Action Cards

Emergency Department Senior Doctor on Duty

Responsibilities:
1. Assume role of Senior Emergency Physician action card until arrival of the ED Consultant On-Call.
2. Ensure that department is prepared for arrival of casualties.
3. Assist the senior emergency consultant in the allocation of medical staff to roles.
4. Undertake role as part of treatment team as directed by the ED Consultant On-Call.

Initial Actions:
1. Liaise with ED Nurse in Charge and check call has been verified with Contact Centre and that ED Consultant On-Call has been informed and is attending.
2. Discharge non-urgent patients from the department.
3. Assume roles of Senior Emergency Physician action card until arrival of the ED Consultant On-Call.
4. Assist in delegating available medical staff into treatment teams.

5. Contact Theatres/Critical Care and the Radiology hub immediately (or delegate task) and notify of Major Incident declaration.

Priorities:
1. Take on role of Senior Emergency Physician until ED Consultant On-Call arrives.

2. Assist in preparation of ED and allocation of roles.

Senior Emergency Physician

Responsibilities:

1. Primary responsibility of organising the reception phase of the major incident.
2. Ensure that triage of casualties is being performed at ambulance entrance.
3. Ensure that treatment teams for Priority 1 and 2 patients are organised in conjunction with the Senior Nurse, Emergency Department.
4. Organise medical staffing for Priority 3 area.
5. Liaise with other members of the Hospital Co-ordination team.

Initial Actions:
1. Wear Senior Emergency Physician tabard kept in the Emergency Department.
2. Prepare to take charge of the incident within the emergency department.

3. Distribute Action Cards to Medical Staff.
4. Ensure ED consultant colleagues are notified as required. (Whatsapp, MI Group)

5. Ask Junior Medical Staff to trigger Whatsapp call in as required.

6. Ensure Theatres/Critical Care/Radiology Hub are notified.

7. Oversee (delegate) discharge of non-urgent patients from the department.
8. Ensure that the emergency department is prepared for reception of casualties from major incident.

9. In discussion with Senior Physician/Surgeon/ICU push current high acuity patients to HDU/ICU
10. If Major Incident Standby, then await further instruction.
11. Keep medical/nursing staff in ED informed at all times.

12. In conjunction with the Senior Nurse Emergency Department designate a [Senior] Triage Officer and position at ambulance entrance with clerical staff.

13. Allocate Senior Doctors to Priority 1, 2 and 3 areas.

14. In discussion with the Senior Nurse Emergency Department, form treatment teams for Priority 1 and 2 patients and distribute around Emergency Dept.

15. Allocate medical staff to Priority 3 area.

16. Keep the Hospital Medical Co-ordinator informed of progress and capacity for further receiving. (30 min check-in comms/significant information.)

17. Oversee medical care and flow of patients through Emergency Department.

Priorities:
1. Ensure all areas adequately medically staffed.
2. Liaise regularly with Medical Co-ordinator in the Hospital Control Room
3. Ensure ED major incident medical staff cascade call-out performed.

Responsibilities:
1. Responsible for the preparation and running of the ED.
2. To work closely with the Senior Emergency Physician to ensure that triage and treatment areas are appropriately prepared and staffed.

Initial Actions:
1. Take Major Incident Hospital Control Room Box from Major Incident Cupboard to Hospital Control Room. A duplicate set of Action cards from ED are at the MI room.
2. Check Contact Centre has been informed by dialling 2222 and that the major incident has been confirmed with police or Ambulance Service. Clarify details of incident.
3. Ensure following staff contacted as per ED Major Incident Call-Out List:
  a) Call out ED Consultant on call.
  b) Call out Lead Nurse ED.
  c) Inform Bed Manager/Clinical Co-ordinator.
  d) Inform Duty Radiographer.
  e) Inform Receiving wards(AAU, medical, surgical, orthopaedic)
  f) Inform Medical Records (Front Desk)
  g) Inform Porter [Senior].
4. Prepare Mobile Site Team (if requested or designated hospital No 4)
5. Find list of department staff for call out (if required).
6. Delegate a member of staff to remain at the ED Staff Base to receive information via telephones using log sheets recording all incoming calls regarding the incident and any action taken, until the Medical Coordinator arrives.
7. Ensure that all clinical staff within the ED are kept informed of developments and allocated to areas of responsibility.
8. If Major Incident – Standby await further instruction.
9. Liaise with ED Consultant about commencing staff call out.
10.Ensure that the Department is cleared of any patients that may go to wards or minor casualties that can promptly be treated.
11.Organise preparation of department to receive casualties from incident. Use equipment boxes in major incident room. Delegate staff accordingly to:
  a) Triage – Allocate nurse and doctor to role of triage officer at ambulance entrance.
  b) Resus Room– Set up for reception of Priority 1 patients
  c) Majors Area – Set up for reception of Priority 2 patients
  d) Minors Area – Set up for reception of Priority 3 patients
12.Inform the Senior Nurse in the Hospital Control Room of additional staffing requirements.
13.Liaise with Senior Porter to ensure adequate porters to transport patients and that Emergency Department access except ambulance entrance.
14.Prepare designated area Outpatients Department, QEB to allow police to set up Police Discharge Area.

