Hospital Incident Command System

Hospital Incident Command System
HICS Management System & Tools for Events Time: 0800 (1200) Introductions – Instructor, class members HICS – Management Tool 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 Learn the principal concepts and features of the Hospital Incident Command System Understand the roles and relationships of the Incident Management Team Understand the principles of Incident Action Planning Our main focus in the second half of the class will be on Incident Action Planning We will use a practical scenario to go through the use of HICS

HICS Incident Command System that helps improve coordination and response between hospitals and emergency responders by using: Logical management structure Defined responsibilities Clear reporting channels A common nomenclature One of the key focuses of the Joint Commission and the National Incident Management System is community collaboration and coordination. By having one system and one “language” that we all use helps to achieve this goal. ICS used universally by fire, law, public safety, governmental agencies

HICS Features Incident Management Team Chart All hazard approach
Incident Action Planning Job Action Sheet Incident Planning Guides Incident Response Guides HICS Forms Promotes Recovery We will be going over these features of HICS

HICS Resources Where do I find HICS information?
EMSA site – documents available in word, as well as pdf

Basic Incident Command Structure
Incident Commander Planning Section Chief Logistics Section Chief Operations Section Chief Finance/ Administration Section Chief Public Information Officer Liaison Medical/ Technical Specialist(s) Safety This is the basic Incident Command structure Pull out the handout of the Incident Management Team chart and keep it handy Below the Section Chiefs is what is unique to hospitals, and the Medical/Technical Specialists The 4 sections are considered functional groups. Normally on a daily basis we function within departments but during a disaster- don’t want to have duplication, so we move to functional activities in ICS. Only the positions that are needed based on the situation should be activated, no extra clutter (positions) even if you have people to assign to them Modular Organization: Functional Sections Activated as Needed

HICS The system is scalable so that more or fewer positions--depending on the emergency--may be implemented One of the main aspects of HICS is it’s scalability Only activate needed positions Incident Commander is the one position that is always activated. It may be the only position that is activated.

Command Command functions Command consists of:
Maintain overall management of the incident Sets Control Objectives and priorities Devise and approve strategies Ensure mission completion Command consists of: Incident Commander Command Staff The first group we are going to talk about is the Command staff “General staff” are the Section Chiefs

Technical Specialist(s)
Command Incident Commander Public Information Officer Liaison Medical/ Technical Specialist(s) Safety Biological/Infectious Disease Chemical Radiological Clinic Administration Hospital Administration Legal Affairs Risk Management Medical Staff Pediatric Care Medical Ethicist Even if you are not functioning in a command position, it is important to have an understanding of what the other positions, sections are doing We are going to talk about each of these positions

Incident Commander Description / Duties:
Determine scope and magnitude of event and facility impact Activate and direct the Hospital Command Center (HCC) Give overall strategic direction for the hospital Initiate and approve the Incident Action Plan Authorize total facility evacuation if warranted Only position always activated Many facilities are not using the CEO as the IC. The CEO needs to remain available to manage the entire hospital (while the IC manages the Event). The CEO also needs to be available to liaison with the Governing Board.

Public Information Officer
Description / Duties: Communicate with internal and external stakeholders including: Staff Visitors and family Media Determine information to be released Collaborate with local community officials (Joint Information Center) on messages for consistent content Obtains Incident Commander approval on all messages Important position. Need a trained person to do it. Example: spokesperson for the Utah Mine Disaster (the owner) vs spokesperson for the Minnesota Bridge collapse (a PIO). The mine disaster was a media relations disaster. Works closely with the Situation Unit Leader Keep staff informed to decrease rumors Works with the JIC – Joint Information Center. Provide a common community message. Example: Northridge Earthquake boil water messages were different. Reports to: Incident Commander

Safety Officer Description / Duties: Reports to: Incident Commander
Ensure safety of staff, patients and visitors Monitor and have authority over the safety of rescue operations and hazardous conditions Determine safety risks of the incident to personnel, the hospital facility, and the environment Initiate corrective/protective actions for safety issues Completes the HICS form 261, Incident Action Plan Safety Analysis Has authority to halt any operation that poses immediate threat to life and health Safety is separated out from security but they may work closely together Reports to: Incident Commander

