HOSPITAL INCIDENT COMMAND SYSTEM

1. HOSPITAL INCIDENT COMMAND SYSTEM Incident Action Planning 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.

2. OBJECTIVES Understand the 9 steps of the Incident Action Planning process Identify Incident Action Plan components Exercise the development of an Incident Action Plan

3. INCIDENT MANAGEMENT: TEAM REVIEW Incident Commander Public Information Officer Safety Officer Medical/ Technical Specialist(s) Liaison Officer Finance / Administration Section Chief Operations Section Chief Planning Section Chief Logistics Section Chief

4. HOSPITAL INCIDENT ACTION PLANNING Key to Effective Response and Recovery

5. Assess the Situation Set the Operational Period Determine Safety Priorities & Establish Control Objectives Determine Operational Period Objectives Determine Strategies & Tactics Determine Needed Resources Issue Assignments Implement Actions Reassess & Adjust Plans INCIDENT ACTION PLANNING

6. 1) ASSESS THE SITUATION • Type of incident, location, magnitude, and possible duration • Ongoing hazards and safety concerns • Determines initial priorities based on: 1) Life saving 2) Incident stabilization 3) Property preservation • Establishes the Hospital Command Center The Incident Commander conducts the initial incident assessment from the information gathered:

7. An Operational Period is: The period of time scheduled for execution of a given set of tactical actions in the Incident Action Plan Set by the Incident Commander The Operational Period is usually set in hours: Does not have to conform to shift times Can be long or short, depending on the intensity of the incident or amount of information available 2) SET THE OPERATIONAL PERIOD

8. General Command and Control Objectives are: Broad organizational objectives that are foundational and do not change during response and recovery. These objectives define where the system wants to be at the end of the response Not limited to an Operational Period Examples: Provide adequate care to all patients who present as a result of the incident Provide for the safety of staff, patients and visitors 3) DETERMINE SAFETY PRIORITIES & ESTABLISH CONTROL OBJECTIVES

9. Operational Period Objectives are: More specific objectives to achieve Command and Control Objectives Steps during the defined Operational Period Should be tangible and measurable Example: Provide prophylaxis to 75% of hospital staff in this operational period Decontaminate 25 victims in 2 hours 4) DETERMINE OPERATIONAL PERIOD OBJECTIVES

10. 5) DETERMINE STRATEGIES AND TACTICS Strategy Defined: • The general direction selected to accomplish incident objectives (NIMS) • The approach to achieving the objectives Tactics Defined: • Specific actions, sequence of actions, procedures, tasks, assignments to meet strategies and objectives • The “boots on the ground” or “doers”

11. 6) DETERMINE NEEDED RESOURCES • Tactical resources may include: • Personnel • Equipment • Supplies • Pharmaceuticals • Vehicles • Available and needed resources to meet the tactical objectives must be identified

12. 7) ISSUE ASSIGNMENTS • Additional HICS positions are activated according to incident needs • Staff are assigned to conduct incident specific operations: • Evacuation • Decontamination • Triage and treatment • Safety measures Once the tactical objectives and necessary resources are identified, assignments are issued:

13. THE INCIDENT ACTION PLANNING MEETING The Incident Action Planning Meeting is: • Led by the Planning Chief • Defines and finalizes operational period objectives, strategies, tactics, and resources as determined by each section for the next operational period • The Section Chiefs submit completed HICS Form 204 Branch Assignment List and the Safety Officer submits completed HICS Form 261 IAP Safety Analysis

14. 8) IMPLEMENT ACTIONS Direct, monitor and evaluate response efforts: • Constant monitoring of strategies and tactics for effectiveness • Assess the Operational Period Objectives • Are the objectives being achieved? • Is the strategy/tactics safe? • Is the strategy/tactics effective? • Evaluation is an ongoing process throughout response and recovery

15. 9) REASSESS & ADJUST PLANS Conduct a Current Situation Assessment: • Update situation/incident information • Assess the impact on the hospital • Length and duration of continued/resolving incident • Resource availability • Assess the Operational Period Objectives • Make sure they are achieved in a safe and timely manner • Revise objectives, strategies, tactics and resource needs for the upcoming operational period

16. INCIDENT ACTION PLAN RESPONSIBILITIES The Incident Commander: Provides general Command and Control Objectives (HICS 202 Incident Objectives) Sets the Operational Period Develops major strategies (priorities) Activates Incident Management Team positions Establishes policy for resource orders Approves initial actions and the completed Incident Action Plan

17. The Safety Officer: Advises the Incident Commander and Section Chiefs on safety issues and measures Develops the Safety Plan (HICS 261 Incident Action Safety Plan Analysis) Oversees the safety of operations and tactics INCIDENT ACTION PLAN RESPONSIBILITIES

