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CHAPTER THREE STAGE ONE FINDINGS

Introduction

3.1 This chapter describes and discusses (in summary) the findings of stage one of the research. Summary tables with notes are presented to allow for a SCG level comparison and where possible a central (national) level picture is recorded. Finally a summary discussion of each workstream is presented.

Overview of the questionnaire: regional capability mapping

3.2 In the summer of 2004 the Scottish Executive sent out the Regional Capability Mapping questionnaire (see Appendix 3) to members of the various Strategic Coordinating Groups. These questionnaires were to be returned by the 10 ^th September, 2004.

3.3 As the data is now over 20 months old it must be recognised that changes in operations and agreements have occurred and are still taking place. Particularly, the following data needs to be read with recognition that changes have resulted in response to the passing of the CCA 2004.

3.4 There were 12 respondents to the questionnaire although there does appear to be some duplication for 2 of the SCG Areas; Lothian & Borders and Northern. This raises several issues including

• communication between strategic group members particularly as it appears in the Lothian and Borders SCG Area
• validity of data that might have been counted more than once giving a false picture of current capacity - again a problem in the Lothian and Borders SCG Area
• responsibility for the work of the groups in these areas; and
• the lack of standardisation in the naming of the strategic coordinating groups.

This has also presented some problems for the analysis of the data (mainly that of clarity) particularly when drawing a picture of regional capacity. For example, appropriate data has been grouped together with regard to the Northern SCG Area to give a regional picture.

3.5 The respondents were:

• Orkney Emergency Forum
• Highlands & Islands Emergencies Coordinating Group (Western Isles Area)
• HIECG - Shetland Islands Council
• Highland Emergency Liaison Partnership
• Lothian & Borders
• Lothian and Borders Emergency Planning Steering Committee
• Fife Emergency Planning Policy Group
• Central Scotland Integrated Emergency Management Group ( SEIM) Group
• Tayside RECAP
• Dumfries & Galloway
• Strathclyde, and
• Grampian Joint Emergencies Committee.

Each of these respondents represented one of the Strategic Coordinating Group ( SCG) for the 8 regions of Scotland.

Approach

3.6 Where possible the raw data was encoded and entered into an SPSS spreadsheet. However for ease of analysis some responses were viewed as qualitative and hence not suitable for inclusion in the tables. These have been transcribed and examined for emerging themes. The nature and particularly the size of the dataset has not allowed for any sophisticated statistics to be utilised therefore simple frequencies and cross-tabulations have been used to elicit information regarding the 5 workstreams under examination.

3.7 These workstreams are

• Mass Fatalities;
• Mass Casualties;
• Infectious Diseases (Human);
• Infectious Diseases (Plant and Animal); and
• Warning and Informing the Public.

3.8 A framework was then developed to provide an overview of the results derived from the questionnaires (see Appendix 4). This framework compliments the following findings, which compare the results for each of the workstreams by the particular SCGs. Using this framework as a starting point each of the workstreams are presented in the following way:

• overall national (Scotland) picture on each theme;
• strategic group level comparison on each theme;
• missing data from each area;
• issues requiring further investigation or clarification in each area; and
• a summary picture of the workstream at the end of each section.

Workstream: mass fatalities

Overall national (Scotland) picture

3.9 National capacity for normal mortuary facilities is reported at 643 whilst national capacity for temporary post-mortem facilities is reported at only 71. Temporary body holding capacity in Scotland is reported at 1516, however this did not account for the use of mobile refrigerated trailers, which some SCG Areas report they would utilise.

3.10 It is very difficult to draw a national picture of this capability particularly as initiation time for temporary mortuaries varies from 12 hours to 72 hours across the different SCG Areas. It might be useful here to assess capacity against population size this would give some indication of the number of facilities per head of population and allow for the identification of those areas where facilities might come under some strain in the event of mass fatalities.

3.11 The national picture for cooperation and formal service level agreements between the different SCG Areas with regard to temporary facilities is poor. Only the Northern SCG have any sort of service level agreements in place and these are within their own SCG Area with neighbouring authorities. The lack of service level agreements presents a worrying picture to the researchers although it is suspected (and this was tested and found to be true in the second stage of the research) that arrangements for using additional facilities in neighbouring SCG Areas are dealt with on an informal basis. It is suggested that formalisation of such arrangements needs to be considered as soon as possible in order to avoid the possibility of assumed capacity being unavailable in the event of a major emergency.

3.12 With regard to support arrangements for relatives and friends of victims core support (bereavement counselling and general support) available nationally. Apart from core support, some SCG Areas offer other types of services including legal support and advocacy support and these are detailed in Appendix 4. Capacity in this area however did not present a clear picture. Some SCGs have still to assess their capacity whilst others suggest that it is not always possible to make estimations.

Strategic group-level comparison

3.13 It would appear that all SCGs demonstrate some level of capability to deal with mass fatalities although it is worth re-emphasising here that capacity should be linked to population to give a truer picture. For instance the capacity for normal mortuary facilities ranges from 300 in the urbanised Strathclyde SCG Area to 97 for the whole of the Northern SCG area. Further, Dumfries & Galloway and Grampian report a capacity of 500 for temporary body holding compared to only 300 in Strathclyde and 266 in the Northern region, thus illustrating the need for further data with regard to location of facilities particularly in the more remote regions of the Northern SCG. Analysis of this additional data would then provide a picture of accessibility in the SCG area which might well be of some importance for the more remote communities.

3.14 The highest capacity for temporary post-mortem facilities was reported in the Tayside SCG Area at 50. Surprisingly, there was very little capacity reported in the Strathclyde SCG Area at only 4 although again there is some confusion here as they list 4 simultaneous tables rather than a capacity for performing or throughput of post mortems. Three areas from the Northern SCG Area report that they have no facilities for this type of temporary mortuary. However, the Northern SCG Area did report the plan to use up to 56 freezer units but did not include this capacity in their estimate. Similarly Fife reported that refrigerated trailers would be used but again give no estimation of this capacity. The Central SCG Area reports no capacity in this area. It is clear from the narratives supplied by respondents that further questions regarding the use and capacity of refrigerated trailers should be asked to elicit data that would give a more accurate picture of this type of temporary facility.

3.15 The longest estimate of time for initiating temporary mortuary facilities (72 hours) is given by Lothian and Borders SCG Area. Tayside and Dumfries and Galloway give the shortest time period at 12 hours. The average time appears to be 24 hours. The Shetland Islands suggest that they would use facilities in Inverness and so have no need for temporary mortuaries.

3.16 At SCG-level, the picture presented by the data is one of very little special support and very uneven provision. Other support services mentioned by respondents included support offered by PFLOs, WRVS, BRC, Benefits agencies, Citizens Advice Bureau, Drivers and escorts and the Council of Churches. Amongst the SCG Areas only 2 (Lothian and Borders and Shetland Islands) reported that they have an enhanced support package for victims and relatives, with the most provision being supplied by the Shetland Islands.

Summary

3.17 Respondents found it difficult to make an estimation with regard to support capacity. Five areas had not made an assessment of capacity where others refer to Police Liaison Officers and the nature of the incident. One SCG Area referred to the cost of providing this type of service. Orkney refer to very limited support. It was recommended that in order to gain a fuller picture of provision in these capabilities that further investigation be carried out. For instance data regarding service providers (voluntary organisations etc), facilities (Family Assistance Centres) and available staff should be elicited to give a better understanding of provision in this area.

3.18 Provision of normal mortuary facilities appears to be linked to the size of population and geographical location although further work needs to be done to confirm this. The provision of temporary mortuary facilities presents a different picture with capacity in the large urban areas being surprisingly small. This may well be because there was some confusion on the part of the respondents regarding the interpretation of the question. Arrangements with neighbouring authorities are non-existent. This presents a worrying picture as provision in the event of a wide area emergency could be compromised. Also the speed at which temporary facilities can be initiated varies between 12 and 72 hours. Again if the type of mistakes that happened in the southern United States in August 2005 are to be avoided then this area also needs to be addressed.

3.19 Provision of support services for survivors, relatives and friends of victims is patchy at best although all SCG Areas have provision for bereavement/general counselling. Overall, provision for legal or advocacy services was also patchy. Some SCG areas supplied legal service but not advocacy while others provided advocacy and not legal services. Only 2 SCGs (Lothian & Borders and Dumfries & Galloway) provided both legal and advocacy services. One SCG Area remarked that this lack was a function of the cost of supplying these types of services. However an enhanced focus on recovery issues in general and the establishment of Family Assistance Centres or 'One Stop Shops' following a major emergency could increase such provision in these areas quite considerably.

Recommended further research

• alignment of both normal and temporary mortuary facilities per head of population to give a clearer picture of provision;
• location of both types of facility with regard to accessibility and distribution;
• further research on the provision for the disposal of large numbers of bodies;
• investigation of plans for the use and capacity of mobile refrigerated units;
• further investigation regarding capacity in terms of post mortem tables and the number of bodies that can be dealt with in 24, 36, 48 hours and so on;
• investigation of the use of service level agreements with neighbouring areas and how wide area emergencies might affect provision of facilities;
• further investigation into the provision of special support for survivors and relatives and friends of the victims of major disaster; and
• investigation into the provision of recovery plans (psycho-social) in general.

Workstream: mass casualties

Overall national (Scotland) picture

3.20 The estimated number of beds that could be made available in the event of a major emergency resulting in mass casualties nationally was reported at 627. However one SCG Area (Fife) has yet to assess their capacity as have the Shetland Island Authority in the Northern SCG Area. Orkney Islands report a limited capacity and the Grampian SCG Area estimation is dependent on the type of incident and the time of incident. They further report that they have no facilities for handling CBRN casualties.

3.21 Within the SCGs, there appears to be a much greater level of cooperation between the various Health Boards than there is overall for the services operating within the SCGs. Six SCG Areas have service level agreements in place. However it was not clear if these agreements work in either direction, or more than 2 directions, nor was the quality of the arrangements specified.

Strategic group-level comparison

3.22 Comparison between the SCG Areas is difficult but as would be expected there is some higher capacity in the major cities of Scotland. Further research might indicate the capacity for dealing with different types of casualties such as those suffering from infectious diseases (pandemic flu for instance) or CBRN contamination to give a truer picture of the distribution of beds.

3.23 More detailed data is required if an accurate picture is to be presented particularly as a number of these arrangements have been described as being informal. Further research is needed to identify the depth of complexity of arrangements, for instance examining whether arrangements are reciprocal or identifying if arrangements are in place with more than one SCG Area.

Workstream: infectious diseases (human)

Overall national (Scotland) picture

3.24 Three SCG Areas did not respond to the question regarding the infectious human diseases workstream. Surprisingly these are the more urban SCG Areas of Scotland suggesting perhaps, that they have not yet considered such issues. The simple nature of the question (and thus the responses) provides insufficient data to assess this issue accurately, especially as the response does not indicate the type of worker by position or sector. We suggest that 'key workers' are readily identifiable through their functional position in critical services; identification can therefore take place rapidly in our experience. However, prior identification is useful. Other issues here include the currency of the lists (are they up to date) and the time when workers may be required, with summer holiday periods being especially problematic.

Strategic group-level comparison

3.25 Only 3 of the SCG Areas have indicated that they have identified key workers. The Northern SCG Area was still awaiting the assessment from The Shetlands. Lothian and Borders had yet to make any assessment. Missing data from 3 respondents as well as the lack of assessment to date in 7 SCG Areas made this difficult to analyse effectively. The figure of 40,000 for Tayside may indicate that the question was misunderstood or that all health workers in the SCG Area were seen as being key workers.

3.26 Further research is needed in this area to identify true capacity particularly for incidents or major emergencies where mass vaccinations may have to be carried out. Particularly needed are

• definition of the term 'key worker';
• responsibilities for the development of mass vaccination plans;
• identification of sectors that could be most affected;
• identification of centres for mass vaccination; and
• identification of responsibilities for and storage of vaccines.

Workstream: infectious diseases (plant and animal)

Overall national (Scotland) picture

3.27 All respondents included animal diseases in their emergency planning arrangements. It was however notable that these plans were largely concerned with Foot and Mouth disease or Rabies. Only one SCG Area Fife had plans for any other disease, that being swine fever, a viral infection of pigs. Three SCG Areas had generic plans for dealing with animal welfare. However, there are other potential widespread and significant animal diseases such as avian influenza, which were not mentioned in the data.

3.28 All SCG Areas had regular meetings with Police, Trading Standards and Veterinary Services, and described working groups or sub committees of the SCG dealing with animal diseases as part of the emergency planning function. One SCG Area (Lothian and Borders) reported plans being developed by their local authorities. Six SCG Areas stressed links with other relevant bodies, including the State Veterinary Services, besides regular meetings with Police, Trading Standards and Veterinary Services.

Strategic group-level comparison

3.29 The data elicited did not make any distinction between domesticated animals, livestock and wild animals, each of which may pose different potential threats. Further research might include identification of:

• other threatening diseases;
• service level agreements between SCG Areas;
• dependencies on Scottish national plans; and
• plans for different categories of animals.

Workstream : warning, alerting and informing

Overall national (Scotland) picture

3.30 All SCG Areas reported some arrangements with partner organisations for handling communications. The HIECG - Western Isles Area did not respond to the question posed, which could suggest that responsibility for these arrangements would lie with another authority somewhere within the SCG Area. Some SCG Areas had service level agreements in place with other SCG Areas and most SCG Areas had media sub-groups with formal protocols for communicating.

3.31 The Coastguard had maritime radio communications in place including satellite communications and arrangements with onshore partners, which involved harbour authorities and emergency services. Identification of the Police as lead partner when communicating information was prevalent. However there were some very different interpretations of the question, which led to a lack of a general consensus in the data. Interpretations of "arrangements … with partner organisations on handling communications in an emergency" included

• media handling protocols;
• hazard warning systems;
• cascade communications arrangements;
• telecoms systems arrangements;
• public information helplines;
• utilities/Industry communications; and
• communications in Command and Control (C&C) infrastructure.

3.32 However, due to the serious variation in interpretations across the data, it is difficult to draw any overall picture of the actual arrangements. Each interpretation is valid in its own right as an aspect of Emergency Communications Arrangements, but in order to be able to make an effective and thorough comparison between the Coordinating groups more specific questions need to be asked. It is therefore suggested that further research is needed in this area using a more structured approach and fielding each aspect of 'Emergency Communications Arrangements' separately. Additionally information regarding the technology used, communication contingency planning (including redundancy), and communications protocols may also be included for further study in this area.

3.33 With regard to communicating with the public 7 SCG areas plus the Coastguard indicated that they had previously tested their protocols for communicating with the media/public; only Tayside gave a negative response.

3.34 A large number of the themes identified emerged from questions asked about lessons learned, all of which were singly valid. In general, each lesson learnt was distinctly positive in nature; solution-centred rather than problem-centred. Themes included:

• media briefings are essential; the media must be briefed;
• briefings must be coordinated, proactive, clear and honest;
• reviews needed for the arrangements for media briefing centre, including location (proximity to incident) and communications arrangements or infrastructure;
• an Emergency Management system would be beneficial; and
• help lines are a valuable medium for directly informing the public.

3.35 Further research could be undertaken to establish the rationale for selection of which sectors were to be warned and informed particularly by the Coastguard as information regarding the conditions at sea could be useful for warning individuals planning sea trips and across Scotland generally. Such early warnings could lead to a decrease in vulnerability and an increase in the capability of the services. The warning and informing of other sectors such as business and places to target for the dissemination of information varied across the SCG with regions such as Tayside and Grampian having no procedures in place to disseminate information.

3.36 Radio, television, the press and the World Wide Web were universally cited as adopted media for warning and informing the public. The use of public address systems and sirens was limited in nearly all SCG Areas. Large print versions of publications were almost ubiquitous across the nation; while Braille was the most underrepresented method of delivery.

3.37 Central Scotland would appear to have a serious comparative discrepancy in providing such information formats and this may prove to be indicative of increased vulnerability. Almost unanimously, the respondents indicated that it was impossible to gauge the proportion of population that could be informed.

Strategic group-level comparison

3.38 There is little consistency between the groups in their responses. What is clear is that the Tayside and Grampian SCG Areas appear to have little capability in respect to this workstream as illustrated by this data. Lothian & Borders provided no data for all 5 fields. Northern respondents have a combination of affirmative responses and missing data, which may indicate negative responses rather than a genuine lack of information. The Coastguard only disseminate to shipping businesses

Summary

3.39 It would appear from the 2004 data that Scotland's capability for 'Warning, Informing and alerting' is inconsistent across the SCG Areas. Media/public communications would appear to have been well tested across the nation, and a number of valuable lessons have been identified and, hopefully, learnt. Nearly all groups plan to utilise the full spectrum of media available to them for disseminating information to the public and it is clear that there is general provision for this information to be translated into other languages as required.

3.40 There was, however, little consistent information regarding 'Emergency Communications Arrangements' as (due in part to the questionnaire's phrasing) responses showed conflicting interpretations of the question. The arrangements for the distribution of information to special needs groups also merits some attention as there is potential for already vulnerable groups to be excluded from a process which is designed to ultimately increase civil resilience.

Summary

We suggest that the data provided by the questionnaire has proved of limited value in assessing Scotland's capability and it is likely that capability is higher than it appears from our analysis. The data has been analysed as thoroughly and as rigorously as it permitted. However, we urge caution in any use of the findings. The results of the questionnaire suffered from significant limitations, overlap and ambiguity and revealed numerous gaps in the data and different approaches to answering the questions themselves. These limitations include:

• The questionnaire design was inappropriate and inadequate for a self administered research tool in so far as it allowed individual respondent interpretation of how to analyse and answer each question.
• Questions were themselves often ambiguous and confusing and not written to extract precise information.
• A number of subject areas were ignored, most particularly social and organisational capabilities and vulnerabilities in relations to capacity.
• The data included answers that were suggestive of double counting (region A answered on the basis of being supported by region B, while region B relied equally on region A).
• Many questions were not answered at all, and this lack of data could not be interpreted.
• The data is over 20 months old and it must be recognised that changes in operations and agreements have occurred and are still taking place.

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