Liaison Officer Description / Duties: Reports to: Incident Commander
Hospital Command Center contact for supporting agencies and organizations Make facility needs and requests for assistance and resources Reports to: Incident Commander Contrast with PIO role: Communication with other agencies and facilities involved in incident Single point of contact for outsiders into the Command Center

Medical / Technical Specialist
Description/Duties: Subject matter experts that advise the Incident Commander and/or assigned section. May be assigned as technical advisor in the Hospital Command Center May be assigned to advise and oversee specific hospital operations Example: Decontamination operations during a chemical exposure situation Often determined by the type of event and expertise needed Subject Matter Experts Reports to: Incident Commander

Medical / Technical Specialist
Can Include: Biological Infectious Disease Chemical Radiological Legal Affairs Risk Management Medical Staff Pediatric Care Medical Ethicist Clinical Administration Hospital Administration Briefly go through each example For example the Incident Commander might activate: Legal Affairs / Risk Management – Infant abduction Ethicist – who gets the vents during Pan Flu Reports to: Incident Commander

Command Review The IC is the only position ALWAYS activated
The Incident Commander is responsible for: Management of the Incident Activities within the Hospital Command Center Continuing as Incident Commander until authority is delegated to another The Command Staff consists of: Public Information Officer (PIO) Liaison Officer Safety Officer Medical / Technical Specialist(s)

Sections Incident Commander
Operations Section Chief Planning Section Chief Logistics Section Chief Finance / Administration Section Chief Incident Commander Public Information Officer Liaison Medical/ Technical Specialist(s) Safety In normal day to day operations we have redundant activities through each department--such as staffing, obtaining resources, budget/financials, etc… HOWEVER, during an incident we don’t want that redundancy, so we manage through the functions of each section. For example, Logistics handles the obtaining of resources for the entire incident, Finance handles the budget issues for the entire incident. Command and general staff must continually interact and share vital information and estimates of current and future situation Now we will go through the sections

Sections Sections include: Sections are led by a Chief
Operations Planning Logistics Finance/Administration Sections are led by a Chief Section Chiefs are called General Staff The color coding is also universal with ICS

Operations Section Operations Section Chief Security Branch Director
Staging Manager Security Branch Director Business Continuity Branch Director Infrastructure Branch HazMat Branch Medical Care Branch Outpatient Unit Leader Casualty Care Unit Leader Inpatient Unit Leader Mental Health Unit Leader HVAC Unit Leader Building/Grounds Damage Unit Leader Water/Sewer Unit Leader Medical Gases Unit Power/Lighting Unit Medical Devices Unit Access Control Unit Crowd Control Unit Traffic Control Unit Search Unit Leader Law Enforcement Interface Unit Leader Information Technology Unit Leader Service Continuity Unit Records Preservation Business Function Relocation Unit Leader Spill Response Unit Victim Decontamination Detection and Monitoring Facility/Equipment Decontamination Unit Vehicle Staging Team Equipment/Supply Staging Team Leader Personnel Staging Team Medication Staging Team Clinical Support Services Patient Registration Unit Environmental Services Food Services Unit

Operations Section Operations Section Mission:
Manage tactical operations Direct all tactical resources Carry out the mission and Incident Action Plan Directs all tactical resources Led by a Section Chief Hands on – “DOERS”, boots on the ground

Operations Section The Section includes: Staging Area
Medical Care Branch Infrastructure Branch HazMat Branch Security Branch Business Continuity Branch These will be covered individually, so don’t explain in detail now

Staging Manager Mission:
Organize and manage the deployment of supplementary resources, including personnel, vehicles, equipment, supplies, and medications Staging – “ready to put to use” – waiting for assignment Can be virtual or physical (i.e. personnel staging area – Cafeteria - physical, paper list – virtual) Logistics checks them in, then when the resource is ready, Operations decides how to use the resource This position and Operations have to coordinate with Logistics

