Hospital Incident Command System Part II Hostage Barricade

Hospital Incident Command System Part II Hostage Barricade Tabletop Exercise Application of Incident Action Plan and Forms 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. 2018 Update 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 Tabletop Exercise learning process 3

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

Scenario • A patient’s son has been very upset about his mothers condition. She is in ICU and may die. On each visit, he is increasingly agitated and demands information from the staff. • On today’s visit the son seems calmer. However, upon seeing his mother he becomes agitated, demanding to see the doctor. The nurses are attempting to calm him, but he becomes increasingly agitated. 5

Scenario • He pulls 2 handguns from his jacket and fires twice into the ceiling. A security guard rushes into the unit and the gunman shoots him in the leg. • The gunman demands that staff move equipment and beds to barricade the doors and announces that he will kill anyone who gets in his way and demands to see his mother’s physician • The ICU is full and there are visitors at the bedsides 6

Scenario • An employee escapes from the ICU and notifies security • Power and communications services are functioning normally in the area • Time: 1400 • Weather: Clear, 75º F, no winds 7

First Actions Local law enforcement is immediately notified • Is this an incident? • What are your first actions? • 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 HICS form 202 Incident Objectives ü Weather/environmental implications for period 9

Which Positions to Activate? 10

Incident Action Planning 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 HICS forms (Box 1) 11

Incident Action Planning Step 2: Set the Operational Period • Incident Commander sets the Operational Period ü Based on number of simultaneous activities ü How quickly the situation is changing • An Operational Period breaks the incident down into manageable timeframes • The current Operational Period is documented on all HICS forms 12

Incident Action Planning Step 3: Determine Safety Priorities and Incident Objectives Safety Priorities: • Safety priorities are documented on HICS form 215 A Incident Action Plan (IAP) Safety Analysis by the Safety Officer after completing an operational risk assessment to identify and resolve hazard, safety, and health issues • The 215 A IAP Safety Analysis is updated every Operational Period 13

Incident Action Planning Step 3: Determine Safety Priorities and Incident Objectives: • Control Objectives are the overarching objectives that will last throughout all Operational Periods of the response • Control Objectives are approved by the Incident Commander and documented on the HICS 202 Incident Objectives, and again on the HICS 201 Incident Briefing 14

Incident Objectives Utilize the Incident Response Guide (IRG) Hostage/Barricade: • Ensure the safety of patients, staff, and visitors • Maintain communications with staff, patients, visitors, and the media • Coordinate response, release of information, and ongoing operations with law enforcement • Provide behavioral health support and stress management services to patients, staff, and visitors • Return to normal operations as quickly as possible 15

Scenario Update #1 • It has been 20 minutes since the gunman barricaded the ICU • Law enforcement has arrived at the hospital and is in communication with the ICU • SWAT team is responding 16

Side Note: Safety Officer Tasks • Assess the safety issues • What hazards exist and what precautions need to be taken ü Potential contamination of the facility, activate limited access ü Ensure safety of staff receiving victims, appropriate PPE ü Potential of hospital to be overwhelmed by incoming victims, insure security response • Complete form 215 A – Incident Action Plan Safety Analysis 17

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

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

Side Note: Documenting your Actions • Utilize HICS forms (They are listed on each Job Action Sheet) • Form 214 - Operational Log 20

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

Incident Action Planning Step 5: Determine Strategies and Tactics • Strategies and tactics are HOW your Branch/Section is going to achieve the objectives • What actions do you need to take? • Use your facility response plans and Incident Response Guides • Record strategies and tactics on form 204 – Branch Assignment List 22

Incident Action Planning Step 6: Determine Needed Resources • WHAT RESOURCES do you need? ü Space ü Personnel ü Equipment/Supplies/Pharmaceuticals ü Communication devices • Document resource activities: ü Resources assigned (form 204) ü Resource requests (form 213) ü Actions taken to utilize and obtain resources (form 214) 23

Incident Action Planning Step 7: Issue Assignments • Who will be assigned to the units? • Fill in the assignments on form 204 – Assignment List • Are there other branches that need activated? 24

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 and disseminates it once approved by the Incident Commander 25

IAP Quick Start Form IAP Quick Start • Combined 201 -202 -203 -204 -215 A form ü Can be used for small incidents ü Or for a rapid start to a large incident and then expand out on individual HICS forms ü Great for smaller pre-planned events 26

HICS 200 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 27

Incident Action Planning Step 8: Implement Actions • Put your activities and plans into action • What are some of these activities? 28

Scenario Update #2 It is now 1530 – 1. 5 hrs into the incident • The gunman has released the wounded security guard. He has been received in the Emergency Department. • No other hostages have been released What are your major concerns? 29

Incident Action Planning Step 9: Reassess and Adjust Plans • Towards the end of the Operational Period reevaluate status • Repeat steps 1 -5 • Update the forms (Except 201 Incident Briefing and 202 Incident Objectives) • Evaluate and/or update your Branch/Section Objectives (HICS 204 Assignment List) This creates your Incident Action Plan (game plan) for the next operational period 30

Scenario Update #3 • It is now 4 hours into the incident • The gunman has surrendered to law enforcement • All hostages are released and safe • What issues should be considered? 31

How are we doing? What are things we need to remember to do? • • Share information Demobilization and Recovery After Action Report Improvement Plan 32

Questions? 33

HICS Basics Part 2 Application of Incident Action Plan and Forms Hostage/Barricade 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. 2018 Update 34