DOCUMENT CONTROL:

Version: 12

Ratified by: Corporate Policy Panel

Date ratified: 7 June 2018

Name of originator/author: Emergency Planning Officer

Name of responsible committee/individual:

Corporate Policy Panel

Date issued: 25 June 2018

Review date: May 2021

Target Audience All Staff

Heatwave Plan

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Section

CONTENTS

Page No.

1. Introduction 3

1.1 NHS England & Public Health England Guidance 3

2. Core Elements of Heatwave Plan for England 2014 4

2.1 Alert and response 4

2.2 Heatwave Alerts 5

2.3 NHS England Heatwave Alerts – Guidance for Providers 8

3. Trust Heatwave Action Plan 9

3.1 Trust Heatwave Reporting Structure 9

4. Heatwave Contingencies 10

4.1 Who is at risk? 10

4.2 At risk groups 11

4.3 What are the risks? 12

4.4 Managing the risk 12

Appendix 1 Guidance on keeping your environment cool 15

Appendix 2 Medicines that may have side effects during excessive heat exposure

16

Appendix 3 Supporting People in their own homes to prepare for a heatwave. A Checklist for Professionals, volunteers and Carers.

18

Appendix 4 Supporting people in their own homes during a heatwave. A Checklist for professionals, Volunteers and Carers.

19

Appendix 5 Caring for residents to prepare for a heatwave. 20

Appendix 6 Caring for residents during a heatwave. A checklist for Home Managers and Staff (e.g. Registered and Supported Living Homes

21

Appendix 7 Actions to Take In The Event Of Suspected Heat Exhaustion / Heatstroke

22

Appendix 8 Public Health Core messages 23

Appendix 9 Draft Situation Report (Sitrep) Template 25

Appendix 10 Record of Amendments 27

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1. INTRODUCTION The purpose of this plan is to provide Trust staff with guidance in the event of a heatwave. It is written for use by all Trust staff and may be used in in-patient and community settings or by staff in corporate services. Trusts are required to hold heatwave plans by NHS England Core Standards for Emergency Preparedness, Resilience and Response (EPRR). The plan is covered by the Equality Impact Assessment for the Trust EPRR policy. Definition of a Heatwave: A heatwave is triggered as soon as the Met Office forecasts that there is a 60 per cent chance of temperatures being 290C day and 150C night on at least two consecutive days (For Yorkshire and Humber) which will have significant effects on health. This forecast will normally be made 2–3 days before the event is expected. The aim of the heatwave plan is to put in place procedures to reduce risks to health from severe heat and works in conjunction with team business continuity plans. This plan is underpinned by a system of heatwave alerts, developed by the Met Office which are be issued between June 1st and 15th September each year. The Climate Change Act 2008 makes it a requirement for all statutory sectors to have robust plans in place to deal with the impact the climate change may have. During a heatwave, temperatures which remain abnormally high over more than a couple of days can prove fatal. The rise in mortality, especially amongst older people, follows very sharply after the rise in temperature which contrasts with deaths associated with cold snaps in winter. This means that:

By the time a heatwave starts, the window of opportunity for effective action is very short, therefore preparedness is essential.

1.1 NHS England/Public Health England Guidance

Heatwaves can occur with little warning, therefore, as a Trust and as individual teams we need to plan in advance what actions to undertake in order to reduce the increase of heat related conditions. The information in this document has been taken from the Heatwave Plan for England 2015. Note this plan was last updated in May 2017.

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2. CORE ELEMENTS OF THE HEATWAVE PLAN FOR ENGLAND 2015 (2017 Update)

2.1 Alert and Response

The diagram below depicts the responsibilities at national and local level for alerting and response once a heatwave has been forecast.

Notes: ‡ NHS England Area Teams and CCGs should work collaboratively to ensure that between them they have a cascade mechanism for heatwave alerts to all providers of NHS commissioned care both in business as usual hours and the out of hours period in their area. *PHE Centers would be expected to liaise with Directors of Public Health to offer support, but formal alerting would be expected through usual Local Authority channels. †LHRPs and HWBs are strategic and planning bodies, but may wish to be included in local alert cascades.

