Heatwave plan

Contents

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 to 3 days before the event is expected

The aim of the heatwave plan is to put in place contingencies 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.

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 and 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 2020 (DHSC and NHSE 2021), note this plan was last updated in April 2021.

2 Core elements of heatwave plan for England 2020 to 2021

2.1 Alert and response

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

Met office and heatwave alert are responsible for alerting:

• public via media, TV, radio, newspapers
• Public Health England centres
• department of health or civil contingencies secretariat, other government departments
• local authority emergency planners and directors of public health including local resilience forums and local health resilience partnerships
• NHS England

Department of health or civil contingencies secretariat, other government departments are responsible for alerting:

• summer resilience network

Local authority emergency planners and directors of public health including local resilience forums and local health resilience partnerships are responsible for alerting:

• social services
• schools
• residential homes
• nurseries
• voluntary organisations
• day care centres
• health and wellbeing boards

NHS England, corporate team, national, regional teams and regional are responsible for alerting:

• clinical commissioning group ICSs
• RDaSH
• GPs and district nurses
• pharmacies
• Ambulance Trust
• NHS choices

Clinical commissioning group ICSs are responsible for alerting:

• RDaSH

RDaSH are responsible for alerting:

• GPs and district nurses

Please note, NHS England Regional and CCGs OR ICSs 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 centres 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.

2.2 Heatwave alerts

The plan is underpinned by a system of heatwave alerts, that are issued by the met office. The heatwave alert levels will be triggered by temperature thresholds set according to regional variations.

The heatwave temperature threshold for Yorkshire and the Humber is day 290C, night 150C.

The heatwave alert system comprises of five levels (levels 0 to 4), from long-term planning for severe heat, through summer and heatwave preparedness, to heatwave action and finally a major incident. Each alert level should trigger a series of appropriate actions which are detailed in the heatwave plan.

Between 1 June and 15 September, the met office may forecast heatwaves, as defined by forecasts of day and night-time temperatures.

2.2.1 Heatwave alert levels

2.2.1.1 Level 0 Long-term planning

• All year.

2.2.1.2 Level 1 Heatwave and summer preparedness programme

• 1 June to 15 September.

2.2.1.3 Level 2 Heatwave is forecast, alert and readiness

• 60% risk of heatwave in the next 2 to 3 days.

2.2.1.4 Level 3 Heatwave action

• Temperature reached in one or more met office national severe weather warning service regions.

2.2.1.5 Level 4 major incident, emergency response

• Central government or NHSE will declare a level 4 alert in the event of severe or prolonged heatwave affecting sectors other than health.

2.2.2 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, The trust needs to ensure that awareness and background preparedness are maintained by implementing the measures set out in the heatwave plan.

2.2.3 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 to 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.

2.2.4 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.

2.2.5 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).

2.3 Met office notifications

The following staff are on the mailing list to receive Met Office weather warnings including heatwave alerts:

• business continuity and EPRR manager
• on call silvers
• trust Communications team

They will be colour-coded to indicate more easily the national severe weather warning service (NSWWS) regions affected by a change from one Heatwave Warning level to another (for example, from level 2 to level 3), this will help staff to clarify what actions in turn need to be taken

Warnings will be published and sent by the met office at 9am rather than 10am to aid planners.

Warnings will indicate which local resilience forum (LRF) is situated within the NSWWS region, in order to help responders, the trust falls into the South Yorkshire and Humber LRF areas.

Warnings will include a link to met office and weather pattern maps.

Met office will use social media (for example, X, Twitter or Facebook). The alerts are already backed up by tweets, linking to the alert webpage through the met office twitter feed. You can subscribe to this feed by following: @metoffice (opens in new window).

