Hospital Incident Command System Application of Incident Action

Hospital Incident Command System Application of Incident Action Plan and Forms – Earthquake This material has been developed for training purposes; do not share, distribute, transmit or reproduce without prior written consent of California Hospital Association This course was developed by the CHA Hospital Preparedness Program with grant funds provided by the U. S. Department of Health & Human Services Assistant Secretary for Preparedness & Response Hospital Preparedness Program and awarded by the California Department of Public Health. No part of this course or its materials shall be copied or utilized for monetary gain. 1

Objectives • Demonstrate the Incident Action Planning Process • • Demonstrate the use of HICS Forms Implement the use of the Incident Response Guides 2

Scenario Based Implementation • Discuss and rehearse practical implementation of the Incident Action Planning process utilizing HICS forms and the Incident Response Guides • Utilize a “Table Top” learning process 3

Incident Action Planning 1. Assess the Situation 2. Set the Operational Period 3. Determine Safety Priorities & Establish Incident Objectives 4. Determine Branch/Section Objectives 5. Determine Strategies & Tactics 6. Determine Needed Resources 7. Issue Assignments 8. Implement Actions 9. Reassess & Adjust Plans 4

Scenario • A 7. 8 -magnitude earthquake occurs along a fault zone 50 miles from your hospital. Ground shaking occurs impacting a 6 county region. Moderate to major damage is reported for 200 square miles. Multiple severe aftershocks are expected for days and weeks after the initial earthquake. • Hundreds of thousands of people sustain mild to severe injuries. Hospitals sustain moderate to severe damage to their infrastructure. EMS is overwhelmed with request for assistance. Transport to hospitals is difficult due to debris in roadways. 5

Scenario • Your hospital has sustained moderate to severe damage. • The Emergency Department and outpatient surgery are non-functional due to damage and must be relocated. • Main water and power services are disrupted, however emergency power (generators) is functioning. Telephone and internet service is down. 6

Scenario • • • Time: 0830 Weather: Clear, 68º F, no winds Within 15 minutes large numbers of injured are presenting to the hospital for care. Many who are not injured seek shelter and reassurance from medical providers. 7

First Actions • Time until restoration of main power, water, phone, internet: Unknown ü Is this an incident? ü What are your first actions? ü Who is in charge? 8

Incident Action Planning Step 1: Assess the Situation • • Use HICS form 214: Operational Log Complete HICS form 201: Incident Briefing ü Event History and Current Actions Summary • Begin form 202: Incident Objectives ü Weather/environmental implications for period 9

Which Positions to Activate? 10

Immediate Time Period Position Immediate Extende d X X X Recovery X X Intermediat e X X Incident Commander Public Information Officer Liaison Officer Safety Officer Medical-Technical Specialist: Seismic or Structural Engineer Operations Section Chief Medical Care Branch Director Infrastructure Branch Director Security Branch Director Business Continuity Branch Director Patient Family Assistance Branch Dir. X X X X X Planning Section Chief Resources Unit Leader Situation Unit Leader Documentation Unit Leader Demobilization Unit Leader X X X X Logistics Section Chief Service Branch Director Support Branch Director X X X Finance /Administration Section Chief Time Unit Leader Procurement Unit Leader Compensation/Claims Unit Leader Cost Unit Leader X X X X X X 11

Naming the Incident • The Incident Commander names the incident • If the incident is a community-based incident, the appropriate jurisdiction will name the incident (e. g. , county, city, EMS) • The incident name should be documented on all forms 12

Incident Action Planning Step 2: Set the Operational Period • HICS form 202: Incident Objectives ü Operational Period Date/Time • Incident Commander sets the Operational Period o Based on number of simultaneous activities o How quickly the situation is changing • An Operational Period breaks the incident down into manageable timeframes 13

Incident Action Planning Step 3: Determine Safety Priorities & Incident Objectives • Identify Incident Objectives (these are the overarching objectives that will last throughout the whole response) • HICS form 202: Incident Objectives 14

Control Objectives Utilize the Incident Response Guide Earthquake: Provide for patient care and management Provide for the safety of patients, staff, families, and visitors Provide for continuing operational status of the hospital or safe evacuation from the hospital 15

Scenario Update #1 • • • It has been 30 minutes since the incident. • Other areas of the hospital are under assessment, however structural damage is not expected to result in total evacuation There have been multiple aftershocks The emergency department and outpatient surgery have been determined to be unsafe and must be evacuated 16