Medical Care Branch Director
Mission: Organize and manage the delivery of emergency, inpatient, outpatient, and casualty care, and clinical support services Duties: Address provision of acute & continuous care Work with Logistics for resource acquisition Work with Staging Manager for delivery of resources to areas All the aspects of patient care Will cover the Units in the next slide

Medical Care Branch Director
Supervises: Inpatient Unit Leader (all inpatient units) Outpatient Unit Leader (all outpatient services) Casualty Care Unit Leader (Emergency Department) Behavioral/Mental Health Unit Leader Clinical Support Unit Leader (Lab, Diagnostic Imaging, Pharmacy, Morgue, Blood Donor) Patient Registration Unit Leader Mental Health (soon to be Behavioral ) Unit Leader - Mental health for patients, staff fall under logistics

Infrastructure Branch Director
Mission: Organize and manage the services required to sustain and repair the hospital’s infrastructure operations Duties: Maintain overall facility operations and operating capacity Identify and fixes utility service-delivery failures Assign a strike team to address damage This is for areas that are “broken” or “overwhelmed” Units are covered on the next slide

Infrastructure Branch Director
Supervises: Power/Lighting Unit Leader Water/Sewer Unit Leader HVAC Unit Leader Building/Grounds Unit Leader Medical Gases/Medical Devices Unit Leader Environmental Services Unit Leader Food Services Unit Leader (for inpatients) Food Services Unit Leader will be moving to Logistics (all food services will fall under one person)

Hazmat Branch Director
Mission: Organize and direct hazardous material incident response activities Technical, and emergency decontamination; and facility and equipment decontamination Duties: Oversee hazmat event Decontamination of victims, staff, facility Safe and appropriate use of PPE Clean up operations Collaborates with Medical Care Branch Director Units are covered on the next slide

Hazmat Branch Director
Supervises: Detection and Monitoring Unit Leader Spill Response Team Unit Leader Victim Decontamination Unit Leader Facility / Equipment Decontamination Unit Leader

Security Branch Director
Mission: Coordinate activities related to internal and external personnel and facility security Duties: Implement facility security measures Ensure security and access control of the Hospital Command Center Liaison with responding law enforcement Oversee search and rescue operations Units on next slide

Security Branch Director
Supervises: Access Control Unit Leader Crowd Control Unit Leader Traffic Control Unit Leader Search Unit Leader Law Enforcement Interface Unit Leader For example, the Chief may activate: Search UL – bomb threat Law Enforcement Interface – this is a “liaison” with the operational side of law enforcement. Provide information with them and collaborate on tactics.

Business Continuity Branch Director
Mission: Ensure business functions are maintained, restored or augmented Duties: Facilitate acquisition and access to essential recovery resources, including business records Coordinate IT services with Logistics Section Assist Branches and impacted areas to restore normal operations Business continuity is an area that is greatly overlooked. Business recovery was once the arena only of the IT departments. However, the resumption on “normal” services and recovery of the facility is essential for community health and facility financial viability. It is very important that business continuity be addressed during the response phase and managed throughout recovery. This is if there is a disruption of business activities Units on next slide

Business Continuity Branch Director
Supervises: Information Technology Unit Leader Service Continuity Unit Leader Records Preservation Unit Leader Business Function Relocation Unit Leader IT – if the IT systems (network) is down. We are very dependant on IT nowadays. Electronic Med Records, other IT systems. Service – What other critical services need to be maintained? Records Preservation – what if Med Records get wet or computer network goes down? How can they be restored? Business Function – if the business area is damaged, where can they be relocated so the business functions can be continued?

