Emergencies and Unplanned Events
Scope of this chapter
Emergencies: Serious, unexpected and sometimes dangerous situations requiring immediate action.
Unplanned events: Events that have not been previously anticipated.
Regardless of your role in the service, it is important that you know what to do so that situations can be managed safely, sensitively and calmly to achieve the best possible outcome for the person being supported at the time.
This chapter explains about emergency plans and offers specific guidance for responding to some of the most common emergencies and unplanned situations that you may encounter.
Relevant Regulations
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Regulation 12: Safe care and treatment
Regulation 13: Safeguarding service users from abuse and improper treatment
Regulation 17: Good governance
Care Quality Commission (Registration) Regulations 2009
Related Chapters and Guidance
- Accessing the Community
- Accidents, Injury and Incidents
- Assessing and Monitoring Health and Safety Risk
- Recognising Abuse and Neglect
- Risk Assessment (person-centred)
- Partnership Working
- Personal Safety and Wellbeing
- Notifications: Guidance for non-NHS trust providers
Amendment
In May 2024, information about Regulation 9A: Visiting and accompanying in care homes, hospitals and hospices was added to Section 5, Unknown visitors.
The registered person is responsible for developing emergency plans for the service.
Plans should be in place for a range of situations and events that may occur. This should be determined through a robust process of risk assessment.
Plans could be related to the whole service or could be specific to a particular person.
Plans should aim, wherever possible, to prevent an emergency situation from occurring in the first place.
Where the emergency situation occurs, plans should be easily accessible and set out clearly what staff should do.
All staff should know what emergency plans exist and where to find them.
Emergency plans should be reviewed regularly and always when new people start to be supported by the service. This will ensure that the specific needs of individuals are included in the plan. For example, mobility needs during an evacuation. During a review it is also important to check that the contact details for managers and organisations mentioned in the plan are still current.
It may be beneficial to involve or seek the advice of another agency in the development of the plan, for example the local authority or the fire service. Regard should also be given to any emergency plans that have been developed by the emergency services, local authorities and NHS bodies under the Civil Contingencies Act 2004. Where such plans exist, the registered person should ensure that the plan they develop does not contradict any instructions in that plan.
For further information emergency plans under the Civil Contingencies Act see: Preparation and planning for emergencies: responsibilities of responder agencies and others.
It can be a stressful time when an emergency or unplanned event occurs. This is especially the case when it is not clear how to respond.
- Remain calm;
- Take any immediate action required to keep yourself and others safe;
- Provide appropriate reassurance to anyone being supported;
- Quickly locate any emergency plan relating to the situation;
- Follow the instructions in the plan.
If there is no emergency plan, or the plan is not accessible:
- Remain calm;
- Take any immediate action required to keep yourself and others safe;
- Provide appropriate reassurance to anyone being supported;
- Contact a manager, explain the situation and follow their instructions.
It is important to reflect on the event to identify any changes that may be needed to an individual care or support plan, an emergency plan, or any need to develop an emergency plan in case the situation occurs again.
There may also be lessons to be learned if the emergency or event was not handled as well as it could have been, or training needed to ensure staff understand what to do in the future.
See: Learning from Safeguarding Enquiries, Safety Incidents and Complaints
Depending on the nature of the emergency or event, there could be a legal requirement to notify the Care Quality Commission or the local authority.
For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.
Whenever a person being supported goes into the community independently, any risk that they could go missing should be assessed, using evidence and not assumption.
See: Risk Assessment (person-centred)
Some factors that could increase the risk:
- They have a health condition that can cause confusion, memory or orientation issues;
- They have severe depression or suicidal thoughts;
- They are easily influenced by others;
- Their capacity or ability to be independent in the community fluctuates;
- They have gone missing before.
If there is a risk, an emergency plan should be developed and kept with their individual care or support plan. Wherever possible, the plan should be developed with the person. This will enable them to understand the concerns and consider the best way to reduce risks for themselves. If this is not possible, the person should still be made aware of the plan.
