Good evening everyone and welcome to the first live webinar of 2022. This is also the first webinar of our new practise management programme, which is proudly sponsored by the Veterinary Management Group. Our topic tonight is how do I create a disaster plan for my practise, and I have the pleasure of introducing you to our speaker, Doctor Hannah Perrin.

Hannah has over 20 years of experience in veterinary leadership and management. Originally qualifying as a pharmacologist, she subsequently became practise manager at a busy foresight veterinary group in Kent. In 2010, she went back to school for a part-time master's degree in health services research while consulting for a variety of first opinion and referral practises, followed by a PhD in veterinary education focusing on the development of professional identity.

She taught both undergraduate and postgraduate students and staff at the RBC for a few years before joining the veterinary Management Group in 2018. She's now the learning and development lead for the BMG and course director for the VMG ILM award certificate and diploma in Veterinary Leadership and Management. If you have any questions or comments for Hannah as we go along, please hover your mouse on the screen, click on the Q&A box, and we will cover as many of those as we can at the end of the session.

But without further delay, let me extend an exceptionally warm welcome to the webinar there, Hannah, and over to you. Thank you very much, Jackie, thank you for the lovely introduction. Yes, warm welcome indeed seeing as it's flipping chilly down here today.

Yeah, so the, the first, webinar of this, management series. We're actually gonna talk about catastrophe, which, we thought would be a lovely way to start the new year. And I'm afraid we're gonna, make you have a bit of a think about what could possibly go wrong, in our practise.

So, apologies for the, the doom, but hopefully we can, Give you some good tips and tricks, give you some good information that will make you feel a little bit more confident, about your, emergency preparedness, and, what you can do to reduce the risks to your practise, your people, your patients, and your property. So let's just have a quick overview of what we'll be covering this evening. So for part one, we're going to look at the principles of what we call disaster planning or emergency planning.

We'll look at It's a big, a lot of risk assessment, obviously. So we'll look at how we identify the risks, we'll look at what information we need to gather, how we can quantify, the risks that we may have to our practise. We'll look at mitigations, so, ways we can reduce, the risk of, well, the risk of disaster happening and reduce the impact of any emergency that may happen.

We will look at what needs to go into your emergency action plan under the three priorities, that is people, patients, and property. We'll look a little bit at, training. A fundamental cornerstone of your, emergency preparedness planning, should be at team training.

And then in the second part, we will look at a few, examples, of emergencies that you may come across, in practise. So we'll look at one, sort of a combined look at fire and flood because in terms of potential damage, potential impact. They're actually quite similar.

We'll look at an example of a significant loss of power, to the practise, and we'll also look at an example of cyberattack, which is, an increasing, risk to practise these days. So let's go into part one and have a look at the principles when we're starting to think about planning for emergencies. So there are, like I said, 6 stages.

We identify the risk, we gather our data, we take steps to minimise our risk, we create an action plan, we train. And then, of course, the last step in any good, risk assessment is, testing, review, evaluation, and the cycle starts again with, what we're identifying. So, with that in mind, we're gonna have a, a bit more of a look in a bit more detail at each of these steps.

If you already have, some form of emergency planning document structure in place, then fantastic. And I hope that this session will give you some extra hints, maybe a few little tips that you haven't come across, maybe a few little things that you haven't yet looked at that might sort of trigger a, a bit of interest for you that, oh, yeah, we should probably look at that in a bit more detail. If you haven't yet got a a formal emergency plan in place, then hopefully this will give you some really good steps to take to start getting one put together.

So we're gonna go through all the components that you should include. So, to start with, I'm afraid I'm gonna have to ask you to put your, your really big pessimistic hats on, because what we're gonna start with essentially is by saying, what could possibly go wrong. And without wanting to jinx things happening in practise, when we're looking at emergency preparedness, we really do need to look at the worst possible scenarios.

It's not nice to think about. It's not nice to have to make these plans. But, as we said in the, in the session description, it's always better to think about these things before you have to.

And if you've got plans in place, it will make the whole situation that bit less stressful. So let's think about what could possibly go wrong. So, the three things we need to look at under this sort of section under this heading are what could happen?

What would be at risk and who would be at risk. So let's have a quick look at those. So, what we're talking about, a lot in terms of emergency preparedness is things like natural disasters, so that could be things like fire, flood, storm, hurricanes.

Earthquakes, that kind of thing. Here in the UK, we are very lucky in that our weather tends to be relatively benign. We don't tend to get major earthquakes.

We don't tend to get major storms, that kind of thing. But it is still worth considering the impact. We have, we call them man-made emergencies, but stuff that, as a result of some human activity.

So that could be things like fire and flood, it could be things like Power cuts. It could be things like, we'll talk a little bit later on, things like civil unrest in your area, lots of different things, that will depend, as I say, on your local area or region. So it's really important to consider where physically your practise is.

So, are you At the bottom of the hill, next to a river, on a flood plain, etc. That's gonna be one particular level of risk. Are you in a, an area where, heath fires or forest fires are a risk?

That kind of thing. So it's very much. Important to consider your geographical area, where your practise physically is, including branch surgeries, include your sort of catchment area, your visit area, particularly if you're an ambulatory practise.

Just think about sort of the geography, of where you are. The next heading is to think about what might be, at risk. Obviously, the most significant one will be personal injury to people, whether that's staff, clients, local community, and potentially to patients as well.

