Hospital Incident Command System Incident Action Planning Incident Action Planning is the process by which HICS is made operational. It provides a plan for command, control and coordination of the emergency response. It documents objectives, strategies and tactics for the event. Instructor Notes: Start with Introductions – Instructor, class members One of the Statewide Medical and Health Exercise objectives is to develop an Incident Action Plan Goal – Develop an Incident Action Plan for the first operational period Discuss how process of Incident Action Planning assist in moving Hospital Incident Management Team to action without having to over focus on job action sheets. Updated with May 2014 HICS Revisions 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 Understand the 9 steps of the Incident Action Planning process Identify Incident Action Plan components Exercise the development of an Incident Action Plan

Hospital Incident Management Team Review Operations Section Chief Planning Section Chief Logistics Section Chief Finance / Administration Section Chief Incident Commander Public Information Officer Liaison Medical/ Technical Specialist(s) Safety Instructor Notes: Provide brief overview of Command and General Staff In normal day to day operations we have redundant activities through each department--such as staffing, obtaining resources, budget/financials, etc… HOWEVER, during an incident we don’t want that redundancy, so we manage through the functions of each section. For example, Logistics handles the obtaining of resources for the entire incident, Finance handles the budget issues for the entire incident. Command and general staff must continually interact and share vital information and estimates of current and future situation

Hospital Incident Action Planning Key to Effective Response and Recovery Incident action planning is a core concept for a successful response and recovery from any incident. Developing and utilizing an Incident Action Plan (IAP) provides the goals, strategies, and tactics to facilitate the Management by Objectives (MBO) and ensures understanding of the strategic direction. The planning process is effective for both smaller, short-term incidents and more complicated long-term incidents and the IAP is scalable (e.g., HICS IAP Quick Start versus a fully documented IAP). Incident action planning provides the following benefits:   Provides the organization’s strategic direction   Maximizes available resources   Reduces omissions and duplication of efforts   Reduces cost   Gathers and disseminates information   Improves and enhances communication   Provides a historical record of the incident Instructor Note: Incident Action Planning is the key to having an organized, logical, planned out response The forms used to make up Incident Action Planning vary by incident, but a minimum include: 201, 202, 203, 204 & 215A. The IAP QuickStart may also be used at the beginning of an event or for smaller incidents HICS forms augment the Incident Action Planning process

Incident Action Planning Assess the Situation Set the Operational Period Determine Safety Priorities and Establish Incident Objectives Determine Branch/Section Objectives Determine Strategies and Tactics Determine Needed Resources Issue Assignments Implement Actions Reassess & Adjust Plans Instructor Note: Action planning is what we do on a daily basis: Home – plan your day out, critical items you need to do, take the kids to soccer, MD appointment. Who is going to do what. Evaluate at the end of the day – did you get everything done. Work – review all your emails, what do you need to get done now, today. How are you going to get it done, delegate some of it. Evaluate at the end of the day – did you get everything done, what do you have to do first thing tomorrow. We sill cover this process in the following slides.

#1 Assess the Situation The Incident Commander conducts the initial incident assessment: Type, location, magnitude, possible duration On-going hazards and safety concerns Determine initial priorities based on: 1 - Life saving 2 - Incident stabilization 3 - Property preservation Establishes the Hospital Command Center Sets the initial “Operational Period”

#2 Set the Operational Period An Operational Period is: The time period scheduled for execution 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 The operational period is the time period in which chosen objectives are to be met and identified strategies and tactics are carried out. This time period is flexible, may be of various lengths, and is determined by the Incident Commander according to the needs of the incident. The length of the operational period varies, usually between 2 and 24 hours. The operational period does not need to correspond to hospital shift times and may be shortened or extended based on situational response and incident progression. Instructor Note: The Operational Period is almost never shorter than 2 hours Usually the 1st period is 2 hours long. Depends on how fast things are changing, if the situation is still not fully assessed.

