Hospital Incident Command System

Hospital Incident Command System
HICS Basics Part 1 Management System and Tools for Events Updated with May 2014 HICS Revisions Instructor Notes: Introductions – Instructor, class members 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 Hospital Incident Management Team Understand the principles of Incident Action Planning These are the objectives for HICS Basics Part I. Learn the principal concepts and features of the Hospital Incident Command System Understand the roles and relationships of the Hospital Incident Management Team Understand the principles of Incident Action Planning The benefits of using HICS include: 1) Efficient and coordinated response to emergencies; 2) Seamless integration in the Multi-Agency Coordination System (MACS) with community response partners; used by fire, law, public safety, governmental agencies. Provides for community collaboration and coordination. 3) National Incident Management System (NIMS) consistence; 4) Federal preparedness and response grant consistence; and 5) Accreditation consistence Instructor Notes: 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 Overview Assists in emergency management planning, response, and recovery capabilities for unplanned and planned events Consistent with ICS and the National Incident Management System (NIMS) principles Logical management structure Defined responsibilities Clear reporting channels Common nomenclature HICS is a comprehensive all-hazards incident management strategy that:  Is a model for hospital emergency management systems and is used both nationally and internationally.  Can be used in both emergent and non-emergent incidents and events. Some hospitals only see HICS as a system to manage emergency incidents. However, the modular design and flexibility of HICS lends itself to managing non-emergency incidents or events, such as moving patients within the facility, dispensing medication to hospital staff, annual influenza vaccination programs or hosting a large hospital or community event. HICS is based on fundamental elements: 1) Predictable chain of command with a suggested span of control 2) Accountability of position and team function, including prioritized action checklists 3) Common language for promoting interagency communication 4) A flexible and scalable incident management system addressing planning and response needs of any size hospital with universal applicability 5) Modular design and adaptability allowing planning and management of non-emergent incidents or events 6) Guidance requirements from the NIMS and accreditation agencies regarding hospital use of incident command system principles in unity of effort with community response partners 7) Management by Objectives in which the problem encountered is evaluated, a plan to remedy the problem identified and implemented, and the necessary resources assigned Instructor Note: 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. 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 2014 Revision - The Hospital Incident Command System (HICS) is an incident management system that can be used by any hospital to manage threats, planned events, or emergency incidents. As a system, HICS is extremely useful; not only does it provide an organizational structure for incident management but it also guides the process for planning, building, and adapting that structure. Using HICS for every incident or planned event helps hone and maintain skills needed for the large scale incidents.

What HICS is Not HICS is not:
HICS does not replace or supplant daily hospital operations The HICS Guidebook does not replace the hospital’s Emergency Operations Plan HICS is not meant to replace the everyday organization design. The HICS organization structure frequently does not correlate to the daily administrative structure of the hospital. This practice is purposeful and done to reduce role and title confusion. The HICS Guidebook does not serve as the hospital’s Emergency Operations Plan. Each hospital is unique and requires a detailed, all-hazards EOP with specific functional annexes to address special situations and threat scenarios.

HICS Features Hospital Incident Management Team Chart
All hazard approach Incident Action Planning Job Action Sheet Incident Planning Guides Incident Response Guides HICS Forms Promotes Recovery Instructor Notes: We will be going over these features of HICS HICS 2014 Revision - The word “hospital” was added to the Incident Management Team to differentiate between federal and state Incident Management Teams

HICS Resources Where do I find HICS information?
vices_division_hospital_incident_comma nd_system Instructor Note: The documents are 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 Instructor Notes: This is the basic Incident Command structure Pull out the handout of the Hospital 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 Modular Organization: Functional Sections Activated as Needed

Hospital Incident Command System
The system is scalable so that more or fewer positions--depending on the emergency--may be implemented Instructor Notes: 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 incident objectives and priorities Devise and approve strategies Ensure mission completion Command consists of: Incident Commander Command Staff Instructor Notes: The first group we are going to talk about is the Command staff. The “General staff” are the Section Chiefs

Technical Specialist(s)
Command Chemical Clinic Administration Biological/Infectious Disease Hospital Administration Legal Affairs Medical Ethicist Medical Staff Pediatric Care Radiological Risk Management Incident Commander Public Information Officer Liaison Medical/ Technical Specialist(s) Safety Instructor Notes: 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 Give overall strategic direction for the hospital Initiate and approve the Incident Action Plan Authorize total facility evacuation if warranted Only position always activated The Incident Commander is the only position always activated in HICS. The Incident Commander is responsible for the management of the incident within the hospital. The Incident Commander directs all of the activities within the Hospital Command Center, sets the operational periods, and devises strategies and priorities to address those objectives that are communicated in the Incident Action Plan. Instructor Note: Many facilities are not using the CEO as the Incident Commander. 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) for consistent content Obtains Incident Commander approval on all messages The Public Information Officer (PIO) is responsible for coordinating information sharing inside and outside the hospital. He/she serves as a conduit for information to internal personnel and external stakeholders, including the media or other organizations/agencies. Instructor Note: This is an important position and requires a trained person in the position. 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 Initiate corrective/protective actions Completes the HICS form 215A, Incident Action Plan Safety Analysis Has authority to halt any operation that poses immediate threat to life and health The Safety Officer monitors hospital response operations to identify and correct unsafe practices. He/she institutes measures for assuring the safety of all assigned personnel. Reports to: Incident Commander

