What happens when a critical incident is declared?
BBCAn NHS trust that oversees two major hospitals in Nottingham has declared a "critical incident" after experiencing a surge in demand for emergency care.
Nottingham University Hospitals (NUH) NHS Trust, which runs the Queen's Medical Centre and Nottingham City Hospital, confirmed critical incident status on Monday - citing the recent extreme heat as a factor in the increased pressure on services.
A similar declaration was made by East Midlands Ambulance Service following the recent hot weather and ran until Monday. So what has caused health bosses to declare these critical incidents, and what do they mean, in practice, for patients?
What is a critical incident and what has caused it?
In basic terms, a critical incident means an NHS trust or health body is struggling to meet the demands being placed on its services.
There is no set criteria for what constitutes a critical incident, according to BBC East Midlands health correspondent Rob Sissons.
He said: "It's very much down to local NHS managers.
"Typically, critical incidents are to do with system pressures, about the flow of patients through the entire NHS and social care system, and they are basically a smoke alarm.
"We're not seeing them just in winter now. People on the front line, anecdotally, say that they're experiencing surging demands all-year round."
The current pressures in Nottingham are, in part, being blamed on the recent hot weather, with NUH saying it has seen an increase in people with dehydration and other conditions related to the recent record-breaking high temperatures.
The trust added more patients than expected were staying in hospital after they were ready to be discharged.
Andrew Hall, chief operating officer at NUH, said: "Despite our teams working tirelessly throughout the extreme heat and often in difficult environments over the last week, the demand on our hospitals currently far exceeds our capacity.
"Declaring a critical incident is not a decision we have taken lightly, but it is necessary to protect patient safety."
What do critical incidents mean for patients and how can people help?
Critical incidents are declared as an attempt to get patients to think carefully about what part of the NHS they seek treatment from.
People are asked only to call 999 or attend accident and emergency (A&E) departments for serious and life-threatening emergencies.
Patients are urged to consider phoning 111 for less pressing complaints as well as using urgent treatment centres for non-emergencies, such as sprains, cuts and bites.
Other advice commonly issued is to use pharmacies for minor ailments and to avoid visiting people in hospital if you are sick.
As part of NUH's critical incident, the trust has said the emergency department will see the sickest patients first and anyone attending with conditions not deemed an emergency "will have an extremely long wait and may be redirected to use other services instead,".
NUH said while it only had an A&E department at the QMC, the critical incident was impacting all of its sites.
The trust added it would take several actions as a result of the critical incident:
- Rearranging some elective procedures to create capacity for the sickest patients. Anyone affected will be contacted, NUH said
- Opening all available beds and spaces
- Redeploying staff to help alleviate pressures
- Stopping non-essential meetings and activity
People with planned appointments should still attend unless told otherwise - but some elective procedures were being rearranged to make room for the sickest patients.
The trust also needs families and community partners to help more patients to return home when they are able to.
Hall said: "When we're discharging patients, we ask that their friends or loved ones pick them up from hospital as soon as possible and have everything they need at home."
And anyone with the flu or symptoms of other respiratory illnesses is asked to not visit friends and relatives until better.
How long do critical incidents last, and should we expect more?
It depends on the individual situation.
They were more common during winter, when services are traditionally more pressurised, but have now started to occur during spells of extreme hot weather.
But there are different trigger points - one previous critical incident in Nottingham was in part caused by problems with a new digital patient system.
Additionally, it is not possible to predict exactly when pressures will ease.
Critical incidents at the trust earlier this year took two days to be stood down in January, and four in February, while the recent EMAS incident ran over three days.
BBC correspondent Sissons added: "Hospitals, a bit like budget hotels, often run at very high occupancy levels and there are very few beds free most of the time.
"And so it doesn't take much to tip the bed capacity over the edge, where you're struggling to find space for patients.
"Nottingham's home to one of England's busiest A&Es, so they've got big pressures. Longer-term, they want a new A&E facility in Nottingham, although there are changes to the same day emergency care service, which will help."
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