18. The Planning Section Chief: Prepares for the Planning Meetings Gathers information for the Incident Action Plan (HICS 201, 202, 203, 204’s and 261) Develops demobilization and contingency plans Conducts the Planning Meeting Coordinates and submits the Incident Action Plan to the Incident Commander for approval Disseminates the Incident Action Plan to all Hospital Command Center personnel INCIDENT ACTION PLAN RESPONSIBILITIES

19. The Operations Section Chief: Determines/assesses areas of operation Advises Incident Commander of activated Operations positions and work assignments Determines tactics (HICS 204 Branch Assignment List) Determines resource requirements (HICS 204 Branch Assignment List) and communicates needs with Logistics INCIDENT ACTION PLAN RESPONSIBILITIES

20. The Logistics Section Chief: Ensures resource ordering meets the needs Advises Incident Commander on activated Logistics positions Ensures resources to support the Incident Action Plan Develops plans that support the Incident Action Plan Communications Plans Transportation Plans INCIDENT ACTION PLAN RESPONSIBILITIES

21. The Finance/Administration Section Chief: Provides cost implications of the Command and Control, and Operational Period Objectives Ensures the Incident Action Plan is within cost limitations Advises the Incident Commander on Finance/Admin activated positions INCIDENT ACTION PLAN RESPONSIBILITIES

22. The Incident Action Plan: Provides Incident Management Team personnel with direction for the Operational Period Incident Action Planning is a process of Management by Objectives General Command and Control Objectives vs. Operational Period Objectives Essential for effective response and recovery INCIDENT ACTION PLAN SECTION REVIEW

23. QUESTIONS?

24. Provides Incident Specific: Suggestions for Command and Control Objectives Can assist in determining Operational Period Objectives for each section Management tasks by function according to timeframes Sample Incident Management Teams Can be used as documentation INCIDENT RESPONSE GUIDES

25. SCENARIOS: EXTERNAL Nuclear Detonation, Radiological Attack Bio Attack (Anthrax, Food Contamination, Plague) Pandemic Chemical Attack (Blister, Toxic, Nerve Agent, Chlorine) Natural Disaster (Earthquake and Hurricane) Explosives Cyber Attack Hazard Vulnerability Analysis There are 14 National Planning Scenarios to assist in planning and training:

26. Bomb Threat Evacuation Fire HazMat Spill Hospital Overload Infant/Child Abduction Internal Flooding SCENARIOS: INTERNAL Hazard Vulnerability Analysis There are 13 Internal Scenarios to assist in planning and training: • Loss of HVAC • Loss of Power • Loss of Water • Severe Weather • Hostage/Barricade • Work Stoppage

27. HICS FORMS USED IN THE INCIDENT ACTION PLAN

28. HICS FORMS

29. HICS FORMS

30. Where do I find HICS information? www.emsa.ca.gov/hics/hics.asp http://ems.dhs.lacounty.gov/Disaster/HICS/HICsIndex.htm www.hicscenter.org www.calhospitalprepare.org HICS Resources

31. Purpose:Document Incident issues encountered Decisions made Notifications conveyed Origination: Command and General Staff When to complete: Continuously, from activation through demobilization HICS FORM 214:Operational Log

33. Application of Incident Action Plan – Earthquake Hospital Incident Command System 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.

34. Incident Action Planning Assess the Situation Set the Operational Period Determine Safety Priorities & Establish Control Objectives Determine Operational Period Objectives Determine Strategies & Tactics Determine Needed Resources Issue Assignments Implement Actions Reassess & Adjust Plans

35. 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 requests for assistance. Transport to hospitals is difficult due to debris in roadways.

36. 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.

37. 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.

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

39. 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 form 202: Incident Objectives • Weather/environmental implications for period

40. Which Positions to Activate?

41. Immediate Time Period

42. 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

43. Incident Action Planning Step 2: Set the Operational Period • HICS form 202: Incident Objectives • Operational Period Date/Time • 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

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

45. Control Objectives • Utilize the Incident Response Guide • Earthquake: • Damage Assessment • Patients, visitors, staff assessed for injuries and accounted for • Patient tracking • Hospital facility self-sustainment capability

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

47. Side Note: Safety Officer Tasks • Assess the Safety issues • What hazards exist and what precautions need to be taken • Ensure safe entry/exit of essential personnel to and from hospital • Ensure safety of patients, visitors, staff • Ensure all essential life support is on emergency power • Complete form 261 – Incident Action Plan Safety Analysis

48. 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) or with law enforcement PIO

49. 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 should be notified of hospital status? Bed status? How? • 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

50. Incident Action Planning Step 4: Determine Operational Period Objectives • Document on HICS 204 – Branch Assignment List • They are based on the Control Objectives • These 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)