Liaison Officer Description/Duties:
Hospital Command Center contact for supporting agencies and organizations Make facility needs and requests for assistance and resources The Liaison Officer is the hospital’s primary contact for external agencies assigned to support the hospital during incident response. In some cases, a Liaison Officer may be assigned to the Hospital Command Center and a Deputy Liaison Officer or Assistant (or an Agency Representative) assigned to represent the hospital at the field Incident Command Post or local emergency operations center Instructor Note: Contrast the Liaison Officer with the Public Information Officer role, including communication with other agencies and facilities involved in incident Reports to: Incident Commander

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 Medical-Technical Specialists are persons with specialized expertise in areas such as infectious disease, legal affairs, risk management, medical ethics, etc., who may be asked to provide the HIMT staff with needed insight and recommendations. Medical-Technical Specialists may be assigned anywhere in the HICS structure as needed. Reports to: Incident Commander

Medical/Technical Specialist
Examples Include: Biological Infectious Disease Chemical Radiological Legal Affairs Risk Management Medical Staff Pediatric Care Medical Ethicist Clinical Administration Hospital Administration Instructor Notes: 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 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 Finance / Administration Section Chief Incident Commander Public Information Officer Liaison Medical/ Technical Specialist(s) Safety Depending on the event, other General Staff positions (e.g., Operations, Planning, Logistics, and Finance/Administration Section Chiefs) may be activated by the Incident Commander. Qualified personnel assigned to serve as Section Chiefs receive a briefing, their names are recorded on the Hospital Incident Management Team chart, and their appointment is announced as outlined in the hospital’s Emergency Operations Plan> Instructor Note: 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 Logistics Section Chief

Sections Sections include: Operations Planning Logistics
Finance/Administration Sections are led by a Chief Section Chiefs are called General Staff

Operations The Operations Section manages all incident tactical activities and implements the Incident Action Plan (IAP). This section is typically the largest due to the role of management and coordination of immediate resources needed to respond to the incident. Branches and units are implemented as needed to maintain a manageable span of control and streamline the organizational management. The number of positions activated depends on situational needs and the availability of qualified staff.

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

Operations Section The Section includes: Staging Area
Medical Care Branch Patient Family Assistance Branch Infrastructure Branch HazMat Branch Security Branch Business Continuity Branch The Medical Care, Infrastructure, Security, Hazardous Materials (HazMat), Business Continuity, and Patient Family Assistance Branches are included in the Operations Section because each of these areas provides services that are essential for supporting the mission of delivering patient care in the challenging circumstances of the immediate incident and not simply routine day-to-day logistical support. For example, the facilities personnel in the Infrastructure Branch are providing for the utility needs for the incident; security personnel are maintaining order; and the information technology and business continuity personnel are keeping the computerized systems operational for information sharing and record keeping among various areas of the hospital. In some internal emergencies (e.g., child abduction, water outage, or computer system failure) the function of one or more of these areas becomes an essential part of restoring normal operations. HICS 2014 Revision - To separate patient and employee family assistance, a Patient Family Assistance Branch has been added under the Operations Section to address patient family needs during a response, and an Employee Family Care Unit Leader has been included in the Support Branch within the Logistics Section to assist healthcare staff and clinicians by providing support for their families. Instructor Note: All of these branches will be covered individually, so you do not need to explain in detail now

Staging Manager Mission:
Organize and manage the deployment of supplementary resources, including personnel, vehicles, equipment, supplies, and medications The Staging Manager works closely with the Logistics Section to learn what is needed and ensure that the requested item(s) are delivered to the correct location as soon as possible. In turn, the Logistics Section works to obtain those needed items and directs their arrival to the Staging Area as outlined in the Emergency Operations Plan (EOP) and/or at the request of the Staging Manager. In situations where the number of staged items is too great or must be kept in separate locations, a team leader can be assigned to coordinate each type of asset being staged (e.g., Personnel Staging Team Leader, Vehicle Staging Team Leader, Equipment/Supply Staging Team Leader, and Medication Staging Team Leader). Instructor Notes: Staging – “ready to put to use” – waiting for assignment The Staging Area can be virtual or physical (i.e. personnel staging area – Cafeteria - physical, paper list – virtual)

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 and continuous care Work with Logistics for resource acquisition Work with Staging Manager for delivery of resources to areas The Medical Care Branch is responsible for providing care to the incident victims, non-incident related arrivals, as well as patients already within the hospital.

Medical Care Branch Director
Supervises: Inpatient Unit Leader (all inpatient units) Outpatient Unit Leader (all outpatient services) Casualty Care Unit Leader (Emergency Department) Behavioral Health Unit Leader Clinical Support Unit Leader (i.e., Lab, Diagnostic Imaging, Pharmacy, Morgue, Blood Donor) Patient Registration Unit Leader The Medical Care Branch coordinates inpatient services (Inpatient Unit), outpatient services (Outpatient Unit), behavioral health services (Behavioral Health Unit), clinical support services (Clinical Support Services Unit), and patient registration services (Patient Registration Unit). The Medical Care Branch Director works with the Logistics Branch to ensure needed personnel, equipment, medication, and supplies. The Casualty Care Unit Leader is often located in the emergency department but can appoint additional personnel to coordinate triage and treatment activities elsewhere on the campus. These activities are conducted in accordance with the hospital’s Emergency Operations Plan (e.g., separation of victims into triage categories such as Immediate, Delayed, and Minor treatment areas). Patients arriving at the hospital must be quickly triaged to a treatment location for expedited medical care. If activated, the Triage Unit Leader’s treatment priority (triage category) should be plainly identified on a patient’s tag or band. A quick but reliable registration process should be implemented by the Patient Registration Unit to avoid delays in medical care and facilitate patient tracking. The daily registration process can be reinstituted once the incident is stabilized and staffing allows.

