1. Application of Incident Action Plan and Forms – Evacuation
Hospital Incident Command System
Application of
Incident Action Plan and Forms – Evacuation
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. 1

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

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 3

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 4

5. Scenario
During a construction project, workers sever a water main in the basement
The two emergency generators are in a flooded section of the basement and have been rendered unusable
All power to the building has been interrupted, and the electric company has said it will be twelve or more hours before even partial restoration of services can be accomplished

6. Scenario
Pharmacy services and the lab are located in the basement and cannot provide service due to flooding
Patients on Life Support are being manually supported and some on battery backup
Total evacuation of the facility must occur immediately
Current census is at 85%
Time: 1000
Weather: Clear, 75º F, no winds

7. First Actions Time until repaired: Unknown Is this an incident?
What are your first actions?
Who is in charge?
Start with 201
Is this an incident?
Yes
First Actions –
Person in charge takes command
Assure life support activities are underway
Activates Response plans, HICS
Establish an alternative Hospital Command Center
Question for the class: Do your communication systems rely on electricity? How will you communicate with one another?

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

9. Which Positions to Activate?
Based on this situation, what needs to be activated?
Use the Evacuation IRG
Staging, Medical Care, Infrastructure, Security
Situation unit leader
Support Branch
Finance Section Chief (not included in IRG, but should be considered)
How long did that take us to figure out? (go to next slide)

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

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

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

13. Step 3: Determine Safety Priorities & 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 response)
HICS form 202: Incident Objectives
Control objectives –
Maintain safety of patients, staff, visitors
Maintain life support functions
Conduct safe and rapid evacuation of the facility
After they come up with some ideas then you can show them objectives on the IRG – next slide

14. Control Objectives Utilize the Incident Response Guide
Evacuation:
Maintain safety of patients, staff, visitors
Maintain life support functions
Conduct safe and rapid evacuation of the facility
Plan for patient repatriation and restoration of services
(Fill in what they decide on the 202)

15. Scenario Update #1 ICU – has 10 patients on ventilators
PICU – has 4 patients on ventilators
NICU – 8 patients on ventilators, 2 on ECMO, 6 additional patients in incubators
8 patients in surgery

16. Side Note: Safety Officer Tasks
Assess the Safety issues
What hazards exist and what precautions need to be taken
Monitor the immediate stabilization of the facility and basement flooding
Ensure safe movement/egress of patients, visitors and staff from facility
Ensure evacuation holding areas are safe/secure
Complete form 261 – Incident Action Plan Safety Analysis
Safety Officer to work on the 261

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

18. Side Note: Liaison Officer
Who or what entity operates as the county contact/MHOAC, and how do you contact?
Who should be notified of the situation?
Who should be notified of hospital status? 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
What resources or assistance is needed for evacuation?

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

20. 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

21. Operational Period Objectives
A common problem during exercises is that Sections/Branches don’t develop their objectives promptly
Report top 3 objectives
Have the groups share their top 3 objectives
Some examples:
Operations
Assure life support functions are occurring
Prioritize and prepare patients for evacuation
Provide for facility security, traffic and crowd control
Assess damage, attempt to activate other back up systems
Planning
Track patients and personnel including evacuation location and receiving facility
Develop the Incident action plan in collaboration with the Incident Commander
Facilitate Planning meeting
Logistics
Conduct an inventory of critical needs for patient management
Supply resources and supplemental staffing to key areas to facilitate evacuation
Finance
Track costs

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

23. Incident Action Planning
Step 6: Determine Needed Resources
Where can patients be moved to?
What personnel resources do you need?
What equipment and/or supplies do you need?
What resources do you need in the patient collection/holding area?
What transport resources do you need?
Document resource activities:
Resources assigned (form 204)
Resource requests (form 213)
Actions taken to utilize and obtain resources (form 214)
Staging areas to prepare for transport
Evacuation devices – med sleds, stair chairs, etc.
Go kits
Staff to help with evacuation
Coordinate transportation needs

24. 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

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

26. 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

27. Scenario Update #2 It is now 1130 – 1.5 hrs into the incident
3 ICU patients, 4 NICU patients have been transferred to 2 other hospitals in town
Continuing to arrange transfer of critical patients out of the facility
10 patients have been discharged home
What are your major concerns?
Major Concerns:
Maintaining life support services as needed
Continued safe evacuation
Safety of evacuation staff
Notification of family members
Communication with outside agencies
Dealing with the media

28. 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

29. Scenario Update #3 It is now 4 hours into the incident
All critical patients have been transferred out
Surgery patients have been transferred
Large portable generator has been hooked up and emergency power is restored
What are some of the issues to consider?
Prioritize which additional areas have greatest need for power
Determine on what level evacuation needs to continue
Plan for patient repatriation and restoration of services

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

31. Questions?
Clean-up, part of any event is recovery-put the vests back as they belong
Post test
Evaluation 31

32. Incident Action Plan and Forms Evacuation
HICS Basics Part 2
Application of
Incident Action Plan and Forms Evacuation
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.