3 Heatwave contingencies

3.1 Heatwave action cards

Action cards showing the actions that will be taken at each heatwave alert level upon receipt of notification from the met office can be found in the appendix. Action cards include:

• generic guidance for all staff
• specific guidance for inpatient staff
• specific guidance for staff seeing patients in their own homes or care home or LD home etc
• specific guidance for staff seeing patients in a clinic setting in healthcare premises
• specific medicines management guidance
• specific guidance on the use of portable air conditioning units where their use is appropriate
• specific guidance to the business continuity and EPRR manager
• specific guidance to the trust Communications team
• specific guidance to care group directors

3.2 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.

Heatwave Plan for England 2020, Making the case, the impact on heat and health, now and in the future (PHE 20150029)

3.2.1 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 result in cell death, organ failure, brain damage or death. Heatstroke can be either classical or exertional (for example, in athletes) 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
  • core body temperature exceeding 40ºC for between 45 minutes and eight hours

3.3 At risk group

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:
  • cardiovascular and cerebrovascular conditions
  • obesity
  • malnutrition
  • diabetes
  • Parkinson’s disease
  • respiratory Insufficiency
  • renal insufficiency
  • peripheral vascular conditions
  • Alzheimer’s or related diseases
  • too much alcohol

3.4 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
• 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
• death

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

4 Equality impact assessment screening

To access the equality impact assessment for this policy, please see the overarching equality impact assessment.

5 Appendices

5.1 Appendix A Action card for inclusion in all team business continuity plans

Note, this action card is for inclusion in all team business continuity plans and includes the following:

• generic guidance for all staff
• specific guidance for inpatient staff
• specific guidance for staff seeing patients in their own homes or care home or LD home etc
• specific guidance for staff seeing patients in a clinic setting in healthcare premises
• specific medicines management guidance
• specific guidance on the use of portable air conditioning units where their use is appropriate

This action card has been written in adherence to guidance issued to minimise the spread of Covid 19 infection.

5.1.1 Action card, heatwave

5.1.1.1 Actions for all staff

Heatwave level 1, 1 June to 15 September:

• ensure staff are aware of this action card in the business continuity plan and the trust heatwave plan
• ensure that the team is prepared in case a level 2 or level 3 heatwave is declared
• ensure you have a system in place to cascade alerts to staff if they are issued
• identify vulnerable staff members (for example, those with underlying health conditions on multiple medications)

Heatwave level 2, heatwave is forecast, alert and readiness, 60% of heatwave in the next 2 to 3 days:

• consider alternative working arrangements such as working from home, if appropriate, for vulnerable staff members (for example, those with underlying health conditions on multiple medications). At risk groups are identified in the trust heatwave plan
• include hot weather concerns as an item for discussion in team meetings or safety huddles
• ensure staffing levels are sufficient to cover the heat wave
• refer to the beat the heat leaflets (opens in new window) online for further information and guidance

Heatwave level 3, heatwave action, heatwave temperature reached in our region:

• where possible, identify a cool area (where possible less than 26C) where staff can work
• wear light, loose fitting cotton Uniformed staff may wear black or blue smart cropped trousers or knee length shorts (which meet IPC requirements) with the tunic top
• full shoes must be worn not sandals or flipflops
• keep windows exposed to the sun during the current Covid 19 pandemic keep windows that are not exposed to the sun open where appropriate
• fans must not be used in areas where there are patients with suspected or confirmed infections such as flu, MRSA, respiratory infections and Covid 19. Portable air conditioning units must not be used
• close curtains or blinds to windows that receive morning and afternoon
• turn off non-essential electrical equipment where practical
• make sure you are hydrated (checking your urine is an easy way of keeping an eye on your hydration levels, dark or strong-smelling urine is a sign that you should drink more fluids)
• be aware of the signs and symptoms of heat stress and dehydration (thirst, dry mouth, dark or strong-smelling urine, urinating infrequently or in small amounts, inability to concentrate, muscle cramps, fainting)
• don’t wait until you start to feel unwell before you take a break
• use a buddy system with your team to look out for the signs of heat stress (for example, confusion, looking pale or clammy, fast breathing) in each other
• between shifts, try to stay cool as this will give your body a chance to recover
• if using ice to cool fluids ensure bags of ice are purchased and stored appropriately. The contents must not be touched by hand due to the risk of contamination. Any utensils used to extract the ice cubes must be clean
• if appropriate increase number of staff breaks, somewhere cool if possible, ensure IPC guidance is adhered to
• ensure that PPE supplies are sufficient to cover a likely increase in demand for certain PPE items during warmer months due to staff changing equipment more frequently. PPE also needs to be changed and discarded when it becomes uncomfortable or damp, for example with sweat
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

