Hazardous Area Response Team (HART)

The Hazardous Area Response Teams (HART) initiative was born from a need for ambulance service paramedics to triage and treat patients within particularly hazardous, and/or potentially contaminated areas.

Exercise Osiris held in 2003, involving a CBRN incident at Bank underground station in London, highlighted the lack of clinical care prior to decontamination and the potential for unnecessary loss of life and/or increased morbidity. Ambulance personnel have not traditionally worked in the inner cordon (hot zone) of a CBRN incident but have waited for Fire & Rescue crews to bring casualties out of the inner cordon. However, it was recognised that the delays in providing immediate treatment to casualties within the inner cordon could result in unnecessary loss of life.

The HART project, funded by the Department of Health, was initiated in 2005 to provide the ambulance service with the capability to work within the inner cordon at CBRN or HAZMAT incidents and other appropriate major incidents.


National Context

HART forms part of the health response in support of the national capabilities programme being led by the Home Office. This programme aims to ensure that fewer lives would be risked or lost in the event of a terrorist CBRN incident or an accidental release of hazardous materials. Within this, the key objective is to improve CBRN response capabilities towards ensuring that "if a terrorist attack occurs, the response from all concerned will be quick and effective with the result that lives will be saved, and the impact on property and the environment will be minimised". The initiative sits under the Prepare strand of the Government's Counter Terrorist strategy, 'CONTEST'.

NWAS HART will provide two of the planned 15 teams across England. The two teams will be based in Manchester and Liverpool working alongside teams in the North East, Yorkshire, East Midlands, West Midlands, the East of England, Great Western, South Western, South Central, South East Coast and London. Further similar teams have and are being developed in the devolved administrations.

The locations for these teams have been selected to support the resilience and capability requirements identified by the Home Office. The sites have been selected to ensure a comprehensive coverage of the country with rapid response times whilst taking account of areas of high population density.

The national HART strategy is overseen by the National Ambulance Resilience Unit (NARU) on behalf of the Department of Health. NARU has a responsibility to broaden the awareness across all emergency services of the HART role. To find out more about NWAS HART in a national context visit National Ambulance Resilience Unit website. 


Why NWAS needs a HART

NWAS is the largest ambulance service in the UK, providing an emergency and planned care service to a population of over 7 million in an area of over 5,500 square miles. The introduction of HART is a key development in the Trust's continuing commitment to deliver an efficient and effective emergency service that is responsive to local needs across the North West region. The introduction of the HART team will ensure NWAS is well-placed to deal with a major incident to the highest level of the Trust's capabilities - providing the right experience, expertise and equipment to effectively handle the situation and monitor and treat casualties.


The HART Role

NWAS HART members are specially recruited and trained personnel who provide the ambulance response to major incidents. These may involve Chemical, Biological, Radiological, Nuclear (CBRN) or Explosives (E) or other hazardous material, or could involve other complex incidents such as train crashes, large-scale motorway accidents, building collapses, significant fires or flooding. These scenarios could be the result of an accident, environment or could have been caused deliberately.


The HART team works alongside fire and rescue services within the "inner cordon" (or "hot zone") of a major incident. Their job is to triage and treat casualties and to save lives in very difficult circumstances. The team also has a role in looking after other emergency service personnel who may become injured whilst attending incidents.


The following list identifies the types of incident for which a HART response may be deployed:

  • Hazardous Material (HAZMAT)/ Chemical, Biological, Radiological or Nuclear (CBRN): any incidents involving actual or suspected HAZMAT/CBRN, including gas leaks and fires involving HAZMAT
  • Fires & Explosions: including fires involving unsafe structures
  • Transport-related: Incidents involving transport systems, including rail, road and air
  • Suspect packages / Vehicles and Explosive Devices: Incidents involving suspect packages, bags, vehicles and envelopes as well as explosive devices such as ordnance related to the WWI & II
  • Unsafe Structures: Incidents involving unsafe structures such as building collapses, scaffolding collapses, demolition sites
  • Unconscious: Incidents involving unconscious patients - cause undetermined (STEPS 1-2-3)
  • Working at height: Up on scaffolding; cranes, trees, tops of buildings
  • Difficult Access: trench collapse, under machinery, wells, silos
  • Mountain & Cave rescue - with specialist rescue teams
  • Other Urban Search and Rescue (USAR) incidents: Incidents where response is instigated by FIRE USAR coordination centre
  • Inland Water Operations- Working with colleagues in FRS, MCA, RNLI responding to widespread flooding requiring clinical support in areas cut off by flood water or fast flowing rivers
  • Ambulance Intervention Teams- Large scale incidents involving firearms and explosives


HART Programme

Within the HART programme, there are currently four main components:

  • HART-IRU (Incident Response Unit)
  • HART - USAR (Urban Search and Rescue)
  • HART - IWO (Inland Water Operations)
  • HART - AIT (Ambulance Intervention Teams)
  • All HART members are trained to form part of the IRU, AIT and IWO and a minimum of 24 staff  also undergo additional USAR training.


HART-IRU - Incident Response Unit

The HART-IRU capability means that ambulance personnel can provide a clinical response alongside colleagues from the other emergency services within the inner cordon of hazardous incidents, such as:

  • CBRNE Incidents or those involving hazardous materials (HAZMAT). These could include events such as explosion at a chemical factory, large fires, complex transport accidents, incidents involving suspicious substances, illicit drugs manufacturing or a suspected terrorist attack.
  • Operations in support of the military in the UK.
  • Covert police operations support.
  • Certain public order incidents.


HART-USAR - Urban Search and Rescue

HART-USAR paramedics are specially equipped with the latest technology to safely access, stabilise, treat and rescue casualties from dangerous environments such as collapsed buildings. They work closely with their fire USAR colleagues in carrying out these functions. HART-USAR paramedics are trained specifically for this hazardous role and have specialist skills which enable them to provide clinical intervention at the following types of incident:

  • Collapsed building or structures.
  • In tunnels, such as the major evacuation of a tube train or in sewers.
  • Heavy transportation or multiple vehicle collisions resulting in a number of casualties.
  • At height, for example a casualty located in the cab of a construction crane.


HART - IWO - Inland Water Operations

Staff are equipped with appropriate PPE including dry suits, personal flotation devices etc and undergo a rigorous course with Fire and Rescue Service Instructors enabling them to commit alongside emergency service colleagues to areas of flood or fast flowing rivers to undertake clinical interventions / support not previously available.


HART - AIT- Ambulance Intervention Teams

Wearing appropriate PPE and working alongside Police Firearms Teams and Fire and Rescue Service Colleagues to undertake rapid triage and treatment of patients suffering gunshot injuries involved in a Mass Casualty Incident.