Department of Health/Civil

Contingencies Secretariat

Other Government Departments

Summer Resilience Network

Met Office Heatwave

Alert Public Health

England Centres*

NHS Choices

Public via media - TV,

radio, newspapers

NHS England

Corporate Team National

Regional Teams

‡ NHS England Area Teams

Ambulance Trust

Clinical Commissioning

Groups

Health & Wellbeing Boards ††

RDaSH

Local Authority Emergency Planners &

Directors of Public Health

Including Local Resilience Forums and Local Health Resilience

Partnerships†

Schools

Residential Homes

Nurseries

Voluntary Orgs

Social Services

Day Care Centres

Pharmacies

GPs & District Nurses

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2.2 Heatwave Alerts

The Heatwave alert levels will be triggered by temperature thresholds set according to regional variations, and a Heat Health Watch system will operate from 1st June to 15th September.

The temperature threshold for Yorkshire and the Humber is day 290C, night 150C. Fig 2.3 Heatwave Alert Levels

Level 0

Long-term planning All year

Level 1 Heatwave and Summer preparedness programme 1 June – 15 September

Level 2 Heatwave is forecast - Alert and readiness 60% risk of heatwave in the next 2-3 days

Level 3

Heatwave Action Temperature reached in one or more Met Office national Severe Weather Warning Service regions

Level 4 Major incident – Emergency response Central Government will declare a Level 4 alert in the event of severe or prolonged heatwave affecting sectors other than health

Level 1: Heatwave and Summer Preparedness: Summer preparedness runs from 1 June to 15 September when a Level 1 alert will be issued. The Heatwave Plan will remain at Level 1 unless a higher alert is triggered. During the summer months, social and healthcare services need to ensure that awareness and background preparedness are maintained by implementing the measures set out in the Heatwave Plan. Public Health England (PHE) will routinely monitor outputs from real-time syndromic surveillance systems including calls to NHS 111, GP in hours and out of hours consultations and emergency department attendances (on a daily basis, week days only), for the impact of heat-related morbidity using a range of syndromic health indicators. Information on heat-related illness will be included in routine weekly surveillance reports published on the PHE website; these will provide a source of intelligence on how severe the effects are and how well services are responding. PHE will continue to provide heatwave mortality surveillance, producing weekly excess all-cause mortality estimates based on Office National Statistics (ONS) weekly data during the summer and publish outputs once a fortnight on the PHE website in the PHE flu report, with archived reports also available (PHE flu report archive).

PHE will make advice available to the public and health and social care professionals in affected regions, in preparation for an imminent heatwave,

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via NHS Choices and the websites of the Met Office, PHE and DH. www.nhs.uk/summerhealth includes information on how to stay well in hot weather.

Level 2: Alert and readiness: This is triggered as soon as the Met Office forecasts that there is a 60 per cent chance of temperatures being high enough on at least two consecutive days to have significant effects on health. This will normally occur 2–3 days before the event is expected. As death rates rise soon after temperature increases, with many deaths occurring in the first two days, this is an important stage to ensure readiness and swift action to reduce harm from a potential heatwave. PHE will continue to monitor routine syndromic surveillance systems for any increases in heat-related illness including calls to NHS 111, GP in hours and out of hours consultations and emergency department attendances (on a daily basis, week days only). It will continue to provide information on heat-related illness in routine weekly surveillance reports. PHE will continue to produce weekly excess all-cause mortality estimates based on weekly ONS data during the summer and publish outputs once a fortnight on the PHE website in the PHE flu report. In addition, PHE will request release of daily deaths data and monitor daily any increase in excess summer deaths based on available data. Daily monitoring will continue up until one week after return to level 1.

The Emergency Planning Officer (EPO) and Care Group Directors (CGDs) will be notified if Level 2 is triggered and will initiate any required actions (Section 3.0). Refer to section 3 for actions to take in the event of the notification of a heatwave alert.

It is the responsibility of Care Group Directors to ensure that actions detailed at level 2 are completed as per section 3 of the trust heatwave plan.

Level 3: Heatwave action:

This is triggered as soon as the Met Office confirms that threshold temperatures have been reached in any one region or more. This stage requires specific actions targeted at high-risk groups. High risk groups are identified in 4.2. Actions to take at level 3 are described in section 3 of the heatwave plan. PHE will continue to monitor any increases in heat-related illness reported in calls to NHS 111, GP in hours and out of hours consultations and emergency department attendances (on a daily basis, week days only) and will produce an additional single weekly heat wave syndromic surveillance report, in

