When crises like mass-casualty events or widespread disease outbreaks strain healthcare resources, coordinated emergency responses become essential to protect lives and services. The NHS Emergency Preparedness, Resilience and Response (EPRR) Framework classifies a major incident as any situation exceeding normal operational capacity. Data from 2024 shows NHS England recorded 217 incident declarations, including 19 major incidents and 198 critical incidents, illustrating the frequency of such challenges.
These incidents place significant demands on pharmacy services, which must be prepared to respond with emergency medicines, analgesics, and anaesthetic agents. The Civil Contingencies Act (CCA) 2004 outlines the legislative framework governing NHS preparedness, classifying certain organizations as Category 1 responders with full civil protection duties.
Statutory and Operational Responsibilities
Pharmacy professionals have clinical and operational responsibilities that are central to an effective major incident response. They must demonstrate annual compliance against NHS core standards for EPRR, which set out minimum requirements for emergency preparedness, resilience, and response. The Royal College of Pharmacy emphasizes the need for robust, integrated pharmacy services that are resilient to disruptions.
The London Ambulance Service NHS Trust pharmacy team provides specialist medicines governance for emergency preparedness and resilience capabilities, working closely with EPRR and Hazardous Area Response Team (HART) colleagues. Similar governance arrangements exist across NHS ambulance services to promote interoperability and mutual aid, ensuring medicines are available, safe, and fit for purpose during exceptional operational circumstances.
Medicines Management and CBRN Incidents
Medicines management during major incidents involves having a designated stocklist, stock visibility, sufficient stockholding, and a clear plan for deploying stock rapidly. Pharmacy teams must be aware of CBRN countermeasures that are held centrally and have a process for requesting and receiving these products. The NHS core standards for EPRR detail CBRN preparedness requirements, training, exercising, and business continuity.
In the event of a nerve agent incident, pharmacy teams would be required to rapidly receive, verify, and prepare antidotes, including atropine and pralidoxime. These agents must be administered promptly, making pre-prepared pharmacy action cards and clear mobilization pathways clinically critical.
Hospital pharmacy departments should maintain stock levels relevant to their local risk profile and aligned to their local risk registers. They should also have adequate stockholding of mass casualty drugs and information on medicines stocked in-house, as well as those that require central coordination.
The National Health Service Act 2006 and the Health and Care Act 2022 reinforce the duties of Category 1 responders, including NHS trusts and NHS England, to ensure effective emergency preparedness and response.
Lessons Learned from Previous Incidents
The 2017 Manchester Arena attack highlighted the importance of pharmacy’s integration into major incident command structure. The public inquiry into the attack emphasized the need for rapid deployment of fast-acting analgesia to victims. This led to a review of regulations to enable paramedics to provide fentanyl lozenges to injured persons.
The COVID-19 pandemic also revealed the importance of workforce wellbeing as part of resilience planning. ICU/intensive trauma unit pharmacists working through the acute phases of COVID-19 benefited from structured psychological support, including regular reflective practice sessions facilitated by a clinical psychologist.