1. Application of Incident Action Plan and Forms – Earthquake
Hospital Incident Command System
Application of
Incident Action Plan and Forms – Earthquake
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
A 7.8-magnitude earthquake occurs along a fault zone 50 miles from your hospital. Ground shaking occurs impacting a 6 county region. Moderate to major damage is reported for 200 square miles. Multiple severe aftershocks are expected for days and weeks after the initial earthquake.
Hundreds of thousands of people sustain mild to severe injuries. Hospitals sustain moderate to severe damage to their infrastructure. EMS is overwhelmed with request for assistance. Transport to hospitals is difficult due to debris in roadways.

6. Scenario Your hospital has sustained moderate to severe damage.
The Emergency Department and outpatient surgery are non-functional due to damage and must be relocated.
Main water and power services are disrupted, however emergency power (generators) is functioning. Telephone and internet service is down.

7. Scenario Time: 0830 Weather: Clear, 68º F, no winds
Within 15 minutes large numbers of injured are presenting to the hospital for care. Many who are not injured seek shelter and reassurance from medical providers.

8. First Actions
Time until restoration of main power, water, phone, internet: Unknown
Is this an incident?
What are your first actions?
Who is in charge?
Start with 201
Is this an incident?
Yes
First Actions –
Appropriate person takes role as Incident Commander
Activates EOP, HICS
Conduct situational assessment
Notify local EMS of status (Satellite phone, HAM radio)
Determine if any life sustaining/critical functions are disrupted
Assess for injuries to patients, staff, visitors
Begin facility status assessment
Determine where triage and initial treatment will take place
Determine status of HCC, activate HCC

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 Natural Disaster – Major Earthquake Incident Response Guide
Command Staff
Section Chiefs (consider finance)
Infrastructure Branch Director
Medical Care Branch Director
Security Branch Director
Situation Unit Leader
Support Branch Director
How long did that take us to figure out? (go to next slide)

11. Immediate Time Period
Look at the IRG for Major Earthquake (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
Have the incident commander name the incident

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. 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 –
Patients, visitors and staff assessed for injuries and accounted for (as identified in step 1 as a life saving priority)
Hospital Self-sustainment for 72 hours
Provide patient care management
Communicate situation status and updates to staff, patients, and visitors
Communicate to community response partners (EMS, PHD, local fire and law enforcement)
Maintain security and safety of facility
Damage assessment
After they come up with some ideas then you can show them objectives on the IRG – next slide

15. Control Objectives Utilize the Incident Response Guide
Earthquake:
Damage Assessment
Patients , visitors, staff assessed for injuries and accounted for
Patient tracking
Hospital facility self-sustainment capability
Fill in what they decide on the 202
Loss of Power, Water, Evacuation or Hospital Overload IRGs may apply

16. Scenario Update #1 It has been 30 minutes since the incident.
There have been multiple aftershocks
The emergency department and outpatient surgery have been determined to be unsafe and must be evacuated
Other areas of the hospital are under assessment, however structural damage is not expected to result in total evacuation

17. Side Note: Safety Officer Tasks
Assess the Safety issues
What hazards exist and what precautions need to be taken
Ensure safe entry/exit of essential personnel to and from hospital
Ensure safety of patients, visitors, staff
Ensure all essential life support is on emergency power
Complete form 261 – Incident Action Plan Safety Analysis
Safety Officer to work on the 261
Safe Evacuation Routes
Safety of search operations
Safe passage within facility due to debris, lack of lighting, etc

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) or with law enforcement PIO

19. Side Note: Liaison Officer
Who or what entity operates as the county contact/MHOAC, and how do you make contact?
Who else should be notified of the situation?
Who should be notified of hospital status? Bed status? How?
Who is the source of government resources in your local plan? (e.g., local EMS Department Operations Center (DOC), PHD DOC, County/City Emergency Operations Center)
Key contacts should be determined prior to the incident
If there are immediate needs for patient evacuation, what resources or assistance is needed?
What other resources could be requested?
Note: “Situation” refers to the event summery. Hospital “status” refers to functioning, partial functioning, non-functioning.

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

21. 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/Branches don’t develop their objectives promptly
Report top 3 objectives
Have the groups share their top 3 objectives
Some examples:
Operations
Evacuation of unsafe areas
Activate hospital alternate care sites for evacuated patients
Assess damage, secure unsafe areas and initiate repair
Prepare to receive casualties, initiate triage and treatment
Ensure continued functioning of emergency power
Planning
Track patients and beds including evacuation location
Develop the Incident action plan in collaboration with the Command and General Staff
Initiate materiel and personnel tracking procedures
Logistics
Inventory and assess for damage all supplies, equipment, food and water stores
Conduct an inventory of critical needs for patient and staff management
Activate alternate communication systems and establish contact with the local EOC, EMS and ensure intra-hospital communications such as walkie-talkies, runners, etc.
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
Assure any earthquake, loss of water, loss of power, surge related policies, plans, procedures are available from the EOP in the Hospital Command Center

24. 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 communication devices do you need?
Document resource activities:
Resources assigned (form 204)
Resource requests (form 213)
Actions taken to utilize and obtain resources (form 214)
Radios
Evacuation devices – med sleds, stair chairs, etc.
Alternate care locations
Drinking water
Go kits
Staff to help with evacuation
Runners
Note: Discuss coordinating any evacuations through the government point of contact

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 1000 – 1.5 hrs into the incident
Utility workers expect restore water service to the hospital within 10 – 12 hours
Main power restoration expected in 24 hours
What are your major concerns?
Major Concerns:
Continued Medical Care
Evacuation where needed
Maintain Emergency Power
Sanitation issues
Media management
Disruption of services
Maintaining utilities/systems dependant on water
PIO messaging to patients, staff, media
Communication to governmental agencies (Liaison)
Campus/Building safety
Ability to maintain food services (emergency power only)
Influx of community looking at hospital as a safe haven

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
Utility repair personnel have encountered complications and report main power may not be restored for 3 days, potentially outlasting your generator fuel stores
What issues should be considered?
Procure more fuel
Need for evacuation/partial evacuation/transfer of patients if possible
Communication with local DOC/EOC to determine what resources can be provided to the hospital and if services can be continued
Staff Communication
Public Information
Consider activation of Business Continuity Branch
Ability to self-sustain 72 hours
Ability to obtain resources (vendors/MOUs/community/government)

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