Operations Section Review
The Operations Section is responsible for: The tactical objectives and organization All tactical operations Directing all tactical resources Operations is led by a Chief Operations positions are activated as needed by the incident

Logistics Logistics are the “Getters” Works closely with Operations
Logistics Section Chief Support Branch Director Service Branch IT/IS Unit Leader Staff Food & Water Unit Leader Communications Unit Leader Family Care Unit Supply Unit Employee Health & Well-Being Unit Facilities Unit Transportation Labor Pool & Credentialing Unit Logistics are the “Getters” Works closely with Operations Logistics takes care of the “Doers”--they get what is needed and take care of the resources

Logistics Section Mission:
Organize and direct maintenance of the physical environment – providing human resources, material, and services to support the incident. Provides support (stuff) to other sections Acquires resources from internal and external sources Through Liaison, links to local Emergency Operations Center (EOC) for resource requests Led by a Section Chief Branches will be covered in next slides

Logistics and Operations
Logistics and Operations are closely linked and must work collaboratively Logistics Section are the “getters” Operations Section are the “doers” Scope and Responsibilities overlap Logistics Supply Unit and Operations’ Infrastructure Branch Labor Pool and Credentialing Unit and Staging Manager– Personnel Team Leader Some actions seem to overlap between the sections but there is a demarcation between them, for example: Personnel Logistics (Labor Pool) “gets” more personnel. Once cleared for use – Staging in Operations holds them for deployment Operations decides how to use them Planning writes the plan of how they will be used and tracks where they ended up Finance calculates how much it will cost

Logistics The Section includes: Service Branch Support Branch
Explained in the next slides

Service Branch Director
Mission: Organize and manage services to maintain hospital communication, food and water supply and information technology and systems Oversees: Communications Unit Leader IT/IS Unit Leader Food and Water Unit Leader Communications Unit Leader - Manages communication hardware, i.e. phones, radios IT/IS Unit Leader - Provide computer hardware, software and infrastructure Coordinates closely with Operations Section Business Continuity Branch, IT Unit Food and Water Unit Leader Organize food and water stores and prepare for rationing during periods of anticipated or actual shortage Coordinates closely with Operations Section Infrastructure Branch, Food Services Unit A future HICS revision will be consolidating patient and staff food services into one position.

Support Branch Director
Mission: Manage supplies, facilities, transportation, and labor pool. Provide logistical, psychological, and medical support to hospital staff and their dependents Oversees: Employee Health and Well-Being Unit Leader Family Care Unit Leader Supply Unit Leader Facility Unit Leader Transportation Unit Leader Labor Pool and Credentialing Unit Leader Employee Health – includes staff Mental/Behavioral Health Family Care – pet care might be a team here or a separate Unit Facility Unit Leader – maintaining day to day facility operations (i.e. light bulbs) as opposed to Infrastructure

Logistics Section Review
The Logistics Section is responsible for: Organizing and directing internal and external resources to support the incident Providing support to other sections Logistics supports the incident resource requirements Logistics has two branches: Support Service Logistics is led by a Chief who works closely with the Operations Section

Planning Section Chief
Situation Unit Leader Documentation Unit Leader Resources Unit Demobilization Personnel Tracking Manager Materiel Tracking Patient Tracking Bed Tracking “Brains” “Thinkers” – they are the keepers of the information, track and document the event. And they do some current/future planning and share information.

Planning Section Mission:
Collect, evaluate, and disseminate incident action information and intelligence to Incident Commander Prepare status report Develop the Incident Action Plan (IAP) Led by a Section Chief How many victims have we received? What is the building status? They don’t take action to fix or do things, they just track the information. What are the major problems? Develop IAP Future projections based on the facts/status information that they are receiving Critical that everyone sends information to Planning

Planning Section Chief
Supervises: Resources Unit Leader Personnel Tracking Material Tracking Situation Unit Leader Patient Tracking Bed Tracking Documentation Unit Leader Demobilization Unit Leader Resources Unit Leader - Keeping track of how resources were used. Essential to the finance section. Situation unit leader should be in HCC with command and section chiefs. This is a very busy position. Documentation Unit Leader – assures paperwork in order. Emergency Planners “best friend”. Demobilization Unit Leader – starts to put together plans to demobilize. What is needed.