#3 Determine Safety Priorities and Establish Incident Objectives Broad organizational objectives that are foundational and do not change during response and recovery; 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 hospital personnel Initial priorities are based on life safety, incident stabilization, and property preservation. To ensure safety of patients, staff, and visitors, the Safety Officer assesses the hazards, determines strategies to mitigate the hazards, and assigns personnel to carry out the tactics and initiates the HICS 215A: Incident Action Plan (IAP) Safety Analysis. The Incident Commander determines the initial incident objectives. The incident objectives are documented on the HICS 202: Incident Objectives. (Individual sections, branches and units will identify strategies and tactics for their response (HICS 204: Assignment List) based on these objectives which is done in Step 4.) The Planning Section Chief initiates the HICS 202: which includes:   Incident name   Operational period date and time   Incident objectives, as obtained from the Incident Commander   Weather and environmental implications   Factors to consider (refer to the HICS 215A: Incident Action Plan (IAP) Safety Analysis)    Incident Commander approval Instructor Note: These will last through out the whole event Usually has to do with Safety, Patient Care, Dealing with media and other agencies Documented on the HICS 202 Incident Objectives

#4 Determine Individual Section/Branch Objectives More specific Branch/Section objectives to achieve overall Incident Objectives Steps during the defined Operational Period Should be tangible and measurable Example: Provide prophylaxis to 75% of direct patient care staff within 2 hours Decontaminate 50 victims within 1 hour Additional incident objectives will be identified by Section Chiefs and/or Branch Directors to be addressed in the specified operational period. These incident objectives will comprise a section/branch/unit–specific set of strategies, tactical actions, and resources identified to address the priorities for the operational period and accomplish the incident objectives. Documentation includes:   Section Chiefs and/or Branch Directors complete the HICS 204: Assignment List stating section/branch/unit-specific incident objectives   The HICS 204: Assignment Lists are submitted to the Planning Section and distributed to Command, General Staff, and Documentation Unit Leader as part of the Incident Action Plan Instructor Note: These are the individual Section/Branch objectives just for the current Operational Period. What do you need to focus on for this time frame. Each Section/Branch (Operations, Logistics, Planning, Finance) will have their own objectives These individual incident objectives are documented on an individual 204 for each Section/Branch/Unit

#5 Determine Strategies and Tactics Strategy defined: The general direction selected to accomplish incident objectives 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” Strategies are the general plans or directions selected to accomplish incident objectives for individual sections. Tactics are the short-term, specific actions taken to complete, or satisfy, the incident objectives (e.g., the directing/deployment of resources during an incident). The Section Chiefs and Branch Directors document strategies and tactics on the HICS 204: Assignment List. Instructor Note: Some hospital people may be confused by the use of the word “tactical” in ICS. The Operations Section is the boots on the ground, the ones who are mounting the defense and carrying out patient care operations, using equipment, supplies, and personnel resources to accomplish the mission. Therefore, the word “tactics” is used for operations, as they are responsible for managing tactical resources, or the boots/troops on the ground. Ask class, “How are you going to accomplish the objectives?” Strategy = planning Tactics = hands on

#6 Determine Needed Resources Available and needed resources to meet the objectives must be identified Tactical resources may include: Personnel Equipment Supplies Pharmaceuticals Vehicles The next step is to identify needed resources. Examples of needed resources include personnel, equipment, supplies, pharmaceuticals, and vehicles. Just as in daily operations, there are many components to resource identification, requisition, distribution, and restocking. The following must be ensured:   Section Chiefs coordinate with Branch Directors and Unit Leaders to determine needed resources within their specific section   Logistics Section Chief confers with Operations Section Chief to coordinate obtaining the resources   Finance/Administration Section Chief confers with Logistics and Operations Section Chiefs to assure appropriate financial tracking as individual sections identify resource needs Documentation includes:   HICS 204: Assignment Lists are used to document specific resources needed within the section/branch/unit   Logistic Section Communication Unit Leader completes the HICS 205A: Communications List to identify communication resources and designate equipment and channels to be used within the hospital and for coordination with internal and external partners  Logistic Section Employee Health and Well-Being Unit Leader completes the HICS 206: Staff Medical Plan to outline resources for medical care of injured/ill hospital personnel, as needed

#7 Issue Assignments Once the objectives and needed resources are identified, assignments are issued: Hospital Command Center positions are activated according to incident needs Staff are assigned to conduct incident specific operations: Evacuation Decontamination Triage and treatment Safety measures The next step is for the Section Chiefs, Branch Directors, and Unit Leaders to make staff assignments specific to response action (e.g., Triage, Evacuation, Decontamination, Security). This step includes completion and distribution of the following:   HICS 204: Assignment List documents specific assignments within each section/branch/unit activated   The Planning Section Chief, or designee (Resource Unit Leader) completes the HICS 203: Organization Assignment List and distributes to Command and General Staff, Branch Directors and Documentation Unit Leader

The Planning Meeting The Planning Meeting is: HICS Across The Sections: Connecting the Incident Action Plan to the Incident Management Team & Response The Planning Meeting The 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 Followed by: Incident Commander approval and duplication of sufficient copies for dissemination.

The Planning Meeting The Planning Meeting is conducted after: HICS Across The Sections: Connecting the Incident Action Plan to the Incident Management Team & Response The Planning Meeting The Planning Meeting is conducted after: Incident Commander has provided an incident briefing and determined the Incident Objectives and identified the Operational Period Sections have met to discuss their response priorities and identified Section/Branch objectives Followed by: Incident Commander approval and duplication of sufficient copies for dissemination. Refer to Planning handout 4 from “HICS Across Sections”

The Planning Meeting The Planning Meeting is: HICS Across The Sections: Connecting the Incident Action Plan to the Incident Management Team & Response The Planning Meeting The Planning Meeting is: Based on a fixed agenda and includes a report out of section-specific objectives for the Operational Period, resources assigned, resource needs Attended by Incident Commander, Command and General Staff

The Planning Meeting At the end of the Planning Meeting: HICS Across The Sections: Connecting the Incident Action Plan to the Incident Management Team & Response The Planning Meeting At the end of the Planning Meeting: The Section Chiefs submit completed HICS Form 204 Assignment List The Safety Officer submits completed HICS Form 215A Incident Action Plan Safety Analysis

#8 Implement Actions Direct, monitor and evaluate response: Constant monitoring of strategies and tactics for effectiveness Assess the Branch/Section 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

#9 Evaluate and Revise Plans Conduct a current situation assessment Update situation/incident information Assess the impact on the hospital Length and duration of incident Resource availability Assess the Incident Objectives Assure objectives are achieved in a safe and timely manner Revise objectives, strategies, tactics and resource needs for the upcoming operational period As the Incident Action Plan (IAP) is used in the response, there is ongoing assessment of the effectiveness of strategies and tactics. Plans should be continually reassessed and revised. The revision of the plan does not have to wait in step 9 serves as the road map for the next operational period. Adjustments in assignments, activation of additional branches or units, and revised safety plans should be documented and distributed to the HIMT as needed. The Section Chiefs evaluate the response and share the information with the Command and General Staff and make corrective actions. As an operational period is concluding, the Incident Action Plan (IAP) process sets off again, beginning with an updated situational assessment/review of the objectives to direct planning activities within sections and identification of continuing activities and objectives for the next operational period using a new or revised set of forms and documents. The staffing of positions, the assignment of resources, and other critical information should be developed for this new operational period (and/or oncoming HIMT). The IAP will serve as the guidance for what is to be done during this next operational period. Instructor Notes: Determine where changes need to be made and what activities need to continue. Before the end of the Operational Period – you will evaluate how things are going Is the plan working? Are there new issues to address?

Incident Action Plan Responsibilities The Incident Commander Provides overall Incident Objectives (HICS 202) Sets the Operational Period Develops major strategies (priorities) Activates Hospital Incident Management Team Establishes policy for resource orders Approves initial actions and the completed Incident Action Plan The Command Staff:   Develops overall incident objectives and strategy   Determines the operational period   Approves resource orders and (later) demobilization   Approves the Incident Action Plan (IAP)

Incident Action Plan Responsibilities The Safety Officer Advises the Incident Commander and Section Chiefs on safety issues and measures Develops the Safety Plan (HICS 215A) Oversees the safety of operations and tactics

Incident Action Plan Responsibilities The Operations Section Chief Determines/assesses areas of operation Advises Incident Commander of activated Operations positions and work assignments Determines tactics (HICS 204) Determines resource requirements (HICS 204) and communicates needs with Logistics The Operations Section: Assists with developing strategy Identifies, assigns, and supervises the resources needed to accomplish the incident objectives

Incident Action Plan Responsibilities The Planning Section Chief Prepares for the Planning Meetings Gathers information for the Incident Action Plan (HICS 201, 202, 203, 204s and 215A) Develops demobilization plans Conducts the Planning Meeting Coordinates and submits the Incident Action Plan to the Incident Commander for approval Disseminates the Incident Action Plan The Planning Section: Provides status reports Tracks resources and identifies shortages  Manages the planning process  Develops the Incident Action Plan (IAP) Instructor Notes: Included in your materials is an IAP Coversheet we have developed to help ensure the necessary components of your IAP are included (Have participants look at cover sheet)

Incident Action Plan Responsibilities The Logistics Section Chief Determine tactics and resource requirements (204) Ensures resource ordering meets the needs Advises activated Logistics positions Ensures resources to support Incident Action Plan Develops plans that support the Incident Action Plan Communications Plans Transportation Plans The Logistics Section: Orders resources Assists in the development of the transportation, communications, and medical plans

Incident Action Plan Responsibilities The Finance/Administration Section Chief Determine tactics and resource requirements (204) Provides cost implications of the Incident Objectives Ensures the Incident Action Plan is within cost limitations Advises the Incident Commander on Finance/Admin activated positions The Finance/Administration Section: Develops cost analyses to help ensure that the Incident Action Plan (IAP) is within the financial limits established by the Incident Commander Develops contracts, procures, and pays for the resources Reports costs

Incident Action Plan Responsibilities The Incident Action Plan Provides Hospital Incident Management Team with direction for the Operational Period Uses the elements of Management by Objectives Developed by Command, General Staff provide input Essential for effective response and recovery

Questions?

Incident Planning Guides There are 18 Scenario-based Incident Response Guides : Active Shooter  Chemical Incident Earthquake  Evacuation, Shelter-in-Place, & Hospital Abandonment Explosive Incident Hostage or Barricade Incident Infectious Disease  Incident Planning Guides and Incident Response Guides are tools hospitals and healthcare partners may use to evaluate and improve their level of preparedness. IPGs outline strategic considerations for hospitals to assess when writing their response plans. IRGs develop incident-specific response guides for the hazards that may impact the hospital. The guides include the following:   The Incident Scenario   The Incident Planning Guide (IPG)   The Incident Response Guide (IRG)   A recommended list of Documents and Tools, including HICS Forms   A recommended Hospital Incident Management Team (HIMT) Activation Chart for each response period

Incident Planning Guides (continued) Information Technology (IT) Failure  Mass Casualty Incident Missing Person  Radiation Incident  Severe Weather with Warning Staff Shortage  Tornado  Utility Failure  Wildland Fire 

Incident Response Guides Provides Incident-specific: Directions Incident Objectives Management tasks by function and timeframes Sample Hospital Incident Management Teams Should compliment: Emergency Operations Plan and Job Action Sheets Can be used as documentation Instructor Note: For each of the 18 scenarios there are Incident Response Guides These are great tools/cheat sheets We will utilize these in our practice tabletop

Section Review Incident Response Guides Are incident-specific tools to assist with planning, training and response/recovery Assist in meeting regulatory requirements Guide Command and General Staff with decision-making and actions Should be consistent with the Emergency Operations Plan Do not replace the Job Action Sheets

Questions?

HICS Forms HICS Revision 2014 - The HICS Forms have been revised to be more consistent with those used by the Federal Emergency Management Agency (FEMA). Additionally, there are 3 new HICS Forms available for hospital use: Incident Action Plan (IAP) Quick Start; the HICS 200: IAP Cover Sheet; and the HICS 221: Demobilization Check-Out.

The Value of Using HICS Forms Serves as a road map in response: everyone acting from the same plan Serves as foundation for corrective action Ensures consistency and compliance with regulatory guidelines Complies with documentation for FEMA reimbursement Having a standardized form used by all responders provides a familiar and consistent method of documenting an incident and ease in sharing information. Local and federal agencies have adopted standardized forms with the use of Federal Emergency Management Agency (FEMA) Incident Command System (ICS) forms. HICS has modified select FEMA ICS forms (2010 edition) to reflect hospital functions. Where possible, HICS has maintained the intent and layout of the FEMA forms. Not every FEMA ICS form is applicable to a hospital; in that case, the FEMA form has not been utilized by HICS. There are additional functions performed by hospitals that are not addressed by FEMA forms, so additional hospital based forms have been developed to fill those needs. Instructor Note: The forms are essentials tools: - They help to document and guide the Incident Action Planning Process - The County Emergency Operations Center is utilizing similar forms - The forms match up with FEMA forms - Necessary for federal reimbursement for an event

HICS Form 200 Incident Action Plan Cover Sheet Purpose: Provides a cover sheet and a checklist for HICS Forms and other documents included in the operational period Incident Action Plan Origination: Incident Commander or Planning Section Chief Copies to: Command and General Staff and Documentation Unit Leader Helpful Tips: Additions may be made to the form to meet the organization’s needs

HICS Form 201 Incident Briefing Purpose: Documents initial response information & actions at start-up Origination: Incident Commander Copies to: Command Staff, Section Chiefs, and Documentation Unit Leader When to Complete: Prior to briefing the current operational period Helpful Tips: Distribute to all staff before initial briefing 201 Incident Briefing Most significant changes Changed to match the FEMA 201 form Designed to provide a summary of the current Operational Period Provides a situational status report and update to the oncoming Incident Commander Instructor Notes: On the bottom of each form it gives the: - Purpose - Who originates it - Who to send copies to - When to complete - and helpful tips Move on to the next slide to look at the form

HICS Form 201 Incident Briefing

HICS Form 202 Incident Objectives Purpose: Defines incident objectives Instructions: Include - Weather/Environmental Implications General Safety/Safety Messages Attachments Prepared by Planning Section Chief Approved by: Incident Commander

HICS Form 202 Incident Objectives Instructor Notes: Have participants look at the form

HICS Form 203: Organizational Assignment List Purpose: To document Hospital Command Center staffing Origination: The Planning Section Chief or designee (Resources Unit Leader) Copies to: Command Staff and General Staff Branch Directors and Agency Staff Documentation Unit Leader

HICS Form 203: Organization Assignment List Instructor Notes: Have participants look at the form

HICS Form 204: Assignment List Purpose: Document branch assignments, objectives, strategies/tactics and resource needs Origination: Section Chief or Branch Director Copies to: Command, General Staff and Documentation Unit Leader Prepared by: Branch Director When to complete: At the start of each operational period 204 Assignment List(s) Previously 204 – Branch Assignment List Documents the objectives, strategies and tactics, and resources needed for each Section/Branch for the current operational period Used in development of the Incident Action Plan The order has been changed to begin with what are our objectives, strategies and tactics, and needed resources, followed by who is activated to the Unit to flow with the Incident Action Plan process. The 204 is the only form that looks significantly different than the FEMA form in that it addresses the needed information for the Incident Action Plan

HICS Form 204: Assignment List Instructor Notes: Have participants look at the form

HICS Form 215A: Incident Action Plan Safety Plan Analysis Purpose: Document hazards and mitigation Origination: Safety Officer Copies to: Command and General Staff, Sections, and Branches Prepared by: Safety Officer Approved by: Incident Commander When to complete: Prior to safety briefing during the Operations Briefing and at transfer of role Initial priorities are based on life safety, incident stabilization, and property preservation. To ensure safety of patients, staff, and visitors, the Safety Officer assesses the hazards, determines strategies to mitigate the hazards, and assigns personnel to carry out the tactics. This information is recorded on the HICS 215A: Incident Action Plan (IAP) Safety Analysis. The Safety Officer initiates the HICS 215A which includes:   Incident name   Operational period date and time   Identification of hazards (potential and actual)   Actions to be taken to reduce risk and ensure safety   Assignments for mitigation activities listed   Date prepared   Time prepared   Facility name   Incident Commander approval HICS 2014 Revision - This form was previously 261 – Now changed to 215A to conform with new FEMA form numbering

HICS Form 215A: Incident Action Plan Safety Plan Analysis Instructor Notes: Have participants look at the form

HICS Form 213: Incident Message Form Purpose: Provide standardized message recording Instructions: Response Required: Indicate a reply was requested and to whom reply addressed Priority: Indicate level of urgency Message: Keep all messages/requests brief, to the point, and very specific Transcribe complete, concise, and specific content of message Action Taken (if any) Instructor Notes: 3 types of information must be documented - Assignments made - Resources requested - Status updates If they are not documented elsewhere this form, then the information can be passed on with this form If a request is made the response can be documented on this form

HICS Form 213: Incident Message Form Instructor Notes: Have participants look at the form

HICS Form 214: Activity Log Purpose: Document Incident issues encountered Decisions made Notifications conveyed Origination: Command and General Staff When to complete: Continuously, from activation through demobilization Instructor Notes: Very important document This is where you document the nuts and bolts of actions you have taken Should not use yellow pads, scratch pads and other odds and ends notes Since all documentation should be standard, this is the form to use

HICS Form 214: Operational Log Instructor Notes: Have participants look at the form

HICS Form IAP Quick Start Purpose: A short form combining forms 201, 202, 203, 204 and 215A. May be used in place of full forms to document initial actions or short incidents, and can expand to the full forms as needed. Origination: Incident Commander or Planning Section Chief The HICS IAP Quick Start was designed because there are often limited resources or time to complete multiple forms or the incident may be small in scope, requiring less documentation. The HICS IAP Quick Start was developed to provide a shorter, more concise documentation tool. As the incident expands or additional assistance is available, the information can be expanded onto the full version of the complementing HICS Form. HICS 2014 Revision – This is a new form

HICS Form IAP Quick Start Instructor Notes: Have participants look at the form

Section Review The HICS Forms: Provide the Hospital Incident Management Team with documents needed to manage a response Assist in communication with external agencies Assist in communication with hospital staff Documents response and recovery

Questions?

Incident Action Planning Updated with May 2014 HICS Revisions 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.