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 personnel to address damage

Infrastructure Branch Director
Supervises: Power/Lighting Unit Leader Water/Sewer Unit Leader HVAC Unit Leader Building/Grounds Unit Leader Medical Gases Unit Leader The maintenance of overall hospital facility operations support activities to meet the medical care needs of the patients and protect staff. The responsibility for maintaining facility operations primarily rests with the Infrastructure Branch in the Operations Section. Maintenance of the normal operational capability of the facility includes power and lighting (Power/Lighting Unit), water and sewer (Water/Sewer Unit), heating, ventilation, and air-conditioning (HVAC Unit), medical gases (Medical Gases Unit), and building/grounds (Building/Grounds Damage Unit). This branch is responsible for maintaining or potentially expanding operating capacity as well as identifying and fixing utility service delivery failures. Instructor Note: Units are covered on the next slide

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 Instructor Note: Security Units are addressed 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 The Security Branch coordinates all activities related to patient, staff, and hospital security. A significant number of actions should be considered early in an incident:  Secure and restrict access  Supplemental security staffing  Traffic control  Personal belongings management  Evidence collection and chain-of-custody considerations

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 The HazMat Branch will have the personnel and equipment to address agent identification (Detection and Monitoring Unit), spill response (Spill Response Unit), victim decontamination (Victim Decontamination Unit), and decontamination of equipment and the hospital Instructor Note: HAZMAT Branch 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

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 The function of the Business Continuity Branch is to assist impacted hospital functions, departments and areas to maintain, restore, or augment critical business functions, and meet the designated recovery objectives and recovery strategies outlined in the Incident Action Plan. The Business Continuity Branch:  Ensures the continued effective and efficient operation of the hospital's information system and information technology  Facilitates the acquisition of and access to essential recovery resources, including business records  Supports the Infrastructure and Security Branches with needed movement or relocation to alternate business operation sites.  Coordinates with Logistics Section Communications Unit Leader, Information Technology/Information Services Equipment Unit Leader, and the impacted area(s) to expand and/or restore business functions and review technology requirements.  Maintains and repairs information technology equipment with logistical support from the IT/IS Equipment Unit Leader in the Service Branch of the Logistics Section.  Assists other branches and impacted areas with the restoration and resumption of normal operations. Instructor Note: 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. Business Continuity Branch Units are addressed on the next slide

Business Continuity Branch Director
Supervises: IT Systems and Applications Unit Leader Service Continuity Unit Leader Records Management Unit Leader Instructor Note: If the IT systems (network) is down, we are very dependent on IT, including Electronic Medical Records, and other IT systems. Ask the class: 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?

Patient Family Assistance Branch Director
Mission: Organize and manage assistance for patient family care needs, including communication, lodging, food, health care, spiritual, and emotional needs that arise during the incident. Duties: Ensure patient family assistance resources Coordinate external community resource requests Ensure Family reunification, Social Service, Cultural and Spiritual needs Communication with law, government and non- governmental agencies, and media through the Liaison Officer and Public Information Officer When large numbers of patients are received at a hospital the Patient Family Assistance Branch may be activated to assist in meeting their needs. Family support should be provided in a secure location suitable in size to accommodate the number of families being assisted. Refreshments for their consumption should be obtained from the Food Services Unit Leader and the availability of phones should be coordinated with the Communications Unit Leader. The Social Services Unit Leader will work with the families to address their behavioral health needs and other general support requirements. The Family Reunification Unit Leader will take the lead in assisting a family to locate their loved one or friend through the hospital's patient tracking program (working with the Planning Section’s Patient Tracking Manager) or the community’s patient location system

Patient Family Assistance Branch Director
Supervises: Social Services Unit Leader Family Reunification Unit Leader The mission of the Social Services Unit Leader is to organize and manage patient social service requirements during a disaster, by coordinating with community and government resources. The Unit addresses: Housing, shelters and authorized care sites Food and water distribution centers and resources Clothing distribution centers Community warming and cooling stations Medical and non-medical transportation Pharmacies, including 24 hour availability Pet and animal shelters Translator services, such as ATT Child, adult, and dependent day care Access to government services Insurance response and coordination centers Interface with Faith-based organizations Interface with the American Red Cross Interface with the Salvation Army Family Reunification Unit Leader organized and managed the services and processes required to assist in family reunification. Family unification area, protocols, including: identification, tracking, documentation, and communication. Resources, cultural and spiritual, interpreter services, transportation needs

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 Instructor Note: Logistics are the “Getters”
Logistics works closely with Operations Logistics takes care of the “Doers” - they get what is needed and take care of the resources

Logistics Section 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 for resource requests Led by a Section Chief The Logistics Section provides for all the support needs of the incident. These responsibilities include acquiring resources from internal and external sources, using standard and emergency acquisition procedures as well as requests to other hospitals, corporate partners, and the local emergency operations centers (EOC) or the Regional Hospital Coordination Center (RHCC) or equivalent. Instructor Note: Logistic Section 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 Tracking Manager Instructor Note: 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 Section The Section includes: Service Branch Support Branch
The Service Branch is responsible for supporting communication (Communications Unit); information technology/information services resource needs (Information Technology/Information Services [IT/IS] Equipment Unit); and food services for patients and staff (Food Services Unit). The Support Branch is responsible for acquiring needed supplies (Supply Unit); coordinating internal and external transportation (Transportation Unit); acquiring and credentialing additional personnel (Labor Pool and Credentialing Unit); employee health and behavioral health (Employee Health and Well-Being Unit); and staff family care (Employee Family Care Unit).