The other risks, obviously, you have loss of business, if you can't operate for a period for whatever reason, that's going to have a financial impact. Damage to your building, On any scale from minor to catastrophic, utility supply, will you still have electricity, gas if you have it, a safe water supply? Data and records, obviously as veterinary practises, we collect vast amounts of data and information about patients, about clients, about staff that could potentially be at risk.

And it's also important to consider. Your reputation. So is there a reputational risk with a potential emergency?

Is there a risk of a loss of trust, either with your immediate clients, with your neighbours, with your local community? Again, it's something that you need to consider and you need to put into a risk assessment. And again, looking at who is at risk, staff, clients, visitors who may be on site, perhaps not so much at the moment, during COVID.

And your local community. So whether that's your immediate geographical neighbours, where you are, whether that's a local community that you provide particular services to, that would then be without that service, again, that should go into your identifying risk category. While we're talking about identifying risk, I'm going to just quickly mention insurance.

Obviously, it's something that all practises will have. And you will have your standard property insurance, you will have public liability insurance. You should also have, and it's worth putting up this little sort of checklist of things that it's worth checking that you are covered for.

So things like cyberattack and data breach. If you've got, well, you will have property insurance, what is covered in terms of your branch surgeries and your vehicles, because those can change. Are you covered for legal and forensic services for post-emergency or post disaster, whatever might happen, and are you covered for business interruption?

And to focus on that, a little bit more, again, it's worth checking your, your small print and just doing a little checklist to make sure things that you might potentially need are, in fact, covered under your business insurance, particularly as the veterinary sector is, is a very specific way of working. So, are you covered for payroll expenses under your business interruption insurance should be, cleanup costs, depending on what's happened, if there's been fire that has then had water damage on top of that from tackling a fire, that kind of thing. Are you covered for rent if you need a temporary site, if your building is completely unusable and you have to go somewhere else?

Would your, insurance cover those costs? Are you covered for lease payments on equipment that you are, may or may not be using or able to get the usual income for? Are you covered for lost income generally?

And are you covered for PR and media management costs is something we'll talk about, in a little while, but there might potentially be some crisis management that the practise or you personally might need to do? Will you need to engage people to work with the media if you've had something significant happen and are the costs of that covered under your insurance are worth checking those little things? OK, step 2 in our planning process is the compile stage.

This is where we gather our information. What do we need to have in order to contribute to this plan and make sure that we're prepared as we can be for any emergencies that might happen. So, two headings here.

So, Up to-date records are really, really important. So this will include your asset register, your list of all the equipment and all the kit and its value that you may have in the practise. Obviously, that's very important for insurance purposes, but it's also worth categorising that into.

What can we not function without, or what would be, what would be very restricted on what services we could offer if whatever piece of kit was not available to us? A list of your suppliers and potential alternative suppliers for critical stock and services. So again, what could you not function without?

Who supplies that? Are there alternatives if, for whatever reason, the supplier can't get to you if there's been a supply chain issue? Make sure you know what the contact details are, how to get hold of people, and preferably have alternatives in place if you aren't, for whatever reason, able to contact your regular supplier.

And repair services. So for immediate aftermath of some kind of emergency, who do you need to call to get yourselves back up and running as quickly as possible. And again, prioritise that.

So what do we need to have in place first, to, to offer a basic first aid and, pain relief service, for example, emergencies, and then take it back up back up to what would be business as usual. And the next, compile factor is your emergency contacts for whatever needs doing immediately. So, all your staff and their emergency contacts, useful to consider there who has access or who can access people's emergency contacts.

So there's a balance to be made there between accessing emergency contacts and obviously, data protection. So that's a discussion that you'll need to have in your practises. If it's only the practise manager that has staff's emergency contacts stored on one computer and the practise manager for whatever reason isn't there.

What would you do? So you need to have some kind of backup system, in place. Emergency contacts for your insurance company, relocation options.

So, if for whatever reason your building is unusable, where would you go? Where would you operate out of? Is there a building nearby?

Do you have good relationships with a neighbouring practise? This is where you have an advantage if you're part of a group practise in that you'll probably be able to distribute your services. But what are your options?

Is there a church hall down the road that you can run out of for a week? That kind of thing. If it's a flood situation, have you got somewhere on high ground, that you could relocate to temporarily?

And other emergency contacts, things like your local authorities, emergency management agencies, people like the Environment Agency, your local fire and rescue service, all of that kind of thing that you might need to contact in a hurry. And then the next aspect of this is the quantifying it, and this could be, this can be quite challenging because essentially we're asking you to think like how, how bad could it be and put some kind of sort of scale on that. And I find that the easiest way to do this is to, to create scenarios.

So, what could happen and how bad could it be? And then have some kind of scale to rate the impact of each potential emergency. So, that will then allow to establish what they call a coup, a, a continuity of operations plan.

So what you would need to do in each scenario and estimate the potential time to recover. So, this is in a terms of scale, and that will then enable you in your plan to prioritise. So, what would be a mild inconvenience, and what would be an utter catastrophe, and everything in between.

And this can be quite a tricky thing to get hold of. So, what I'm going to show you is just an example, of this that comes from outside the veterinary sector, actually, but it's quite a helpful way, I think, of doing it. This example uses, a scale from 1 to 10.

