Objectives

• During working hours: SJH CCC1 role will be managed or reallocated, by the Intensive Care Consultant.
• Out of Hours: The SJH CCC1 (3561 bleep holder) role will be fulfilled by the Senior Anaesthetist/intensivist on site. The on-call consultant anaesthetist should be contacted to attend as soon as possible if the resident bleep holder is not a consultant to assume this role. 

Action Card 1. Critical Care Consultant 1 (CCC1)

 Work through the Action Card in a sequential manner. DO NOT become involved in direct clinical care;  remove yourself from this as soon as possible. The Theatre Control Team will gather in the Anaesthetic Seminar Room and Theatre Coordinators Office in the theatre corridor.

Specifically they must: 

• Coordinate the critical care response to the incident 
• Communicate and coordinate this response with appropriate colleagues 
• Oversee clinical activity in SJH theatre, recovery suites and other areas requesting anaesthetic assistance e.g Emergency Department (ED)

Activate this plan if requested to do so by Service Director/Senior Manager or if a major incident has been declared affecting your area 

If not already informed alert the senior theatre coordinator on duty via bleep 3541 and OPD bleep 3656 

Initial Actions

Access Major Incident Box in Anaesthetic Seminar Room, put on ‘CCC1’ identifying tabard, carry 3096 bleep  (walkie talkie will be distributed to you by site coordinator).

• Go to ED and get an update about nature of incident and likely numbers/types of patients diverted to SJH
• Inform Clinical Director for Anaesthesia (Murray Geddes 07914 241670)
• Identify staff required to manage incident and initiate call out procedures if required (call-out procedure, phone numbers and log sheets available in major incident box)
• Allocate following roles: Hospital controller; CCC2 (ED); CCC3 (Red ICU, ground floor); CCC4 (Theatre corridor); CCC5 (Green ICU, 2^nd floor)
• ‘Theatre Control Team’ should set up  in Anaesthetic Seminar Room and Theatre Coordinators Office(theatre bleep holder, Recovery Lead, Surgeon 2 and CCC1)

Theatre Control TEAM (Anaesthetic Seminar Room)

• Communicate with Hospital Control Team:
• Get the following reports:

• Theatre coordinator (Bleep 3541): Number of theatres running with estimated time to completion  
• Recovery Lead: (Bleep?) Status of cases in recovery including any concerning patients  
• Surgical consultant 2: Clinical urgency of emergencies pending 
• Theatre Control Team: to decide on elective/non-urgent CEPOD cancellations 
• Begin the Major Incident Log (or delegate if available)
• Identify any immediate resource requirements to the control room

Continuous Actions: Inpatients

• Confirm placement/destination of patients currently within theatres and recovery
• Ensure that Main Recovery is being cleared (Recovery Lead will coordinate)
• Initiate transfer of patients fit for discharge to wards/waiting areas 
• Transfer patients from main recovery to Day Surgery recovery areas for ongoing post-op care if not yet ward fit 
• Risk assess patients in surgery or anaesthetic room. Transfer patients to Day Surgery recovery for immediate post-op care or back to wards/home if surgery can be postponed 

Continuous Actions: New admissions

• Allocate critical care teams to support and offload resus bays.
• Facilitate clearance of anaesthetic rooms and theatres to receive patients from ED
• Consider having Belmonts/CVVH primed and transfer trolleys checked in anticipation of clinical activity
• Patient flow of critically unwell patients should initially be from ED to theatre corridor for resuscitation and stabilisation. Transfer thereafter dependent on situation: Theatre recovery post pre or post procedure; Red ICU unstable/surgical; Green ICU stable/medical; Inter-hospital transfer
• Theatre Control Team to identify likely requirements of patients coming to theatre, plan/kit required and initiate set up. Theatre coordinator (XXXX) bleep holder will coordinate theatre nursing and ODP staff, theatre and equipment availability.
• Use Major Incident White Board  (on the wall in anaesthetic seminar room – remove laminates) to record theatre availability, patient and procedure details. Use patient ‘Major Incident Number’ as identifier
• Assemble and allocate suitable anaesthetic teams for each patient requiring surgery/ resuscitation. Initial assembly room should be the Aneathetic Department Seminar Room
• Coordinate activity with CCC 2,3,4,5. 
• Main Recovery to be used for Critical Care overflow if required
• Brief theatre teams about actions required and provide them with regular updates
• Maintain oversight of clinical activities in theatre. 
• Identify staff provision for subsequent shifts. Enlist assistance of unit coordinator/rota administrator/clinical director if available for this task
• Keep a log of key events, decisions and communications
• Refer all external requests for information about incident to the control room

Communication

• Establish a working communication pathwaywith Surgeon 2, Surgical Consultant in charge, Theatre bleep holder, Recovery Lead, Critical Care Consultant Leads and Hospital Medical Controller.
• Practice closed loop communication – repeat requests back and confirm response.
• Patients should be referred to by their Major Incident Number during all communications if transferred to SJH site. 
• Communication failure plan:
• Plan A – designated MI walkie talkies 
• Plan B – usual ICU/theatre extensions, switchboard likely to be overwhelmed 
• Plan C – WhatsApp (WIFI if cellular network down) 
• Plan D – face to face utilising runners 

SITREPS

Report to hospital control room should include the following information:

• capacity in use (e.g. theatres/beds occupied with simple breakdown of severity) 
• currently available capacity and projected capacity over the next 24 hours including staffing resource to support 
• blood and Equipment Issues 
• recent significant events (e.g. deaths, loss of resources) 
• serious or immediate risks to service delivery or safety (including risks to other areas that depend on this area and anticipated future risks) 
• requests for specific support or information.

Wellbeing/Resilience

• Consider shorter shifts
• Encourage buddy systems
• Keep logs up to date to facilitate debriefs following the incident
• Awareness that staff may know people involved
• Offer support
• Signpost cool down/safe area ? Education centre