Hazardous Area Response Teams (HART)

Hazardous Area Response Teams

Hazardous Area Response Teams – more commonly known as HART – are comprised of specially recruited personnel who are trained and equipped to provide the ambulance response to high-risk and complex emergency situations.

HART teams are based in each of England’s ten NHS Ambulance Trusts, which means they can cover the whole of the country, in some cases working together on specific, large scale or high-profile incidents, either accidental or deliberately caused.

HART teams work alongside the police and fire & rescue services within what is known as the ‘inner cordon’ (or ‘hot zone’) of a major incident. The job of the HART teams is to triage and treat casualties and to help save lives in very difficult circumstances.

They are also there to look after other emergency personnel who may become injured whilst attending these difficult and challenging incidents.

HART teams are tactically capable of responding to the following types of challenging incident:

  • Hazardous Materials – Working inside the inner cordon where hazardous materials are present; dealing with the aftermath of industrial accidents; transporting patients with high risk infectious diseases, for example Ebola; undertaking complex transportation cases (for example, after large scale accidents).
  • CBRN(e) – Chemical, Biological, Radiological, Nuclear and Explosives – Providing the NHS specialist healthcare inner cordon response to CBRN(e) events.
  • MTA – Marauding Terrorist Attack – Providing the NHS specialist healthcare response to acts of terrorism involving explosive devices, firearms, knives and / or weaponised vehicles.
  • SWAH – Safe Working at Height – Providing the specialist healthcare response to patients taken ill at height, either on man-made structures or within the natural environment.
  • Confined Spaces Providing the specialist healthcare response to patients caught in substantially enclosed spaces; following building collapses; where compromised atmospheres are present; where entrapment of patients is hampering the delivery of care.
  • Unstable Terrain Providing the specialist healthcare response to patients caught within active rubble piles or where rural access or difficult terrain is providing a specific challenge to the rescue and extrication effort.
  • Water Operations Providing the specialist healthcare response to patients caught in water environments, for example swift water rescue, or where urban or rural flooding has occurred, and including deployment to boat operations.
  • Providing support to security operations – Providing healthcare support to specific Government security operations, support to police operations such as incidents where illicit drug laboratories are present, and VIP close protection support.

HART Utilisation in 2019 / 2020

As ever, 2019/20 was a busy year for our HART teams, with a 5.4% increase on utilisations taking the yearly total to 13,379 incidents where HART was deployed on the scene.

The below tables break down the types of capabilities that were deployed in the 12 months from 01/04/19 to 31/03/20.

Executive Summary 
Total UtilisationsNumber of incidents where HART was deployed at the scene.13,379
Total Stand DownsTotal HART responses resulting in a ‘stood down’ en-route.8,910
Total ReactivationsHART assets were initially stood down but then had to be reactivated or remobilised due to being required at the scene.85
Total Responses All mobilisations of HART within the reporting period 22,289

Capability Utilisation Summary (Actual Deployments of the Capability at the Incident)
Hazardous MaterialsIncludes hot and warm zone deployments at incidents involving hazardous materials and CBRN deployments. Also includes high consequence infectious disease (HCID) transfers.2,336
Safe Working at HeightIncludes working at height deployments on man-made structures and natural features.1,054
Confined SpaceIncludes high, medium and low risk deployments into confined spaces.204
Unstable TerrainIncludes deployments onto active rubble piles, access using specialist all terrain vehicles and trench operations.410
Water OperationsIncludes deployments for inland water rescue, flooding operations and deployments within the UK costal margins.746
Support to Security OperationsIncludes deployments with police firearms teams, support to public order
operations and support to other specialist security operations (i.e. VIP close
protection or supporting high risk pre-planned operations).
Operational SupportIncludes providing clinical support to operational Ambulance Crews, providing lifting or extraction support and standing by to cover certain highrisk events.7,975
TOTAL 13,379
Total for previous reporting period 12,689
Percentage increase 5.4%

Specialist training

HART personnel must undergo rigorous specialist training at the National Ambulance Resilience Unit Training & Education Centre before they can be deployed. This involves:

  • Training in the use of Personal Protective Equipment (PPE) such as PRPS, CR1 suits, Breathing Apparatus and Gas Tight Suits.
  • A three-week residential IRU training module which covers everything from clinical training, CBRNe and equipment & vehicles, through to team building, welfare and command & control.
  • A three-week residential USAR training module which covers issues such as safe working at height; specialist clinical training such as crush and blast injuries, suspension trauma, triage and confined space medicine; equipment and vehicles; a thorough range of practical exercises and; welfare and health & safety issues.
  • A three-day Inland Water Operations course featuring flood theory, water incident organisation and multi-agency working’ self-rescue techniques and bank-based rescues, river crossing and wading techniques, working in boats and specific clinical issues related to water.

HART training is ongoing and features regular fitness assessments, ongoing PPE training and refresher training, reflective practice and Continuing Professional Development (CPD).