Application of Incident Action Plan and Forms – Earthquake Hospital Incident Command System Application of Incident Action Plan and Forms – Earthquake 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 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 request for assistance. Transport to hospitals is difficult due to debris in roadways.

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.

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.

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? Start with 201 Is this an incident? Yes First Actions – Appropriate person takes role as Incident Commander Activates EOP, HICS Conduct situational assessment Notify local EMS of status (Satellite phone, HAM radio) Determine if any life sustaining/critical functions are disrupted Assess for injuries to patients, staff, visitors Begin facility status assessment Determine where triage and initial treatment will take place Determine status of HCC, activate HCC

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 Natural Disaster – Major Earthquake Incident Response Guide Command Staff Section Chiefs (consider finance) Infrastructure Branch Director Medical Care Branch Director Security Branch Director Situation Unit Leader Support Branch Director How long did that take us to figure out? (go to next slide)

Immediate Time Period Look at the IRG for Major Earthquake (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.

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 – Patients, visitors and staff assessed for injuries and accounted for (as identified in step 1 as a life saving priority) Hospital Self-sustainment for 72 hours Provide patient care management Communicate situation status and updates to staff, patients, and visitors Communicate to community response partners (EMS, PHD, local fire and law enforcement) Maintain security and safety of facility Damage assessment 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 Earthquake: Damage Assessment Patients , visitors, staff assessed for injuries and accounted for Patient tracking Hospital facility self-sustainment capability Fill in what they decide on the 202 Loss of Power, Water, Evacuation or Hospital Overload IRGs may apply

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

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 Safety Officer to work on the 261 Safe Evacuation Routes Safety of search operations Safe passage within facility due to debris, lack of lighting, etc

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 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 If there are immediate needs for patient evacuation, what resources or assistance is needed? What other resources could be requested? Note: “Situation” refers to the event summery. Hospital “status” refers to functioning, partial functioning, non-functioning.

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

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 Evacuation of unsafe areas Activate hospital alternate care sites for evacuated patients Assess damage, secure unsafe areas and initiate repair Prepare to receive casualties, initiate triage and treatment Ensure continued functioning of emergency power Planning Track patients and beds including evacuation location Develop the Incident action plan in collaboration with the Command and General Staff Initiate materiel and personnel tracking procedures Logistics Inventory and assess for damage all supplies, equipment, food and water stores Conduct an inventory of critical needs for patient and staff management Activate alternate communication systems and establish contact with the local EOC, EMS and ensure intra-hospital communications such as walkie-talkies, runners, etc. 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 earthquake, loss of water, loss of power, surge 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 communication devices do you need? Document resource activities: Resources assigned (form 204) Resource requests (form 213) Actions taken to utilize and obtain resources (form 214) Radios Evacuation devices – med sleds, stair chairs, etc. Alternate care locations Drinking water Go kits Staff to help with evacuation Runners Note: Discuss coordinating any evacuations through the government point of contact

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 1000 – 1.5 hrs into the incident Utility workers expect restore water service to the hospital within 10 – 12 hours Main power restoration expected in 24 hours What are your major concerns? Major Concerns: Continued Medical Care Evacuation where needed Maintain Emergency Power Sanitation issues Media management Disruption of services Maintaining utilities/systems dependant on water PIO messaging to patients, staff, media Communication to governmental agencies (Liaison) Campus/Building safety Ability to maintain food services (emergency power only) Influx of community looking at hospital as a safe haven

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 Utility repair personnel have encountered complications and report main power may not be restored for 3 days, potentially outlasting your generator fuel stores What issues should be considered? Procure more fuel Need for evacuation/partial evacuation/transfer of patients if possible 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 Ability to self-sustain 72 hours Ability to obtain resources (vendors/MOUs/community/government)

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