1. Application of Incident Action Plan and Forms – Loss of Water
Hospital Incident Command System
Application of
Incident Action Plan and Forms – Loss of Water
2014 Revision
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.

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

3. 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

4. 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

5. Scenario
Without warning, the main water supply line to the hospital breaks, disrupting water service to the entire facility
The hospital’s water systems, including potable water supply are non-functional
Local water sources and vendors are not impacted
Large volume of water is flowing out from beneath pavement on main roadway in front of hospital causing access challenges (no hospital flooding)

6. Scenario Services, including food and radiology are disrupted
Toilets and hand washing areas are not functioning and alternate methods must be provided
Time: 2300
Weather: Clear, 68º F, no winds

7. First Actions Water has been disrupted for 15 minutes
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
Activates Response plans, HICS
Contact Administration on-call
Notify local EMS of status
Determine if any life sustaining/critical functions are disrupted
Begin facility status assessment

8. 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

9. Which Positions to Activate?
Based on this situation, what needs to be activated?
Use the Loss of Water Incident Response Guide
Command Staff
Section Chiefs (consider finance)
Infrastructure Branch Director
Medical Care Branch Director
Support Branch Director
How long did that take us to figure out? (go to next slide)

10. 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

11. 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

12. 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.

13. Step 3: Determine Safety Priorities & Incident Objectives
Incident Action Planning
Step 3: Determine Safety Priorities & Incident Objectives
Identify Command & Control Objectives (these are the overarching objectives that will last throughout the whole response)
HICS form 202: Incident Objectives
Incident objectives –
Restore water supply
Identify and obtain alternate sources of potable water
Maintain patient care management
Communicate situation status and updates to staff, patients, visitors and facility
After they come up with some ideas then you can show them objectives on the IRG – next slide

14. Control Objectives Utilize the Incident Response Guide Utility Loss:
Identify extent of outage and consider evacuation
Maintain patient care capabilities
Minimize impact on hospital operations and clinical services
Communicate the situation status to patients, staff, and the public
Fill in what they decide on the 202

15. Scenario Update #1 It has been 30 minutes since the water main break
The hospital is only accessible to emergency vehicles

16. 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 in non-impacted areas
Ensure hydration/sanitation is addressed
Complete form 215A – Incident Action Plan Safety Analysis
Safety Officer to work on the 215A

17. 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

18. 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? 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
If there are immediate needs for patient evacuation, what resources or assistance is needed?

19. Side Note: Documenting your Actions
Utilize HICS forms
Form Operational Log

20. Step 4: Determine Branch/Section Objectives
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 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

21. Branch/Section 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 (See IRG)

22. 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 – Branch Assignment List
Assure any loss of water related policies, plans, procedures are available from the EOP in the Hospital Command Center

23. Incident Action Planning
Step 6: Determine Needed Resources
What equipment and/or supplies do you need?
What personnel resources 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)
Water for hydration & sanitation
Portable toilets, portable hand washing stations
Emergency water for critical needs
Means to transport water
Portable suction
Needs for HVAC, fans

24. Incident Action Planning
Step 7: Issue Assignments
Who will be assigned to the units?
Fill in the assignments on form 204 – Assignment List
Are there other branches that need activated?
Have them work in groups on their strategies, tactics and assignments for their branches

25. Incident Action Planning
For the first Operational Period the Incident Action Plan should be done within minutes
What makes up the Incident Action Plan?
Form Incident Briefing
Form Incident Objectives
Form Incident Assignments
Form Branch Assignments
Form 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

26. 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

27. IAP Cover Sheet
Can be used for the IAP Quick Start or full Incident Action Plan forms
Can make different colors if you want to differentiate Operational Periods

28. 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

29. Scenario Update #2 It is now 0030 – 1.5 hrs into the incident
Utility workers expect to repair the damage and restore water service to the hospital within 10 – 12 hours
What are your major concerns?
Major Concerns:
Continued Medical Care
Sanitation issues
Media management
Disruption of services
Maintaining utilities/systems dependant on water

30. 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

31. Scenario Update #3 It is now 4 hours into the incident
Utility repair personnel have encountered complications and report water may not be restored for 3 days
What issues should be considered?
Need for evacuation/partial evacuation/transfer of patients in need of services dependant on water
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

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

33. Questions?
Clean-up, part of any event is recovery-put the vests back as they belong
Post test
Evaluation

34. Incident Action Plan and Forms Loss of Water
HICS Basics Part 2
Application of
Incident Action Plan and Forms Loss of Water
developed by the
California Hospital Association’s
Hospital Preparedness Program
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.