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 and Equipment Unit Leader Food Services Unit Leader Instructor Notes: Communications Unit Leader - Manages communication hardware, i.e. phones, radios IT/IS Unit and Equipment Unit Leader - Provide computer hardware, software and infrastructure Coordinates closely with Operations Section Business Continuity Branch, IT Unit Food Services Unit Leader Organize food and water stores and prepare for rationing during periods of anticipated or actual shortage

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 Employee Family Care Unit Leader Supply Unit Leader Transportation Unit Leader Labor Pool and Credentialing Unit Leader Instructor Notes: Employee Health – includes staff Mental/Behavioral Health Employee 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 position deleted

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 The Planning Section collects, evaluates, and disseminates situational information and intelligence regarding incident operations and assigned resources, conducts planning meetings, and prepares the Incident Action Plan for each operational period. The effectiveness of the Planning Section has a direct impact on the availability of information needed for the critical strategic decision-making done by the Incident Commander and the other General Staff positions. Instructor Note: The Planning Section personnel are the “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 Led by a Section Chief Instructor Note: Ask the class about information gathering and plan development – 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 and Incident Action Plan 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 Materiel Tracking Situation Unit Leader Patient Tracking Bed Tracking Documentation Unit Leader Demobilization Unit Leader The Resources Unit Leader tracks the status of personnel and material resources that are being utilized in various locations of the hospital. Personnel Tracking and Materiel Tracking Managers may be appointed to assist when necessary. The Situation Unit Leader is responsible for writing and maintaining situational updates based on internal and external events, including those related to patient tracking and bed tracking. These managers maintain current patient location assignments/bed capacity and make this information available to Hospital Incident Management Team personnel as well as the local emergency operations centers and other appropriate external agencies through the Liaison Officer. Monitoring the media (TV, radio, and print) will also provide needed situational awareness and should be performed by the Situation Unit Leader unless assigned to other personnel. Important information may be displayed using tracking boards, chart pads, or computer software programs. The Documentation Unit Leader completes the Incident Action Plans and other supporting documents and archives them based on instructions from the Incident Commander or the Emergency Operations Plan. Assures documentation is in order, key role to the emergency planner. The Demobilization Unit Leader is responsible for developing demobilization activities (e.g., a Demobilization Plan) for approval by the Incident Commander, presenting the plan to designated Command Staff and revising the plan as needed once implementation is underway. The HICS 221: Demobilization Check-Out may be used as part of demobilization activities

Planning Section Chief
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 Section The Finance/Administration Section coordinates personnel time (Time Unit); orders items and initiates contracts (Procurement Unit); arranges personnel-related payments and Workers’ Compensation (Compensation/Claims Unit); and tracks response and recovery costs and payment of invoices (Cost Unit). Instructor Note: Activating Finance in beginning of event or in drills plays an essential role in financial guidance and recovery Finance Section Units are on the 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. The Finance Section Chief keeps track of all the costs of an event. Instructor Note: 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 Instructor Notes: Time Unit Leader– personnel time Cost Unit Leader– puts together all cost + lost revenue (cancelled surgeries)

The Hospital Incident Management Team
Putting it all together: Choosing the Hospital Incident Management Team: Incident Commander is the only position that must be included The Incident Commander chooses down to the Chief Level Each Chief appoints positions in their section needed to complete the mission based on available personnel Both the Incident Commander and the Chiefs assign positions only as determined by the scope and magnitude of the incident in keeping with the principle of scalability, which is important during an emergency.

Questions? 52

Job Action Sheets 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 The Job Action Sheet (JAS) is an incident management tool designed to familiarize the user with critical aspects of the management position he or she is assuming. Information provided on a JAS includes the position title and mission, to whom the position reports, and critical action considerations. These tasks are intended to prompt the Hospital Incident Management Team members to take needed actions related to their roles and responsibilities. The JAS format allows for personnel to document each action taken at specific times. The JAS also depicts the position within the HIMT and highlights reporting relationships. HICS 2014 Revision: The JAS have been extensively revised and include action steps sectioned into time frames.

Job Action Sheet Format
Operations Section Chief Mission: Develop and implement strategies and tactics to carry out the objectives established by the Incident Commander. Organize, assign, and supervise the resources of the Staging Area, the Medical Care, Infrastructure, Security, Hazardous Materials (HazMat), Business Continuity, and Patient Family Assistance Branches.

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

Determine the incident objectives, tactics, and assignments
Immediate Response (0-2 Hours) Time Initial Receive appointment Obtain a briefing from the Incident Commander on: o Size and complexity of the incident o Expectations of the Incident Commander o Incident objectives o Involvement of outside agencies, stakeholders, and organizations o The situation, incident activities, and any special concerns Assume the role of Operations Section Chief Review this Job Action Sheet Put on position identification (e.g., position vest) Notify your usual supervisor of your assignment Assess the operational situation Obtain information and status from the Staging Manager, and the Medical Care, Infrastructure, Security, Hazardous Materials (HazMat), Business Continuity, and Patient Family Assistance Branch Directors Provide information to the Incident Commander on the operational situation including capabilities and limitations Determine the incident objectives, tactics, and assignments Determine which Operations Section functions need to be activated

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
HICS Organization Assignment List HICS Assignment List  HICS 205A - Communications List  HICS General Message Form  HICS Activity Log  HICS 215A - Incident Action Plan (IAP) Safety Analysis  HICS Demobilization Check-Out  HICS Facility System Status Report  HICS Section Personnel Time Sheet  HICS Disaster Victim/Patient Tracking  HICS Master Patient Evacuation Tracking  HICS Resource Accounting Record  HICS Hospital Casualty/Fatality Report  HICS Patient Evacuation Tracking  Hospital Emergency Operations Plan  Incident Specific Plans or Annexes  Hospital organization chart  Hospital telephone directory  Telephone/cell phone/satellite phone/internet/amateur radio/2-way radio

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

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 response time periods: 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 Instructor Notes: You may customize the Job Action Sheets to facility, but keep title and mission the same

Questions?

