NHS England business continuity management toolkit case study: flooding

Organisation: Kingston Hospital NHS Foundation Trust
Incident: flooding

Action taken

One Friday afternoon, a hot water pipe in the ceiling of the intensive care unit (ITU) burst, causing a severe leak and activating the fire alarms at approximately 1210hrs. The ITU staff responded by moving the 9 patients within the unit out of the side rooms affected, and into a place of safety where their treatment could be maintained. The unit was able to return to the normal operating level of 10 beds, despite the unit’s side rooms being unavailable for use as they required long-term drying out and checking of safety equipment. The drying out and checking of safety equipment was completed by the following Thursday. During the incident all patients and staff remained safe and no injuries were sustained.

Action taken

Overall, the response to this business continuity incident was effective and staff across the Trust responded calmly, quickly and effectively to ensure that patient safety was maintained, whilst services across the trust continued. The recovery was established quickly, with a return to normal operating levels achieved within 4 hours, reducing the impact to the local health economy.

During the incident, command and control was implemented.

  • ITU patients who needed to remain on ITU were horizontally evacuated into a separate unaffected bay and theatre recovery areas, deemed to be places of safety where care could be maintained with the HDU doors closed
  • All admitted patients were assessed, including those in theatre to ascertain if any may require admission to ITU within the next 24-48 hours. Those patients identified were either moved appropriately internally or transferred to a neighbouring trust.
  • Estates and facilities teams isolated the broken joint in the pipework which had caused the flood, stemming the flow of water. Flooded areas were cleared of water and cleaned, with electrics checked for safety. De-humidifiers were hired to undertake longer term recovery of the affected ITU side rooms.
  • No ambulance diverts were required, and ambulance services were informed of the short-term reduction in ITU capacity. Regular reporting of bed states and patients likely to require treatment in Resus or ITU was implemented.
  • Staffing levels were assessed to ensure the ability to undertake medical transfer of a patient requiring ITU treatment to another hospital, whilst maintaining ITU and Resus capability. Patient records at risk of water damaged were moved, plastic sheeting was placed over computers to protect them from water, rubbish bins were used to collect water, and prevent damage to desks and floors.

Lessons identified

A number of lessons were identified:

1. Matrons and senior Leads, likely to be making initial decisions in response to an
incident should be provided with Loggist training to ensure they understand the importance of and method for making contemporaneous notes as soon as practicable after the initial response.
2. Internal business continuity plans need to dovetail with Incident Response Plans and training needs to reflect this dovetailing.
3. Alerting arrangements need to be clear and rehearsed and understood by all participants and recipients and the tools (bleeps, pagers, blackberries, phone numbers etc.) need to be in place, have been checked/tested and working.
4. During an incident on-going communications arrangement need to ensure that those with roles and responsibilities during a business continuity incident are kept informed and that reports about the impacts of incidents are received by those in command and control.
5. There needs to be a planned incident communications plan in place; Email may not be the best method of communication during an incident and other methods of communicating should be considered within this plan.
6. Expert advice (likely to be estates and facilities) needs to be available to support staff should they for example, need to unplug electrical items in a watery environment
7. Fire doors should be checked during fire alarm drills to ensure they function as expected when the fire alarm is activated.
8. Those managing the incident need to be relieved of other duties so they can focus on the task in hand and appropriately supported in the Incident Control Centre (ICC) by administrative support. There needs to be sufficient equipment within an ICC to support all the roles that need to be carried out from that location including communications.