That might be slightly overcomplicating things, and you might want to take it down, a little bit, but essentially it's going from sort of minor bother up to complete catastrophe. And what this example uses is sort of categories thinking what might be affected, and that will then, Inform what you put in your plan for how then to deal with it. So I'm gonna show you a chart.

There we go. So their levels are 1 to 10, starting from water damage during working hours. So that might be something like a leaky washing machine, a burst pipe.

Like, it's annoying and it might cause some damage, but you can generally carry on as usual. It's interesting when you're thinking about scales to consider time of day or day of the week, particularly in a, in an industry such as ours that, that works 24 hours. If you have a, a, a burst pipe during the day, you can probably deal with it fairly quickly.

If it happens overnight, if there's nobody on site overnight, or if you just have a skeleton staff, you have emergency staff on site, do they know where the water stock clock is, and that kind of thing. Getting a little bit more complicated. The example of an unknown contaminant, .

The, the, the example, of this was, the, the sort of the classic white powder in an envelope kind of thing, where you don't know what it is, but it could potentially be quite serious. Power cuts, flooding, a toxic spill, their example, there was, I think a tanker had overturned sort of outside the practise, and we needed to evacuate. Fires, obviously, if the fire is not immediately threatening your building, you might have smoke damage, and that kind of thing you might need to evacuate.

Civil unrest, interesting one. They talk about sort of rioting and protests, that kind of thing. Earthquakes, tornadoes.

That kind of thing right up to the complete catastrophic that could cause catastrophic damage to your business. So, I think that's, that might be slightly overcomplicated for a starting point, but I think it's a useful way of charting things, because you then look at what the impact could be. So, if this happened, would all our staff be able to work?

Yes or no? And if that's gonna be a significant risk, then your colour in the box. If it's a less significant risk, you might put some a paler colour or a smaller number, however you want to do it.

If there's gonna be a risk to your water supply, potential contamination that might be need specialist, treatment. Loss of power could come in with all sorts of, natural disasters, as well as, being a sort of primary power cut, and obviously different levels of, of potential damage to buildings as well. .

So quantifying risk can be quite a tricky thing, but I think if you've got some kind of sort of scale to use, that does make it a little bit easier. Obviously you can use whatever works for you, you can use a mild, medium, high risk, you can use colours, you can use numbers. Whatever works for you.

The idea is that you can then prioritise and say, right, we need to plan for this. You generally start with the most catastrophic and sort of work your way backwards. So, let's have a look at risk reduction.

So now we've identified what could potentially, go wrong. How do we then reduce the risk of that happening? So, a lot of this is fairly common sense, but it's worth reiterating.

So, for things like natural disasters, you can sign up for emergency alerts. So if you're at a flood risk, the Environment Agency do, alerts, similar things for wildfires, things for weather warnings, if you're on the coast, that kind of thing. There are various emergency alerts that you can sign up for.

If you live in a country that has a bit more extreme weather than we do here in the UK, obviously, they have all sorts of earthquake warnings, tornado warnings, that kind of thing that you can sign up for. Critical supply stores is worth considering. So what are your critical suppliers?

What could you not run your practise without? How much of that stuff do you have in store, and how long could you run on your minimum level of stock? So it's worth having a think about that if you have alternative suppliers, like we said earlier, think about your stock levels and what you might need.

Building security, is obviously a fairly standard one, but it's worth considering in terms of, emergency risk. Do the emergency services have access if they need it, and equally, can people evacuate efficiently when they need it? We'll talk a little bit more about that, in a sec when we talk about power failure.

And fire protection should be fairly standard, should all have that, in place, but again, keep it up to date, keep doing your fire drills, make sure your maintenance is done. IT and data backups, again, we'll talk about that, a bit when we talk about cybercrime, but making sure things are up to date, backed up, making sure your backups are off site in case of damage to your building. So whether that's cloud storage, whether that's physically taking, a removable storage device.

Elsewhere, how often do you back up and then how often do you overwrite that backup, is worth thinking about, and again, we'll talk about that, a bit more, in a little bit. Backup power, so whether that's, a UPS, an uninterruptible power supply or a generator or some form of backup for if your power goes off without warning. Again, we'll talk about that when we come to the, examples.

And in big letters, training, the absolute fundamental principle of risk reduction should be training your staff. And I've put cross-training, in brackets there. And what I mean by that is making sure that you don't have any key person risk.

So, if there is one person that the whole system relies on, that's too high a risk. So, make sure that, for example, The only person that knows how to turn your generator on is the maintenance person and maybe the practise manager. Make sure that Night staff know how to do that.

Make sure that people working in the evenings know how to do that. Make sure that information doesn't rest in one place with one person. Make sure that different groups of staff know how to do different things.

So, whether that is how to shut off the, water supply or how to Think of other examples. Oh, for, clinicals of how to safely move a patient out of the building if need be, talking about sort of safe restraint for patients, that kind of thing. Again, we'll talk about that, a bit more in a minute, but that should be an absolute fundamental part, of your risk reduction should be.

Training your staff, awareness and training. And we'll talk a little bit more about training again in a second. So let's talk about your actual emergency action plan.

And EAPs traditionally for veterinary practises will fall under three headings. So you've got to protect your people, you've got to protect your patients, and you've got to protect your property, and those should be the three priorities in that order. And we'll we'll have a word about that in a sec.