Hospital Incident Action Planning
Key to Effective Response and Recovery Incident action planning is a core concept for a successful response and recovery from any incident. Developing and utilizing an Incident Action Plan (IAP) provides the goals, strategies, and tactics to facilitate the Management by Objectives (MBO) and ensures understanding of the strategic direction. The planning process is effective for both smaller, short-term incidents and more complicated long-term incidents and the IAP is scalable (e.g., HICS IAP Quick Start versus a fully documented IAP). Incident action planning provides the following benefits:  Provides the organization’s strategic direction  Maximizes available resources  Reduces omissions and duplication of efforts  Reduces cost  Gathers and disseminates information  Improves and enhances communication  Provides a historical record of the incident Instructor Note: Incident Action Planning is the key to having an organized, logical, planned out response The forms used to make up the Incident Action Planning vary by incident, but a minimum include: 201, 202, 203, 204 & 215A, and the IAP QuickStart may also be used at the beginning of an event or for smaller incidents HICS forms augment the Incident Action Planning process

Hospital Incident Action Planning
Assess the Situation Set the Operational Period Determine Safety Priorities and Establish Incident Objectives Determine Branch/Section Objectives Determine Strategies and Tactics Determine Needed Resources Issue Assignments Implement Actions Reassess & Adjust Plans Instructor Note: 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. We sill cover this process in the following slides.

#1 Assess the Situation The Incident Commander conducts the initial incident assessment: Type, 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 time period scheduled for execution 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 The operational period is the time period in which chosen objectives are to be met and identified strategies and tactics are carried out. This time period is flexible, may be of various lengths, and is determined by the Incident Commander according to the needs of the incident. The length of the operational period varies, usually between 2 and 24 hours. The operational period does not need to correspond to hospital shift times and may be shortened or extended based on situational response and incident progression. Instructor Note: The Operational Period is almost 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 Incident Objectives
Broad organizational objectives that are foundational and do not change during response and recovery; 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 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 and initiates the HICS 215A: Incident Action Plan (IAP) Safety Analysis. The Incident Commander determines the initial incident objectives. The incident objectives are documented on the HICS 201: Incident Briefing and the HICS 202: Incident Objectives. (Individual sections, branches and units will identify strategies and tactics for their response (HICS 204: Assignment List) based on these objectives set by the Incident Commander which is done in Step 4.) The Planning Section Chief initiates the HICS 202: Incident Objectives which includes:  Incident name  Operational period date and time  Incident objectives, as obtained from the Incident Commander  Weather and environmental implications for the operational period to include as appropriate (e.g., forecast, wind speed and direction, daylight, etc.)  Factors to consider (refer to the HICS 215A: Incident Action Plan (IAP) Safety Analysis)  Date prepared  Time prepared  Incident Commander approval Instructor Note: 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 Individual Section/Branch Objectives
More specific Branch/Section objectives to achieve overall Incident Objectives Steps during the defined Operational Period Should be tangible and measurable Example: Provide prophylaxis to 75% of direct patient care staff within 2 hours Decontaminate 50 victims within 1 hour Additional incident objectives will be identified by Section Chiefs and/or Branch Directors to be addressed in the specified operational period. These incident objectives will comprise a section/branch/unit–specific set of strategies, tactical actions, and resources identified to address the priorities for the operational period and accomplish the incident objectives. Documentation includes:  Section Chiefs and/or Branch Directors complete the HICS 204: Assignment List stating section/branch/unit-specific incident objectives  The HICS 204: Assignment Lists are submitted to the Planning Section and distributed to Command, General Staff, and Documentation Unit Leader as part of the Incident Action Plan Instructor Note: These are the individual Section/Branch 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 These individual incident objectives are documented on an individual 204 for each Section/Branch/Unit

#5 Determine Strategies and Determine Strategies and Tactics
Strategy defined: The general direction selected to accomplish incident objectives 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” Strategies are the general plans or directions selected to accomplish incident objectives for individual sections. Tactics are the short-term, specific actions taken to complete, or satisfy, the incident objectives (e.g., the directing/deployment of resources during an incident). The Section Chiefs and Branch Directors document strategies and tactics on the HICS 204: Assignment List. Instructor Note: 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. Ask class, “How are you going to accomplish the objectives?” Strategy = planning Tactics = hands on

#6 Determine Needed Resources
Available and needed resources to meet the objectives must be identified Tactical resources may include: Personnel Equipment Supplies Pharmaceuticals Vehicles The next step is to identify needed resources. Examples of needed resources include personnel, equipment, supplies, pharmaceuticals, and vehicles. Just as in daily operations, there are many components to resource identification, requisition, distribution, and restocking. The following must be ensured:  Section Chiefs coordinate with Branch Directors and Unit Leaders to determine needed resources within their specific section  Logistics Section Chief confers with Operations Section Chief to coordinate obtaining the resources  Finance/Administration Section Chief confers with Logistics and Operations Section Chiefs to assure appropriate financial tracking as individual sections identify resource needs Documentation includes:  HICS 204: Assignment Lists are used to document specific resources needed within the section/branch/unit  Logistic Section Communication Unit Leader completes the HICS 205A: Communications List to identify communication resources and designate equipment and channels to be used within the hospital and for coordination with internal and external partners  Logistic Section Employee Health and Well-Being Unit Leader completes the HICS 206: Staff Medical Plan to outline resources for medical care of injured/ill hospital personnel, as needed

#7 Issue Assignments Once the 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 The next step is for the Section Chiefs, Branch Directors, and Unit Leaders to make staff assignments specific to response action (e.g., Triage, Evacuation, Decontamination, Security). This step includes completion and distribution of the following:  HICS 204: Assignment List documents specific assignments within each section/branch/unit activated  The Planning Section Chief, or designee (Resource Unit Leader) completes the HICS 203: Organization Assignment List and distributes to Command and General Staff, Branch Directors and Documentation Unit Leader

The Planning Meeting The Planning Meeting is:
HICS Across The Sections: Connecting the Incident Action Plan to the Incident Management Team & Response The Planning Meeting The Planning Meeting is: Led by the Planning Section Chief Defines and finalizes operational period objectives, strategies, tactics, and resources as determined by each section for the next operational period Followed by: Incident Commander approval and duplication of sufficient copies for dissemination.

The Planning Meeting The Planning Meeting is conducted after:
HICS Across The Sections: Connecting the Incident Action Plan to the Incident Management Team & Response The Planning Meeting The Planning Meeting is conducted after: Incident Commander has provided an incident briefing and determined the Incident Objectives and identified the Operational Period Sections have met to discuss their response priorities and identified Section/Branch objectives Followed by: Incident Commander approval and duplication of sufficient copies for dissemination. Refer to Planning handout 4 from “HICS Across Sections”

The Planning Meeting At the end of the Planning Meeting:
HICS Across The Sections: Connecting the Incident Action Plan to the Incident Management Team & Response The Planning Meeting At the end of the Planning Meeting: The Section Chiefs submit completed HICS Form 204 Assignment List The Safety Officer submits completed HICS Form 215A Incident Action Plan Safety Analysis

#8 Implement Actions Direct, monitor and evaluate response:
Constant monitoring of strategies and tactics for effectiveness Assess the Branch/Section 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 The next step is to implement actions. Supervisors meet with their staff for a detailed briefing on their assignments using the approved Incident Action Plan (IAP). Staff members are directed to complete their assignments and to report their activities.

#9 Evaluate and Revise Plans
Conduct a current situation assessment Update situation/incident information Assess the impact on the hospital Length and duration of incident Resource availability Assess the Incident Objectives Assure objectives are achieved in a safe and timely manner Revise objectives, strategies, tactics and resource needs for the upcoming operational period As the Incident Action Plan (IAP) is used in the response, there is ongoing assessment of the effectiveness of strategies and tactics. Plans should be continually reassessed and revised. The revision of the plan does not have to wait in step 9 serves as the road map for the next operational period. Adjustments in assignments, activation of additional branches or units, and revised safety plans should be documented and distributed to the HIMT as needed. The Section Chiefs evaluate the response and share the information with the Command and General Staff and make corrective actions. As an operational period is concluding, the Incident Action Plan (IAP) process sets off again, beginning with an updated situational assessment/review of the objectives to direct planning activities within sections and identification of continuing activities and objectives for the next operational period using a new or revised set of forms and documents. The staffing of positions, the assignment of resources, and other critical information should be developed for this new operational period (and/or oncoming HIMT). The IAP will serve as the guidance for what is to be done during this next operational period. Instructor Notes: Determine where changes need to be made and what activities need to continue. Before the end of the Operational Period – you will evaluate how things are going Is the plan working? Are there new issues to address?

Incident Action Plan Responsibilities
The Incident Commander Provides overall Incident Objectives (HICS 202) Sets the Operational Period Develops major strategies (priorities) Activates Hospital Incident Management Team Establishes policy for resource orders Approves initial actions and the completed Incident Action Plan The Command Staff:  Develops overall incident objectives and strategy  Determines the operational period  Approves resource orders and (later) demobilization  Approves the Incident Action Plan (IAP)

The Safety Officer Advises the Incident Commander and Section Chiefs on safety issues and measures Develops the Safety Plan (HICS 215A) Oversees the safety of operations and tactics

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 Operations Section: Assists with developing strategy  Identifies, assigns, and supervises the resources needed to accomplish the incident objectives

The Planning Section Chief Prepares for the Planning Meetings Gathers information for the Incident Action Plan (HICS 201, 202, 203, 204s and 215A) Develops demobilization plans Conducts the Planning Meeting Coordinates and submits the Incident Action Plan to the Incident Commander for approval Disseminates the Incident Action Plan The Planning Section: Provides status reports  Tracks resources and identifies shortages  Manages the planning process  Develops the Incident Action Plan (IAP) Instructor Notes: 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 Logistics Section Chief Determine tactics and resource requirement (HICS 204) Advises activated Logistics positions Ensures resources to support Incident Action Plan Develops plans that support the Incident Action Plan Communications Plans Transportation Plans The Logistics Section: Orders resources Assists in the development of the transportation, communications, and medical plans

The Finance/Administration Section Chief Determine tactics and resource requirement (HICS 204) Provides cost implications of the Incident Objectives Ensures the Incident Action Plan is within cost limitations Advises the Incident Commander on Finance/Admin activated positions The Finance/Administration Section: Develops cost analyses to help ensure that the Incident Action Plan (IAP) is within the financial limits established by the Incident Commander Develops contracts, procures, and pays for the resources Reports costs

The Incident Action Plan Provides Hospital Incident Management Team with direction for the Operational Period Uses the elements of Management by Objectives Developed by Command, General Staff provide input Essential for effective response and recovery

Questions?

Demobilization and Recovery
Planning for demobilization should begin early in the response. The Planning Section Demobilization Unit Leader is tasked with developing preliminary activities (e.g., Demobilization Plan) for when and how demobilization is to occur and revising the plan as needed once implementation is underway. The decision to move from response to demobilization will be made by the Incident Commander.

Preparation for Demobilization
The Demobilization Plan is created by the Demobilization Unit Leader and approved by the Planning Section Chief and Incident Commander 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 Depending on the situation, not all areas of the hospital will begin demobilization at the same time. Planning should address not only when the demobilization process is to begin but also how it will be implemented. When the decision to demobilize has been made, it should be communicated by the Planning Chief or Demobilization Unit Leader to hospital staff and by the Liaison Officer to appropriate external agencies (e.g., EMS, fire, law enforcement, local health department, and emergency management). Select information may need to be shared with the patients and their families. The Public Information Officer (PIO) should also determine the need to share information with the general public, particularly in situations where hospital operations have been curtailed and will subsequently be resumed

Preparation for Demobilization
Demobilization Considerations Demobilizing must be a part of the Incident Action Plan Managing public perception Equipment rehab and restocking Financial restoration Addressing hospital personnel concerns Instructor Notes: Managing public perception Hospital reputation can be damaged Demobilization (decreasing response) may be perceived unfavorably by the public The facility 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 A hospital’s return to day-to-day operations may be progressive. Planning should take into account that ramped-up methods to accommodate medical surge will be dismantled as patient care activities allow. Extra equipment, supplies, and medications will return to the pre-incident “just-in-time” inventory levels as soon as the opportunity permits. Recovery efforts will also need to address various other personnel issues. The Logistic Section’s Support Branch plays an important coordination role for all matters pertaining to staff and family support. Operations Section Chief will primarily be responsible for coordination of this activity, along with the Medical Care and Infrastructure Branches. The costs associated with a hospital’s response to any incident can be significant. This is especially true if documentation is not collected properly. From the outset, the Finance/Administration Section has the responsibility to track the various costs associated with the response including personnel, patient care, resources, equipment repair and replacement, and hospital repair/operations. Normally, hospitals enjoy the trust of the communities they serve. However, this trust may be shaken when performance during an incident is below public expectations. In addition, there may be concerns about a hospital’s capability for providing patient care if there has been noticeable damage or if the cleanliness and safety of the hospital has been compromised by the perceived presence of HazMat or a dangerous pathogen. The hospital must remain responsive to these issues and proactive in allaying fears and, if necessary, rebuilding the public trust.

Organizational Learning
The recovery plan includes principles of organizational learning and improvement: After Action Report and 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 Following the termination of the response, a series of debriefing meetings should be held at various levels to provide involved staff with the chance to share information on what worked well and possible improvement options. These comments should be formally recorded and reflected as part of the After Action Report (AAR) and Corrective Action and Improvement Plan (IP) process for the incident. Instructor Notes: 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, Policies and Procedures New equipment, supplies, systems Identify additional training and exercises

Section Review Demobilization and Recovery should be planned early
Demobilization and Recovery is the return to “normal,” or “new-normal” Demobilization is managed by the Planning Section The development of a Demobilization Plan by the Demobilization Unit Leader

Questions?

Scenarios, Incident Planning Guides and Incident Response Guides
There are 13 Scenario/Incident Planning and Response Guides to assist in planning and training: 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

Scenarios Information Technology (IT) Failure Mass Casualty Incident
Missing Person Radiation Incident Severe Weather with Warning Staff Shortage Tornado Utility Failure Wildland Fire

Incident Planning Guides
Incident Planning Guides assist hospitals with evaluating existing plans or writing needed plans They address 18 scenarios They are intended to identify actions or strategies to prepare for identified hazards Assess current plans and identify gaps Develop event-specific response guides The Incident Planning Guide (IPG) identifies potential actions or strategies the hospital may use in preparing for the identified hazard. The IPG actions are grouped into the four phases of emergency management: mitigation, preparedness, response, and recovery. This allows the emergency manager to ensure that activities within each of the emergency management phases are considered during plan development. The IPG should be viewed as a template, with hospitals carefully considering the recommended actions for their customized plans. Hospitals may use the IPG in a variety of ways, including: Develop strategies and actions to reduce the impact of the event or threat Assess current plans and identify gaps in planning Develop or customize event-specific response guides for the hospital Instructor Note: These are used in the planning process, not the response HICS Revision 2014 – The Incident Planning Guides (IPGs) and Incident Response Guides (IRGs) have been reformatted and consolidated or expanded for improved application among hospitals

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 18 scenarios there are Incident Response Guides 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 HICS Revision The HICS Forms have been revised to be more consistent with those used by the Federal Emergency Management Agency (FEMA). Additionally, there are 3 new HICS Forms available for hospital use: Incident Action Plan (IAP) Quick Start; the HICS 200: IAP Cover Sheet; and the HICS 221: Demobilization Check-Out.

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 Having a standardized form used by all responders provides a familiar and consistent method of documenting an incident and ease in sharing information. Local and federal agencies have adopted standardized forms with the use of Federal Emergency Management Agency (FEMA) Incident Command System (ICS) forms. HICS has modified select FEMA ICS forms (2010 edition) to reflect hospital functions. Where possible, HICS has maintained the intent and layout of the FEMA forms. Not every FEMA ICS form is applicable to a hospital; in that case, the FEMA form has not been utilized by HICS. There are additional functions performed by hospitals that are not addressed by FEMA forms, so additional hospital based forms have been developed to fill those needs. Instructor Note: 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

HICS Forms No. Name Responsible 200 Incident Action Plan Cover Sheet
Planning Section Chief 201 Incident Briefing Incident Commander 202 Incident Objectives Section Chiefs 203 Organizational Assignment List Resource Unit Leader 204 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 All HIMT Staff 215a Incident Action Plan Safety Analysis Safety Officer IAP QS IAP QuickStart Incident Commander and Planning Instructor Notes: 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 221 Demobilization Check-Out
Demobilization Unit Leader 251 Facility System Status Report Infrastructure Branch Director 252 Section Personnel Time Sheet Section Chiefs 253 Volunteer Staff Registration Labor Pool and Credentailiting Unit Leader 254 Disaster Victim / Patient Tracking Patient Tracking Manager 255 Master Patient 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 Inpatient Unit Leader Outpatient Unit Leader, Casualty Care Unit Leader

HICS Forms 200: Incident Action Plan 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 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
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 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 Approved by: Incident Commander

HICS Form 202: Incident Objectives Instructor Notes:
Have participants look at the form

Organization Assignment List
HICS Form 203: Organization Assignment List Purpose: To document Hospital Command Center staffing Origination: Planning Section Chief or designee (Resources Unit Leader) Copies to: Command Staff and General Staff Branch Directors and Agency Staff Documentation Unit Leader

Organization Assignment List
HICS Form 203: Organization Assignment List Instructor Notes: Have participants look at the form

HICS Form 204: 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 When to complete: At the start of each operational period Instructor Notes: 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 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

Assignment List (page 1)
HICS Form 204: Assignment List (page 1) Instructor Notes: Have participants look at the form

Assignment List (page 2)
HICS Form 204: Assignment List (page 2) Instructor Notes: Have participants look at the form

HICS Form 215A: Incident Action Plan Safety 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 roles 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 Analysis
Instructor Notes: Have participants look at the form

HICS FORM 213: General Message Form
Purpose: Provide standardized message recording Instructions: Response required: Indicate a reply was requested and to whom reply addressed Priority: Indicate level of urgency Message: Keep all messages/requests brief, to the point, and very specific Transcribe complete, concise, and specific content of message. Action Taken (if any) Instructor Notes: 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 213: General Message 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: Activity Log

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

(page 1) HICS Form IAP Quick Start: Instructor Notes:

(page 2) HICS Form IAP Quick Start: Instructor Notes:

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

HICS During Off Hours and Small and Rural Hospitals
The same principles for large hospitals is used at smaller hospitals or off hours, holidays and weekends at all size hospitals Activate needed Hospital Incident Management Team members When not enough staff, it may be necessary to blend job roles into a single Job Action Sheet For example, the Incident Commander may assume the role of the Public Information Officer and even the Liaison Officer. The same HICS principles that make it useful for large hospitals apply to small hospitals as well. In addition, hospitals of all sizes must be able to apply HICS to crises that occur during off hours and on holidays and weekends. Small hospitals will benefit from the use of HICS, but some have found it difficult to make needed adaptations. The same problem exists for all hospitals operating at night, on the weekend, or during holidays. The successful use of HICS depends in part on only activating the Hospital Incident Management Team (HIMT) positions that the situation requires. For a small hospital, successful adaptation requires the blending of some job roles into single Job Action Sheets (JAS). For example, staff at Critical Access Hospitals routinely perform multiple job roles on a daily basis. During an emergency, those same people will need to assume more than one position on the HIMT, at least initially. During nights, weekends, and holidays, hospitals of medium and large size will likely have to begin to build their HIMT in a similar fashion. Some positions are more easily combined than others. It’s not uncommon for the Incident Commander to assume the role of the Public Information Officer (PIO) and even the Liaison Officer. However, some positions, such as the Safety Officer or Medical- Technical Specialists, should not be combined with other job responsibilities unless absolutely necessary. HICS 2014 Revision - A new chapter addressing the implementation of HICS during off hours and for small and rural hospitals has been added.

Operationalizing HICS
Assign an individual in charge of implementation Obtain support from the CEO/senior leadership Make it high priority for administrators and staff Provide budgets support Establish training requirements/competencies Promote integration into the community response Provide training of HICS and the Emergency Operations Plan Exercise the plan and use of HICS The application and adaptation of HICS to the individual hospital requires education and training to produce proficiency and competency. Once mastered, it provides an easy-to use framework to manage any incident. Several steps are necessary to integrate HICS into hospital operations, including:  Assign an individual with appropriate authority and respect within the hospital to be in charge of HICS implementation according to an outlined plan  Obtain support from the hospital’s Chief Executive Officer (CEO) and other senior administrators  Encourage the recognition that HICS implementation must be a high priority for both administrators and staff  Provide financial resources and budgets needed to support emergency management and HICS activities  Establish training requirements/competencies that meet established national standards  Promote hospital integration into the community-based response  Provide training of HICS, in addition to training of the hospital Emergency Operations Plan (EOP)

Questions?

HICS Basics Part 1 Management System and Tools for Events
Updated with May 2014 HICS Revisions developed by the California Hospital Association’s Hospital Preparedness Program Instructor Notes: 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

Similar presentations

Presentation on theme: "Hospital Incident Command System"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Hospital Incident Command System

Similar presentations

Presentation on theme: "Hospital Incident Command System"— Presentation transcript:

Similar presentations

About project

Feedback