Application of Incident Action Plan and Forms – Evacuation Hospital Incident Command System Application of Incident Action Plan and Forms – Evacuation 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. 1

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

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 3

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 4

Scenario During a construction project, workers sever a water main in the basement The two emergency generators are in a flooded section of the basement and have been rendered unusable All power to the building has been interrupted, and the electric company has said it will be twelve or more hours before even partial restoration of services can be accomplished

Scenario Pharmacy services and the lab are located in the basement and cannot provide service due to flooding Patients on Life Support are being manually supported and some on battery backup Total evacuation of the facility must occur immediately Current census is at 85% Time: 1000 Weather: Clear, 75º F, no winds

First Actions 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 Assure life support activities are underway Activates Response plans, HICS Establish an alternative Hospital Command Center Question for the class: Do your communication systems rely on electricity? How will you communicate with one another?

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 Evacuation IRG Staging, Medical Care, Infrastructure, Security Situation unit leader Support Branch Finance Section Chief (not included in IRG, but should be considered) How long did that take us to figure out? (go to next slide)

Immediate Time Period Look at the IRG for Evacuation (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: Setting 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 response) HICS form 202: Incident Objectives Control objectives – Maintain safety of patients, staff, visitors Maintain life support functions Conduct safe and rapid evacuation of the 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 Evacuation: Maintain safety of patients, staff, visitors Maintain life support functions Conduct safe and rapid evacuation of the facility Plan for patient repatriation and restoration of services (Fill in what they decide on the 202)

Scenario Update #1 ICU – has 10 patients on ventilators PICU – has 4 patients on ventilators NICU – 8 patients on ventilators, 2 on ECMO, 6 additional patients in incubators 8 patients in surgery

Side Note: Safety Officer Tasks Assess the Safety issues What hazards exist and what precautions need to be taken Monitor the immediate stabilization of the facility and basement flooding Ensure safe movement/egress of patients, visitors and staff from facility Ensure evacuation holding areas are safe/secure 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) 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? 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 What resources or assistance is needed for evacuation?

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/Branches don’t develop their objectives promptly Report top 3 objectives Have the groups share their top 3 objectives Some examples: Operations Assure life support functions are occurring Prioritize and prepare patients for evacuation Provide for facility security, traffic and crowd control Assess damage, attempt to activate other back up systems Planning Track patients and personnel including evacuation location and receiving facility Develop the Incident action plan in collaboration with the Incident Commander Facilitate Planning meeting Logistics Conduct an inventory of critical needs for patient management Supply resources and supplemental staffing to key areas to facilitate evacuation 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 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 Where can patients be moved to? What personnel resources do you need? What equipment and/or supplies do you need? What resources do you need in the patient collection/holding area? What transport resources do you need? Document resource activities: Resources assigned (form 204) Resource requests (form 213) Actions taken to utilize and obtain resources (form 214) Staging areas to prepare for transport Evacuation devices – med sleds, stair chairs, etc. Go kits Staff to help with evacuation Coordinate transportation needs

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 1130 – 1.5 hrs into the incident 3 ICU patients, 4 NICU patients have been transferred to 2 other hospitals in town Continuing to arrange transfer of critical patients out of the facility 10 patients have been discharged home What are your major concerns? Major Concerns: Maintaining life support services as needed Continued safe evacuation Safety of evacuation staff Notification of family members Communication with outside agencies Dealing with the media

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 critical patients have been transferred out Surgery patients have been transferred Large portable generator has been hooked up and emergency power is restored What are some of the issues to consider? Prioritize which additional areas have greatest need for power Determine on what level evacuation needs to continue Plan for patient repatriation and restoration of services

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 31

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