So let's talk about protecting people, to start with. Again, this is making sure you have procedures in place that will protect your people and we'll talk again about training in a sec, but you should have in place. Written procedures that everybody knows and everybody understands and everybody has practised for reporting emergencies, fairly standard, calling the emergency services and notifying everyone in the building.

Now, this will, again, very much depend on your practise setup, what your building is like, what your local area is like. When I worked in practise, we had the most beautiful, but impractical Georgian building. It was two houses, knocked together on 4 floors.

It was lovely. It was not the most practical place to run a veterinary practise out of. So we had to have some fairly robust sort of notification systems for things like reporting fires, emergencies, anything like that.

So make sure that everyone in the building can be notified. And make sure you have written down who is responsible for what and when. So who calls the emergency services, who's responsible for notifying people in the building.

And how are you going to evacuate. So, again, this should be already in place as part of things like a fire and risk assessments. Which exits, where to meet emergency shelters if need be.

And local rules rules for specific circumstances, specific to the veterinary sector and particularly some of the work that we do. The most obvious one is obviously theatre. If you have an operation going on in When, for example, a fire alarm goes off, what do you do?

You have to have procedures in place for that, and you really, really, really should practise what happens in that situation. So if you get the notice to immediately evacuate. What do you do and make sure you have that down.

And these are discussions that you, you can and should be having with your clinical staff, and make sure everybody is clear who does what, when, how, where people go, what's done, where things are, that kind of thing. Accounting for everybody once they are evacuated, how do you know who's in the building, where they are and what they're doing? This is where your reception team can be massively useful because they generally have sight of everybody who comes in and goes out and knows where people are.

But make sure you've got some kind of system for whatever, however you do it. Whether it's an old fashioned roll call in a smaller practise, you can probably get away with just gathering people together. In larger practises, you'll need to have formal systems in place with sort of muster stations and fire marshals and, and all that kind of thing, but whatever works, for your practise.

And first aid, again, this is something that should be part, part of how your practise runs anyway, but training your first aid is what goes in your first aid kit, how it's maintained, and how often that kind of thing should be fairly standard stuff. OK. Let's talk about.

Oh, I'm contacting, offsite staff as well. So, whether that's either people who are, working out of the practise, so people, if you've got ambulatory staff, if you've got people doing home visits, that kind of thing, or people who do, are just plain not working that day, or off shift, or depending on what day it is, if you need to protocol and who does it and when. Contacting off site staff and keeping everybody up to date with what's happening.

Obviously over the last sort of year or two we've all got a lot better, I think, at . Not in person, communications, so, there's certainly a lot more sort of systems set up in terms of notifying people and keeping people up to date with practise news and what's going on. OK, let's have a think about patients next priority.

And there are two sort of different, I'm, I'm thinking particularly about, emergencies and evacuation, here, if you have patients on site. So, if you have warning to evacuate, so if you get something like A flood warning saying this is coming, you need to evacuate your building. Obviously, the, the, what you want, need to do is get your patients off site.

So, the easiest, best, safest way to do that is to get the clients to come in and collect their animals, ASAP. If for whatever reason, that isn't possible immediately, then you will need to plan some kind of safe removal site. So if you're a small animal practise and You get I'm quite sure how this would happen, but if you get something like a, a, a flood warning, you need to be able to, you need to have a plan of right, we're gonna box, box up our inpatients and take them.

Wherever. Obviously the larger your patients, the, the trickier that gets. So if you're an equine practise that has, inpatients, obviously slightly harder to transport, but you will need to have a plan in place if you need to evacuate your site for whatever reason, if you have, notice.

If you don't have warnings, if it's a you need to evacuate and you need to do it now, things get obviously a lot more fraught. So the principle, if you need to do an emergency evacuation of your patients, is best chance of survival. And it can be quite a blunt conversation to have, among your staff, but the principles are remove as many as possible if you can do it safely.

Keep an animal evacuation kit, so if you need sort of carriers, lead ropes, etc. Etc. If you can use it.

The principle is the best chance of survival. And as an absolute last resort, if there is immediate threat to buildings, lives, that kind of thing, you can release kennel or stable bolts, locks, whatever, under the best chance of survival principle. It's a tricky one to talk about.

It's one that I think is very useful to talk about in something like staff meetings. Because people have very different ideas, about this, and it's really important that people get a chance to raise any concerns they might have about these types of protocols. And it may be that something different will work for your practise.

Fundamentally, you must prioritise human safety. And I know that's can be really difficult to hear. And again, it's something that is really useful to discuss, among your staff in in terms of, of what if, because it's always better to have the discussion before it's needed.

So I would encourage you to do that. And the third aspect of people patients is property. So providing that your, your people and your patients are OK, what can you do to protect your property?

Again, a lot of this is quite common sense, but it's worth looking at the checklist. So, have you got processes, written processes, understood process in place for things like backing up your data? Do your data backups go off-site?

How often do you run them? How often is that, backup then overwritten? The recommendation is that you keep, data backups for 30 days in case of cyberattack, because it might take that long before someone realises that there's been an issue.

So that's something that's worth considering. Have you got a plan for powering down systems safely? So if you get warning, can you switch stuff off such that it won't damage it?

That's really badly put. But you see what I mean? And again, this is, an example of where cross training is useful.