Side Note: Safety Officer Tasks • • Assess the Safety issues What hazards exist and what precautions need to be taken ü Ensure safe entry/exit of essential personnel to and from hospital ü Ensure safety of patients, visitors, staff ü Ensure all essential life support is on emergency power • Complete form 215 A – Incident Action Plan Safety Analysis 17

Side Note: Public Information Officer Tasks • • Prepare a statement for the media • The statements need approval from the Incident Commander • Coordinate consistent messaging with the Joint Information Center (JIC) or with law enforcement PIO Prepare a statement for the staff, patients and visitors (e. g. , situation, status, safety precautions, next update time) 18

Side Note: Liaison Officer • Who or what entity operates as the county contact/MHOAC, and how do you make contact? • • Who else should be notified of the situation? • Who is the source of government resources in your local plan? (e. g. , local EMS Department Operations Center (DOC), PHD DOC, County/City Emergency Operations Center) • Key contacts should be determined prior to the incident Who should be notified of hospital status? Bed status? How? 19

Side Note: Documenting your Actions • • Utilize HICS forms Form 214 - Operational Log 20

Incident Action Planning Step 4: Determine Branch/Section Objectives • • • Document on HICS 204 – Assignment List • Objectives need to be SMART (Simple, Measurable, Achievable, Realistic, Time Sensitive & Task Oriented) They are based on the Incident Objectives These are based on what is desired to be achieved by the Section in that operational period 21

Operational Period Objectives • A common problem during exercises is that Sections/Branches don’t develop their objectives promptly • Report top 3 objectives 22

Incident Action Planning Step 5: Determine Strategies & Tactics • Strategies & tactics are how your Branch/Section is going to achieve the objectives • • What actions do you need to take? • Record strategies & tactics on form 204 – Branch Assignment List Use your facility response plans and Incident Response Guides 23

Incident Action Planning • • • Step 6: Determine Needed Resources Where can patients be moved to? What personnel resources do you need? What equipment and/or supplies do you need? What resources do you need in the patient collection/holding area? What communication devices do you need? Document resource activities: ü ü ü Resources assigned (form 204) Resource requests (form 213) Actions taken to utilize and obtain resources (form 214) 24

Incident Action Planning Step 7: Issue Assignments • • Who will be assigned to the units? • Are there other branches that need activated? Fill in the assignments on form 204 – Assignment List 25

Incident Action Planning • For the first Operational Period the Incident Action Plan should be done within 30 -45 minutes • What makes up the Incident Action Plan? ü ü ü • Form 201 - Incident Briefing Form 202 - Incident Objectives Form 203 - Incident Assignments Form 204 - Branch Assignments Form 215 A - Incident Action Plan Safety Analysis The Planning Section compiles the forms to create the Incident Action Plans 26

IAP Quick Start • New form • Can be used for small incidents • Or for a rapid start to a large incident and then expand out on individual HICS forms • Great for smaller pre-planned events 27

IAP Cover Sheet • Can be used for the IAP Quick Start or full Incident Action Plan forms • Can make different colors if you want to differentiate Operational Periods 28

Incident Action Planning Step 8: Implement Actions • • Put your activities / plans into action What are some of these activities? 29

Scenario Update #2 • • It is now 1000 – 1. 5 hrs into the incident • • Main power restoration expected in 24 hours Utility workers expect restore water service to the hospital within 10 – 12 hours What are your major concerns? 30

Incident Action Planning Step 9: Reassess & Adjust Plans • Towards the end of the operational period, you will need to evaluate status • • • Repeat steps 1 -8 • This creates your Incident Action Plan (game plan) for the next operational period Update the forms Evaluate and/or update your Branch/Section Objectives 31

Scenario Update #3 • • It is now 4 hours into the incident • What issues should be considered? Utility repair personnel have encountered complications and report main power may not be restored for 3 days, potentially outlasting your generator fuel stores 32

How are we doing? What are things we need to remember to do? ü ü Share information Recovery / Restoration After Action Report Corrective Actions Plan 33

Questions? 34

HICS Basics Part 2 Application of Incident Action Plan and Forms Earthquake developed by the California Hospital Association’s Hospital Preparedness Program www. calhospitalprepare. org This material has been developed for training purposes; do not share, distribute, transmit or reproduce without prior written consent of California Hospital Association This course was developed by the CHA Hospital Preparedness Program with grant funds provided by the U. S. Department of Health & Human Services Assistant Secretary for Preparedness & Response Hospital Preparedness Program and awarded by the California Department of Public Health. No part of this course or its materials shall be copied or utilized for monetary gain. 35