Business Continuity Plan for Northwest Ambulance Services - Case Study Example

Business Continuity Plan for Northwest Ambulance Services Introduction: Operating Environment & Stakeholder Analysis The Northwest Ambulance Service (NWAS) operates under the auspices of the NHS, and provides vital services for Cumbria, Lancashire, Cheshire, Merseyside, and the greater Manchester metropolitan area. In addition to headquarters in Manchester and three area offices services are provided by 114 ambulance stations across the region. (Business Plan 2008/2009, 2008) The service maintains a fleet of 982 vehicles, plus a number of bicycle-equipped cycle responders and two helicopters providing medical airlift services. (Northwest Ambulance Service, 2010) The NWAS has a number of stakeholders whose confidence and satisfaction in how the service is doing its job is vitally important: Patients – There are differences among the patients; some require emergency medical attention and transport, others are elderly or convalescent patients who simply need safe transportation from their home to a medical facility for routine treatment, or from one medical facility to another. Other patients might be those who require only minor attention, and who can be helped by a visit from one of NWAS’ Rapid Response Vehicles or a Cycle Responder. Staff – The workers who provide all NWAS services, of whom there are over 4,500. (Business Plan 2008/2009, 2008) The Business Continuity Plan must answer not only the need for these workers to be able to do their jobs of helping patients effectively, but also maintaining their livelihood. Hospitals and Medical Facilities – Many of the activities of hospitals and other medical facilities are planned and carried out with the services provided by NWAS in mind. A disruption to NWAS’ services can have negative impacts on the services hospitals and other medical facilities are able to provide. Local Governments – The services provided by NWAS are also an important part of local governments’ emergency and service planning. The General Public – The public is a stakeholder in NWAS because their taxes fund the service; they have the right to expect that the funding is used appropriately to maintain NWAS services and activities efficiently and when required. The Business Community – NWAS, apart from its patient care services, also provides training and advice for local businesses on safety and health matters. These services help reduce risks and accidents, and in the long run, make the job of NWAS easier. The NHS – As the main government body overseeing the activities of NWAS, the NHS is ultimately responsible for the efficiency and quality of the services. NWAS, therefore, must have a Business Continuity Plan that satisfies NHS requirements to ensure continued service. Critical Activities & Maximum Tolerable Periods of Disruption There are three general levels of continuing service that can be considered when making a Business Continuity strategy, and these depend on how critical each activity is (Business Continuity Policy, 2009): 1. Full availability: Any disruption of the service or activity is unacceptable. 2. Recovery within a Time Recovery Objective: Service or activity to be restored to an acceptable minimum level within an agreed amount of time. 3. Suspension of service: Service or activity suspended, with no pre-determined time for it to resume. The first is relevant to the most critical activities, and really has no maximum tolerable period of disruption. The second applies to most other activities, and has a maximum tolerable period of disruption that depends on the type of activity. The third applies to only a very few activities, ones for which the maximum tolerable period of disruption can be indefinite. According to the NWAS website (Northwest Ambulance Service, 2010), the following services are provided: 1. Accident and Emergency Services: This entails response by an appropriate ground unit (rapid response vehicle or emergency response ambulance) to a medical emergency. 2. Air Ambulance Services: This service uses a helicopter (one of two Eurocopter EC-135s) to respond to medical emergencies of a very critical, life-threatening nature, or in areas where road access is limited. 3. Commercial Services: NWAS provides training and advisory services to the public and businesses through safety, health, and first aid courses. 4. Patient Transport Services: NWAS provides transportation services for non-emergency patients to and from their hospital and clinic appointments, by arrangement with the patient’s doctor or medical clinic.  5. Community First Responders: These are volunteers trained by NWAS and provided with basic life-saving equipment, and who are dispatched at the same time as the regular ambulance service; because they are in the community, however, the first responder is usually able to arrive at the scene much more quickly, and provide the patient with initial care and reassurance until the ambulance arrives. 6. Volunteer Drivers: NWAS supplements its patient transport services with the use of volunteer drivers, who have a basic amount of orientation and training and use their own vehicles to transport non-emergency patients to and from doctor visits. 