Heatwave level 4, major incident, emergency response

• NHSE 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
• continue actions above as per level 3 unless advised to the contrary. During extreme conditions it is not only high-risk patients and staff at risk.  Therefore, further actions may be required
• situation reports may be requested by care group directors or managers (silver)
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

5.1.1.2 Actions for inpatient staff

Heatwave level 1, 1 June to 15 September:

• ensure staff are aware of this action card in the business continuity plan and the trust heatwave plan. Ensure that the team is prepared in case a level 2 or level 3 heatwave is declared
• ensure you have a system in place to cascade alerts to staff if they are issued
• identify vulnerable patients and staff members (for example, those with underlying health conditions on multiple medications)
• ensure you have sufficient wall mounted thermometers available for all rooms where vulnerable people may reside

Heatwave level 2, heatwave is forecast, alert and readiness,  60% of heatwave in the next 2 to 3 days:

• include hot weather concerns as an item for discussion in team meetings or safety huddles
• ensure staffing levels are sufficient to cover the heat wave
• ensure wall mounted thermometers are in place where vulnerable people may reside, include communal areas
• review PPE supplies as in hot weather increased breaks may be necessary that may require increased use of PPE
• where possible, identify a cool area ( less than 26C) so you can encourage patients to reside in this area, prioritise patients from vulnerable groups. If possible, identify a cool area for staff
• if required contact catering to suggest a choice of salads as an alternative to hot meals for forecasted heatwave days
• include hot weather concerns as an item for discussion in team meetings or safety huddles

Heatwave level 3, heatwave action, heatwave temperature reached in our region:

• monitor patients for changes in behaviour that may be caused by excess heat such as signs of:
  • headache
  • unusual tiredness
  • weakness
  • disorientation
  • sleeping problems
  • heat rash
  • dehydration
  • heat exhaustion and heat
• be aware that those patients recovering from Covid 19 are likely to be more vulnerable to risks from heat stress and dehydration due to complications, for example, damage to their kidneys
• check patients body temperature
• indoor thermometers should be checked at the hottest times of the day
• where possible and encourage patients to reside in the designated cool area ( less than 26C) prioritise vulnerable patients
• ensure any physio, OT, or group activity sessions are carried out in cooler hours of the day
• if possible consider moving visiting hours to mornings and evenings but ensure consistency with current Covid pandemic visiting guidance
• encourage patients to drink cold drinks such as water and diluted fruit juice regularly but avoid caffeine (tea, coffee, coca cola), or very sweet ice lollies are another way of hydrating patients and keeping cool
• monitor patient daily fluid intake, particularly if they are not always able to drink
• suggest patients receive tepid or cool showers
• suggest patients to wear light, loose fitting cotton
• discourage patients from physical activity during the hottest part of the day (11am to 3pm)
• keep windows exposed to the sun during the current Covid 19 pandemic keep windows that are not exposed to the sun open where appropriate.
• close curtains or blinds to windows that receive morning and afternoon sun
• turn off non-essential electrical equipment where practical
• use fans or air conditioning where appropriate and available but ensure infection prevention and control policies are. These must be turned off for a minimum of 30 minutes prior to an invasive clinical procedures being undertaken and also during the intervention. For example, wound care, phlebotomy
• if the temperature stays above 25C for 7 days and treatment involves injectable medicines, then staff need to contact pharmacy for consideration of usability or a change of expiry date
• fans must not be used where there are patients with suspected or confirmed infections such as flu, MRSA, respiratory infections and Covid 19. Portable air conditioning units may not be used in inpatient areas. Use of fans may be permitted in single occupancy areas such as rehabilitation bungalows however advice from IPC team and safety team should be sought before they are used
• if appropriate increase number of staff breaks, ensure IPC guidance is adhered to
• make sure you are hydrated (checking your urine is an easy way of keeping an eye on your hydration levels, dark or strong-smelling urine is a sign that you should drink more fluids)
• be aware of the signs and symptoms of heat stress and dehydration (thirst, dry mouth, dark or strong-smelling urine, urinating infrequently or in small amounts, inability to concentrate, muscle cramps, fainting). Don’t wait until you start to feel unwell before you take a break
• use a buddy system with your team to look out for the signs of heat stress (for example, confusion, looking pale or clammy, fast breathing) in each other
• between shifts, try to stay cool as this will give your body a chance to recover
• ensure that PPE supplies are sufficient to cover a likely increase in demand for certain PPE items during warmer months due to staff changing equipment more frequently. PPE also needs to be changed and discarded when it becomes uncomfortable or damp, for example with sweat
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