Planning Section Review
The Planning Section is responsible for: Collecting, evaluating and disseminating incident situation information to the Hospital Command Center Maintaining resource status Developing the Incident Action Plan (IAP) and obtaining Incident Commander approval on IAP Archiving response and recovery documentation Assisting with After-Action Report development

Finance Finance/ Administration Section Chief Procurement Unit Leader Compensation/ Claims Unit Time Unit Leader Cost Unit Leader Activating Finance in beginning of event or in drills plays an essential role in financial guidance and recovery “Banker” Units are on next slide

Finance / Administration Section Chief
Mission: Monitor the utilization of financial assets and the accounting for financial expenditures. Supervise the documentation of expenditures and cost reimbursement. Keep track of all the costs of an event. Remember to include lost revenue (from cancelled cases).

Finance / Administration Section Chief
Supervises: Time Unit Leader Procurement Unit Leader Compensation/ Claims Unit Leader Cost Unit Leader Time Unit Leader– personnel time Cost Unit Leader– puts together all cost + lost revenue (cancelled surgeries)

Questions? 48

Job Action Sheet Series of action steps to “prompt” team members to take needed actions related to their roles and responsibilities One for each position Includes title, mission/function and duties Adjusted to meet hospital needs Refers to supporting forms

Job Action Sheet Format
OPERATIONS SECTION CHIEF Mission: Develop and implement strategy and tactics to carry out the objectives established by the Incident Commander. Organize, assign, and supervise Staging, Medical Care, Infrastructure, Security, Hazardous Materials, and Business Continuity Branch resources. Date: Start: End: Position Assigned to: Initial: __ Position Reports to: Incident Commander Signature: __ Hospital Command Center (HCC) Location: Telephone: Fax: Other Contact Info: Radio Title: __

Action Steps and Considerations Job Action Sheet provides position action steps and considerations Actions listed by Operational Periods Immediate –2 hours Intermediate –12 hours Extended Beyond 12 hours Demobilization/System Recovery

Immediate (Operational Period 0-2 Hours)
Time Initial Receive appointment and briefing from the Incident Commander. Obtain packet containing Operations Section Job Action Sheets. Read this entire Job Action Sheet and review organization chart (HICS Form 207). Put on position identification. Notify your usual supervisor of your HICS assignment. Determine need to appoint Staging Manager, Branch Directors, and Unit Leaders in Operations Section; distribute corresponding Job Action Sheets and position identification. Complete the Branch Assignment List (HICS Form 204). Brief Operations Section Branch Directors and Staging Manager on current situation and incident objectives; develop response strategy and tactics; outline Section action plan and designate time for next briefing. Participate in Incident Action Plan preparation, briefings, and meetings as needed; assist in identifying strategies; determine tactics, work assignments, and resource requirements. Obtain information and updates regularly from Operations Section Branch Directors and Staging Manager; maintain current status of all areas; inform Situation Unit Leader of status information. Actions common to all positions are listed in blue. All positions have common duties listed on the JAS.

Documents/Tools: A listing of pertinent HICS forms this position is responsible for using Forms noted in Job Action Sheet action steps Other tools that will help them fulfill their role and responsibilities Hospital plans, policies and procedures Technology tools Other adjuncts

Documents / Tools: Operations Chief
Incident Action Plan HICS Form 204 – Branch Assignment Sheet HICS Form 213 – Incident Message Form HICS Form 214 – Operational Log HICS Form 257 – Resource Accounting Record Hospital Emergency Operations Plan Hospital organization chart Hospital telephone directory Radio/satellite phone

Job Action Sheet Use Job Action Sheets are used continuously
Actions in all operational periods should be continued and monitored Job Action Sheets should transfer to your replacement and actions continued Upon shift change or position change Notation of shift change should be documented on JAS when it occurs – do not use new JAS

Job Action Sheet Section Review
The Job Action Sheets are: An incident management tool A series of actions to meet the incident response Are divided in time phases: Immediate: 0-2 hours Intermediate: 2-12 hours Extended : Greater than 12 hours Demobilization/System Recovery Standardized to facilitate interagency response Customizable for the unique facility needs/roles Customize to facility, but keep title and mission the same

Questions? Should be at the first Break here 0930 (1330)
Take about 10 minutes

Hospital Incident Action Planning
Key to Effective Response and Recovery Incident Action Planning is the key to having an organized, logical, planned out response The forms used to make up the IAP vary by incident, but a minimum include: 201, 202, 203, 204 & 261 HICS forms augment the IAP 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 Action planning is what we do on a daily basis: Home – plan your day out, critical items you need to do, take the kids to soccer, MD appointment. Who is going to do what. Evaluate at the end of the day – did you get everything done. Work – review all your s, what do you need to get done now, today. How are you going to get it done, delegate some of it. Evaluate at the end of the day – did you get everything done, what do you have to do first thing tomorrow. Will go over this process in the next slides.