7. Hazardous Area Response Team (HART): HART is a specially-trained and equipped team to provide medical services at large-scale incidents where there may be many casualties. At present, NWAS has one HART team in Manchester, with a second scheduled to be stationed in Liverpool in January 2011. (Northwest Ambulance Service, 2010) The maximum tolerable periods of disruption are as follows: 1. Accident and Emergency Services: None. In the case of a disruption in one or more stations or service areas, service coverage must be provided by another nearby station. 2. Air Ambulance Services: None. If the helicopters are unable to fly, arrangements must be made with another air ambulance service to provide coverage whilst the problem is being corrected. 3. Commercial Services: Up to 30 days. The training courses and advisory services provided by NWAS are important, but they are not critical or life-saving activities. 4. Patient Transport Services: Up to seven days, if Volunteer Drivers are otherwise available; up to three days if there are no Volunteer Drivers. 5. Community First Responders: Up to three days. The Community First Responders do help to provide critical first-aid to patients, and their help can mean the difference between life and death for badly injured people. However, the main job of attending and moving patients to a hospital is still the responsibility of the ambulance service, so the first responders are just a helpful addition to this. 6. Volunteer Drivers: Up to seven days, if NWAS regular patient transport services are still available; up to three days if the regular service is also not operating. 7. HART Team: Up to 30 days. The HART Team is a relatively new part of NWAS, and prior to its existence, the plan for large-scale incidents was simply integrated with NWAS’ existing resources. If the HART Team is disrupted, its activities can be covered by the existing services, although it will be helpful to have the HART Team recovered as soon as possible. Time Recovery Objectives The Time Recovery Objectives are based on the Maximum Tolerable Periods of disruption. 1. Ambulance Services (Ground and Air): Coverage for the affected vehicles to be arranged within 60 minutes, with recovery for the affected vehicles within 48 hours. 2. Commercial Services: NWAS should be able to resume its training and advisory programs within 30 days of any disruption. 3. Patient Transport Services (NWAS and Volunteer): If just one vehicle or driver is affected, recovery should be within seven days. If the service generally is disrupted, recovery should be within three days (72 hours). 4. Community First Responders: Community First Response in any area should be recovered within three days (72 hours). 5. HART Team: The HART Team should be recovered within 30 days. Critical Dependencies There are five Critical Dependencies that must be considered in the Business Continuity Plan, and each of these dependencies has a number of parts. First are the people working for NWAS, and they fall into three categories: Management, Skilled Personnel, and Volunteers. The skilled personnel are the most important, because of their training and abilities. The second critical dependency is the vehicle fleet: the air ambulances, the specially-equipped ambulances and rapid response vehicles, and the basic transport vehicles including the cars used by volunteers. Of these, the ambulances are the most important, because they are the most versatile and can be used for any of the services provided by NWAS if necessary. The third critical dependency is the buildings that are used as ambulance stations, area offices, and the headquarters. These serve as bases for the communications and supply networks the service needs. The fourth critical dependency is the information infrastructure, the communications and computer networks. The fifth critical dependency is supply, and this has three parts: fuel for vehicles, maintenance and repair for vehicles, and medical supplies. Strategies for Maintaining Critical Activities People: NWAS already has a procedure to maintain management in the case of a crisis. The Area Emergency Manager is the first contact and responsible party, and he in turn will notify the Local Operational Manager to address the situation until the Area Director can be notified. Overall management of the incident is the responsibility of the NWAS Medical Director, or other designated senior director. (Serious Untoward Incident Policy, 2007) Each of these managers should have at least one designated on-call back-up. In like fashion, the skilled personnel – paramedics and other medically-trained people – should have at least two back-ups who can be called to duty in an emergency situation. Ideally, this arrangement will allow for continued service even with up to half of the administration personnel and two-thirds of the skilled medical personnel not available, although only for a limited time, perhaps 8 to 12 hours. That time should be sufficient, however, for other arrangements – such as borrowing personnel from other ambulance services – to be made. If Volunteer Drivers or First Responders are not available, the Area Emergency Manager in the affected area should notify the regular NWAS personnel in that area, so that interruptions in services are kept to a minimum. Vehicles: There are 114 ambulance stations organised into three areas in NWAS. Each station should be organised with the next two nearest stations to provide continuous coverage in case of the loss of a vehicle. This is done as part of normal