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READERS’ BLOG

Maintaining patient safety during a critical incident

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On 5th December, Storm Desmond hit Cumbria and Lancashire causing unprecedented devastation to a large part of the area. Executive Chief Nurse, Sue Smith, explains how health services dealt with the crisis

Our two largest hospitals in Barrow-in-Furness and Lancaster went into major incident mode during the day on 5th December due to the impact of the floods.

Another of our hospitals, Westmorland General Hospital in Kendal, also experienced significant challenges. The roads into and out of Kendal were flooded and impassable – a situation that started to spread throughout the region, making access to and from our hospitals difficult and, at times, impossible.

”The roads into and out of Kendal were flooded and impassable”

The emergency and public services in the widest sense of the word came together to keep the public of Cumbria and Lancashire safe.

At 2230 hrs on 5th December, our on call managers were informed that the power was about to go off and over 60,000 homes would be affected. We also experienced time without mobile coverage for a large part of the weekend and into the following week.

As a result of electricity and mobile phones not working, staff and the public also lost the ability to connect to the internet, listen to the radio, watch TV etc, meaning that getting messages to them was challenging.

At this point some care homes were now being evacuated due to flooding.

”At midnight the team was informed that within 6 hours, at high tide, the River Lune in Lancaster was expected to breach”

Military vehicles had been requested and at midnight the team was informed that within 6 hours, at high tide, the River Lune in Lancaster was expected to breach. All roads were closed in and out of Lancaster. In the early hours of 6th, Lancaster flooded.

We put a ‘call out’ for extra staff to come into work but without full communication services this was challenging. But by using a wide range of methods, staff did respond and, to ensure they were safe, both the military and mountain rescue services provided ‘door-to-door’ transport for them.

”By 3am I had fumbled around in the dark and was driving to my nearest site”

While electricity, phones and mobile/internet were down, a single text message did eventually make it through to my phone at 0245 regarding the major incident. By 3am I had fumbled around in the dark and was driving to my nearest site, the Royal Lancaster Infirmary.

The first road I tried was cordoned off and so was the second route. Eventually I spoke to a mobile police team who explained that all routes were impassable and I would have to take a very circuitous route if I wanted to get in.

The police told me that some patients were being taken to hospital by army boats and vehicles in life or death situations - including, I believe, some patients with their home ventilators where electricity had failed in their home. I arrived on site at 5am.

”Some patients were being taken to hospital by army boats and vehicles in life or death situations”

As an executive team we are part of the incident response and whilst we were also ‘on site’ our established structures for dealing with such situations kicked into place and took control. We all did what we could to provide additional help a variety of ways, from delivering food to frontline staff, through to helping with cleaning and making beds.

Estates teams and catering teams kept patients and staff in electricity and provided them with hot food and drink. At one point, electricity load got a little high and a message was sent for staff to turn lights off for a while in non-essential areas to preserve fuel.

Led by our on-call management team, a citizens’ ward was set up for people who manage their own ventilator but just needed to have an electricity supply. We were the only source of electricity for the whole area, which meant we had to bring in security staff to stop local people coming in to charge their mobile devices in our corridors as we needed to conserve our emergency power for patient care.

“We had to bring in security staff to stop local people coming in to charge their mobile devices in our corridors”

My own role in our major incident has been small - an executive presence in case escalation is needed. I made a few beds and facilitated some small changes to support the team, but it is our staff and partners who deserve the credit for their amazing management of a most unusual major incident. The emergency services including police, army, environment agency, fire, ambulance, council, highways and many more - all pulled together to ensure the system was joined up.

Let me give you some examples of the best I have observed:

Management teams - clinical and non-clinical, working together across sites to ensure patient safety is maintained at all times. Pragmatic and sensible but creative solutions to issues that are difficult to plan for - such as patients on home oxygen and home ventilators turning up at our front door.

One nurse, despite her home being flooded in Appleby, turned in on time every day to work and keep patients safe. Doctors and nurses who work in other trusts but live close to our hospitals offered themselves for work during their days off. The army and mountain rescue volunteers ferried staff and patients in. Nurse practitioners went out with Mountain Rescue to see and treat patients in their own homes and reduce the impact on ambulance and hospital.

”One nurse, despite her home being flooded in Appleby, turned in on time every day to work and keep patients safe”

Two of our clinical support workers went to work in a local care home to enable them to receive patients who were in hospital but didn’t need to be. Many staff and volunteers slept in the hospital so they could be available when needed.

On day 3, the RLI was still running on emergency generators. Many staff have worked extra-long hours but the morale remains high and there is a real feeling of pride in what we are achieving as a team.

We have had to cancel a number of outpatient and elective surgical activity so that we can focus on hands-on patient care. Emergency and urgent operations have been undertaken wherever possible.

”Morale remains high and there is a real feeling of pride in what we are achieving as a team”

As I write this, on day 4, generators are still keeping the RLI going but we are stepping down from major incident to critical incident at Lancaster with other sites resorting to business as usual. It will take a few days to fully recover and we still have many challenges to work through.

As I reflect on what I am seeing and feeling, I am immensely proud to work alongside the amazing staff and those across the NHS - surely, there is no other institution like it in the world. I love my job but can honestly say that my sense of pride and satisfaction at what is being achieved by staff at every level is humbling.

As a final word it is important that we remember that this terrible situation isn’t over, and sadly there has been loss of life. The impact for some people in terms of the impact to their homes and business will go on for years and in a few weeks when we are celebrating Christmas, many of them will be without their homes and presents.

Sue Smith is Executive Chief Nurse at University Hospitals of Morecambe Bay

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