Level 4, major incident, emergency response:

• NHSE 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
• continue actions above as per level 3 unless advised to the contrary. During extreme conditions it is not only high-risk patients and staff at risk. Therefore, further actions may be required
• situation reports may be requested by care group directors (silver)
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

5.1.1.3 Actions for staff seeing patient in their own homes or care home or LD home etc.

Heatwave level 1, 1 June to 15 September:

• ensure staff are aware of this action card in the business continuity plan and the trust heatwave plan. Ensure that the team is prepared in case a level 2 or level 3 heatwave is declared
• ensure you have a system in place to cascade alerts to staff if they are issued
• identify vulnerable patients and staff members (for example, those with underlying health conditions on multiple medications)

Heatwave level 2, heatwave is forecast, alert and readiness, 60% of heatwave in the next 2 to 3 days:

• include hot weather concerns as an item for discussion in team meetings or safety huddles
• ensure staffing levels are sufficient to cover the heat wave
• if a level 3 heatwave is declared any patient in a high-risk category that lives alone is will daily contact either in person or via telephone by staff or volunteers or informal carers, ensure resources are in place to manage this requirement if needed. Consider liaison with partner agencies to manage this need
• staff supporting patients with their administration of medicines should be familiar with requirement to advise patients of appropriate storage
• refer to the beat the heat leaflets (opens in new window) online for further information and guidance

Heatwave level 3, heatwave action, heatwave temperature reached in our region:

• any patient in a high-risk category that lives alone will require daily contact by staff or volunteers or informal carers either in person or via telephone
• prioritise visits or telephone calls to high-risk patients as appropriate.
• Be aware that those patients recovering from Covid 19 are likely to be more vulnerable to risks from heat stress and dehydration due to complications, for example, damage to their kidneys
• before visits in person request patients that any fans must be turned off for a minimum of 30 minutes prior to an invasive clinical procedures being undertaken and also during the clinical intervention. For example, wound care, phlebotomy. During Covid 19 pandemic this guidance remains the same
• for non-invasive interventions staff may make a polite request for any fans to be turned off. Staff PPE is sufficient to reduce risk
• advise that fans should not be used if anyone at home has symptoms of Covid 19
• monitor patients for changes in behaviour that may be caused by excess heat such as:
  • • signs of headache
    • unusual tiredness
    • weakness
    • disorientation
    • sleeping problems
    • heat rash
    • dehydration
    • heat exhaustion and heat
• check patients body
• staff supporting patients with their administration of medicines should advise patients of appropriate storage
• if the temperature stays above 25C for 7 days and visits involve injectable medicines, then staff should contact pharmacy for consideration of usability or a change of expiry date
• provide patient or patient’s carer with public health guidance on keeping cool
• make sure you are hydrated (checking your urine is an easy way of keeping an eye on your hydration levels, dark or strong-smelling urine is a sign that you should drink more fluids)
• be aware of the signs and symptoms of heat stress and dehydration (thirst, dry mouth, dark or strong-smelling urine, urinating infrequently or in small amounts, inability to concentrate, muscle cramps, fainting). Don’t wait until you start to feel unwell before you take a break
• where possible use a buddy system with your team to look out for the signs of heat stress (for example, confusion, looking pale or clammy, fast breathing) in each other
• between shifts, try to stay cool as this will give your body a chance to recover
• ensure that PPE supplies are sufficient to cover a likely increase in demand for certain PPE items during warmer months due to staff changing equipment more frequently. PPE also needs to be changed and discarded when it becomes uncomfortable or damp, for example with sweat
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