Do enough people know how to switch things off safely, without relying on one or two people in the practise? Securing things in the practise that might pose a particular hazard to, others, to either your staff, to emergency personnel, potentially, so things like biohazards, medication, equipment. And maintaining your, emergency power supplies, things like generators, have you got fuel stocks?

Have you got a maintenance schedule for your generator, that kind of thing? Plus, of course, all your standard health and safety, fire safety stuff that should be already in place. I've put PR and media management here because that, will come in after the immediate aftermath of whatever emergency that you might have dealt with, be dealing with.

It's worth mentioning that if you have some kind of disaster happen, then you will need to let your clients know. Potentially, you will need to let the local community know, potentially, and you might have media interest, depending on what exactly has happened. So, again, Always better to have this stuff planned before you need to have it planned.

So, nominate a person to talk to the person from the Dover and De Mercury, in my, in my case, the local paper. Nominate a person to put something out on your social media saying, what's happened, what you're doing. That kind of thing.

Always best to have these things planned in advance. And train the team again, big emphasis on this, so a few tips from me. The first tip is to encourage input when you're going through this process of planning, is to encourage input from all of your staff.

Everybody works in a slightly different way, in different areas. They use different processes. They know different people, they work with different people.

So, for example, if you, as the practise manager, are putting this together, Make sure you speak to everybody because you could quite happily say, OK, if this happens, we'll do this, and one of the nurses will say, well, no, that won't work because. X, Y and Z or someone on reception will say, well, hang on, this happened, so we need to put that in the plan. So that's one aspect of it, and also you're far more likely, just as a fundamental, good leadership principle.

To get buy-in from the whole team if they have been involved in the creation of these kind of things. So, what do you think is a very powerful question? Please give me your input.

Here's some ideas that I have. I'd love to hear what you think, what do you think needs changing? What would be the best way to approach these kind of things?

Good questions to ask. And in big capital letters, practise. And I know fire drills can be tedious, and they get in the way and blah blah, blah.

But again, it's one of those things that, yes, the likelihood of it happening is very slim, but the consequences could be significant. So the importance of practise, is really, really, really important to emphasise. So obviously you have your standard things like fire drills, make sure they're regular, make sure they're logged, make sure they're reviewed.

It's not just a yes, we did that tick and put the piece of paper back in the folder. There are 4 types of exercise that I just want to run through that I think that, that it could be useful, for you to consider. So, 4 types of sort of practise exercise that you can use in your practise.

And they go up in complexity. And for that reason, you should probably do a kind of, well, do the easier ones more often, like every time you have a practise meeting, we're gonna talk about this aspect, and do a full sort of simulation, maybe once every 6 months, once every year. So discussion is just what it sounds like.

Let's discuss this scenario. If this happened, what would we do? Simple discussion, you can do it as part of a practise meeting, just talk it through, get people's ideas, that kind of thing, have a discussion.

Next level up is what we call a tabletop exercise, which is more scenario based, again, but it tends to be run in real time. So, it's like, right, if this happens now, in this scenario where we are, what do we do? For bigger teams of people, you can split people into different groups.

So you might have the vets and the nurses and the receptionists because they have to work together and how things communicate. So it can be useful for you as a leader to sort of watch that happen. And you can throw in some curveballs if you want to.

So if you're doing, for example, an evacuation, right, what happens if the way out of this door is blocked, for example? Simulations are just what they sound like. You set up a you actually physically set up a, a simulated scenario, and you have people actually walk through what would happen.

Again, you, it's sort of going up in sort of realisticness, as we go through these. And a live exercise is, again, exactly what it sounds like. You actually do it in real time with all the people.

That can be quite tricky to do safely when you're talking about, emergency planning or disaster planning. But simulations can be massively useful. I'm just gonna show to do, so, run, run scenarios.

So, for example, what if Fluffy, the magical unicorn was on the table in theatre and, for example, the fire alarm went off? You can talk about this till you blow in the face. You can write out your protocols, but until you actually physically do it, so, right, we've got fluffy, Fluffy is under anaesthetic.

What do we do? Until you physically do it, you really don't get the full, anywhere near the full benefit of the, the training experience when until you actually do it. What would you do?

Who does what, when, where are things? What are the exit routes, that kind of thing. So that's a really good example that, I would encourage you to practise doing a, a theatre evacuation of some kind.

And another one, that I've done in practise, this is actually quite fun, is the unknown substance spill. So again, you can do a really good simulation of this, which is quite literally, wherever you are on the floor, on a consult room table, you just squirt something, water, whatever it is. There's something a bit gloopy tends to work quite well on the table, right?

You don't know what it is. What are you gonna do? How do you clear it up?

It's good to practise things like dealing with chemical spills or anything that might potentially be toxic. You can talk about PPE. There's lots of different things that you can sort of work through.

But essentially, the more real that you can make the training. The the better in all possible ways. So I'd really encourage you to think about doing those kinds of things.

So let's move on and we're just going to have a run through a couple of examples of things that you might want to check in your emergency plans for specific scenarios. So fire and flood, like I say, I've kind of, sort of bundled together because the responses can be quite similar. The risk can be quite similar in terms of its risk to life and limb, potentially to start with, and then damage to your building tends to be, the next, concern, whether that's fire damage, smoke damage, flood damage, water damage from firefighting, that kind of thing.