The plan should set out the circumstances when the police should be contacted, and anyone else that needs to be notified e.g. family members.
Depending on the person’s needs and level of risk, the plan could include the following steps:
- Try to contact the person directly;
- Check the building and garden to make sure that the person is not hiding/trapped anywhere;
- Check that the person isn’t disoriented in a nearby street;
- Try to establish if there is a logical explanation e.g., have the buses been delayed;
- Contact family to see if the person is with them, or if they know what may have happened;
- Find out if the person has been admitted to a local hospital;
- Call the police to report that the person has gone missing and follow any advice given.
- Ask the person where they are going and when they plan to be back;
- Check they have their mobile phone and that it is charged;
- Ask them to let you know if they are running late, or their plans change;
- Make a note of what they are wearing.
The person doesn’t have to provide you with this information, but if they do it can help the police a great deal should they go missing.
Any information that is provided should be proportionately recorded so that you don’t have to rely on memory alone.
If you have concerns about where the person is going, discuss these with your manager. For example, you may be worried that they are meeting someone who may be exploiting them financially.
These are police protocols which have been implemented around the country for recording information around people who are at risk of going missing.
They include a range of helpful information about the person that can be used by the police when trying to locate them.
This includes:
- A recent photograph of the person (or photographs if their appearance changes);
- Their date of birth and age;
- A full description of the person, including race, ethnicity, gender, height, hair colour, glasses, facial hair, scars, tattoos etc.;
- Details of any health conditions and medication - is this time sensitive?
- Communication needs/style;
- Previous addresses;
- Known contacts and their contact details (friends/family);
- Favourite places, including places of worship;
- Interests;
- Travel patterns - do they use buses, trains and how far are they likely to travel?
- Phobias and anxieties.
Whenever a person is at risk of going missing, the relevant protocol should be completed and kept with their individual care or support plan, alongside any emergency plan that has been developed.
The protocol should be reviewed and updated whenever the information changes.
Herbert protocol: use when the person has dementia
Winnie protocol: use in any other circumstances
Both protocols should be downloadable from the local police website. However, if not available the service can create its own template.
- Remain calm;
- Quickly locate any emergency plan relating to the situation;
- Follow the instructions in the plan.
If there is no emergency plan, the following steps are reasonable in most cases:
- Try to contact the person directly;
- Check the building and garden to make sure that the person is not hiding/trapped anywhere;
- Check that the person isn’t disoriented in a nearby street;
- Try to establish if there is a logical explanation e.g., have the buses been delayed;
- Contact family to see if the person is with them, or if they know what may have happened;
- Find out if the person has been admitted to a local hospital;
- Call the police to report that the person has gone missing and follow any advice given.
Depending on the circumstances in which the person has gone missing, there could be a legal requirement to notify the Care Quality Commission or the local authority.
For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.
If the person lives in a care home, Regulation 9A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires that, unless there are exceptional circumstances, the person must be able to receive visits from anyone they wish to see.
The person’s individual care or support plan should contain information about any visitors that are not permitted to see them. For example, the person may have stated they do not wish to see a particular family member, or the Court of Protection may have restricted contact with someone. All staff supporting the person must be aware of any such information.
If there is a court order restricting contact with a named individual this contact cannot lawfully be permitted without the permission of the Court.
In all other circumstances, if the person has the capacity to decide whether to accept a visitor, they can make this choice and it should be respected.
See: Mental Capacity
If the person does not have the capacity to make this decision, you will need to do so in their best interests. If the person wants to see the visitor you should respect their wishes, unless there is evidence to suggest the person (or other vulnerable adults in the vicinity) may be at risk of harm from the visitor.
In all cases, it is reasonable to introduce yourself and invite the visitor to do the same, ideally before they enter. Try to establish their name and relationship with the person. If you have concerns about their intentions, also ask them what the purpose of their visit is.
