1. Incident Action Plan and Forms – Improvised Explosive Device (IED)
Hospital Incident Command System
Application of
Incident Action Plan and Forms – Improvised Explosive Device (IED)
This material has been developed for training purposes; do not share, distribute, transmit or reproduce without prior written consent of California Hospital Association This course was developed by the CHA Hospital Preparedness Program with grant funds provided by the U.S. Department of Health & Human Services Assistant Secretary for Preparedness & Response Hospital Preparedness Program and awarded by the California Department of Public Health. No part of this course or its materials shall be copied or utilized for monetary gain.

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

3. Scenario Based Implementation
Discuss and rehearse practical implementation of the Incident Action Planning process utilizing HICS forms and the Incident Response Guides
Utilize a “Table Top” learning process

4. Incident Action Planning
Assess the Situation
Set the Operational Period
Determine Safety Priorities & Establish Control Objectives
Determine Operational Period Objectives
Determine Strategies & Tactics
Determine Needed Resources
Issue Assignments
Implement Actions
Reassess & Adjust Plans
We will be using the Incident Action Planning Process to walk through our scenario
Usually multiple things are being done at once but we are going to be linear and go through one thing at a time
Reference the CHA IAP Checklist

5. Scenario
The Universal Adversary terrorist group has detonated a vehicle bomb in the parking lot of the community’s largest public building during business hours
The building is currently hosting a convention with a large number attendees at the event
Part of the structure has collapsed, fires are burning throughout the facility and there is severe blast and fire damage to the surrounding buildings

6. Scenario
There are a large number of people with trauma and burn injuries, including children
There are an unknown number of people trapped in the primary and surrounding buildings
There are many fatalities

7. Scenario
Your hospital is the closest Medical Center to the public building, but has not been damaged by the blast
Water, power and communications services are functioning normally in the area
Time: 1400
Weather: Clear, 75º F, Light winds

8. First Actions
Victims and uninjured begin arriving at the facility within 15 minutes of the blast
Number of victims expected to arrive: Unknown
Is this an incident?
What are your first actions?
Who is in charge?
Start with 201
Is this an incident?
Yes
First Actions –
Person in charge takes command
Assure triage is established
Activates Response plans, HICS

9. Incident Action Planning
Step 1: Assess the Situation
Use HICS form 214: Operational Log
Complete HICS form 201: Incident Briefing
Event History and Current Actions Summary
Begin form 202: Incident Objectives
Weather/environmental implications for period
Refer to forms in handouts
Have the Incident Commander give you the summary to put on the 201
Put the weather on the 202

10. Which Positions to Activate?
Based on this situation, what needs to be activated?
Use the Explosives Attack IED Incident Response Guide
Medical Care, Security
Situation unit leader
Support Branch
Finance Section Chief
How long did that take us to figure out? (go to next slide)

11. Immediate Time Period
Look at the IRG for Explosives Attack (towards the back of the handout)
This is a great cheat sheet, use the IRG to figure out what positions to activate

12. Naming the Incident The Incident Commander names the incident
If the incident is a community-based incident, the appropriate jurisdiction will name the incident (e.g., county, city, EMS)
The incident name should be documented on all forms
Since this is a community-based incident, the incident should already be named

13. Incident Action Planning
Step 2: Set the Operational Period
HICS form 202: Incident Objectives
Operational Period Date/Time
Incident Commander sets the Operational Period
Based on number of simultaneous activities
How quickly the situation is changing
An Operational Period breaks the incident down into manageable timeframes
Incident Commander should state the Operational Period
In a situation that is not stable, still changing – it should be 2 hours. Usually the 1st Op Period is 2 hours.

14. Step 3: Determine Safety Priorities & Control Objectives
Incident Action Planning
Step 3: Determine Safety Priorities & Control Objectives
Identify Command & Control Objectives (these are the overarching objectives that will last throughout the whole response)
HICS form 202: Incident Objectives
Control objectives – Triage and treat arriving victims, Keep facility secure, Communicate with responding agencies and EMS (through the EOC/DOC)
After they come up with some ideas then you can show them the short cut – next slide

15. Control Objectives Utilize the Incident Response Guide
Explosives Attack:
Prepare for the influx/surge of trauma and burn victims
Ensure facility security
Prepare for patient triage and medical management
Collect forensic evidence for law enforcement
Communicate the situation status and information to staff, patients, media and the public
Fill in what they decide on the 202

16. Scenario Update #1 It has been 30 minutes since the explosion
The ED has received 2 critical burn/trauma patients by private car
20 victims have been triaged
2 immediate
2 delayed
16 minor
ED estimates 20 victims waiting for triage
EMS reports as many as 200 victims

17. Side Note: Safety Officer Tasks
Assess the Safety issues
What hazards exist and what precautions need to be taken
Security Needs (e.g., increased surveillance, secondary device, crowd control)
Complete form 261 – Incident Action Plan Safety Analysis
Safety Officer to work on the 261