#1 Assess the Situation It is essential to understand the situation:
Gather and analyze information: Hazard/incident type Impact of the hazard/incident on the hospital Expected duration of the incident Incident Commander is responsible for gathering the information from sources (ie-Planning Section, other section chiefs, etc.) The situation must be assessed regularly throughout the response and recovery process How do you know to activate? Is the incident effecting multiple departments? If yes, that may be a good indicator.

#1 Assess the Situation The Incident Commander conducts the initial incident assessment: Type of incident, location, magnitude, possible duration On-going hazards and safety concerns Determine initial priorities based on: 1 - Life saving 2 - Incident stabilization 3 - Property preservation Establishes the Hospital Command Center Sets the initial “Operational Period”

#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 Never shorter than 2 hours Usually the 1st period is 2 hours long. Depends on how fast things are changing, if the situation is still not fully assessed.

#3 Determine Safety Priorities & Establish Control Objectives
“General Command and Control Objectives” Broad organizational objectives that are foundational and do not change during response and recovery--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 hospital personnel These will last through out the whole event Usually has to do with Safety, Patient Care, Dealing with media and other agencies Documented on the HICS 202 Incident Objectives

#4 Determine Operational Period Objectives
More specific objectives to achieve Command and Control Objectives Steps during the defined Operational Period Should be tangible and measurable Example: Provide prophylaxis to hospital staff Conduct decontamination of victims 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 objectives Documented on the 204

#5 Determine Strategies & 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” Some hospital people may be confused by the use of the word “tactical” in ICS. The Operations Section is the boots on the ground, the ones who are mounting the defense and carrying out patient care operations, using equipment, supplies, and personnel resources to accomplish the mission. Therefore, the word “tactics” is used for operations, as they are responsible for managing tactical resources, or the boots/troops on the ground. How are you going to accomplish the objectives Strategy = planning Tactics = hands on

#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 needed resources are identified, assignments are issued: Hospital Command Center positions are activated according to incident needs Staff are assigned to conduct incident specific operations: Evacuation Decontamination Triage and treatment Safety measures Documented on the HICS 204 and 203

#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 Operational Period Objectives Assure 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) 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 (I couldn’t think of a way to reduce these slides, so just go through them quickly)

The Safety Officer Advises the Incident Commander and Section Chiefs on safety issues and measures Develops the Safety Plan (HICS 261) Oversees the safety of operations and tactics

The Planning Section Chief Prepares for the Planning Meetings Gathers information for the Incident Action Plan (HICS 201, 202, 203,204’s and 261) Develops demobilization and contingency plans Conducts the Planning Meeting Coordinates and submits the Incident Action Plan to the Incident Commander for approval Disseminates the Incident Action Plan to all Hospital Command Center personnel Included in your materials is an IAP Coversheet we have developed to help ensure the necessary components of your IAP are included (Have participants look at cover sheet)

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

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

The Finance/Administration Section Chief Provides cost implications of the Control and Operational Period Objectives Ensures the Incident Action Plan is within cost limitations Advises the Incident Commander on Finance/Admin activated positions

Incident Action Plan Section Review The Incident Action Plan
Provides Incident Management Team personnel with direction for the Operational Period Incident Action Planning uses the elements of Management by Objectives General Command and Control Objectives vs. Operational Period Objectives Developed by Command, General Staff provide input Essential for effective response and recovery

Questions?

