Operational Protocols NWAS HART works to nationally agreed Standard Operating Procedures (SOPs). These detail the use of equipment, PPE, communications, call types and deployment. The SOPs also define the mechanisms for working with other emergency services in the challenging conditions that can be posed at a major incident. Equipment HART teams have some of most sophisticated equipment in Europe, specially designed to provide a safe and effective way of working. Vehicles Each HART unit has the following vehicles: Forward Command Vehicle Light Equipment/Reconnaissance Vehicle Heavy Equipment Vehicle Two Rapid Response Vehicles (RRV) carrying all the kit a regular RRV carries but with the addition of breathing apparatus and GTCS Two USAR 4x4 Vehicles. One for USAR and one for IWO Polaris and Carrier. A 6 wheel drive all terrain vehicle with its own bespoke carrier vehicle NB. The HART team is not involved in transportation of patients. Command vehicle Each HART team has access to a forward command Incident Response Unit. The command vehicle incorporates mobile satellite communications to enable the use of voice, data and video operations, this includes an independent mobile phone network for recognised users - all of which can be deployed and manned from the vehicle within four minutes of arriving on scene. The vehicle also includes a mast for CCTV and infra-red thermal imaging cameras for search and rescue purposes, heavy duty touch screen displays, a weather monitoring station, computers and incident management software designed to operate wherever the HART units are deployed. HART team members can also be equipped with body-worn cameras - either fitted to their helmets or protective suits - which beam back live footage. These operate in difficult environments such as tunnels and are a key safety element for the team as well as providing vital and immediate information to their support colleagues. Reconnaissance vehicle A second reconnaissance vehicle, which can accommodate up to four team members, is fitted with the initial assessment, detection, safety and medical equipment. This includes equipment used to identify specific hazards and for initial triaging of casualties. It also carries different types of Personal Protective Equipment (PPE) (see below) which may be used following an initial risk assessment. They include Breathing Apparatus and a wardrobe of protective suits for every eventuality. Equipment vehicle The third vehicle, carrying two people, contains bulk equipment including a multiple oxygen delivery system and replacements for any kit which may be damaged or contaminated during the response. Personal Protective Equipment (PPE) HART teams are equipped with four types of protective clothing: Basic Incident Ground Kit The Civil Responder 1 (CR1) suit also worn by the police. The powered respirator protection suit (PRPS), used by the fire service and issued within the NHS A gas-tight chemical suit, worn with breathing apparatus. The selection of the most appropriate PPE to use will depend upon the situation, a risk assessment carried out by the Team Leader on site and a discussion with colleagues from the other emergency services. CR1 Suit This is the suit currently used by the police. Its key advantage is that the respirator is separate from the suit so that personnel can be on stand-by for long periods of time in the suit, only wearing the respirator when a response is required. The suit enables greater mobility and is useful if a HART paramedic needs to access an area of restricted space. This suit would be used for support to pre-planned police operations. PRPS Suit In order to operate in the inner cordon, HART teams need PPE that provides the manual dexterity necessary to undertake clinical interventions whilst keeping personnel safe. The new NHS PRPS suit comes with high standards of safety and under gone rigorous testing by the Ambulance service before being put into use. Gas-tight Chemical Suit and Breathing Apparatus This suit offers the highest level of protection and is used in the most hazardous situations. The downside is that it restricts mobility and therefore the manual dexterity and vision needed for clinical interventions which also limits the length of time HART paramedics can operate in the suits. Other equipment The HART teams are equipped with multiple oxygen delivery systems which enable the team to provide oxygen to 48 people simultaneously within the hot zone. Detection, Identification and Monitoring The HART teams have limited capability for detection, identification and monitoring (DIM) of chemical and radiological hazards. The Fire and Rescue Services have lead responsibility for DIM at the scene and all brigades have been equipped with a range of sophisticated equipment with which to carry out this responsibility. HART teams do carry Ram-Gene 1 contamination radiation monitors. Clinical Care in the Hot Zone Due to the circumstances, the clinical care that can be provided to patients in the hot zone are necessarily limited. Clinical care that is administered is based on the Joint Royal Colleges Ambulance Liaison Committee Guidelines 2006 and focuses on the following: Triage and Assessment Airway Management Control of Major Haemorrhage Drug Administration Multiple Casualty Oxygen Antidotes for CBRN incidents The HART team provides support to the other emergency services at the scene of a major incident and will provide early alerting to the wider health service and the Health Protection Agency (HPA) as required. Decontamination Whilst not the primary role of the HART teams they are able to carry out decontamination of casualties should they not be required in a hot zone for casualty management. Communication The liaison between the NWAS HART team in the hot zone and the ambulance crew in the warm zone of a major incident must be fully integrated to ensure the smooth flow of casualties out of the hot zone. The HART team is responsible for ensuring that accurate patient information is passed back via the Ambulance Service and the Medical Incident Commander (MIC) to the wider NHS and HPA. The HART team has a facility to send encrypted pictures and messages from the heart of the incident to a number of control centres and is fully equipped to enable secure communications with all other emergency services responding to the incident.