So actions to take, checklists to run through. So check your risk level. Again, we talked about things like flood maps, that kind of thing, the Environment Agency, you can check your flood risk, it's worth having a look on the website.

Don't assume that just because you're at the top of the hill, you don't have a flood risk. You could quite easily have a burst pipe, your neighbour could have a burst pipe, which impacts you, that kind of thing. And again, just basic maintenance of your wiring and plumbing, that kind of thing, just basic good maintenance of the fabric of your building, will help reduce your risk.

Prepare and practise evacuation plans, I've talked about that already, but again, try and make them as realistic as possible, in order to reduce your risk. Subscribe to alert systems. So again, depending on where, where in the country, where in the world, you are, whatever your risks might be, make sure you're subscribe to any notification systems that are appropriate for wherever you are.

Identify several locations for evacuation sites. So, again, we've kind of mentioned this. So, do you have good relationships with neighbouring practises, with alternative spaces?

Could you go mobile? What are your options? Make sure you have, several options for, if you, if your building is unusable for whatever reason.

Create emergency kits for staff, and patients. Again, if you do have to evacuate, if you've got, in terms of, fire, you might need to treat, it might be first aid, it might be more serious, but if you do need to do first aid, treatment for burns, smoke inhalation, and that could be for people or for patients. So make sure, you have both, available.

And, of course, safe restraint for patients if you need to evacuate, any, animal occupants of your buildings. Again, ensure all your staff know how to turn off the electricity and gas supplies. Put a big red arrow on the cupboard where the gas stop clock is, or whatever, make it very, very obvious.

And going back into your building. Only when it's deemed safe. So, when fire and rescue say so, listen to them, they know what they're talking about.

Consider what PPE you might need to go back in again, take advice from the experts. Things to take particular care of. So, has there been damage to your electrical wiring system?

Has it been damage to the sewage system? Can you smell gas? Do you have safe drinking water?

Make sure you have those four things safe. Before going back into your building and this is something that you might need, you probably will need expert input into. Document your damage and losses if there has been damage to your building.

So photographs, massively useful. Make sure you have, as comprehensive, as you can, a list of, the damage that's been sustained, what's unusable, what's damaged, what needs repair, that kind of thing. And absolutely fundamentally take care of your people.

If you have some kind of emergency happen. At whatever scale, it's fundamentally important that you look after your people. Make sure everyone is OK, not just physically, make sure everybody is psychologically and mentally OK.

These things can be traumatic. They will cause stress, anxiety, fear, that kind of thing. Make sure everyone is OK.

Allow people time to come back into the building. If they're reluctant, allow, provide any kind of support that you can, whether that's external counselling, if you have an employee support system, anything like that are absolutely crucial in these kinds of scenarios. Power loss, is an interesting one, to think about.

I've put this in a giant table, because I thought, well, OK, if the power went out in my practise, like, what, what would I lose? What would I not be able to do? And, and came up with quite a significant list.

So it's a useful exercise, to, a sort of a mental exercise to run through. So, I'm gonna show you the chart that I came up with. And you can absolutely sort of, modify this, and add to it to, to what's, specific to your practise.

But in the case of, unplanned power loss, obviously, the most immediate threats could be, again, if, if you've got something going on in theatre, so you will lose your lighting, you might lose things like if you've got patients on ventilators, that kind of thing. So, your, your immediate critical clinical work will be your most, urgent risk. So you'll need to make sure that you've got, control measures, in place.

Urgent things. I might as well put the list up. There you go.

So theatre and uses. Staff and clients, if you lose your lighting, obviously you'd be able to, particularly if it's this time of year when it gets dark at 4:30. People won't be able to see where they're going, what they're doing.

And you need to, consider if you've got any high risk people on site. So whether that's children or clients, whether that's people with, visual impairments, people with limited mobility, or if you've got visitors. Particularly visitors that are backstage.

So, obviously it's not happening quite so much at the moment, but under normal circumstances, have you got a drug rep on site? Have you got a client visiting an inpatient? Have you got a work experience student or an EMS student who may be unfamiliar with your building layout, that kind of thing?

If the power goes out, can you get into your building? Have you got a, a fancy with the electronic access system and does it still work if the power goes off? And your safety systems as well, so things like smoke detectors, fire alarms, burglar alarms, CCTV.

will be an immediate risk. If the power goes off, you're quite likely to lose your phone system depending on what your setup is, so emergency calls won't be able to either come in or be made. You'll lose your practise management system, which means clinical records.

Obvious, you won't have access to clinical records. Refrigeration can be quite a significant one, again, depending slightly on where you are in the world or what time of year it is, your waste freezers, your vaccine fridges, your drugs fridges, will all go off. And any kind of clinical equipment that, you might have in use.

So, ventilators, JA monitors, might be the most immediate, but then, obviously, it goes on to sort of surgical tools, diagnostic imaging machines. If you're an equine practise, winches, oxygen concentrates, anything that's sort of immediately critical. And then if it goes on, we have I won't go through all of these.

But it's, it's an exercise that it's really useful for you to run through, when you start thinking about what will not work, if, if the power goes off. So, I won't run through them. I'll leave it, and then you can have a look, in your own time.

