock essential items of hard to find items like pasta during the early days of the pandemic whilst switching to contactless payments which is a welcome benefit to the staff.

Having only been in post for seven months prior to the pandemic I can say with some certainty that this is the biggest live incident I’ve been part of, and it has been exhausting and I’ve not even been anywhere near the front line like my colleagues. But what has come out of it from an emergency planning perspective is the interest in the subject throughout the organisation, from the board level who will be taking part in a table top exercise in the near future, to making sure that new starters have an introduction to emergency planning as part of their induction. It’s also given us the opportunity to take stock and invest in preparations for the next wave, or winter or EU Transition or whatever the next emergency is. It’s this where my first involvement with the institute began.

The institute are funding a brand new state of the art Incident Command Centre so that we can manage whatever comes next. It’s fantastic news for EPRR within Medway and for the hospital that we can run an incident from somewhere that’s bespoke and isn’t a space that we have to ‘make do’ with.  Having had input on the design from the ground up and modelling the design on Blue light partners’ control rooms the aim is to create an environment that instils confidence not only in those that have to respond internally but also in partners that may have to come on site such as Kent Police or Kent Fire and Rescue.

Before I finish I would like to say that the overall response, as a hospital and as a healthcare system has been incredible, we haven’t always got it right but in true Emergency Planning style we realised the issue, assessed our options and implemented the new strategy. It’s truly been remarkable witnessing the trenches mentality (MFT vs COVID-19) during this event and has shown that some people have gone to exceptional lengths to support one another and the people that use our hospital.

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