operations anyway, but is generally only organised with one level of back-up; in other words, if an ambulance or Rapid Response Vehicle from one station is engaged, the next nearest station will answer an emergency call in the first station’s area if necessary. (Northwest Ambulance Service, 2010) Thus, adding a third station ensures this back-up scheme remains in place even if a vehicle is lost. This should allow for basic emergency services to be provided for NWAS even in the case of the loss of up to a third of the vehicles. The air ambulances are a slightly different case, because there are only two of them available, both based normally at Blackpool Airport. (About Northwest Air Ambulance, 2008) If one aircraft is lost or not available, the other will serve as the primary aircraft, with back-up to be arranged in co-operation with the Midlands Air Ambulance Service, whose aircraft can cover the southern part of the NWAS area, and the Yorkshire Air Ambulance, which can reach the eastern and northern parts of the NWAS area. (Air Ambulance Coverage Map, 2010) Buildings: The primary purpose of the ambulance stations is for sheltering and resupplying the vehicles between calls, and to provide staff a place to rest and attend to personnel and human resources-related functions. Communications are based in the stations, although all the ambulances and Rapid Response Vehicles have self-contained systems. (Northwest Ambulance Service, 2010) An arrangement similar to that for vehicles, with the next two nearest stations serving as primary and secondary back-up locations, will answer the loss of any single station. To avoid congestion at the back-up station and to maintain good response time, the affected vehicles can be deployed to suitable waiting locations in their areas after they have re-stocked and attended to staff needs at their temporary station. If the Air Ambulance base at Blackpool is unusable, the two aircraft can be temporarily relocated to another airport in the NWAS area. Manchester is a large and fully-equipped airport and would be a good substitute location, however, the amount of air traffic there might be a safety and time risk. The Woodford airfield at Manchester, Liverpool Airport, or the Warton airfield (which is close to Blackpool, and would minimise the air crew’s inconvenience) would be good alternatives. Communications & Information Infrastructure: The main risk is to the control and co-ordination system for communications, and data files. Each of the three area offices should be equipped with a communications system identical to the headquarters system, so that in case of a loss of the main system any of the three could serve as the main communications hub. Critical data files must be backed up regularly and kept in a secure location away from the main system, so that they can be retrieved and restored quickly in case of a major system problem. Supplies: There should be at least two alternative sources of supply for all vehicle-related needs and medical supplies, in addition to the main suppliers. Primary suppliers should be required to have their own Business Continuity Plans in place as a condition of doing business with NWAS, to ensure timely delivery of needed items under any circumstances. Monitoring Critical Dependencies The front-line personnel are the ones who will experience the problem first and are in the best position to monitor and report on critical dependencies, and in accordance with NWAS’ Serious Untoward Incident Policy, the Area Emergency Manager is the first contact in case of an incident that might warrant activating the Business Continuity Plan. (Serious Untoward Incident Policy, 2007) The communications path of a potential problem reported by one of NWAS’ personnel would then be as follows: 1. Potential problem is reported to Area Emergency Manager by personnel. 2. Area Emergency Manager reports to Local Operational Manager. 3. If a minor problem for which there is a local procedure in place, LOM instructs AEM, who relays instructions back to personnel. Problem corrected. LOM makes report to Area Director. 4. If it is a more serious problem, LOM reports to Area Director. 5. Area Director decides if it is a problem that might activity the Business Continuity Plan. If so, Area Director notifies the NWAS Medical Director (or designated management leader of the crisis team). 6. If problem is not serious enough for the Business Continuity Plan, Area Director decides what action will be taken and informs AEM, who relays instructions back to personnel. Problem corrected. Report of the incident is made so that it may be analysed later to help prevent future problems. Examples of problems that could be handled by regular procedures short of the Business Continuity Plan would be a temporarily disabled vehicle – such as a flat tire, or a minor accident not involving other drivers or injuries – a temporary electrical blackout at a station, workers having to leave their shift for a personal emergency, unexpected shortage of some supplies at a station, and other relatively minor problems that only affect one station or a few workers for a short time, and do not generally affect the operations of the entire system. Arrangements for Activating Response Plans If there is a more serious problem that will affect operations for an extended period of time, or that will involve more than one or two local stations