If, during the visit, the visitor behaves in a manner that causes the person (or other vulnerable adults) distress, you should intervene by asking the person if they are OK and if they would like the visitor to leave. If the person wishes for the visitor to leave, you should politely ask them to leave. If the visitor refuses to do so, it may be necessary to seek support from a manager or contact the police. If it is other adults that are in distress, rather than the person receiving the visitor, you should seek an alternative place for the person to spend time with their visitor.
If the person is not in distress but you are concerned that they (or others) are at risk of harm, you should take steps to minimise this risk. For example, you could stay in the room to observe or sit in between the person and the visitor.
There is always a possibility that the person will ask you to leave so they can spend time alone with their visitor. In a care home setting, the risks are somewhat easier to manage, as you will still be on site and therefore on hand to provide support if needed. If the person lives in the community and asks you to leave their home entirely it is much harder. If the person has the capacity to make the decision to refuse your support, you may have no alternative but to leave. Before doing so, you should speak with a manager and take advice. It may be that you stay outside in the car or return a little while later to make sure the person is OK. You may decide to contact the local authority safeguarding team for guidance and to raise an immediate concern. If the risk of harm is high, it may be that the police are called.
Depending on the circumstances, there could be a legal requirement to notify the Care Quality Commission or the local authority.
For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.
Geoff lives in his own flat and Sarah is there supporting him. Whilst there, Geoff gets a visit from a man that Sarah has not seen before. Geoff lets this man in and seems to know who he is. Sarah says hello to the man and introduces herself. The man says hello back but doesn’t give his name. It is clear to Sarah that the man is intoxicated. The man sits down on Geoff’s sofa and uses the remote control to turn the TV over from the programme Geoff had been watching onto a music channel. Geoff doesn’t seem to mind but he doesn’t like to complain generally. Sarah asks Geoff if he is OK and if he needs anything. Geoff says he is fine and tells Sarah that he doesn’t need her to stay any longer because Jay is here. Sarah feels uneasy about leaving and explains to Geoff that she needs to check with her manager that it is OK for her to finish early. Sarah explains the situation to her manager. They agree that Sarah will leave initially but will sit in her car for 30 minutes. After this time, she will return to make sure that Geoff is OK. After 30 minutes, Sarah returns to find that Jay has passed out on the sofa and is snoring loudly. Geoff says he is OK and that Jay often comes round to sleep the booze off. He reiterates to Sarah that he is fine and that she can leave. Sarah makes sure that Geoff has her phone number and can call if he needs her for anything. Sarah leaves but calls the local authority safeguarding team from her car to raise a concern. Even though there is no evidence that Geoff is at risk of harm, Sarah is worried about what she has seen.
Not all physical or mental health issues can be foreseen and planned for. Sometimes urgent, unplanned medical attention or investigation may be needed. For example, if the person has an accident or suddenly becomes unwell.
This can be very distressing for the person, especially if they are in pain, have a phobia or anxiety around hospitals or do not understand what is happening. It is important to stay calm as this can help to reduce anxiety - if you panic anxiety and distress can increase.
A Hospital/Health passport is a document that is given to health professionals when a person is going to hospital. It supports health practitioners to quickly understand the person’s current health and social care needs, so that any necessary adjustments can be made to ensure they are met during their time in hospital.
A passport contains important information about the person, including personal details, current health conditions and the medication they are taking.
The passport also includes additional information about the support that a person normally receives, their likes and dislikes and any wishes and preferences they have about medical treatment provided to them.
For example:
- Communication style, including how to know if they are happy, upset and in discomfort/pain;
- Communication aids and techniques used;
- Known anxieties, how these are shown and how best to support the person;
- General likes and dislikes - do's and don’ts;
- Any support with mobility;
- Any support with eating and drinking, and nutritional needs e.g., allergies, special diet;
- Any support with continence.
If the person has a Lasting Power of Attorney or a Deputy appointed to make decisions about their care or treatment, their contact details should be documented on the passport.