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addition to the routine weekly surveillance outputs, for incorporation into a weekly PHE heatwave output. This additional report will provide a source of intelligence on how severe the reported effects are including further information on the impact on existing regions and age groups. PHE will continue to monitor any increase in mortality based on available daily and weekly data. Level 4: Emergency: This is reached when a heatwave is so severe and/or prolonged that its effects extend outside health and social care, such as power or water shortages, and/or where the integrity of health and social care systems is threatened. At this level, illness and death may occur among the fit and healthy, and not just in high-risk groups and will require a multi-sector response at national and regional levels. The decision to go to a Level 4 is made at national level and will be taken in light of a cross-government assessment of the weather conditions, co-ordinated by the Civil Contingencies Secretariat (Cabinet Office). Actions to take in the event of a level 4 emergency are described in section 3. PHE will continue to monitor any increases in heat-related illness reported in calls to NHS 111, GP in hours and out of hours consultations and emergency department attendances (on a daily basis, week days only), providing a daily (weekday only) syndromic surveillance report on heat-related illness in the community, for incorporation into a daily PHE output. Mortality will be monitored as per level 3.

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Figure 2.3: NHS England Heatwave Plan 2015 Guidance (2017 Update) - Providers - health and social care staff in all

settings (community, hospitals and care homes)

Level 0 Level 1 Level 2 Level 3 Level 4

Long-term planning All year See accompanying document ‘Making the Case’ for more detail

Heatwave and Summer preparedness programme 1 June – 15 September

Heatwave is forecast - Alert and readiness 60% risk of heatwave in the next 2-3 days

Heatwave Action Temperature reached in one or more Met Office national Severe Weather Warning Service regions

Major incident – Emergency response Central Government will declare a Level 4 alert in the event of severe or prolonged heatwave affecting sectors other than health

Professional Staff (all settings):

Develop systems to identify and improve resilience of high-risk individuals

Request an HHSRS assessment from EH for clients at particular risk.

Encourage cycling/walking where possible to reduce heat levels and poor air quality in urban areas.

Care Homes and Hospitals

Work with commissioners to develop longer term plans to prepare for heatwaves

Make environmental improvements to provide a safe environment for clients in the event of a heatwave

Prepare business continuity plans to cover the event of a heatwave (e.g. storage of medicines, computer resilience, etc)

Work with partners and staff to raise awareness of the impacts of severe heat and on risk reduction awareness (key public health messages - box 1)

Professional Staff (all settings)

Identify high-risk individuals on your caseload and raise awareness of heat illnesses and their prevention among clients and carers (see key public health messages – box 1)

Include risk in care records and consider whether changes might be necessary to care plans in the event of a heatwave (e.g. initiating daily visits by formal or informal care givers for those living alone)

Care Homes and Hospitals

Ensure business continuity plans are in place and implement as required; ensure appropriate contact details are provided to LA/NHS emergency planning officers to facilitate transfer of emergency information

Identify or create cool rooms/areas (able to be maintained below 26°C)

Install thermometers where vulnerable individuals spend substantial time

Professional staff (all settings):

Check high-risk people have visitor/phone call arrangements in place

Reconfirm key public health messages to clients

Check client’s room temperature if visiting

Care Homes and Hospitals

Check indoor temperatures are recorded regularly during the hottest periods for all areas where patients reside

Ensure cool areas are below 26°C

Review and prioritise high-risk people

Ensure sufficient cold water and ice

Consider weighing clients regularly to identify dehydration and rescheduling physio to cooler hours

Communicate alerts to staff and make sure that they are aware of heatwave plans

Ensure sufficient staffing

Implement business continuity

Professional staff (all settings):

Visit/phone high-risk people

Reconfirm key public health messages to clients

Advise carers to contact GP if concerns re health

Care Homes and Hospitals Activate plans to maintain

business continuity – including a possible surge in demand

Check indoor temperatures are recorded regularly during the hottest periods for all areas where patients reside

Ensure staff can help and advise clients including access to cool rooms, close monitoring of vulnerable individuals, reducing internal temperatures through shading, turning off unnecessary lights/equipment, cooling building at night, ensuring discharge planning takes home temperatures and support into account

Level 4 alert declared NATIONAL EMERGENCY Continue actions as per Level 3 unless advised to the contrary Central government will declare a Level 4 alert in the event of severe or prolonged heatwave affecting sectors other than health and if requiring coordinated multi-agency response

*Because Level 2 is based on a prediction, there may be jumps between levels. Following Level 3, wait until temperatures cool to Level 1 before stopping Level 3 actions. ** Level 4: A decision to issue a Level 4 alert at national level will be taken in light of a cross-government assessment of the weather conditions, co-ordinated by the Civil Contingencies Secretariat

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3.0 Trust Heatwave Action Plan

The Emergency Planning Officer (EPO), Accountable Emergency Officer (AEO) and Care Group Directors (CGDs) are directly notified of Heatwave Alert Levels via email from the Met Office. The following Action Card shows the actions that will be performed by the EPO (or CGDs in the absence of the EPO) that corresponds with the issue of each Heatwave Alert level.