in either the problem or the response, then the Business Continuity Plan will be activated. As described above, the decision for doing so will be with the NWAS Medical Director, who is designated the responsible director by the Serious Untoward Incident Policy. It is the responsibility of the Area Directors to notify the Medical Director immediately of any problems that exceed the very simple conditions explained above, and which may potentially activate the plan. The Medical Director (or his designated on-call substitute) will notify the NWAS Director and the appropriate internal and external managers and agencies, depending on the type of emergency, such as: Police Fire Coroner Local doctors and medical facilities, especially if a number of injuries have happened NWAS IT management Legal advisors Media co-ordinator NHS officials as required Local government agencies and officials Designated contacts in other Ambulance Services, if their assistance is needed An incident management centre will be set up away from the main headquarters and operations, so that the response can be managed as much as possible without disrupting normal operations. Generic Responses to Disruptions The first steps in the process of reporting a problem and assessing whether or not it will activate the Business Continuity Plan are also the generic response to any disruption. It can be summarised as: Problem reported to Area Emergency Manager. Area Emergency Manager co-ordinates with Local Operational Manager. Level 1, Minor Problem: Local Operational Manager decides on remedy, instructions are passed to personnel by Area Emergency Manager. Problem and resolution reported to Area Director. Level 2, Moderate Problem: Local Operational Manager reports to Area Director, who decides on remedy. Instructions passed to personnel by Area Emergency Manager. Area Director reports problem to NWAS Medical Director and Director. Level 3, Serious Problem: Area Director determines remedy is not within his authority or established procedure, reports immediately to NWAS Medical Director. Medical Director decides and/or consults on remedy, and issues instructions with approval of NWAS Director. Level 4, Very Serious Problem: NWAS Medical Director determines problem requires activation of Business Continuity Plan, and notifies appropriate managers and other parties. Plan is activated. Media Strategy for Reassuring Stakeholders & the Public Information given to the public and NWAS stakeholders through the media should be truthful and detailed, but controlled. All media statements and inquiries should be managed by a single designated Media Co-ordinator, and the information he gives should include: An accurate description of the emergency. How it affects NWAS’ normal services. What steps are being taken to compensate for the loss. When the situation is expected to be resolved. This information should be given as soon as possible, but only after the plan has been activated and decisions on what actions to take have been made; it is very important that the information being given is accurate. Above all, it should be stressed that a specific plan to handle emergencies has been in place and that NWAS is prepared to respond immediately. Hopefully, the public and NWAS’ stakeholders will be reassured that even though the emergency is unfortunate, it is not unexpected, and that the service will be restored quickly. Integrating the Response Plans into Day-to-Day Operations In order to integrate the response plan into day-to-day operations, the plan must be written and distributed to all NWAS personnel in a simple, outline form; one possible way to do this is to present a number of likely scenarios, and the specific steps each personnel position would have to accomplish if that happened. This format would also help to increase the buy-in of managers and front-line personnel, because their feedback could be sought to help develop the “what if” scenarios. It would also serve as a specific and useful guide to practising the plan. Although the responses in the plan are situation-specific, there are a number of general tests that can be done to help ensure that it works when needed. For example, practising setting up a separate control centre, restoring data from back-ups, or using an area office as a temporary headquarters can identify problems with these activities beforehand, which can be corrected before there is an actual emergency. References About Northwest Air Ambulance. (2008) Northwest Air Ambulance, 2008. [Internet] Available from: . Air Ambulance Coverage Map. (2010) The Association of Air Ambulances, 2010. [Internet] Available from: . Business Continuity Policy. (2009) East Midlands Ambulance Service NHS Trust, 6 May 2009. [Internet/PDF] Available from: . Business Plan 2008/2009. (2008) Northwest Ambulance Service NHS Trust, 21 April 2008. [Internet/PDF] Available from: . Northwest Ambulance Service. (2010) Northwest Ambulance Service [Website]. NWAS/NHS Trust, March 2010. Available from: . Serious Untoward Incident Policy. (2007) Northwest Ambulance Service NHS Trust, August 2007. [Internet/PDF] Available from: . Strathclyde Emergencies Co-ordination Group. (2009) A Guide to Business Continuity Planning for Business and Voluntary Organisations. South Lanarkshire Council Corporate Communications and Public Affairs, February 2009. [Internet/PDF] Available from: . Read More