If the person has prepared an Advance Statement or has an Advance Decision to Refuse Treatment, this should also be clearly recorded.
Anyone with a diagnosed learning disability should always have a Hospital/Health passport, but it is good practice for everyone being supported by a social care provider to have one, especially if they lack capacity to make decisions around care or treatment, have specific communication needs or complex care needs. This will reduce the risk of miscommunication during an emergency and help ensure their needs are met and wishes upheld.
The person’s GP should be able to tell you if there is a locally developed Hospital/Health Passport template that can be used. If the person has a Community Learning Disability Nurse, they will be able to provide a template and support with the development of the passport. Alternatively, the service may develop their own.
An example template can be accessed at the Together for Short Lives website.
Hospital/Health passports should be easily accessible in an emergency. They should also be reviewed regularly, and always when the person’s health needs or medication changes.
If the person has a Hospital/Health passport, this should always be provided.
If there is no passport, a copy of the person’s individual care or support plan should be provided.
In all cases, urgent or pertinent information should also be provided verbally - it is unlikely that the health professional will be able to read written information straight away. For example, if the person is anxious in hospitals, or if they are due an important dose of medication soon.
Any medication that the person is currently prescribed should also accompany them to hospital.
If an ambulance is called and you feel that the person will need staff support on the way to hospital and during admission, this should be communicated to the ambulance staff along with the rationale behind this. For example, if the person is very anxious and the presence of a familiar face will help reduce this anxiety and any associated risk of harm to the person or others. In most cases, your support will be welcomed but this is ultimately the decision of the ambulance personnel.
Any personal effects that the person needs or wants should be taken to them after any emergency treatment is completed. Family may do this, but if there is no informal network (or family are not available), staff may need to.
Depending on the person’s needs, they may require social care support while in hospital. For example, with eating and drinking. Legally, it is the responsibility of the NHS to provide all the support that the person needs whilst they are in their care. However, the capacity of health staff to do this is often limited. Family and friends may be willing and able to step in, but if the person has no informal networks (or they are not able to support), the registered person should contact the commissioning body to discuss whether the service can be resourced to provide this.
You should always notify anyone that the person specifically asks you to notify.
You should always notify the person’s next of kin. They will often take responsibility for notifying other family members and friends, but you should be prepared to assist with this task if the need is urgent and there are a lot of people to inform.
If the person has a Lasting Power of Attorney or Deputy with legal responsibility for making decisions about care or treatment, they should be notified.
If the registered person was not present at the time, they should be notified and any advice that they give about staff actions required should be followed.
Any relevant professionals involved in the person’s care or treatment should also be notified, as they may need to work with health practitioners in hospital to ensure that specific needs are understood and met. For example, a Social Worker, Speech and Language Therapist, Clinical Psychologist, Clinical Psychiatrist, Physiotherapist or Dietician.
If the person has a learning disability, the local Community Learning Disability Nursing Team (or named nurse if allocated) should be notified. They can take steps to ensure that the hospital understands the needs of the person and can also monitor that these are being met.
Depending on the circumstances leading up to the unplanned hospital admission, there could be a legal requirement to notify the Care Quality Commission or the local authority. For example, if there are concerns about abuse or the police were involved.
For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.
There should be an emergency plan setting out what staff should do in the event of a power cut.
The plan should set out any specific actions regarding care and support equipment that relies on electricity. For example, hoisting equipment, oxygen and portable equipment that requires regular charging.
The plan should include relevant telephone numbers, including the national information and advice line for power cuts (Tel: 105), the number of the electricity supplier and the number for the local authority.
All the practical things that may be needed during a power cut should be stored together and easily accessible. For example, portable heaters, torches (and batteries), hot water bottles, blankets, foil blankets, gloves, hats etc.
The Priority Services Register is a free support service offered by energy suppliers and network operators to help people in vulnerable situations.
Anyone on the register can receive advance notice of planned power cuts and priority support in an emergency. This can include the provision of emergency heating or cooking facilities.