Level 4, major incident, emergency response:

• NHSE 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
• continue actions above as per level 3 unless advised to the contrary. During extreme conditions it is not only high-risk patients and staff at risk. Therefore, further actions may be required
• situation reports may be requested by care group directors (silver)
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

4.1.1.4 Actions for staff seeing patients in a clinic setting in healthcare premises

Heatwave level 1, 1 June to 15 September:

• ensure staff are aware of this action card in the business continuity plan and the trust heatwave plan. Ensure that the team is prepared in case a level 2 or level 3 heatwave is declared
• ensure you have a system in place to cascade alerts to staff if they are issued
• identify vulnerable patients and staff members (for example, those with underlying health conditions on multiple medications)
• ensure you have wall mounted thermometers in clinic areas, if not available speak to buildings manager

Heatwave level 2, heatwave is forecast, alert and readiness, 60% of heatwave in the next 2 to 3 days:

• consider whether some clinic appointments are necessary or appropriate in a heatwave and if they could be performed via a home visit.
• check wall mounted thermometers are in clinic areas, if not available speak to buildings manager.
• include hot weather concerns as an item for discussion in team meetings or safety huddles
• staff supporting patients with their administration of medicines should be familiar with requirement to advise patients of appropriate storage
• refer to the beat the heat leaflets (opens in new window) online for further information and guidance

Heatwave level 3, heatwave action, heatwave temperature reached in our region:

• where possible, try to keep the clinic room below 26C if this is not possible rescheduling appointments if clinically appropriate.
• ensure any physio, OT, or group activity sessions are carried out in cooler hours of the day or postponed. During the Covid 19 pandemic refer to guidance on group activity sessions
• monitor patients for changes in behaviour that may be caused by excess heat such as signs of headache, unusual tiredness, weakness, disorientation or sleeping problems, heat rash, dehydration, heat exhaustion and heat
• be aware that those patients recovering from Covid 19 are likely to be more vulnerable to risks from heat stress and dehydration due to complications, for example, damage to their kidneys
• provide advice to patients on keeping cool during the hot weather
• keep windows exposed to the sun during the current Covid 19 pandemic keep windows that are not exposed to the sun open where appropriate
• close curtains or blinds to windows that receive morning and afternoon
• turn off non-essential electrical equipment where practical
• use fans or air conditioning where appropriate and available but ensure infection prevention and control policies are These must be turned off for a minimum of 30 minutes prior to an invasive clinical procedures being undertaken and also during the intervention. For example, wound care, phlebotomy
• staff supporting patients with their administration of medicines should advise patients of appropriate storage
• if the temperature stays above 25C for 7 days and visits involve injectable medicines, then staff should contact pharmacy for consideration of usability or a change of expiry date
• fans must not be used for patients with suspected or confirmed infections such as flu, MRSA, respiratory infections and Covid 19. Portable air conditioning units must not be used in clinic areas. Use of fans may be permitted in single occupancy areas such as rehabilitation bungalows however advice from IPC team and safety team should be sought before they are used
• make sure you are hydrated (checking your urine is an easy way of keeping an eye on your hydration levels, dark or strong-smelling urine is a sign that you should drink more fluids)
• be aware of the signs and symptoms of heat stress and dehydration (thirst, dry mouth, dark or strong-smelling urine, urinating infrequently or in small amounts, inability to concentrate, muscle cramps, fainting). Don’t wait until you start to feel unwell before you take a break
• if possible use a buddy system with your team to look out for the signs of heat stress (for example, confusion, looking pale or clammy, fast breathing) in each other
• between shifts, try to stay cool as this will give your body a chance to recover
• ensure that PPE supplies are sufficient to cover a likely increase in demand for certain PPE items during warmer months due to staff changing equipment more frequently. PPE also needs to be changed and discarded when it becomes uncomfortable or damp, for example with sweat
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

Level 4, major incident, emergency response:

• NHSE 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
• continue actions above as per level 3 unless advised to the contrary. During extreme conditions it is not only high-risk patients and staff at risk. Therefore further actions may be required
• situation reports may be requested by care group directors (silver)
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

5.1.1.5 Medicines management actions

• Medicines should be stored at or below the temperature stated on the summary of product characteristics (SPC). The majority of medications, with the exception of those requiring cold storage such as vaccines or insulin, this is 25C.
• If the temperature stays above 25C for 7 days and treatment involves injectable medicines, then staff need to contact pharmacy for consideration of usability or a change of expiry date.
• The medicine fridge temperature must be checked daily and recorded on the monitoring The temperature should be within 2C negative 8C and any deviation from this range must be reported immediately to estates and pharmacy.
• Staff supporting patients with their administration of medicines should advise patients of appropriate storage.
• A document is available on the specialist pharmacy service website (opens in new window) which details what medicines could cause problems for patients during a heatwave. Enter ‘heatwave’ to download it. For further advice speak to pharmacy.

General guidance:

• store away from sources of heat, such as fridges and radiators
• away from direct light, consider the use of blinds on windows
• turn off lights when not the room not in use
• ensure the room can be ventilated, taking in to account of the security of the room
• consider air conditioning if the temperature is running consistently high but ensure you comply with air conditioning actions below
• when transporting medication in cars, be aware of the extreme temperatures they may be exposed to
• the room temperature where medicines are stored should be monitored on a daily basis (minimum and maximum), where staff are present
• if the temperature reaches 26C or above staff should contact pharmacy services on 01302 798308 for advice with regards to open liquids. Solid dosage forms and unopened bottles should be stable for a short duration
• if the temperature stays above 25C for 7 days, an IR1 must be completed and estates should be contacted for advice with regards to methods to reduce the temperature.

Pharmacy services should then be contacted who will advise on the stability and shelf life of the medication. This will be based on the temperature and the duration, and on advice from the specialist pharmacist service document.

5.1.1.6 Actions if using portable air conditioning, not portable air conditioning must not be used during the COVID 19 pandemic

• If cool areas cannot be kept at or below 26C then liaise with associate nurse director to ascertain if hire of portable air conditioning units is appropriate (not appropriate during current Covid 19 pandemic).
• Contact air conditioning firm (see contacts) and arrange a visit if required to ascertain needs and conduct risk assessment. Some stand-alone units plug into an electrical socket and require a window vent for ventilation. Units should be placed in the corner of rooms and not in the middle.
• Quotes for air conditioning unit hire must be obtained on a care group basis.
• Units must be supplied in a clean and well-maintained state
• These units are for use only in communal areas such as day rooms, corridors and offices. They must not be used in individual bedrooms or bays or for any patient that has a known or suspected infection due to the risk of cross infection.
• Units employing an internal water reservoir and wick to promote evaporative cooling must not be used in healthcare premises.

5.1.1.5.1 Daily maintenance of mobile air conditioning units (These may NOT be used during COVID 19 Pandemic)

1. Decontaminate hands before commencing cleaning.
2. Switch off or unplug the device from the mains supply.
3. Remove the condensate tray or container and empty contents into a sluice sink or toilet. Wipe tray or container clean with a 2 in 1 antimicrobial wipe (or if an enclosed condensate container flush this with an approved disinfectant as recommended by the manufacturer. Rinse container with fresh water. Clinical wash hand basins or any other type of sink must not be used for the condensate or used disinfectant solution.
4. Allow to air dry.
5. Replace condensate tray or container.
6. Decontaminate hands again.
7. Clean the outside of the machine with a 2 in 1 antimicrobial wipe paying attention to the areas where dust may collect (for example, vents). Allow to air dry.
8. Check that the “warm air vent” hose is free from damage and that it is being vented to the outside of the building (for example, through a window).
9. Reconnect to the mains or switch on.
10. Do not use abrasive cleaners or detergents to clean any part of the machine.
11. Remove and clean any filter elements from the machine only in line with the manufacturer’s recommendations.
12. If for any reason the machine is not operating correctly remove it from service immediately.
13. Prior to storage the condensate tank must be emptied and the unit including filters cleaned.

5.2 Appendix B Actions for business continuity and EPRR manager

5.2.1 Actions for business continuity and EPRR manager

Heatwave level 1, 1 June to 15 September:

• issue a reminder to all staff via trust communications to refresh their knowledge of the heatwave action card in their business continuity plan (BCP) and the trust heatwave plan and to ensure their BCP is up to date.
• remind managers they must have a system in place to cascade alerts to staff if they are issued

Heatwave level 2, heatwave is forecast, alert and readiness, 60% of heatwave in the next 2 to 3 days:

• alert all staff to the forecasted rise in temperatures and the subsequent need to consult BCPs and heatwave plan.
• liaise with trust communications to ensure latest met office advice on the heatwave is shared via Intranet and all staff email updates, staff will be instructed to follow the action card in their BCP for a level 2 heatwave alert.
• in the absence of the business continuity and EPRR manager these actions will be taken by the trust Communications team.
• if a heatwave alert level 2 is received out of hours the on call silver member of staff will inform the business continuity and EPRR manager and trust Communications team so that the actions above can be taken as soon as possible.

Heatwave level 3, heatwave action, heatwave temperature reached in our region:

• alert staff to the new alert level and liaise with trust communications to ensure latest met office advice on the heatwave is shared via Intranet and all staff email updates. Staff will be instructed to follow the heatwave action card in their BCP for a level 3 heatwave alert.
• in the absence of the business continuity and EPRR manager these actions will be taken by the trust Communications team.
• consult with the accountable emergency officer on possible further actions that may be required such as the request for situation reports from silvers on the response to heatwave alert.
• if a heatwave alert level 3 is received out of hours the on call silver member of staff will inform the business continuity and EPRR manager and trust Communications team so that the actions above can be taken as soon as possible

Level 4, major incident, emergency response:

• in the event that a level 4 major incident is declared by NHSE inform the accountable emergency officer.
• support the accountable emergency officer in putting in place major incident response arrangements if required

Stand-down from alert levels:

• when alert levels are withdrawn ensure all staff are made aware via Intranet and all staff email updates. Staff will be instructed to follow the action card in their BCP for whichever alert level now applies.
• in the absence of the business continuity and EPRR manager these actions will be taken by the trust Communications team

5.3 Appendix C Actions for Communications team

5.3.1 Actions for Communications team

Heatwave level 1, 1 June to 15 September:

• support the business continuity and EPRR manager by updating the trust intranet and daily communication email as required with information about heatwave preparation. Ensure messages have sufficient prominence

Heatwave level 2, heatwave is forecast, alert and readiness, 60% of heatwave in the next 2 to 3 days:

• liaise with the business continuity and EPRR manager to ensure latest met office advice on the heatwave is shared via Intranet and all staff email updates. Staff will be instructed to follow the action card in their BCP for a level 2 heatwave alert
• in the absence of the business continuity and EPRR manager the action above will be taken by the trust Communications team
• if a heatwave alert level 2 is received out of hours the on call silver member of staff will inform the business continuity and EPRR manager and trust Communications team so that the actions above can be taken as soon as possible