Priorities:
1. Set up triage and all clinical areas in preparation for reception of casualties.
2. Keep all staff informed.
3. Ensure adequate nursing staffing within ED and AAU areas.

Responsibilities:
1. Responsible for the preparation and running of  SATA.
2. To work closely with the Senior Physician to ensure that all zones and treatment areas are appropriately prepared and staffed.
3. Link with Senior Nurse AMU/ Bed Manager/Site Flow/Clinical Co-ordinator for transfer of existing patients to receiving unit or downstream wards. 

Initial Actions:
1. Ensure following staff contacted as per AAU Major Incident Call-Out List:
  a) Call out Lead Nurse ERC.
  b) Inform Receiving wards(medical)
  c) Inform Medical Records (Front Desk)
  d) Inform Porter [Senior].
2. Find list of department staff for call out - if required. (Stored in red metal box in Zone 1 office.)
3. Ensure that all clinical staff within the SATA are kept informed of developments and allocated to areas of responsibility.
4. Liaise with SATA Consultant about commencing staff call out.
5. Ensure that the Department is cleared of any patients that may go to receiving unit, downstream wards or other area (eg. Zone 4 Ambulatory).
6. Organise preparation of unit to either receive patients from ED or casualties from incident. Delegate staff accordingly to:
  a) Triage- filter patients from ED
  b) Zone 1– Set up for reception of new patients from ED or incident.
  c) Zone 2 – Set up for reception of assessed patients requiring follow-up/further assessment.
  d) Minors Area – Set up for assessed patients requiring admission.

  e. Zone 4 - set up for ambulant patients awaiting assessment/likely discharge.
7. Inform the Senior Nurse in the Hospital Control Room of additional staffing requirements.
8. Liaise with Senior Porter to ensure adequate porters to transfer patients.

Priorities:
1. Set up all clinical areas in preparation for reception of ED patients or casualties.
2. Keep all staff informed.
3. Co-ordinate with ED Senior Nurse and ensure adequate nursing staffing within ED and SATA areas.

4. Keep record of all patients received or moved during the major incident.

Responsibilities:
1. Triage team to ensure that all patients enter through ambulance entrance and undergo adequate triage.
2. Keep ED Department informed of arrival numbers and Triage catagories.
3. Work closely with Triage nurse and Health Records staff to ensure correct identification and documentation for all patients.

Initial Actions:
1. Wear ED Triage Officer tabard. To be collected from Major Incident cupboard, Emergency Department.
2. Triage will be done by triage sieve at the Ambulance entrance by an experienced ED nurse and experienced ED doctor. All other entrances will be closed and locked. Will require:
   Experienced ED Nurse
   Experienced ED Doctor
   Action Cards
   ED cards - prepacked by Health Records
   Marker pens

Major Incident Terminology -

P1 - Immediate

P2 - Urgent

P3 - Delayed

Major Incident Plan Location -

Red - Resuscitation Room

Yellow - Majors Area

Green - Minors Area

Work swiftly. Avoid a bottleneck of patients at the front door

Responsibilities:
The Health Records Department are responsible for providing:
1. A Health Records Documentation Team to register and process patients attending the ED Department following a Major Incident.
2. Senior Health Records Information Officer to assist in the control room.
3. To keep and maintain an Incident Register

Initial Actions:
1. The ED clerical staff should inform a senior Health Records Officer that an Incident has occurred
2. This officer will act as the Incident Officer within the Department ensuring adequate staffing levels are provided during the Incident.
3. The Health Records Incident Officer should set up a clerical incident desk within ED Reception ensuring that the pre-numbered Major Incident packs are available prior to the arrival of the casualties
4. The Health Records Incident Officer should allocate clerical staff to receive the casualties at the appropriate entrance.