Demobilization & Recovery

Preparation for Demobilization
The Demobilization Plan is created by the Demobilization Unit Leader Demobilization begins As incident objectives are met Follow-on objectives are more focused upon recovery and returning to “normal” The demobilization of resources no longer Needed should occur rapidly and efficiently

Preparation for Demobilization
Demobilization Considerations Demobilizing must be a part of the Incident Action Plan (the “decision” to demobilize isn’t part of the plan) Managing public perception Equipment rehab and restocking Financial restoration Addressing hospital personnel concerns Managing public perception Hospital reputation can be damaged Demobilization (decreasing response) may be perceived unfavorably by the public May make the public announcement jointly with jurisdictional authorities Publicize that the hospital is recovering and is returning to its normal business operations

Recovery Recovery follows response and focuses upon returning the hospital to baseline level of functioning The starting point for recovery begins early in the response Transition from response to recovery is rarely obvious Recovery may extend over a long time, from weeks to years

Organizational Learning
The Recovery plan includes principles of organizational learning and improvement: After Action Report & Corrective Improvement Plan Evaluate hospital response/recovery operations Identify strengths, weaknesses, and strategies to: Lessen future vulnerability Improve ability to respond to future incidents Revise the Emergency Operations Plan Purpose of the After Action Report Document exercise and response activities Identify operational successes and deficiencies Analyze findings to determine effectiveness and efficiency of the Emergency Operations Plan Plan of action for implementing needed improvements Corrective Action Plans may include: Emergency Operation Plan revision Develop additional plans, P & Ps New equipment, supplies, systems Identify additional training and exercises

Section Review Demobilization & Recovery should be planned early
Demobilization & Recovery is the return to “normal” or “new-normal” in the hospital Demobilization is managed by the Planning Section The development of a Demobilization Plan by the Demobilization Unit Leader Approved by the Planning Section Chief/Incident Commander

Questions?

Scenarios: External Considering the Hazard Vulnerability Analysis – there are 14 National Planning Scenarios (External) to assist in planning and training: Nuclear Detonation, Radiological Attack Bio Attack (Anthrax, Food Contamination) Pandemic Chemical Attack (Blister, Toxic, Nerve Agent, and Chlorine) Natural Disaster (Earthquake and Hurricane) Explosives Cyber Attack These are based on the Federal Planning Scenarios

Scenarios: Internal Considering the Hazard Vulnerability Analysis – there are 13 Internal Scenarios to assist in planning and training Bomb Threat Evacuation Fire HazMat Spill Hospital Overload Infant/Child Abduction Internal Flooding Loss of HVAC Loss of Power Loss of Water Severe Weather Hostage/Barricade Work Stoppage The HICS workgroup came up with 13 Internal event scenarios

Incident Planning Guides (IPGs)
Incident Planning Guides assist hospitals with evaluating existing plans or writing needed plans The IPGs address the 27 scenarios They are intended to promote more thorough plans For each of the 27 scenarios IPGs were developed These are used in the planning process

Incident Response Guides
Provides Incident Specific: Directions Objectives Management tasks by function according to timeframes Sample Incident Management Teams Should complement: Emergency Operations Plan Job Action Sheets Can be used as documentation For each of the 27 scenarios there are IRGs These are great tools / cheat sheets We will utilize these in our practice tabletop

Section Review Incident Planning Guides and Incident Response Guides
Are incident-specific tools to assist with planning, training and response/recovery Assist in meeting regulatory requirements Guide Command and General Staff with decision-making and actions Should be consistent with the Emergency Operations Plan Do not replace the Job Action Sheets

Questions?

HICS Forms

The Value of Using HICS Forms
Serves as a road map in response: everyone acting from the same plan Serves as foundation for corrective action Ensures consistency and compliance with regulatory guidelines Complies with documentation for FEMA reimbursement The forms are essentials tools: - they help to document and guide the Incident Action Planning Process - the County Emergency Operations Center is utilizing similar forms - the forms match up with FEMA forms - necessary for federal reimbursement for an event Documentation is mandated – this is a common form to use