Level 1 – Summer Preparedness BCP plan authors to check Business Continuity Plans (BCPs) have contingencies in place for Heatwave. EPO will issue reminder to patient facing staff via Intranet and all staff email to refresh knowledge of heatwave contingencies in BCP and Heatwave Plan. Reminder issued to services to ensure they have sufficient equipment (indoor thermometers etc.) in place for summer.

Level 2 – Alert and readiness EPO will request that that staff are alerted to the forecasted rise in temperatures and the significant effects this may have on health and the subsequent need to consult BCPs and Heatwave Plan. EPO will liaise with Trust Communications to ensure latest NHS England/PHE advice on the heatwave is shared via Intranet and all staff email updates: Clinical/Nursing staff to follow contingency procedures set out in appendix 3 of Heatwave Plan and their team BCP. In the absence of the EPO these actions will be taken by the Care Group Directors in liaison with the Accountable Emergency Officer.

Level 3 – Heatwave Action EPO to continue to keep staff updated and to issue reminders to staff to follow contingency procedures set out in Heatwave Plan and BCPs via intranet and email. EPO in conjunction with Accountable Emergency Officer to maintain contact with Care Group Directors who may provide situation reports as required on response to Heatwave. Possible move to Critical Incident or “Standby” situation (see Major Incident Plan) if heatwave set to last for a significant period. In the absence of the EPO these actions will be taken by the Care Group Directors in liaison with the Accountable Emergency Officer.

Level 4 – Emergency In the event of a major incident being declared the Accountable Emergency Officer or deputy will Implement appropriate emergency policies and procedures e.g Major Incident Plan and reporting structure. Accountable Emergency Officer or deputy will provide sitreps and briefing to CCGs/PHE/Local Authority/NHS England as required.

3.1 Trust Heatwave Reporting Structure

During a heatwave it will be necessary for Care Group Directors to gather information from their individual teams about how they are coping with the incident. The template at Appendix 6 may be used for that purpose.

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A Director may instruct Care Group Directors to start completing situation reports (sitreps) at any point during a heatwave to gain an overview of how Trust services are responding. In the event of a critical or major incident being declared for a level 4 heatwave the Director (or Gold Commander) that is coordinating the Trust response will:

Explain the rationale to Care Group Directors (or Silver Commander) for collecting sitreps from each team in their care group.

Set out a clear timetable for when completed sitreps are required.

Give clear instructions as to where completed sitreps should be sent e.g. to Silver Commanders (Care Group Directors).

Be mindful where possible of allowing a reasonable timescale for information to be collected and recorded on the sitrep template.

Be mindful of demands for information from external organisations such as CCGs, PHE, Local Authorities and the NHS England) and ensure sitrep deadlines are met.

Agree a Trust wide communication strategy with the Communications Team to ensure all staff are aware of the Trust response.

In the event of a critical or major incident being declared for a level 4 heatwave the Care Group Directors will:

Identify a person in each team to be responsible for completing the sitrep.

Check completed sitreps for accuracy before sending them to the Director that is coordinating the response.

Ensure all completed sitreps are saved on the team K Drive.

Following an incident a debrief and ‘lessons learned’ exercise may be held using completed Sitreps as a guide to how the response was undertaken.

4.0 HEATWAVE CONTINGENCIES 4.1. Who is at Risk?

Some people may be particularly at risk during hot weather because of their general health, where they live, and the amount of support they have. Health and Social Care workers are in a good position to assess individual levels of risk. Heat related illnesses and groups at risk: (Department of Health Publication 2012)

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4.2 At risk groups include:

Older people, especially those over 75 and/or living on their own or in a care home.

People suffering from mental ill health, those with dementia and those who rely on help from other people to manage day-to-day activities.

People who are bed bound.

People taking certain types of medication.

People suffering from chronic ill health.