And then think about what, what the mitigating factors might be, what control measures you can put in place to reduce the impact of these things. So, The major one should be some sort of backup power. So, whatever that looks like, whether it's a generator, whether it's a UPS and an interruptable power supply, those tend to give you maybe half an hour, maybe, I think, 1 hour at the most.

So it's enough time to finish any urgent stuff, power stuff down that might need to, and then you'll need to come up with a plan B. For, lighting, obviously you can have emergency lighting that comes on when power goes off, that kind of thing, particularly in theatre. If you are a practise standards practise and in the hospital standards, they require a very specific levels of emergency lighting.

So I'll just do a quick quiz through, control measures. So robust induction and, and comes under sort of staff training, make sure everybody knows where to go and what to do, particularly if the power goes off. Again, use your reception team.

They can identify at-risk clients and visitors, that kind of thing. And make sure your premises are well maintained, make sure you don't have trip hazards, that kind of thing, anything unnecessarily, and that might literally trip people up. For building access, make sure you have your manual overrides in place if you've got, electronic entry.

Good supplier relationships will be a control measure here. If you can ring up someone and say, our power's gone off, I need you to help us, and we need it now. If you have good supplier relationships, that can be massively valuable.

If you lose your phone system, have you got an old school corded phone that you can plug in, to take phone calls? Can you use a mobile phone? Can you divert your phone lines?

I mean, that's something that phone suppliers can do. Use your social media. So make sure that you communicate with particular clients you've got due to come in, particularly clients that you may have inpatients on site.

Use your social media to say, this has happened, here's how to contact us. I probably won't go through the, the rest of this because there's quite, a bit there. But again, the, there's, some, top tips for control measures there.

One thing I will just mention in terms of if you lose, a lot of your clinical surgical equipment, one of my colleagues suggested, well, you go back to nursing expertise and old school techniques. So, I'll leave it to the clinical staff to work out, what those might be. But, my old boss always said that the only, The only, but the best item of anaesthetic monitoring equipment you could possibly have is a well-trained veterinary nurse with a stethoscope.

So I think there's something to be said for that. And finally, we just, oh, there we go, an example of, using your, social media just to keep everybody informed. Finally, we're just gonna have a quick think about cyberattack as a relatively new form of potential emergency.

The types of risk, we have here, options are malware, and malware is literally a piece of software that does bad things. Literally, it comes from malicious software. So whether that's stealing your data, and you could well have some data that's very valuable to, these, certainly practises tend to have, financial data for clients, that kind of thing.

Malware might just, just plain render your systems unusable, unusable purely from malicious point of view. And ransomware, again, it's a form of malware where it will render your systems unusable. Usually, it will just blank your screens and then basically ask for a ransom to unfreeze it.

So that's a sort of a subset, of malware. And phishing, with a pH is a form of basically tricking people, using, emails, usually, that, that seem legit and tricking people into either clicking on, malicious links or opening malicious attachments. So, red flags, public email domains.

So if you get a seemingly official email, but that's come from an at Gmail or Yahoo or Hotmail email address, probably not legit. Misspellings and poor grammar, again, should be red flags, suspicious attachments and links. And if any email comes in that says, you must respond to this now, today, straight away, should send up, some red flags.

And there are some really good resources on, these types of risks and on staff training that I will, flag to you in just a second. Potential vulnerabilities, the biggest one is always people, sadly. people who do this kind of thing, they know how to exploit people who may be less confident with computers, who may be busy and just not paying attention.

And, that could quite easily, apply to somebody in better practise. So, fundamental, things here, your practise culture is so important here. Make sure people are able to raise concerns in a safe environment.

Train your staff. Again, I'll, I'll, I'll signpost some, some really good resources in just a sec. Make sure your systems are set up well, so staff don't need to create workarounds.

So, I'll use my login for this because blah blah, blah, blah blah, that kind of thing, and inappropriate access. So using shared logins, weak passwords, single-factor authentication. So, that is when you literally just need to put in a password or something to access something.

Best practise is always to have things, either two-factor authentication, something called multi-factor authentication. But that's the kind of thing you've probably come across where you put a password in and it says, OK, we've got your password, we're now going to send a code to your phone that you also need to put in. So that's the second factor, two-factor authentication.

So that's something to think about if you have critical systems. Out of date software again, make sure all your software is up to date. Make sure you install updates and install patches, that kind of thing, particularly operating systems.

Make sure you dispose of old tech and old storage devices responsibly. Make sure you back up, and make sure that includes portable devices, and also consider if you have people working from home, data security, their backups, that kind of thing. Really good resource, to recommend the National Cybersecurity centre, it's a UK government, website.

They have some absolutely fantastic resources. So, if you are a a slightly larger organisation, if you have an IT department or is an IT person, their 10 steps of cybersecurity gives a good amount of detail in terms of best practise for protecting your business. If you are a smaller practise where sort of IT stuff generally falls on you, the practise manager, or just happen to be the most techie person in the practise.

They have a small business guide, which, puts it much more simply, a bit more straightforwardly for smaller organisations if you're managing your own IT. There's, some really good practise exercises on there. There's a thing called an exercise in a box that's basically a simulation you can run to test some of these systems in your business, in your practise.

So I'd really recommend you go and check those out. And finally some more, resources. So if you are a VMG member on our resource hub, we have all sorts of policy templates that will give you a starting point for a lot of these things.