5. Allocate Health Records Action Cards 1-6.

Upon arrival of the patients the ED clerical staff should:
-  Register the casualties on to the Hospital Administration system using the unique patient identifier number included in the documentation pack provided for each casualty. These unique numbers are known as TJ numbers.
-  After Registration provide the clinical staff with the Major Incident Documentation pack.
-  Provide a copy of the patients Registration document to the Police Bureau which is based in Outpatients (though may relocate to the Hospital Control Room.)
-  Update and maintain the Major Incident Register as the Incident progresses.
-  Liaise with the Hospital Controller.

Stand down
Update the Major Incident Register with all discharge locations ensuring that all patient identifiers have been merged or created.

Responsibilities:
1. Responsible directly for the care of patients within the resuscitation area as part of a treatment team.

Initial Actions:

1. Stay in the resuscitation area until directed otherwise by the Senior Emergency Physician on duty/ED consultant.
2. Treat patients as allocated until directed to other tasks by the Senior Emergency Physician on duty/ED consultant.
3. Complete routine patient processing tasks and documentation.
4. Discuss all patients with the Senior Emergency Physician or ED consultant to plan management and disposal. 
5. Blood bank will still require TWO samples.
6. Imaging priority to be discussed with the Senior Emergency Physician on Duty/Ed consultant.
7. In trauma - trauma protocol CT from head to lowest point of injury.
8. Ensure all patients are logged by Health Records staff before they leave the Emergency Department.

9. Ensure that any patients transferred out of the ED to a major incident receiving ward have been discussed directly with the ward/receiving staff. 

10. If patients are going directly to Theatre ensure this is communicated to Theatres/Surgical and Critical Care Teams.

Priorities:
1. Act as ED link for Treatment Teams. Other Team members may not be familiar with processes within the ED.

2. Communicate patient updates to Senior Emergency Physician on duty/ED consultant.

Responsibilities:
1. Responsible directly for the care of patients within the Major's area as part of a treatment team.

Initial Actions:
1. Stay in the Major's area until directed otherwise by the Senior Emergency Physician on duty or ED consultant.
2. Treat patients as allocated.
3. Complete routine patient processing tasks and documentation.
4. Discuss all patients with the Senior Emergency Physician or ED consultant to plan management and disposal. 
5. Blood bank will still require TWO samples.
6. Imaging priority to be discussed with the Senior Emergency Physician on Duty/Ed consultant.
7. In trauma - trauma protocol CT from head to lowest point of injury.
8. Ensure all patients are logged by Health Records staff before they leave the Emergency Department..
9. Ensure that any patients transferred out of the ED to a major incident receiving ward have been discussed directly with the ward/receiving staff.
10. If patients are going directly to Theatre ensure this is communicated to Theatres/Surgical and Critical Care Teams.

11. Discharges must be communicated to Health Records and book out via the Police Scotland Bureau in Outpatients.

Priorities:
1. Act as ED link for Treatment Teams. Other Team members may not be familiar with processes within the ED.

2. Communicate patient updates to Senior Emergency Physician on duty/ED consultant.

Responsibilities:
1. Responsible directly for the care of patients within the Priority 3 Area 

Initial Actions:
1. Stay in the Priority 3 Area/Major's B until directed otherwise by the Senior Emergency Physician or the Senior Doctor Priority 3 Area.
2. Treat patients as allocated until directed to other tasks by the Senior Emergency Physician or Senior Doctor Priority 3 Area.
3. Examine patients thoroughly and ensure all injuries are documented, treated and an appropriate management plan or follow up is in place.
4. Discuss patients if required with the Senior Emergency Physician or Senior Doctor Priority 3 Area to plan disposal. Also involve the Senior Surgeon or Senior Orthopaedic Surgeon as appropriate.

5. Complete accurate documentation 
6.. Limit investigations including x-rays to absolute minimum until otherwise directed. This is to avoid bottlenecks at x-ray.

7. Provide:
  a) Adequate analgesia.
  b) Appropriate splintage.
  c) Document a clear treatment plan.
8. Ensure all patients leave the Emergency Department through Police Area Outpatients Department, QEB.
9. Ensure all patients are logged by Health Records staff before they leave the Emergency Department.
10. Ensure that any patients transferred out of the ED to the major incident receiving ward have been discussed directly with the ward.
11.If patients are going directly to theatre then ensure that the Theatres/Surgery/Critical Care have been involved.

12. Assist non-ED staff unfamiliar with departmental procedures.

Priorities:
1. Work under the direction of the Senior Doctor Priority 3 Area.
2. Ensure that patients are fully examined and all injuries documented.
3. Ensure all patients when discharged are logged by the Health Records staff and go directly to the discharge area Outpatients Department, QEB.