People suffering from the following:

o Cardiovascular and cerebrovascular conditions o Obesity o Malnutrition o Diabetes o Parkinson’s Disease o Respiratory Insufficiency o Renal insufficiency o Peripheral vascular conditions o Alzheimer’s or related diseases o Too much alcohol

Heat related illnesses

The main causes of illness and death during a heatwave are respiratory and

cardiovascular diseases. Additionally, there are specific heat related illnesses

including:

Heat cramps – caused by dehydration and loss of electrolytes, often following exercise.

Heat rash – small, red, itchy papules.

Heat oedema – mainly in the ankles, due to vasodilation and retention of fluid.

Heat syncope – dizziness and fainting, due to dehydration, vasodilation, cardiovascular disease and certain medications.

Heat exhaustion – is more common. It occurs as a result of water or sodium depletion, with nonspecific features of malaise, vomiting and circulatory collapse, and is present when the core temperature is between 37ºC and 40ºC. Left untreated, heat exhaustion may evolve into heatstroke.

Heatstroke – can become a point of no return whereby the body’s thermoregulation mechanism fails. This leads to a medical emergency, with symptoms of confusion; disorientation; convulsions; unconsciousness; hot dry skin; and core body temperature exceeding 40ºC for between 45 minutes and eight hours. It can result in cell death, organ failure, brain damage or death. Heatstroke can be either classical or exertional (e.g. in athletes).

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4.3 What are the Risks?

Heat exhaustion is usually one of the first signs that someone is at risk of developing heatstroke. Symptoms include:

Headache

Dizziness

Nausea and vomiting

Muscle weakness or cramps

Pale skin

Weak pulse and

High temperature. Heatstroke can develop if the symptoms of heat exhaustion are left untreated. It can also occur suddenly and without warning. Symptoms include:

Confusion and disorientation

Convulsions

Unconsciousness

Racing pulse

Thumping pulse

Flushed

Hot and dry skin

Very sudden rise in temperature.

Heatstroke can result in:

Organ failure

Brain damage or

Death

Heatwaves can happen suddenly and rapid rises in temperature affect vulnerable people very rapidly.

4.4 Managing the Risk

The following preparations should be made:

Cool rooms/cool areas to be identified maintaining a temperature of 26ºC or below. High risk groups, who are vulnerable to the effects of heat, may be physiologically unable to cool themselves efficiently once temperatures rise above this. Keep patients sufficiently hydrated at all times. See Appendix 1 for further information on ‘Keeping your Environment Cool’.

Identification of particularly vulnerable service users (those with chronic/severe illness, on multiple medications), who may require prioritisation for time in a cool room.

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Any room being used in a patient facing setting should be risk assessed with heatwave in mind to ensure it is suitable and not too hot.

Be aware of Trust clinical policies and procedures before using fans to keep the environment cool. For patient facing staff it is acceptable to use fans if in a consultative role only. The blades of the fan must be clean at all times. If not the fan must not be used until it has been appropriately cleaned. If you are undertaking clinical procedures such as dressing changes, blood sampling or administering injections in a clinical/treatment room, fans must be turned off for at least 30 minutes before the procedure is undertaken. If you are undertaking clinical procedures in the patient’s own home then the fan must be turned off for the duration of the procedure.

Indoor thermometers to be installed in each room where vulnerable service users spend substantial time in (bedrooms, living and eating areas) and, during a heatwave, indoor temperatures should be monitored and recorded at least four times a day.

Detailed information on the storage of medicines on wards can be sought through the pharmacy dept. However the salient details are as flows:

Medicines that require refrigeration should be stored in an approved medicines fridge, which must be used solely for the storage of medicines requiring refrigeration.

The fridge must be connected to the electricity supply in such a manner that does not allow accidental disconnection e.g. attached by a spur to the mains electricity supply.

The medicines fridge temperature must be checked daily and recorded on the Trust’s fridge temperature monitoring form. The temperature should be within 20C – 8 0C

Pharmacy or Estates must be contacted if there is a problem (area specific). Out of pharmacy operating hours contact the drug manufacturers for guidance.

See Appendix 2 for list of medicines which may have side effects during excessive heat exposure and Appendix 3 for medications advice for those drugs which are theoretically capable of increasing risk in susceptible individuals.

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Repeat messages to be delivered to staff on risk and protective measures ensuring visits or phone calls are made to advise high risk service users living on their own or without regular contact with a carer.

Seek early medical help if an individual starts to become unwell.

Ensure that discharge planning takes into account the temperature of accommodation and level of daily care during the heatwave period.

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APPENDIX 1

Guidance on Keeping Your Environment Cool

Place a thermometer in your main living room and bedroom to keep a check on the temperature.