So it gives you The charts, it gives you prompts to think about that kind of thing for a lot of the things we've covered. And there's some general, websites there. The Environment Agency is the top one for flood risk.

London Fire Brigade have some really good fire, risk, resources. NCSC, as I've said about cybersecurity, the CDC, the American, centre for Disease Control, actually have some really good information. Obviously it's geared towards the American system, so there are some very severe weather info, but it's quite useful to look at in terms of preparedness.

UK power, networks have some useful info about preparing for power cuts. And the EPC, the Emergency Planning, College, they have some really good stuff about, emergency planning more generally, if you want to have a look at there, for some sort of general resources around putting together, emergency plans and the things that you need to cover. So, That is me done talking.

I think we've got a little bit of time for questions, so I think I'll hand back to Jackie. Thank you so much for that, Hannah. I'm just there we go, got my video back on.

No, that was, that was brilliant. Thank you so, so much. And as you say, we've got a little bit of time left for questions, so I'm gonna to give everyone a few moments if they want to pop any questions into the the Q and A box.

I think, for me, I mean, well, you start off obviously saying, you know, that we have. Less extreme weather over here in the UK and you know, obviously at the moment that is true. I mean, we're a very environmentally conscious company ourselves anyhow, so we're always kind of thinking, you know, how are things going to change, what do we need to know, global warming or things like that.

Who knows what the future will hold for us. But I think, you know, what you've provided there is just a wonderful baseline for all of our international members as well because a lot of those skills can be applied to. Like tornadoes, hurricanes, or, or all the other kind of more extreme things.

It's the same kind of principle, isn't it, when we're looking at at designing these kind of procedures. So it's actually quite interesting actually, because if you look at places like America is my general example, they're generally quite good at preparing for things like the sort of extreme weather. Because it happens more often, it's more likely.

And because our weather is generally that bit more benign over here, it means we're generally actually not as well prepared for if it does happen. So, it's useful to be able to pick up some tips. And like I said, it, it's, it's unlikely, but the potential consequences could be really, really serious, so.

Yeah, we don't want to sit in complacency, do we? And then it catches us out. So, you know, and, well, I mean, I'm, I'm based in North Wales and we've had all sorts of kind of crazy fires and things in recent years.

So, you know, things, things do change, you know. Yeah, well, I'm right down by the coast, so we have, tidal warnings, . Down here, for if we get exceptionally high tides and the beach comes over the road, and, yeah, so.

Can be quite geographically specific. Absolutely, absolutely, yeah, I, I do think, you know, the, the tips and things that you provided there are wonderful, you know, for, for everybody, whatever the circumstances. So, that's fabulous.

We've just had a quick one question come through. Was there access to a template? Yes, so, if you're a BMG member, the all the templates are on our resource hub.

We do have a template for a, a sort of a business continuity plan. And for a, sort of emergency planning, template, can you attach, Jackie, sort of documents and things to the sort of webinar information? Can we do that?

We can to a certain degree or we can email them out if that's easy, you know, we can always send a, a kind of a follow-up email after to anybody that's attended so they can have access to things that way. We, we can always get things to people, however, however we need to so that they've got the resources they need. I'm quite happy if people want to contact me as well.

That's very kind of you, thank you. I just give you a couple more minutes in case there any other questions to come through, but I think the, the other thing that I latched on to obviously as a, as a vet nurse myself, what you said about, if your, if your equipment dies, the best anaesthetic monitoring is a VM stethoscope. I would 100% back that up.

Absolutely we are wonderful, not that I've been for a long time, but it's great to sing, sing a bit of a song for us, yeah, yeah, it's an interesting debate to have actually a particularly on your clinical. Perhaps, particularly among the nurses, and that how reliant are you on, on the tech. And if your ventilator fails, can you do it manually?

If your oxygen concentrator fails, have you got the backups and, and that kind of thing? So, yeah, it can be quite an interesting, conversation to have. And, and, yeah, working out what plan B might be.

Yeah. Yeah. Well, I mean, that, that's the way we always used to work anyway, wasn't it, before all this technology came along.

So you're bringing back the old, old school. I love it. Wonderful.

Well, I don't think there's nothing else coming through. Everyone's very quiet tonight, but I would, I would take that as a positive, Hannah, that I think you've covered everything so beautifully, but they're all probably going off and writing their procedures now as, as we speak, yeah, I think we can have a little bit of time out, I think, you know, just to absorb it and then maybe do it tomorrow. But I would say to everybody that has joined today, thank you so much for your time.

I do hope you've enjoyed the first session of our new practise management series. If you know anyone who has missed tonight's webinar, but they would enjoy it and benefit from it, it will be available on our website to watch back from tomorrow. So please send them along to check it out.

Hopefully, It has also whetted your appetite for the rest of the programme, so do join us for the next in the series, which will be live on Tuesday, the first of February, when Dr. Karen Felsted will be here to answer the question, how do I set effective fees for veterinary services? Thank you, therefore, to our sponsor of this whole wonderful programme, which is the veterinary Management Group.

Thank you to Dawn, our controller behind the scenes here, making sure everything runs smoothly. And most importantly, of course, huge thank you to Doctor Hannah Perrin for making sure we're all prepared for whatever issues and catastrophes 2022 may throw at us. I hope everybody is feeling very well prepared now, so relax, sleep well, and I look forward to see you again soon on another webinar.