18. Side Note: Public Information Officer Tasks
Prepare a statement for the media
Prepare a statement for the staff, patients and visitors (e.g., situation, status, safety precautions, next update time)
The statements need approval from the Incident Commander
Coordinate consistent messaging with the Joint Information Center (JIC)

19. Side Note: Liaison Officer
Who or what entity operates as the county contact/MHOAC, and how do you contact?
What is the situation on-scene?
Who should be notified of bed status? How?
Who is the source of resources in your local plan? (e.g., local EMS Department Operations Center, PHD Department Operations Center, County/City Emergency Operations Center)
Needs should be determined prior to the incident

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

21. Step 4: Determine Operational Period Objectives
Incident Action Planning
Step 4: Determine Operational Period Objectives
Document on HICS 204 – Branch Assignment List
They are based on the Control Objectives
These are based on what is desired to be achieved by the Section in that operational period
Objectives need to be SMART (Simple, Measurable, Achievable, Realistic, Time-Sensitive & Task Oriented)
5 – 10 min for students (section chiefs) to develop 3-4 objectives. PIO does PIO report. Liaison officer making calls. SO – form 261
People get confused about Sections/Branches use. A separate 204 for each Branch, if more than one branch is activated.
Have them work on this in their sections. Actually write on a 204

22. Operational Period Objectives
A common problem during exercises is that Sections don’t develop their objectives promptly
Report top 3 objectives
Have the groups share their top 3 objectives and write on the blow up of the 204. Some Examples:
Operations
Assure all arriving patients receive triage
Assure most severely injured, survivable patients receive care
Provide for facility security, traffic and crowd control
Consider activation of a family information center (FIC)
Planning
Prepare and implement patient, bed, materiel and personnel tracking
Develop the Incident action plan in collaboration with the Incident Commander
Facilitate Planning meeting
Logistics
Conduct an inventory of critical needs for triage, ED and other care areas
Initiate staff call back as necessary
Finance
Track costs

23. Incident Action Planning
Step 5: Determine Strategies & Tactics
Strategies & tactics are how your Section/Branch is going to achieve the objectives
What actions do you need to take?
Use your facility response plans and Incident Response Guides
Record strategies & tactics on form 204 – Branch Assignment List

24. Incident Action Planning
Step 6: Determine Needed Resources
What units/space needs to be activated?
What personnel resources do you need?
What equipment and/or supplies do you need?
Do you need transport resources?
Document resource activities:
Resources assigned (form 204)
Resource requests (form 213)
Actions taken to utilize and obtain resources (form 214)
Delayed treatment area?
Minor/treatment area?
Additional Physician/Nursing staff?
Additional Gurneys?
Security/Traffic Control? Lock Down

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

26. Incident Action Planning
For the first Operational Period the Incident Action Plan should be done within minutes
What makes up the Incident Action Plan?
Form Incident Briefing
Form Incident Objectives
Form Incident Assignments
Form Branch Assignments
Form Incident Action Plan Safety Analysis
The Planning Section compiles the forms to create the Incident Action Plans
As we did this process, completed the forms – THIS made up our IAP
Put a cover on it with the date, time of the Operational Period – process it, share with others

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

28. Scenario Update #2 It is now 1530 – 1.5 hrs into the incident
You have received 2 additional critical trauma patients and 1 critical burn patient from EMS
You have received a total of:
6 Immediate (1 now deceased)
5 delayed
40 minor
What are your major concerns?
Major Concerns:
Are there more victims?
Security management
Availability of higher level of care (transport) if needed?

29. Incident Action Planning
Step 9: Reassess & Adjust Plans
Towards the end of the operational period, you will need to evaluate status
Repeat steps 1-8
Update the forms
Evaluate and/or update your Operational Period Objectives
This creates your Incident Action Plan (game plan) for the next operational period

30. Scenario Update #3 It is now 4 hours into the incident
All victims have been transported or have left the scene
Universal Adversary has claimed responsibility for the bombing and claims a secondary device is in place
What issues should be considered?
Secondary transport to higher level of care
Security considerations
Family Reunification
Recovery
Staff Communication
Public Information
Evidence Preservation
Law Enforcement Communication

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

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

33. Incident Action Plan and Forms Improvised Explosive Device
HICS Basics Part 2
Application of
Incident Action Plan and Forms Improvised Explosive Device
developed by the
California Hospital Association’s
Hospital Preparedness Program
This material has been developed for training purposes; do not share, distribute, transmit or reproduce without prior written consent of California Hospital Association This course was developed by the CHA Hospital Preparedness Program with grant funds provided by the U.S. Department of Health & Human Services Assistant Secretary for Preparedness & Response Hospital Preparedness Program and awarded by the California Department of Public Health. No part of this course or its materials shall be copied or utilized for monetary gain.