Keep windows that are exposed to the sun closed during the day, and open windows at night when the temperature has dropped.

Care should be taken with metal blinds and dark curtains, as these can absorb heat – consider replacing or putting reflective material in-between them and the window space.

Consider putting up external shading outside windows.

Have your loft and cavity walls insulated – this keeps the heat in when it is cold and out when it is hot.

Use pale, reflective external paints.

Turn off non-essential lights and electrical equipment – they generate heat.

Grow trees and leafy plants near windows to act as natural air-conditioners.

Keep indoor plants and bowls of water in the house as evaporation helps cool the air.

If possible, move into a cooler room, especially for sleeping.

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APPENDIX 2

List of Medicines that may have Side Effects during Excessive Heat Exposure

There is very limited published information available on the adverse effects of drug treatment during excessive heat exposure. Also, it is sometimes not clear to what extent the increased risk is due to medication and not to the underlying disease being treated (1). The elderly, young children, and people with heart or respiratory conditions are examples of individuals at greater risk of harm in hot environments, but some medicines also pose particular risks (2). For example, in one study, 59 out of 151 children (39.1%) taking topiramate experienced potentially serious symptoms related to hypohidrosis (reduced perspiration). The authors suggest that paediatric epileptic patients taking topiramate should avoid hot and humid environments (3). Certain medical conditions carry risks because affected patients may take a variety of medicines affecting heat tolerance (e.g. Parkinson’s disease) (4). Some medicines potentially cause multiple side effects which affect the body’s heat response e.g. neuroleptics can cause decreased sweating, raised body temperature, and hypotension; they may also adversely affect CNS thermoregulation. A document is available on the Specialist Pharmacy Service website - Which medicines could cause problems for patients during a heatwave https://www.sps.nhs.uk/ Enter ‘heatwave’ to download it. This suggests some side effects that could theoretically be a problem for patients in a heatwave, together with examples of oral medicines that can cause them. It is not a list based upon clinical research, but is derived from two published lists which appear to be opinion-based (1, 2), the author’s opinion, and a third publication which cites some published evidence to support its conclusions (4). The table omits injections only given in hospital, and gives no indication of the likelihood of the reactions described or the severity of impact. The effects of some drugs are not clear. For example, thyroxine increases heat production via metabolism, but the effects of regularly monitored, chronic substitution therapy with levothyroxine during a heatwave have not been described. Patients already suffering from hyperthermia could find some of their symptoms exacerbated by certain medicines depending upon the severity of their condition. So, drugs that cause renal impairment might hasten the deterioration of kidney function, for example, and sedating medicines might worsen drowsiness or make sufferers appear confused. Medicines that can cause electrolyte imbalance may also be a concern in some hyperthermia sufferers (many antidepressants can cause hyponatraemia, for example). Practical advice for the appropriate action or adjustment of drug treatment in a heatwave situation is limited (1). However, it is suggested that patients’ medication should be reviewed and the risks and benefits of any changes evaluated (2). Patients at risk should be closely monitored (4).

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For more detailed information refer to the Specialist Pharmacy Service website - Which medicines could cause problems for patients during a heatwave? Source: Wessex Drug and Medicines Information Centre, Date published: 04/10/2010 Review date: 28/02/2015

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APPENDIX 3

Supporting People in their Own Home to Prepare for a heatwave A Checklist for Professionals, Volunteers and Carers

REDUCING THE RISK

If you are caring for someone in their own home, these are the steps you should take before the weather gets hot. Where possible, involve their family and any informal carers in these arrangements.

ENVIRONMENT

• Check any south-facing, which let in most sunlight, can be shaded, preferably with curtains. Metal Venetian blinds may make things worse;

• Check the person’s home or room can be properly ventilated, without causing any additional health risk, discomfort of security problems;

• Consider the possibility of moving the person to a cooler room. People living in top floor accommodation may be at particular risk as heat rises.

FACILITIES • Check fridges and freezers work properly; • Check the person has easy access to water/fluids • Check fans and air conditioning work properly; • Check that the person has light, loose-fitting, cotton clothing to wear; • If you plan to move the person somewhere cooler in the event of a heatwave,

consider what help or equipment you might need. ORGANISATION • Check that extra care and support is available if needed; • Check that the person can contact their key worker (e.g. Home Care Enabler/GP

if one of their informal carer’s is unavailable; • Check that their care plan contains contact details of their GP, other care workers

and informal carer’s; • Check that there are adequate arrangements for food shopping.

