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. One of the Statewide objectives is to develop an Incident Action Plan Goal – Develop an Incident Action Plan for the first operational period Discuss how process of IAP assist in moving ICS team to action w/o having to over focus on job action sheets. 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

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

HOSPITAL INCIDENT ACTION PLANNING Key to Effective Response and Recovery Incident Action Planning is the key to having an organized and planned response The forms used to make up the IAP vary by incident, but a minimum include: 201, 202, 203, 204 & 215A

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 Review 2014 changes

1) ASSESS THE SITUATION The Incident Commander conducts the initial incident assessment from the information gathered: Type of incident, location, magnitude, and possible duration Ongoing hazards and safety concerns Determines initial priorities based on: 1) Life saving 2) Incident stabilization 3) Property preservation Establishes the Hospital Command Center

2) SET THE OPERATIONAL PERIOD An Operational Period is: The period of time scheduled for execution of a given set 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 or amount of information available Never shorter than 2 hours The 1st operational period can be 2 hours long due to the dynamics of an unexpected event. The length will depend on how fast things are changing, if the situation is still not fully assessed.

3) DETERMINE SAFETY PRIORITIES & ESTABLISH INCIDENT OBJECTIVES General Command Objectives are: Broad organizational objectives that are foundational and do not change during response and recovery. These objectives define where the system wants to be at the end of the response 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 staff, patients and visitors These will last throughout the whole event Usually has to do with Safety, Patient Care, and communication Documented on the HICS Form 202 Incident Objectives

4) DETERMINE SECTION/BRANCH OBJECTIVES Section/Branch Objectives are: More specific objectives to achieve overall incident objectives Steps during the defined Operational Period Should be tangible and measurable Example: Provide prophylaxis to 75% of hospital staff in this operational period Decontaminate 25 victims in 2 hours These are the 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 Operational Period objectives for the Incident Action Plan Documented on the HICS Form 204 Branch Assignment List

5) DETERMINE STRATEGIES AND TACTICS Strategy Defined: The general direction selected to accomplish incident objectives (NIMS) 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”

6) DETERMINE NEEDED RESOURCES Available and needed resources to meet the tactical objectives must be identified Tactical resources may include: Personnel Equipment Supplies Pharmaceuticals Vehicles

7) ISSUE ASSIGNMENTS Once the tactical objectives and necessary resources are identified, assignments are issued: Additional HICS positions are activated according to incident needs Staff are assigned to conduct incident specific operations: Evacuation Decontamination Triage and treatment Safety measures Who’s going to get the job done? Documented on the HICS 204 and 203

THE INCIDENT ACTION PLANNING MEETING HICS Across The Sections: Connecting the Incident Action Plan to the Incident Management Team & Response THE INCIDENT ACTION PLANNING MEETING The Incident Action Planning Meeting is: Led by the Planning Chief Defines and finalizes branch/section objectives, strategies, tactics, and resources as determined by each section for the next operational period The Section Chiefs submit completed HICS Form 204 Branch Assignment List and the Safety Officer submits completed HICS Form 215A IAP Safety Analysis

8) IMPLEMENT ACTIONS Direct, monitor and evaluate response efforts: Constant monitoring of strategies and tactics for effectiveness Assess the Operational Period 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 Before the end of the Operational Period – you will evaluate how things are going Is the plan working? Are there new issues to address?

9) REASSESS & ADJUST PLANS Conduct a Current Situation Assessment: Update situation/incident information Assess the impact on the hospital Length and duration of continued/resolving incident Resource availability Assess the Incident Objectives Make sure they are achieved in a safe and timely manner Revise objectives, strategies, tactics and resource needs for the upcoming operational period Determine where changes need to be made and what activities need to continue Start the Incident Action Plan Process over with step #1-8 again

INCIDENT ACTION PLAN RESPONSIBILITIES The Incident Commander: Provides general Command and Control Objectives (HICS 202 Incident Objectives) Sets the Operational Period Develops major strategies (priorities) Activates Incident Management Team positions Establishes policy for resource orders Approves initial actions and the completed Incident Action Plan Move through slides 17 -21 rapidly

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 Incident Action Safety Plan Analysis) Oversees the safety of operations and tactics

INCIDENT ACTION PLAN RESPONSIBILITIES The Planning Section Chief: Prepares for the Planning Meetings Gathers information for the Incident Action Plan (HICS 201, 202, 203, 204’s and 215A) Develops demobilization plan Conducts the Planning Meeting Coordinates and submits the Incident Action Plan to the Incident Commander for approval Disseminates the Incident Action Plan