Heatwave level 3, heatwave action, heatwave temperature reached in our region:

• liaise with the business continuity and EPRR manager to ensure latest met office advice on the heatwave is shared via Intranet and all staff email updates: Staff will be instructed to follow the heatwave action card in their BCP for a Level 3 heatwave alert
• in the absence of the business continuity and EPRR manager the action above will be taken by the trust Communications team.
• consult with the business continuity and EPRR manager and accountable emergency officer on possible further actions that may be required such as a need to engage with external partners to ensure consistent communications
• if a heatwave alert level 3 is received out of hours the on call silver member of staff will inform the business continuity and EPRR manager and trust Communications team so that the actions above can be taken as soon as possible

Level 4, major incident, emergency response:

• in the event that a level 4 major incident is declared by NHSE liaise with the business continuity and EPRR manager and the accountable emergency officer and await further instructions
• the Communications team will liaise with external communications managers as appropriate or required

Stand-down from alert levels:

• when alert levels are withdrawn liaise with the business continuity and EPRR manager to ensure all staff are made aware via Intranet and all staff email updates. Staff will be instructed to follow the action card in their BCP for whichever alert level now applies
• in the absence of the business continuity and EPRR manager the action above will be taken by the trust Communications team

5.4 Appendix D Actions for care group directors on call silver

5.4.1 Actions for care group directors or on call silver

Heatwave level 1, 1 June to 15 September:

• seek assurance from managers that heatwave preparations are in place, for example, business continuity plans are up to date, staff are aware of the heatwave action cards
• ensure managers have a system in place to cascade alerts to staff if they are issued

Heatwave level 2, heatwave is forecast, alert and readiness, 60% of heatwave in the next 2 to 3 days:

• seek assurance from managers that they are aware of the heatwave forecast and that preparations are in place as required in the heatwave action card in each business continuity plan
• if a Heatwave alert level 2 is received out of hours the on call silver member of staff will inform the business continuity and EPRR manager and trust Communications team so that appropriate all staff messages and intranet notifications can be issued as soon as possible
• include hot weather concerns as an item for discussion in team meetings or safety huddles

Heatwave level 3, heatwave action, heatwave temperature reached in our region:

• if a Heatwave alert level 3 is received out of hours the on call silver member of staff will inform the business continuity and EPRR manager and trust Communications team so that appropriate all staff messages and intranet notifications can be issued as soon as possible
• seek assurance from managers that they are aware that a level 3 heatwave alert has been reached and that teams are following actions as required in the heatwave action card in each business continuity plan
• consult with the business continuity and EPRR manager and accountable emergency officer on possible further actions that may be required such as a need to activate silver commands
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

Level 4, major incident, emergency response:

• in the event that a level 4 major incident is declared by NHSE liaise with the accountable emergency officer and await further instructions
• liaise with external communications partners as required or appropriate, for example, local place based response meetings
• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles

Stand-down from alert levels:

• continue to include hot weather concerns as an item for discussion in team meetings or safety huddles
• facilitate sharing of best practice or lessons learned within the care group and provide feedback to business continuity and EPRR manager

5.5 Appendix E Actions in the event of severe heat exhaustion heatstroke

5.5.1 Actions in the event of suspected heat exhaustion or heatstroke

Heatstroke is a medical emergency, emergency treatment:

If you suspect someone has heatstroke, call 999. While waiting for the ambulance:

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Document control

• Version: 13.1.
• Unique reference number: 171.
• Approved by: Corporate policy approval group.
• Date approved: 21 December 2023.
• Name of originator or author: Business continuity and EPRR manager.
• Name of responsible individual: Corporate policy panel.
• Date issued: 29 December 2023.
• Review date: July 2024.
• Target audience: All staff.

Page last reviewed: April 30, 2024
Next review due: April 30, 2025

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