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APPENDIX 4 Supporting People in their Own Home during a Heatwave

A Checklist for Professionals, Volunteers and Carers

During a Level 4 Heatwave (and possibly in a long term at Level 3) anyone in a high risk category living alone is likely to need at least daily contact either in person or via telephone, whether by care workers, volunteers or informal carers. In such circumstances Trust Directors or Gold Command will liaise with partners via CCGs to identify how this will be coordinated. People with mobility or mental health problems, which are on certain medication, or living in accommodation that is hard to keep cool, are likely to need some additional care and support. KEEP OUT OF THE HEAT • Keep curtains at windows exposed to the sun closed while the temperature

outside is higher than it is inside; • Once the temperature outside has dropped lower than it is inside, open the

windows. This may require late night visiting; • Advise buying a fan, particularly if their home is difficult to keep cool; KEEP BODY TEMPERATURES DOWN • Suggest regular cool showers, baths or at least an overall body wash; • Advise them to wear light, loose cotton clothes to absorb sweat and prevent skin

irritation; • Suggest sprinkling clothes with water regularly, and splashing cool water on their

face and back of neck; • Recommend cold food, particularly salads and fruit with a high water content; • Advise them to drink regularly, preferably water or fruit juice. ( avoid alcohol and

caffeine if possible); • Monitor their daily fluids intake, particularly if they have several carers or are not

always able to drink unaided. PROVIDE EXTRA CARE • Keep in regular contact throughout the heatwave, and try and visit at least once a

day; • Keep giving advice on what to do to reduce the risks of heat stroke • Check that their care plan has full details of their informal carers and other

support, in case extra help is needed.

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APPENDIX 5 Caring for Residents to Prepare for a Heatwave.

A Checklist for Home Managers and Staff (e.g. Registered and Supported

Living Homes) ADVANCE PREPARATION THE BUILDING • Check windows can be shaded, preferably by curtains rather than metal blinds. • Check that there are no problems opening windows, including security

considerations. • Ensure staff know which rooms are most easy to keep cool and which are more

difficult, and review the distribution of residents accordingly. • If one exits, check the cooling or air conditioning system works properly. It should

be able to keep the air temperature at or below 26ºC in at least one large room. • Make sure you have enough thermometers to monitor accurately temperatures

throughout the building. FACILITIES • Check you have adequate supply of fans and water sprays. • Check water and ice is widely available. Ice must be dispensed from a touch free

ice dispenser. • Arrange for cold drinks to be distributed in the event of a heatwave. • Plan to adapt menus to cold meals, preferably with a high water content, like fruit

and salads, in consultation with residents. WORKING ARRANGEMENTS • Work out a protocol for changes to management arrangements in the event of a

heatwave to cover: • Mobilisation of staff, including recall of those on holiday • Changes to rotas. • Getting extra help from relatives of residents. • Getting extra help from volunteers. If outside activities are planned, consider if these are still appropriate. RESIDENTS • Make sure you know who is most at risk, ask primary health care staff if you are

unsure. • Ensure you have protocols to monitor residents most at risk and to provide

additional care and support. • Ask GPs of at-risk residents about possible changes in treatments or medication

in the event of a Heatwave. • Check the residents have light, loose-fitting, cotton clothing.

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APPENDIX 6 Caring For Residents During a Heatwave

A Checklist for Home Managers and Staff (e.g. Registered and Supported

Living Homes)

ENVIRONMENT

• Try to keep the care home as cool as possible. • Keep curtains and windows closed while the temperature outside is higher than it

is inside. • Open windows once the temperature outside has dropped lower than it is inside.

This may not be until very late at night or in the early hours of the morning Discourage residents from physical activity and going out during the hottest part of the day (11am – 3 pm).

• Monitor temperatures inside the building.

MONITOR RESIDENTS

• Check body temperature and weight regularly. • Watch for any changes in behaviour. • Watch for signs of headache, unusual tiredness, weakness, giddiness,

disorientation or sleeping problems.

REDUCE THE RISK OF HEATSTROKE

• Encourage residents to remain in the coolest part of the home as much as possible

• Monitor their fluid intake, particularly if they are not able to drink unaided. • Advise them to avoid caffeine (tea, coffee, colas) or very sweet drinks, and

alcohol • Encourage them to wear light, loose, cotton clothes to absorb sweat and prevent

skin irritation. • Regularly sprinkle or spray cool water on exposed parts of the body. • Arrange cool showers or baths, if possible.