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 “Doers” Carry out the plan

INCIDENT ACTION PLAN RESPONSIBILITIES The Logistics Section Chief: Ensures resource ordering meets the needs Advises Incident Commander on activated Logistics positions Ensures resources to support the Incident Action Plan Develops plans that support the Incident Action Plan Communications Plans Transportation Plans Getters

INCIDENT ACTION PLAN RESPONSIBILITIES The Finance/Administration Section Chief: Provides cost implications of the Command and Control, and Operational Period Objectives Ensures the Incident Action Plan is within cost limitations Advises the Incident Commander on Finance/Admin activated positions Track cost, assure funds are available

INCIDENT ACTION PLAN SECTION REVIEW The Incident Action Plan: Provides Incident Management Team personnel with direction for the Operational Period Incident Action Planning is a process of Management by Objectives Essential for effective response and recovery

QUESTIONS?

Incident Response Guides There are 16 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 Response 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 16 scenarios there are Incident Response Guides These are great tools/cheat sheets We will utilize these in our practice tabletop

HICS FORMS USED IN THE INCIDENT ACTION PLAN

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 Previously 204 – Branch 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: Incident Action Plan (IAP) Safety Analysis, 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 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

Application of Incident Action Plan – Infectious Disease Hospital Incident Command System Application of Incident Action Plan – Infectious Disease 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.

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 44

Scenario Influenza season has begun and hospitals and primary care see an increase in the number of influenza-like illness (ILI) cases presenting for care including a family of 5 with symptoms of ILI.  Emergency departments and community health centers see a surge in ILI cases presenting, and admissions increase over 10% with acute respiratory illnesses. PHD is stating there is evidence of an emerging infectious disease with respiratory spread and that hospitals should prepare for significant surge.

First Actions Time: 0900 Weather: Clear, 68º F, no winds 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, PHD of status Begin facility status assessment (Beds, Patient tracking) 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

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

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

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 Action Planning Step 3: Determine Safety Priorities & Establish Incident Objectives Identify the Incident Objectives (these are the broad objectives that will last throughout the response or are the priorities) HICS form 202: Incident Objectives Incident objectives – Identify, triage, isolate and treat infectious patients Protect patients and staff from exposure and injury Assure safety and security for patients, staff, visitors and the hospital Admit a large number of infectious patients while protecting other (uninfected) patients After they come up with some ideas then you can show them objectives on the IRG – next slide

Incident Objectives Utilize the Incident Response Guide Infectious Disease: Identify, triage, isolate and treat infectious patients Protect patients and staff from exposure and injury Assure safety and security for patients, staff, visitors and the hospital Admit a large number of infectious patients while protecting other (uninfected) patients

Scenario Update #1 It is reported the several of the patients with ILI symptoms in your hospital are requiring ICU level care and ventilator support.

Side Note: Safety Officer Tasks Assess the Safety issues What hazards exist and what precautions need to be taken Complete the 215A – Incident Action Plan Safety Analysis Safety Officer to work on the 215A Assure safe traffic flow Assure safe and effective use of PPE Assure visitor check in procedures followed

Side Note: Public Information Officer task 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 Make contact with the Public Health Department, EMS Agency or through the local EOC (MHOAC) if activated Who should be notified? 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) These contacts/processes should be identified prior to any incident N 95 PPE Alcohol based hand gel Antivirals, antibiotics Isolation/cohabitation capabilities

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

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 Branch/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 Review IRG See IRG “Immediate Response”

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 –Assignment List Assure any loss of power outage related policies, plans, procedures are available from the EOP in the Hospital Command Center

Incident Action Planning Step 6: Determine Needed Resources What space resources are needed? 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) Cohabitation/Isolation Staff training PPE – N95, gloves, alcohol based hand gel signage

Incident Action Planning Step 7: Issue Assignments Who will be assigned to the units? Fill in assignments on form 204 – Assignment List Are there other branches or units 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? 201 - Incident Briefing 202 - Incident Objectives 203 - Incident Assignments 204 - Branch Assignments 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

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

Scenario Update #2 Your hospitals ICU is at full capacity. Patients will ILI symptoms continue to arrive at a high rate. There are only 3 ventilators left available in the hospital. More Ventilators– LA Co. MAC Space PPE

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

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

Questions?