Incident Action Plan and Forms – Improvised Explosive Device (IED) Hospital Incident Command System Application of Incident Action Plan and Forms – Improvised Explosive Device (IED) 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 Control Objectives Determine Operational Period 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 The Universal Adversary terrorist group has detonated a vehicle bomb in the parking lot of the community’s largest public building during business hours The building is currently hosting a convention with a large number attendees at the event Part of the structure has collapsed, fires are burning throughout the facility and there is severe blast and fire damage to the surrounding buildings

Scenario There are a large number of people with trauma and burn injuries, including children There are an unknown number of people trapped in the primary and surrounding buildings There are many fatalities

Scenario Your hospital is the closest Medical Center to the public building, but has not been damaged by the blast Water, power and communications services are functioning normally in the area Time: 1400 Weather: Clear, 75º F, Light winds

First Actions Victims and uninjured begin arriving at the facility within 15 minutes of the blast Number of victims expected to arrive: 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 Assure triage is established Activates Response plans, HICS

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 Explosives Attack IED Incident Response Guide Medical Care, Security Situation unit leader Support Branch Finance Section Chief How long did that take us to figure out? (go to next slide)

Immediate Time Period Look at the IRG for Explosives Attack (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 Since this is a community-based incident, the incident should already be named

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 & Control Objectives 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 Control objectives – Triage and treat arriving victims, Keep facility secure, Communicate with responding agencies and EMS (through the EOC/DOC) After they come up with some ideas then you can show them the short cut – next slide

Control Objectives Utilize the Incident Response Guide Explosives Attack: Prepare for the influx/surge of trauma and burn victims Ensure facility security Prepare for patient triage and medical management Collect forensic evidence for law enforcement Communicate the situation status and information to staff, patients, media and the public Fill in what they decide on the 202

Scenario Update #1 It has been 30 minutes since the explosion The ED has received 2 critical burn/trauma patients by private car 20 victims have been triaged 2 immediate 2 delayed 16 minor ED estimates 20 victims waiting for triage EMS reports as many as 200 victims

Side Note: Safety Officer Tasks Assess the Safety issues What hazards exist and what precautions need to be taken Security Needs (e.g., increased surveillance, secondary device, crowd control) Complete form 261 – Incident Action Plan Safety Analysis Safety Officer to work on the 261

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)

Side Note: Liaison Officer Who or what entity operates as the county contact/MHOAC, and how do you contact? What is the situation on-scene? Who should be notified of 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

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

Step 4: Determine Operational Period Objectives 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) 5 – 10 min for students (section chiefs) to develop 3-4 objectives. PIO does PIO report. Liaison officer making calls. SO – form 261 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

Operational Period Objectives A common problem during exercises is that Sections don’t develop their objectives promptly Report top 3 objectives Have the groups share their top 3 objectives and write on the blow up of the 204. Some Examples: Operations Assure all arriving patients receive triage Assure most severely injured, survivable patients receive care Provide for facility security, traffic and crowd control Consider activation of a family information center (FIC) Planning Prepare and implement patient, bed, materiel and personnel tracking Develop the Incident action plan in collaboration with the Incident Commander Facilitate Planning meeting Logistics Conduct an inventory of critical needs for triage, ED and other care areas Initiate staff call back as necessary Finance Track costs

Incident Action Planning Step 5: Determine Strategies & Tactics Strategies & tactics are how your Section/Branch 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

Incident Action Planning Step 6: Determine Needed Resources What units/space needs to be activated? What personnel resources do you need? What equipment and/or supplies 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) Delayed treatment area? Minor/treatment area? Additional Physician/Nursing staff? Additional Gurneys? Security/Traffic Control? Lock Down

Incident Action Planning Step 7: Issue Assignments Who will be assigned to the units? Fill in the assignments on form 204 – Branch 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 261 - 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

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 1530 – 1.5 hrs into the incident You have received 2 additional critical trauma patients and 1 critical burn patient from EMS You have received a total of: 6 Immediate (1 now deceased) 5 delayed 40 minor What are your major concerns? Major Concerns: Are there more victims? Security management Availability of higher level of care (transport) if needed?

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 Operational Period 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 All victims have been transported or have left the scene Universal Adversary has claimed responsibility for the bombing and claims a secondary device is in place What issues should be considered? Secondary transport to higher level of care Security considerations Family Reunification Recovery Staff Communication Public Information Evidence Preservation Law Enforcement Communication

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 Improvised Explosive Device HICS Basics Part 2 Application of Incident Action Plan and Forms Improvised Explosive Device 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.