If residents are taking part in exercise outside ensure that they are not in direct sunlight for long periods, take regular cool drinks and are wearing sun screen.

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APPENDIX 7

Actions to Take In The Event Of Suspected Heat Exhaustion / Heatstroke

HEATSTROKE IS A MEDICAL EMERGENCY

EMERGENCY TREATMENT If you suspect someone has heatstroke, call 999. While waiting for the ambulance: • Take the person’s temperature; • If possible, move them somewhere cooler; • Cool them down as quickly as possible by giving them a cool shower, sprinkling

them with water or wrapping them in a damp sheet, and using a fan to create an air current;

• Encourage them to drink fluids, if they are conscious; • Do not give aspirin or paracetamol;

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APPENDIX 8

Public Health Core messages Below are the core messages to be broadcast as official PHE warnings alongside national and regional weather forecasts. They may be expanded or otherwise refined in discussion with broadcasters and weather presenters. Trust Communications may provide links to these messages in order to raise awareness to staff, patients and public along with the draft messages below. Level 1: Summer preparedness and long-term planning No warning required unless there is a 60 per cent probability of the situation reaching Level 2 somewhere in the UK within the next three days, then something along the lines of: Level 1: Draft All Staff Message: June 1st to 15th September is the period most likely to see the country affected by Heatwave. All staff, particularly those who are patient facing, are encouraged to familiarise themselves with the Trust Heatwave Plan and your own team’s Business Continuity Plan for a Heatwave. The Trust Heatwave plan can be found at the following link: http://www.rdash.nhs.uk/corporate-information/publications/policies/emergency-planning/ Level 2: Alert and readiness The Met Office, in conjunction with PHE, is issuing the following heatwave warning for [regions identified]: Level 2: Draft All Staff Message: A Heatwave has been forecast with a 60% likelihood that it will begin in the next 2-4 days. All staff, particularly those who are patient facing, must now follow the advice within the Trust Heatwave Plan and your own team’s Business Continuity Plan for a

“If this does turn out to be a heatwave, we’ll try to give you as much warning as possible. But in the meantime, if you are worried about what to do, either for yourself or somebody you know who you think might be at risk, for advice go to NHS Choices at

www.nhs.uk/summerhealth. Alternatively ring NHS 111.

“Heatwaves can be dangerous, especially for the very young or very old or those with chronic disease. Advice on how to reduce the risk either for yourself or somebody you know can be obtained from NHS Choices at

www.nhs.uk/summerhealth, NHS 111 or from your local chemist.“

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Heatwave. The Trust Heatwave plan can be found at the following link: http://www.rdash.nhs.uk/corporate-information/publications/policies/emergency-planning/ Level 3 and 4: Heatwave action/Emergency The Met Office, in conjunction with PHE, is issuing the following heatwave advice for [regions identified]:

Level 3: Draft All Staff Message

All staff are encouraged to continue to follow the advice detailed in the Trust Heatwave Plan. Requests for information may be made by Managers in order to ascertain how services are coping. Your cooperation with these requests is greatly appreciated. The Trust Heatwave plan can be found at the following link: http://www.rdash.nhs.uk/corporate-information/publications/policies/emergency-planning/

“Stay out of the sun. Keep your home as cool as possible – shading windows and shutting them during the day may help. Open them when it is cooler at night. Keep drinking fluids. If there’s anybody you know, for example an older person living on their own, who might be at special risk,

make sure they know what to do.”

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APPENDIX 9

Draft Situation Report (Sitrep) Template

RDASH Ops Situation Report – SITREP No 1

Form to be completed by Team Managers Care Group Directors to receive completed forms by <insert time & date>.

Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert NIL or N/A.

Care Group and Team:

Date:

Name & Role (completed by):

Time:

Telephone number:

Email address:

Type of Incident (Name) Heatwave

Have you experienced any serious operational difficulties e.g. increased numbers of patients suffering heat related illness.

Impact on services and patients:

Have you invoked Business Continuity Plans?, E.g. Identifying

vulnerable patients, using cool areas. Providing extra care.

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Impact on other service providers

Mitigating actions taken

Additional comments,

Staff Unable to attend work– Please list job roles and numbers:

Role

Number unable to attend

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APPENDIX 10

Record of Amendments When making amendments ensure superseded plans are replaced. Ensure the version number of the plan is altered to reflect the change e.g. V1.0 becomes V2.0

Amendment No

Amendment Made Date Amended by: