Chemical Attack Tabletop Exercise Application of Incident Action Plan and Forms

1. Chemical Attack Tabletop Exercise Application of Incident Action Plan and Forms Hospital Incident Command System Part II 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

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

3. 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

4. Incident Action Planning Assess the Situation Set the Operational Period Determine Safety Priorities and Incident Objectives Determine Branch/Section Objectives Determine Strategies and Tactics Determine Needed Resources Issue Assignments Implement Actions Reassess and Adjust Plans

5. Scenario • The Universal Adversary terrorist group releases Sarin into the ventilation systems of three office buildings. Within minutes, people develop runny nose, watery eyes, coughing, chest tightness, blurred vision, drooling and sweating. • Some develop severe muscle twitching, confusion, nausea and vomiting. Many have died. • There are numerous fall/crush injuries. EMS has initiated triage and performing decontamination outside of the buildings.

6. Scenario • Hazmat confirms Sarin is the causative agent and EMS requests large quantities of nerve agent antidotes for the scene. • Your hospital is closest and many victims self-evacuate and drive to your hospital • EMS begins transporting the most critical victims to your facility with a short ETA. It is unknown if the victims have been fully decontaminated.

7. Scenario • Time: 0830 • Weather: Clear, 68º F, no winds

8. First Actions • Within 15 minutes large numbers of contaminated and worried well are presenting to the hospital for care • Number of victims expected to arrive: Unknown • Is this an incident? • What are your first actions? • Who is in charge?

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

10. Which Positions to Activate?

11. 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)

12. Incident Action Planning Step 2: Set the Operational Period • Incident Commander sets the Operational Period • Based on number of simultaneous activities • 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 (Box 2)

13. Incident Action Planning Step 3: Determine Safety Priorities and Incident Objectives Safety Priorities: • Safety priorities are documented on HICS form 215A 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 215A IAP Safety Analysis is updated every Operational Period

14. Incident Action Planning Step 3: Determine Safety Priorities and Incident Objectives 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 202Incident Objectives, and again on the HICS 201 Incident Briefing

15. Incident Objectives • Utilize the Incident Response Guide • Chemical Incident Objectives: • Provide safe and effective decontamination of incoming contaminated patients • Protect patients, staff, and the hospital from contamination and safely restore normal operations • Communicate effectively with the local Emergency Operations Center and emergency response partners

16. Scenario Update #1 • It has been 30 minutes since the event: • Approximately 40 ambulatory self-transported victims have arrived at the hospital claiming to be in the vicinity of the release • Hospital decontamination set up is complete and victim decontamination has started • EMS reports they have approximately 50 victims in moderate to severe distress and field decontamination is in process • There are additional unknown numbers of minor exposed or contaminated victims

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

18. 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)

19. Side Note: Liaison Officer • Who or what entity operates as the county contact/MHOAC, and how do you make contact? (How do they contact your hospital?) • 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 and updated at least annually

20. Side Note: Documenting your Actions • Utilize HICS forms (Each position has them listed on the Job Action Sheet) • Form 214 - Operational Log

21. 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)

22. 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

23. Incident Action Planning Step 6: Determine Needed Resources • WHAT RESOURCES do you need? • Space • Personnel • Equipment/Supplies/Pharmaceuticals • Communication devices • Document resource activities: • 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? • Fill in the assignments on form 204 – Assignment List • Are there other branches that need activated?

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? • Form 201 - Incident Briefing • Form 202 - Incident Objectives • Form 203 - Incident Assignments • Form 204 - Branch Assignments • Form 215A - 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

26. IAP Quick Start Form IAP Quick Start • Combined 201-202-203-204-215A 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. HICS 200 IAP Cover Sheet 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

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

29. Scenario Update #2 • It is now 1000 – 1.5 hours into the incident • The hospital has received 60 additional ambulatory self-transported victims, 4 in severe distress and 10 in moderate distress • Decontamination of victims continues • EMS has transported 2 critical victims to your hospital • What are your major concerns?

30. 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

31. Scenario Update #3 It is now 4 hours into the incident • All victims have been transported • Hospital decontamination is completed and there is a large volume of victim belongings and grey water collection • Universal Adversary has claimed responsibility and states a secondary device is in place What issues should be considered?

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

33. Questions?

34. developed by the California Hospital Association’s Hospital Preparedness Program www.calhospitalprepare.org Application of Incident Action Plan and Forms: Chemical Attack 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