To find out more about who is eligible to register, and how to do so see: Getting extra help with the Priority Services.
First and foremost, remain calm and take time to reassure people what is happening and that everything will be back to normal soon.
The 3 biggest issues for most people will be:
- Darkness, if it is night-time;
- Being cold;
- Being hungry and thirsty.
There are additional issues for staff which could include equipment failing, perishing food items etc.
Darkness
Make sure that torches are available with the right size batteries.
Being cold, hungry and thirsty
Being in a cold environment is not only unpleasant, but prolonged exposure to cold temperatures can cause hypothermia. This is potentially life threatening. Additionally, a body temperature of 95 degrees Fahrenheit or lower can cause health problems such as kidney issues, heart attacks, liver damage, particularly in older adults and those with existing health conditions.
Wherever possible, it is useful for everyone to stay in the same room. Make sure doors and windows are closed and block up any draughts. These measures will increase the overall temperature of the room.
Support people to wear blankets (including foil blankets if available), hats, scarves, gloves and extra layers of clothing to help stay warm. If cooking appliances are gas, boil saucepans to fill hot water bottles or make hot drinks. If not, check whether any local amenities, such as a local café, are open and have power - can they support with filling up flasks or hot water bottles?
If a hot meal is planned but cannot be cooked, decide whether to order warm food in from a local café or take-away. Make sure there are plenty of snacks so people can keep their energy levels up.
Equipment
Do not try to use any equipment that relies on electricity if there has been a power cut - it will not work and trying to use it could put you or the person being supported at risk.
If it is not possible to move or handle someone safely, the occupational therapy service should be contacted as a matter of urgency for support with alternative equipment or strategies.
If oxygen, or another essential medical treatment/therapy is not available, the person’s GP should be contacted. If the surgery is closed, call 101 and seek advice. Paramedics may need to attend with a backup cylinder, or the person may need to be supported for a short term in an alternative environment.
Refrigeration
UK Power Networks state that if the doors remain closed, food should keep fine for 4-6 hours in a refrigerator and 15-24 hours in the freezer.
Beyond this, items may start to become perishable. Do not take risks. Never use any food item when you believe that its safety for human consumption has been compromised.
Where medication is refrigerated, the GP should be contacted for advice about using the medication prior to giving it.
If a power cut is likely to be prolonged, the energy company or the local authority may be able to provide a backup generator.
You should contact them to explain the specific needs of the person/s being supported and any support they can provide. Local authorities have a duty under the Civil Contingencies Act 2004 to help in emergency situations.
Depending on the impact of the power cut, there could be a legal requirement to notify the Care Quality Commission.
For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.
Adverse weather conditions include high winds, heavy snowfall, heavy rainfall leading to flooding, lightning and ice. If the weather is, or could cause disruption to daily life then it is adverse.
Adverse weather conditions can impact a service in many ways:
- Staff unable to get to work;
- People unable to access services in the community;
- Accidents and injuries;
- Damage to property or equipment.
It may not be deemed necessary to have a bespoke Adverse Weather Events emergency plan, as each of the above is likely to be included in another relevant plan.
The service should, however have a dedicated emergency plan in place for each of the following:
- Severe flooding;
- Fire.
Both plans should set out how people using the service will be supported to safely evacuate.
If a care home service must temporarily close to address damage to property, the local authority must be informed.
Under the Care Act 2014, if the local authority arranged the service following a needs assessment, it must make alternative arrangements for the interim period. This is with one caveat - if the person’s family agrees to provide the required accommodation and care. To decide what is best, the local authority will liaise with the person and their family about available options.
If the local authority did not arrange the service (i.e., if the person is self-funding) the local authority is still required to offer support and may decide to exercise its statutory power to make alternative arrangements.
Depending on the impact of the event, there could be a legal requirement to notify the Care Quality Commission.
For guidance on CQC notifications see Notifications: Guidance for non-NHS trust providers.
Last Updated: April 16, 2024
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