HICS Forms No. Name Responsible 201 Incident Briefing
Incident Commander 202 Incident Objectives Section Chiefs 203 Organizational Assignment List Resource Unit Leader 204 Branch Assignment List Branch Directors 205 Communications Log Communications Unit Leader 206 Staff Medical Plan Support Branch Director 207 Organization Chart 213 Incident Message Form All Positions 214 Operational Log Command Staff, General Staff, and Branch Directors 251 Facility System Status Report Infrastructure Branch Director These 2 slides are the lists of HICS forms The light blue highlighted forms are the minimum forms used in the Incident Action Planning Process

HICS Forms No. Name Responsible 252 Section Personnel Time Sheet
Section Chiefs 253 Volunteer Staff Registration Labor Pool & Credentailiting Unit Leader 254 Disaster Victim / Pt Tracking Patient Tracking Manager 255 Master Pt Evacuation Tracking 256 Procurement Summary Report Procurement Unit Leader 257 Resource Accounting Record 258 Hospital Resource Directory Resource Unit Leader 259 Hospital Casualty / Fatality Report 260 Patient Evacuation Tracking Form Inpt Unit Leader Outpt Unit Leader, Casualty Care Unit Leader 261 Incident Action Plan Safety Analysis Safety Officer

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 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

Have participants look at the form

HICS Form 202: Incident Objectives
Purpose: Defines objectives and issues for operational period Instructions: General Command and Control Objectives for the Incident Weather/Environmental Implications for the Period General Safety/Safety Messages Attachments Prepared by Planning Chief Approved by: Incident Commander

Point out the highlights on the form

HICS Form 203: Organization Assignment List
Purpose: To document Hospital Command Center staffing Origination: Resources Unit Leader Copies to: Command Staff and General Staff Branch Directors and Agency Staff Documentation Unit Leader

HICS Form 204: Branch Assignment List
Purpose: Document branch assignments, operational period objectives, strategies/tactics and resource needs Origination: Branch Director Copies to: Command, General Staff & Documentation Unit Leader Prepared by: Branch Director Approved by: Planning Section Chief When to complete: At the start of each operational period A 204 is filled out by each branch. So if you activated 3 branches in the Operations Section, you should end up with three 204s from the Operations Section. For sections like Planning and Finance that don’t have branches, you would just have one for the whole section

7a. Operational Period Objectives
7b. Strategies/Tactics 7c. Resources Available

A second page has been added to this form that includes additional space for documenting the operational period objectives, strategies/tactics and resources available

HICS Form 261: Incident Action Plan Safety Analysis
Purpose: Document hazards and define mitigation Origination: Safety Officer Copies to: Command & General Staff, Sections & Branches Prepared by: Safety Officer Approved by: Incident Commander When to complete: Prior to safety briefing

HICS Form 261 This is the Incident Action Plan Safety Analysis form
To be filled out by the Safety Officer

HICS Form 213: Incident Message Form
Purpose: Provide standardized method of recording messages received by phone, radio or verbally Instructions Reply requested: Indicate whether a reply was requested and to whom reply should be addressed Priority: Indicate level of urgency of the message Message: Keep all messages/requests brief, to the point, and very specific Transcribe complete, concise, and specific content of message. Action Taken (if any) 3 types of information must be documented - Assignments made - Resources requested - Status updates If they are not documented elsewhere this form, then the information can be passed on with this form If a request is made the response can be documented on this form

HICS FORM 214: Operational Log
Purpose: Document Incident issues encountered Decisions made Notifications conveyed Origination: Command and General Staff When to complete: Continuously, from activation through demobilization 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

Section Review The HICS forms:
Provide the Incident Management Team with the documents needed to manage a response Assist in communication with external agencies and resources Assist in communication with hospital staff Provide documentation for response and recovery activities

Questions?

Management System & Tools for Events
HICS Basics Part 1 Management System & Tools for Events developed by the California Hospital Association’s Hospital Preparedness Program Aim is to be done with this section by 1015 (1415) Optional-Before the Break – Make assignments for the following positions (use the local coordinator to help figure them out, can use table tents) - Incident Commander - Safety Officer - PIO - Liaison - Each section chief Take a 15 minute break Get ready for Part 2 - put the vests on the tables (optional) - start up Part 2 on the computer 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.

Hospital Incident Command System

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Hospital Incident Command System

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