Application of Incident Action Plan and Forms – Loss of Water Hospital Incident Command System Application of Incident Action Plan and Forms – Loss of Water 2014 Revision 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.

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

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

Incident Action Planning Assess the Situation Set the Operational Period Determine Safety Priorities & Establish Incident Objectives Determine Branch/Section Objectives Determine Strategies & Tactics Determine Needed Resources Issue Assignments Implement Actions Reassess & Adjust Plans We will be using the Incident Action Planning Process to walk through our scenario Usually multiple things are being done at once but we are going to be linear and go through one thing at a time Reference the CHA IAP Checklist

Scenario Without warning, the main water supply line to the hospital breaks, disrupting water service to the entire facility The hospital’s water systems, including potable water supply are non-functional Local water sources and vendors are not impacted Large volume of water is flowing out from beneath pavement on main roadway in front of hospital causing access challenges (no hospital flooding)

Scenario Services, including food and radiology are disrupted Toilets and hand washing areas are not functioning and alternate methods must be provided Time: 2300 Weather: Clear, 68º F, no winds

First Actions Water has been disrupted for 15 minutes Time until repaired: Unknown Is this an incident? What are your first actions? Who is in charge? Start with 201 Is this an incident? Yes First Actions – Person in charge takes command Activates Response plans, HICS Contact Administration on-call Notify local EMS of status Determine if any life sustaining/critical functions are disrupted Begin facility status assessment

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 Refer to forms in handouts Have the Incident Commander give you the summary to put on the 201 Put the weather on the 202

Which Positions to Activate? Based on this situation, what needs to be activated? Use the Loss of Water Incident Response Guide Command Staff Section Chiefs (consider finance) Infrastructure Branch Director Medical Care Branch Director Support Branch Director How long did that take us to figure out? (go to next slide)

Immediate Time Period Position Immediate Intermediate Extended Recovery Incident Commander X Public Information Officer Liaison Officer Safety Officer   Operations Section Chief Medical Care Branch Director Infrastructure Branch Director Security Branch Director Business Continuity Branch Director Patient Family Assistance Branch Dir. Planning Section Chief Resources Unit Leader Situation Unit Leader Documentation Unit Leader Demobilization Unit Leader Logistics Section Chief Service Branch Director Support Branch Director Finance /Administration Section Chief Time Unit Leader Procurement Unit Leader Compensation/Claims Unit Leader Cost Unit Leader Look at the IRG for Utility Failure (towards the back of the handout) This is a great cheat sheet, use the IRG to figure out what positions to activate

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 Have the incident commander name the incident

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 Incident Commander should state the Operational Period In a situation that is not stable, still changing – it should be 2 hours. Usually the 1st Op Period is 2 hours.

Step 3: Determine Safety Priorities & Incident Objectives Incident Action Planning Step 3: Determine Safety Priorities & Incident Objectives Identify Command & Control Objectives (these are the overarching objectives that will last throughout the whole response) HICS form 202: Incident Objectives Incident objectives – Restore water supply Identify and obtain alternate sources of potable water Maintain patient care management Communicate situation status and updates to staff, patients, visitors and facility After they come up with some ideas then you can show them objectives on the IRG – next slide

Control Objectives Utilize the Incident Response Guide Utility Loss: Identify extent of outage and consider evacuation Maintain patient care capabilities Minimize impact on hospital operations and clinical services Communicate the situation status to patients, staff, and the public Fill in what they decide on the 202

Scenario Update #1 It has been 30 minutes since the water main break The hospital is only accessible to emergency vehicles

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 in non-impacted areas Ensure hydration/sanitation is addressed Complete form 215A – Incident Action Plan Safety Analysis Safety Officer to work on the 215A

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

Side Note: Liaison Officer Who or what entity operates as the county contact/MHOAC, and how do you contact? Who should be notified of the situation? Who should be notified of hospital status? Bed status? How? Who is the source of resources in your local plan? (e.g., local EMS Department Operations Center, PHD Department Operations Center, County/City Emergency Operations Center) Needs should be determined prior to the incident If there are immediate needs for patient evacuation, what resources or assistance is needed?

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

Step 4: Determine Branch/Section Objectives Incident Action Planning Step 4: Determine Branch/Section Objectives Document on HICS 204 – Assignment List They are based on the Incident 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) 5 – 10 min for students (Section Chiefs) to develop 3-4 objectives. PIO does PIO report. Liaison officer making calls. SO – form 215A People get confused about Sections/Branches use. A separate 204 for each Branch, if more than one branch is activated. Have them work on this in their sections. Actually write on a 204

Branch/Section Objectives A common problem during exercises is that Sections/Branches don’t develop their objectives promptly Report top 3 objectives Have the groups share their top 3 objectives (See IRG)

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? Use your facility response plans and Incident Response Guides Record strategies & tactics on form 204 – Branch Assignment List Assure any loss of water related policies, plans, procedures are available from the EOP in the Hospital Command Center

Incident Action Planning Step 6: Determine Needed Resources What equipment and/or supplies do you need? What personnel resources do you need? Do you need transport resources ? Document resource activities: Resources assigned (form 204) Resource requests (form 213) Actions taken to utilize and obtain resources (form 214) Water for hydration & sanitation Portable toilets, portable hand washing stations Emergency water for critical needs Means to transport water Portable suction Needs for HVAC, fans

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? Have them work in groups on their strategies, tactics and assignments for their branches

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 As we did this process, completed the forms – THIS made up our IAP Put a cover on it with the date, time of the Operational Period – process it, share with others

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

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

Incident Action Planning Step 8: Implement Actions Put your activities / plans into action What are some of these activities? Remind students about monitoring and evaluating activities being implemented

Scenario Update #2 It is now 0030 – 1.5 hrs into the incident Utility workers expect to repair the damage and restore water service to the hospital within 10 – 12 hours What are your major concerns? Major Concerns: Continued Medical Care Sanitation issues Media management Disruption of services Maintaining utilities/systems dependant on water

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 Update the forms Evaluate and/or update your Branch/Section Objectives This creates your Incident Action Plan (game plan) for the next operational period

Scenario Update #3 It is now 4 hours into the incident Utility repair personnel have encountered complications and report water may not be restored for 3 days What issues should be considered? Need for evacuation/partial evacuation/transfer of patients in need of services dependant on water Communication with local DOC/EOC to determine what resources can be provided to the hospital and if services can be continued Staff Communication Public Information Consider activation of Business Continuity Branch

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

Questions? Clean-up, part of any event is recovery-put the vests back as they belong Post test Evaluation

Incident Action Plan and Forms Loss of Water HICS Basics Part 2 Application of Incident Action Plan and Forms Loss of Water 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.